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Today, endodontic files have better materials, improved file design and more user-friendly technology, but there are still cases of endodontic file breaks during root canal treatment. So, what should be done when the endodontic file is damaged?
Technical progress of endodontic files
What are the consequences of a broken endodontic file?
The first change in the root canal measurement method is the conversion of a cemented carbide steel hand file to a stainless steel hand file. This is important in terms of reuse and sterilization. Stainless steel hand files became very popular, and although it was originally designed for K files and reamers, Hurstrom was quickly accepted. The reamer uses a circular technique, while the K-type file uses a quarter-turn twist and pull method. Because of their higher cutting efficiency, hedstrom files are used for pushing and pulling motions. The next major change (and a major event in the field of endodontics) was the introduction of NiTi large taper rotary files in the early 1990s. For those who use manual instruments, the steering rotation technique is significant for many reasons. At first, clinicians realized that the rotation technology caused less fatigue to practitioners, and more importantly, produced a predictable molding effect that was not visible with manual instruments. Another benefit of this new technology is that it greatly shortens the time of the instrument and reduces program errors such as setup and transportation. On the other hand, if technology or design increases the torque and cyclic fatigue of a given file, Niti taper file fracture will occur. However, as more and more dentists start to use rotating instruments, technology and design have become more perfect, the incidence of file separation has dropped significantly, and the advantages of Niti taper file instruments have been firmly established. At this time, the addition of a high-torque rotary engine that can operate between 300 rpm and 1,000 rpm has become the main content of the endodontic arsenal, and it is also the requirement for those practitioners to increase the rotating instrument in their practice.
In order to maintain or improve the prognosis of teeth in traditional endodontic root canal treatment, the broken endodontic file cannot be removed, and clinicians should actively adopt their instrument technology. As mentioned above, using the hand file before using the rotated file will help to establish a glide path to the root tip area, thus helping to reduce file separation. Most filings occur on curved root canals, 5 is a root canal shape we have observed, most of which occur on posterior teeth. In a study by Marroquin, it was reported that the average hole diameter of the upper and lower molars was between 20 and 30 files. 16 Therefore, the use of a hand file with a working length of 20 to 30 gauge can enhance the cleaning of the root canal tissue at the apex of the root canal and better transition to a rotary endodontic file. Another advantageous method is to pre-flash the crown part of the tube before placing the rotary file at the working length. This will not only reduce the chance of file damage,7 but also allow more irrigation agents such as sodium hypochlorite and chlorhexidine to enter the canal. The combination of an irrigant and a hand file in the apical area will help to remove living or inanimate pulp tissue.
The success of root canal treatment depends on the removal of critical or non-critical pulp tissue at critical concentrations. Because each patient's body responds differently to infection and/or inflammation, it is almost impossible to quantitatively determine the exact number of critical tissues in each patient. Therefore, correct root canal debridement and sealing combined with restoration dentistry are still necessary for long-term success. When the large taper rotary file breaks and cannot be removed, by adhering to these methods, the amount of debris beyond the separation point of the file can be reduced, which is expected to obtain a better long-term prognosis of root canal treatment. It is important to note that when a broken file cannot be deleted, the clinician must notify the patient and record it in the patient's record. Although breaking the endodontic file in the root canal is not a medical malpractice, if the doctor does not tell the patient, in most states, the time limit for medical malpractice claims can be many years from the date the endodontic file is broken
In the case of an endodontic file, the successful removal depends more on its position in the spinal canal rather than the specific technique used, but it is more important to ensure that the endodontic file you purchase is a high-quality product that meets the sales standards.If you are looking for a high-quality endodontic file at a reasonable price, Osakadent Co.,Ltd. will provide you with the best products.