Analysis of procedural errors associated with separated instrument management in molar teeth

While existing literature extensively discusses various management methods of separated instruments and their outcomes, there is a notable gap in understanding the relationship between management strategies and procedural errors. This study aims to explore this correlation to enhance clinical decision-making. Ethical approval was obtained, and a retrospective review of molar teeth managed by postgraduate endodontic residents at King Abdulaziz University Dental Hospital was conducted. Data were collected from patient records and radiographs. Procedural errors were independently assessed by two endodontists. Fisher's exact test was used to determine the association between management strategies and procedural errors using SPSS. A multivariable logistic regression analysis was performed to adjust for potential confounding factors. A total of 203 molar teeth were included. Molars with instrument separation were predominantly in the apical third of the root and in canals with mild root curvature. Procedural errors were observed in 26.6% of molars, with perforation being the most common, accounting for 50% of procedural errors (13.3% of overall cases with separation). Management strategy was not significantly associated with procedural errors (P = 0.665). Multivariable logistic regression confirmed that rotary instruments were associated with higher odds of procedural errors compared with hand instruments (OR = 1.995, 95% CI: 1.025–3.882, P = 0.042), while management strategy, canal curvature, and instrument location were not significantly associated with procedural errors. Procedural errors occurred in approximately one-quarter of cases, with perforation being the most common complication. Rotary instruments were independently associated with higher odds of procedural errors, while management strategy showed no significant association.