Analysis of methods for removing the fragments of instruments from the root canal system

INTRODUCTION . Endodontics is a constantly developing area of dentistry. Every year new systems of machine rotating nickel-titanium instruments appear on the dental market which is accompanied by an increase in the incidence of such a complication of endodontic treatment as fragmentation of files in the root canal system. The frequency of this complication, which many dentists encounter, varies from 0.4% to 23%. That is why it is important to know the principles and methods of the safest possible extraction of broken instruments from the root canal system. AIM . To systematize the analysis of methods of therapeutic and surgical extraction of fragmented instruments as well as summarize the indications for their use. MATERIALS AND METHODS . A search of literature sources was carried out in the PubMed, dissercat.com, elibrary.ru, database.ru, cyberleninka.ru by keywords “endodontic treatment”, “iatrogenic events”, “fracture of endodontic instruments”, “methods for removing the fragments of instruments” with a choice of article types “Clinical Trial”, “Meta-Analysis”, “Review”, “Systematic Review”. RESULTS . After analyzing the literature review an idea was obtained about the methods and indications for therapeutic and surgical methods of removing broken files from the root canal system. A protocol for the preparatory and main stages of extracting fragmented instruments using ultrasonic tips is described depending on the degree of visualization of the endodontic instrument. CONCLUSIONS . The tactics of extracting fragmented endodontic instruments are individual in each individual clinical case and depend on a number of factors: the level of file fragmentation, the degree of its visualization, the anatomy of the root canal, and the manual skills of the dentist.