Prevention and management of fractured instruments in endodontic treatment

Table 1 The prevalence and incidence of files separation at different studies

Year	Ref.	Instrument	n	Level	Location	Separation
1997	Ramirez-Salomon et al[10]	LightSpeed	162	Canals	Molars	3.7%
			52	Teeth	Molars	11.5%
2000	Sattapan et al[11]	Quantec Series 2000	378	Files	Tooth	21%
2003	Al-Fouzan et al[12]	Profile	1457	Canals	Molars	1.4%
			419	Teeth	Molars	5%
2003	Hülsmann et al[13]	Quantec Sc	50	Canals	Molars	6%
			25	Teeth	Molars	12%
		LightSpeed	50	Canals	Molars	10%
			25	Teeth	Molars	20%
2004	Ankrum et al[14]	Profile	59	Files	Molars	1.7%
		Protaper	84	Files	Molars	6.0%
		K3 Endo	48	Files	Molars	2.1%
2006	Troian et al[15]	RaCe	50	Canals	Artificial	12%
		K3	50	Canals	Artificial	0%
2006	Iqbal et al[16]	Hand and rotary instrument	10237	Canals	Tooth	0.09%
			4116	Teeth	Tooth	0.22%
		Hand only	1801	Canals	Tooth	0.17%
			749	Teeth	Tooth	0.40%
		Rotary instrument	10237	Canals	Tooth	0.67%
			4116	Teeth	Tooth	1.68%
2006	Di Fiore et al[4]	Profile	2476	Files	Tooth	0.28%
		Protaper	1689	Files	Tooth	0.41%
		GTRotary	771	Files	Tooth	0.39%
		K3Endo	1725	Files	Tooth	0.52%
2006	Knowles et al[8]	LightSpeed	3543	Canals	Tooth	1.30%
2009	Inan et al[7]	Mtwo	593	Files	Tooth	16.2%
2009	Shen et al[2,5]	Profile	3706	Files	Tooth	0.3%
		Protaper	1895	Files	Tooth	0.26%
		Protaper for hand use	280	Files	Tooth	2.9%
		K3	294	Files	Tooth	3%
2011	Wu et al[17]	Protaper	6154	Canals	Tooth	1.1%
			2654	Teeth	Tooth	2.6%
2013	Gu et al[18]	Protaper	2061	Files	Tooth	28.2%
2014	Plotino et al[19]	Reciproc	3780	Canals	Tooth	0.21%
			1696	Files	Tooth	0.47%
2014	Labaf et al[20]	Hero642	233	Canals	Simulated	4.75%
		FlexMaster	92	Canals	Simulated	3.92%
		Mtwo	152	Canals	Simulated	6.33%
2014	Wang et al[6]	Mtwo	24108	Canals	Tooth	1.0%
			11036	Teeth	Tooth	2.2%
2014	Ungerechts et al[3]	Hand instruments	3854	Teeth	Tooth	1.0%

Table 2 The recommended use times of different studies

Year	Ref.	Instruments (rotary)	n	Used times	Operator	Deformation (files)	Separation (files)
2006	Wolcott et al[77]	ProTaper	4652 canals	1 tooth	Experienced		20
				2 teeth	Experienced		12
				3 teeth	Experienced		23
				4 teeth	Experienced		19
				5 teeth	Experienced		39
2009	Shen et al[75]	ProFile 0.04,	1071 files	1 visit	Experienced	8 (0.75%)	0
		ProFile Series 29 0.04	432 files	1 visit	Experienced	0	0
		ProTaper	1895 files	1 visit	Experienced	55 (2.9%)	5 (0.26%)
2009	Inan et al[7]	Mtwo	593 files	4 molar teeth or 2 molar teeth with curved canals	10 trained	58 (9.78%) (unwinding and curve/bend)	95 (16.02%)
2009	Vieira et al[48]	ProTaper Universal	10 sets files	5 molar teeth	Experienced	0	0
2010	Ma et al[74]	ProTaper	432 case	20 canals			27
2012	Shen et al[53]	ProFile Vortex	2023 files	1 visit	Undergraduate students	0	1 (0.04)
2013	Shen et al[76]	HyFlex CM	468 files	3 teeth	9 residents	16 (3.4%)	0
2015	Plotino et al[19]	Reciproc	1696 files	1 tooth		6 (0.35%)	8 (0.47%)