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Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Intracanal separation of endodontic instruments may hinder cleaning and shaping procedures within the root canal system, with a potential impact on the outcome of treatment. The purposes of this narrative review of separated instruments were to (1) review the literature regarding treatment options, influencing factors, and complications and (2) suggest a decision-making process for their management. Methods: An online search was conducted in peer-review journals listed in PubMed to retrieve clinical and experimental studies, case reports, and review articles by using the following key words: instruments, files, obstructions, fractured, separated, broken, removal, retrieval, management, bypassing, and complications with or without root canal and endodontic. Results: There is a lack of high-level evidence on management of separated instruments. Conventional conservative management includes removal of or bypassing the fragment or filling the root canal system to the coronal level of the fragment. A surgical intervention remains an alternative approach. These approaches are influenced by a number of factors and may be associated with complications. On the basis of current clinical evidence, a decision-making process for management is suggested. Conclusions: Guidelines for management of intracanal separated instruments have not been formulated. Decisions on management should consider the following: (1) the constraints of the root canal accommodating the fragment, (2) the stage of root canal preparation at which the instrument separated, (3) the expertise of the clinician, (4) the armamentaria available, (5) the potential complications of the treatment approach adopted, and (6) the strategic importance of the tooth involved and the presence/or absence of periapical pathosis. Clinical experience and understanding of these influencing factors as well as the ability to make a balanced decision are essential. [Copyright &y& Elsevier]

Abstract: Introduction: A potentially damaging temperature rise within the root canal and thus on the external root surface may be induced because of frictional contact of ultrasonic tips during the removal of separated instruments. The efficiency of a new ultrasonic unit, with air-spray function and ET40D (Satelec/Acteon, Merignac, France) and CPR5 (Obtura-Spartan, Fenton, MO) ultrasonic tips, in reducing temperature rise on the external root surface during the removal of fractured files was investigated. Methods: Four millimeters of F2 ProTaper files (Dentsply, Surrey, UK) were fractured 2.5 mm from the canal access of 60 lower incisor roots. Roots were randomly divided into six groups: groups CPR5/no air and ET40D/no air in which tips were used without air flow, groups CPR5/15 psi and ET40D/15 psi (tips used with 15-psi air pressure), and groups CPR5/10 psi and ET40D/10 psi (10-psi air pressure). The temperature rise was measured on the external proximal root surface, adjacent to the most coronal aspect of the fractured fragment, at 15 seconds and then at 30-second intervals up to 120 seconds. Results: After 120 seconds, the mean temperature rise (4.2°C) with the air flow active was significantly lower than that with nonactive air flow (11°C). At 10- and 15-psi pressures, the temperature rise after 120 seconds induced by ET40D tips was 4° and 2.4°C, respectively. These were significantly lower than with CPR5 tips (6.3° and 4.2°C, respectively). Conclusions: A new ultrasonic unit incorporating an air-flow function proved to be effective in reducing the temperature rise during removal of fractured files. ET40D ultrasonic tips were more effective than the CPR5 tip. However, both tips could be safely activated with air spray up to 120 seconds. [Copyright &y& Elsevier]

Abstract: This in vitro study aimed to investigate the effect of ultrasonic removal of endodontic fractured files on tooth structure. Fifty-three canine roots were cleaned and weighed. They were scanned by a microcomputed tomography scanner producing two-dimensional images that were reconstructed into two-dimensional slices, and, finally, the canal volume was measured. In a control group, canals were prepared to F5-size ProTaper (Dentsply Ltd, Surrey, UK). In three experimental groups, F5-fractured files were ultrasonically removed from three root canal locations: coronal, middle, and apical. All roots were reweighed and rescanned. Reconstruction and analysis were performed to remeasure the canal volume. The differences in root mass (weight) and canal volume between before and after treatment were calculated. The highest change increase in canal volume was found when fractured files were removed from the apical part followed by middle and coronal. A positive correlation existed between canal volume and root mass changes. Microcomputed tomography scanning can reliably determine changes in canal volume resulting from fractured-file removal. [Copyright &y& Elsevier]

Abstract: Temperature rise (TR) on the external root surface during ultrasonic removal of separated files (SFs) from 50 lower incisors roots of 10-mm length was investigated. CPR ultrasonic tips (Obtura-Spartan, Fenton, MO) were used dry to retrieve F2 ProTaper (Dentsply, Surrey, UK) segments fractured 2.5 mm from the coronal access in five groups: CPR2, CPR5, and CPR6 at power setting 1 and CPR5 at power settings 2.5 and 5. Temperature changes were inspected at 30-second intervals up to 120 seconds at three different sites: two at mesiodistal and buccolingual surfaces adjacent to the most coronal aspect of the SF and the third adjacent to the most apical aspect. Overall, the highest mean TR was at the buccolingual root surface followed by that at the mesiodistal and the more apical site surfaces. At power setting 1, CPR6 produced a significantly lower TR than CPR5, and both can be used for 120 and 60 seconds, respectively. Power setting 5 is not recommended for the removal of SF because this induces a hazardous TR. [Copyright &y& Elsevier]