Incidence and localization of reciprocating endodontic instrument separation: a systematic review and meta-analysis
Authors
Nicola Maria Grande, Gianluca Gambarini, Massimo Galli, Francesca Romana Federici, Adrianna Adamek-Mrozowska
Abstract
Despite the advantages provided by the motion single file reciprocating instruments may also be subjected to intracanal separation. Understanding the incidence and common anatomical locations of separation is critical for risk assessment and clinical decision-making. The aim of the present review was to evaluate the incidence of reciprocating endodontic instrument separation and to identify the most common anatomical locations of failure. Two independent reviewers performed data extraction and quality assessment using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. A meta-analysis of proportions was performed using a random-effects model.A total of 34 studies (18 in vivo, 16 in vitro) were included, involving 14,389 canals prepared using reciprocating instruments. The pooled incidence of instrument separation was 1.09% (95% CI: 0.84% to 1.38%). The most common sites of separation were the apical third (66.4%) followed by the middle third (30.2%). Reciprocating instruments were more likely to separate in molars, particularly mandibular molars. Instrument fatigue was the most frequently cited cause.It can be concluded that incidence of separation with reciprocating instruments is low but clinically relevant. The apical third is the most vulnerable region. Clinicians should remain vigilant, especially when treating molars and reusing instruments.
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