Keywords
Endodontists
Pakistan
Prevalence
How to Cite
Abstract
The study aimed to find the incidence and awareness of endodontic instrument separation and its management among dental house officers, postgraduate trainees, demonstrators, consultants, and general dentists. Methods: This online questionnaire-based cross-sectional study was conducted with the approval of the IRB in private and public dental hospitals and dental clinics in Punjab. The authors developed the survey tool, which comprises 24 closed-ended items regarding demographics, the incidence of file separation, and awareness about its management. The data were analyzed using IBM SPSS version 24. The Chi-Square Test was used to compare percentages of categorical variables. Results: Postgraduate trainees experienced the most instrument separations (43.6%), made the most retrieval attempts (49.2%), and experienced the most secondary errors during retrieval (52.1%) (p<0.001). Around four out of ten respondents always informed the patients (39.6%) and department (41.6%) about errors. Manual files (69.8%), stainless steel files (75.8%), and short files (60.4%) were more frequently separated, and the most frequent cause was older fatigue files (57.7%). Manual files were more frequently broken in public dental institutes (p=0.003). Two-thirds of the file separations (72.5%) occurred during cleaning and shaping in the apical third of molars (65.1%), especially in mesiolingual canal (56.4%). Bypass attempt was the most common in symptomatic teeth (47.7%). Conclusions: Preventive approaches such as limiting file reuse and constructing a glide path can reduce the occurrence of file separation. Operators should be familiar with the number of uses of the instrument before fatigue and should be trained through workshops and refresher courses.
References
Hassan H, Ali SM, Riaz S, Aziz S, Saleem MN, Raja HZ. Prevalence of endodontic mishaps and their management in private and public dental institutes in Punjab, Pakistan. Rawal Med J. 2023 Apr;48(2):468-72.
Shilpa-Jain DP, Santosh SS, Archana D, Smita S, Saumya-Rajesh P, Velmurugan N. Knowledge-, attitude-, and practice-based survey on instrument separation and its management among endodontists and postgraduates in India - A cross-sectional web-based questionnaire. Saudi Endod J. 2021 Jan;11:80-7. doi: 10.4103/sej.sej_187_19.
Amza O, Dimitriu B, Suciu I, Bartok R, Chirila M. Etiology and prevention of an endodontic iatrogenic event: instrument fracture. J Med Life. 2020 Jul-Sep;13(3):378-81. doi: 10.25122/jml-2020-0137.
McCoy T. Managing endodontic instrument separation. J Vet Dent. 2015 Winter;32(4):262-5. doi: 10.1177/089875641503200412.
Santos-Junior AO, De Castro Pinto L, Mateo-Castillo JF, Pinheiro CR. Success or failure of endodontic treatments: a retrospective study. J Conserv Dent. 2019 Mar-Apr;22(2):129-32. doi: 10.4103/JCD.JCD_507_18.
Vouzara T, El Chares M, Lyroudia K. Separated instrument in endodontics: frequency, treatment and prognosis. Balkan J Dent Med. 2018;22(3):123–32. doi: 10.2478/bjdm-2018-0022.
Van Der Vyver PJ, Vorster M, Jonker CH. Modern considerations when approaching fractured endodontic instruments-Part 2: a review of the literature and clinical techniques. J Dent Assoc South Afr. 2020 Nov;75(10):564-74. doi: 10.17159/2519-0105/2020/v75no10a5.
Amaral RR, Cohen S, Ferreira MVL, Soares BM, Côrtes MIS. Antimicrobial photodynamic therapy associated with long term success in endodontic treatment with separated instruments: a case report. Photodiagnosis Photodyn Ther. 2019 Jun;26:15-18. doi: 10.1016/j.pdpdt.2019.02.015.
Hargreaves KM. Cohen’s pathways of the pulp: South Asia edition E-book. 12th ed. New Delhi, India: Elsevier; 2020.
Dobrzańska J, Dobrzański LB, Gołombek K, Dobrzański LA, Dobrzańska-Danikiewicz AD. Virtual approach to the comparative analysis of biomaterials used in endodontic treatment. Processes (Basel). 2021;9(6):926. doi: 10.3390/pr9060926.
Hülsmann M, Lambrianidis T. Comparative evaluation of techniques and devices for the removal of fractured instruments. In: Lambrianidis T, editor. Management of fractured endodontic instruments: a clinical guide. Springer; 2018 Sep.207-24.
Bhuva B, Ikram O. Complications in endodontics. Prim Dent J. 2020 Dec;9(4):52-8. doi: 10.1177/2050168420963306.
Orafi I. Opinions and attitudes of general dental practitioners in Libya towards the intracanal separation of endodontic instruments. Libyan J Sci Technol. 2020 Oct;11(2):126-35.
Rumyyan AA, Alissa H, Alkuraidis H, Sager M, Alraffa S, Alhumud I, et al. The Prevalence of endodontic instrument separation among dental practitioners and dental students in Riyadh, Saudi Arabia: a cross-sectional study. Int J Med Res Health Sci. 2020 Sep;9(9):49–54.
Pedir SS, Mahran AH, Beshr K, Baroudi K. Evaluation of the factors and treatment options of separated endodontic files among dentists and undergraduate students in Riyadh area. J Clin Diagn Res. 2016 Mar;10(3):18-23. doi: 10.7860/JCDR/2016/16785.7353.
Ba-Hattab R, Rahman I, Elsayed LK, Alasmari WF, Abidia R, Abdelgaffar S, Bahattab A. Ethical aspects concerning instrument separation and perforations during endodontic treatment: a cross-sectional study. Int J Dent. 2020 Sep 15;2020:8849105. doi: 10.1155/2020/8849105.
da Silva PB, Duarte SF, Alcalde MP, Duarte MAH, Vivan RR, da Rosa RA, et al. Influence of cervical preflaring and root canal preparation on the fracture resistance of endodontically treated teeth. BMC Oral Health. 2020 Apr 16;20(1):111. doi: 10.1186/s12903-020-1050-8.
Hassan H, Ali SM, Chaudhry AA, Riaz S, Khawar B, Aziz S. Endodontic procedural errors and their reporting and referral among dental graduates working at dental institutes in Punjab: a cross-sectional study. Khyber Med Univ J. 2023;15(2):96-100. doi: 10.35845/kmuj.2023.23006.
Khasnis SA, Kar PP, Kamal A, Patil JD. Rotary science and its impact on instrument separation: a focused review. J Conserv Dent. 2018 Mar-Apr;21(2):116-124. doi: 10.4103/JCD.JCD_240_17.
Bhatti UA, Qureshi B, Azam S. Trends in contemporary endodontic practice of pakistan: a national survey. J Pakistan Dent Assoc. 2018 Apr;27(2):50-6.
McGuigan MB, Louca C, Duncan HF. Endodontic instrument fracture: causes and prevention. Br Dent J. 2013 Apr;214(7):341-8. doi: 10.1038/sj.bdj.2013.324.
Gandevivala A, Parekh B, Poplai G, Sayed A. Surgical removal of fractured endodontic instrument in the periapex of mandibular first molar. J Int Oral Health. 2014 Jul;6(4):85-8.
Maqbool M, Tirmazi SSM, Shakoor A, Akram Z, Nazir R, Chohan AN, Karobari MI, Noorani TY. Perception of dental house officers regarding endodontic file separation during endodontic treatment. Biomed Res Int. 2023 Feb 16;2023:1044541. doi: 10.1155/2023/1044541.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2022 Hammad Hassan, Syed Moiz Ali, Baneen Khawar, Sidra Riaz, Razia Zia, Marij Hameed
Downloads
