Prevalence and management techniques for separated endodontic files among endodontic postgraduate students in the Qassim region: A retrospective cross-sectional study

Abstract Introduction: Endodontic files separation is the common complication in endodontics. This study aimed to determine the prevalence and management techniques for separated endodontic files among endodontic postgraduate students in the Qassim region. Materials and Methods: This retrospective cross-sectional study evaluated nonsurgical endodontic treatments performed by postgraduate students in the Qassim region, Saudi Arabia, including 1879 permanent teeth with complete records. Data were collected using a structured pro forma on patient demographics, file separation during treatment (type, location, and management), and follow-up. Associations between file separation, training center, and year of training were assessed using the Chi-squared or Fisher’s exact tests. Risk factors for file separation were identified using binary logistic regression. Results: File separation occurred in 48 cases (2.6%) and did not differ between centers but was significantly associated with year of training, being highest among 2 nd -year residents (14.4%). Most separations involved rotary files (79.2%), particularly ProTaper Next (31.3%) and EdgeFile X7 (25.0%) and were most frequent in molars (72.9%), especially the mesio-buccal canal, typically in the apical third, with fragment lengths ≤3 mm. Multivariate analysis showed 2 nd -year trainees (odds ratios [OR] 17.3, 95% confidence intervals [CI] 7.06-50.2), rotary file use (OR 3.89, 95% CI 1.93–7.85), and molar teeth (OR 4.88, 95% CI 1.55–15.39) as the significant predictors of file separation. Most of cases with instrument separation were managed by bypassing the fragment (39.6%). When an active removal method was applied, ultrasonics was the most commonly used. Conclusions: Although separation of endodontic files was low (2.6%) among postgraduates, it occurred more often with rotary files in molars and among 2 nd -year trainees. Most of the separated files were handled by either bypassing the fragment or leaving it in place highlighting the importance of careful technique and supervised training.