Preserving tooth structure after instrument separation: Effects of management strategy on root fracture resistance and structural outcomes related to tooth preservation.

Authors

Mohamed M Elashiry, Rana Zeitoun, Franklin Tay

Published in

Journal of endodontics. Oct 30, 2026. Epub Oct 30, 2026.

Abstract

A separated endodontic instrument can limit cleaning apical to the fragment. However, removal may require substantial sacrifice of radicular dentin. This narrative review examined how nonsurgical retrieval, bypass, retention, and surgical management affect fracture resistance, healing, and tooth retention.
Clinical studies, systematic reviews, biomechanical laboratory studies, and recent expert consensus were synthesized with emphasis on residual dentin, fracture resistance, periapical status, healing, and tooth retention.
Aggressive retrieval can remove substantial dentin, particularly when fragments lie apically or within curved canals. Clinical evidence is mainly observational. Retained fragments are not consistently associated with poorer healing when apical periodontitis is absent; pre-operative disease status is a stronger prognostic factor. Evidence specific to successful bypass and surgical removal of separated instruments is limited. Root fracture has been reported as a late cause of failure after retrieval, although available cohort data do not establish that retrieval caused those fractures. No strategy has been shown superior for long-term tooth survival in controlled comparative studies; laboratory fracture-resistance data and observational healing data address different endpoints and cannot be equated.
A separated instrument is a management problem, not an automatic indication for removal. No management strategy has demonstrated superiority in long-term tooth retention on the basis of controlled comparative clinical evidence. Management should balance the biological value of gaining apical access against the structural and procedural cost of doing so recognizing that this balance is a clinically reasonable principle rather than a comparatively validated outcome. Fragment position, canal curvature, infection status, stage of canal preparation, residual dentin, and feasibility of disinfection should determine whether retrieval, bypass, retention, or surgery is selected.

PMID:
42962853
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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