Open Journal Systems

Cover Image

Solution methods of instrumentation related complications in endodontic treatment

Fatih Ucar, İrem Eren, Huda Melike Alaca


Background: Endodontics is a skill that requires the use of precision instruments in tight spaces and is a complex discipline often underestimated by clinicians and patients. Inevitably, this will lead to complications. Complications encountered during endodontic treatment occur during diagnosis, anesthesia, cleaning, and shaping of the root canals and filling the root canals. Complications can occur at any stage of treatment. The various procedures associated with root canal treatment can be divided into three treatment phases: Pre-operative, operative, and post-operative. Since endodontic complications may occur at any of the pre-operative, intraoperative, and post-operative stages, complications that may develop are also classified in the same way. Aim: In this review, operative complications including instrument fracture, ledge formation, canal obstruction, apical transportation, and strip perforation that may occur during canal preparation in endodontic treatment are discussed. Conclusion: Technological developments in endodontics have revealed methods and instruments enable successful treatment of calcified root canals, severe canal curvatures, ledges, resorption defects, perforations, and broken canal instruments without complications. Clinical Significance: Therefore, the physician should always be ready to manage complications. The task of the physician is to know how to avoid potential complications and how to manage complications that may arise during treatment.


Canal preparation; Complication; Root-canal treatment

Full Text:

Abstract PDF


Anthony J. Endodontic complications. Clin Tech Small Anim Pract 2001;16:168-72.

Kakehashi S, Stanley H, Fitzgerald R. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965;20:340-9.

Li UM, Lee BS, Shih CT, Lan WH, Lin CP. Cyclic fatigue of endodontic nickel titanium rotary instruments: Static and dynamic tests. J Endod 2002;28:448-51.

Suter B. Separated root canal instruments an overview of incidence, localisation, treatment strategies and outcome. Swiss Dent J 2017;127:233-7.

Spili P, Parashos P, Messer HH. The impact of instrument fracture on outcome of endodontic treatment. J Endod 2005;31:845-50.

Iqbal MK, Kohli MR, Kim JS. A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: A PennEndo database study. J Endod 2006;32:1048-52.

Ankrum MT, Hartwell GR, Truitt JE. K3 Endo, ProTaper, and ProFile systems: Breakage and distortion in severely curved roots of molars. J Endod 2004;30:234-7.

Feldman G, Solomon C, Notaro P, Moskowitz E. Retrieving broken endodontic instruments. J Am Dent Assoc 1974;88:588-91.

Wei X, Ling J, Jiang J, Huang X, Liu L. Modes of failure of ProTaper nickel-titanium rotary instruments after clinical use. J Endod 2007;33:276-9.

Cheung GS. Instrument fracture: Mechanisms, removal of fragments, and clinical outcomes. Endod Top 2007;16:1-26.

McGuigan M, Louca C, Duncan H. Endodontic instrument fracture: Causes and prevention. Br Dent J 2013;214:341-8.

Ward JR, Parashos P, Messer HH. Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: An experimental study. J Endod 2003;29:756-63.

Hülsmann M, Schinkel I. Influence of several factors on the success or failure of removal of fractured instruments from the root canal. Dent Traumatol 1999;15:252-8.

Gencoglu N, Helvacioglu D. Comparison of the different techniques to remove fractured endodontic instruments from root canal systems. Eur J Dent 2009;3:90-5.

Madarati A, Watts D, Qualtrough A. Opinions and attitudes of endodontists and general dental practitioners in the UK towards the intra‐canal fracture of endodontic instruments. Part 2. Int Endod J 2008;41:1079-87.

Terauchi Y, O’Leary L, Suda H. Removal of separated files from root canals with a new file-removal system. J Endod 2006;32:789-97.

Terauchi Y, O’Leary L, Kikuchi I, Asanagi M, Yoshioka T, Kobayashi C, et al. Evaluation of the efficiency of a new file removal system in comparison with two conventional systems. J Endod 2007;33:585-8.

Okiji T. Modified usage of the Masserann kit for removing intracanal broken instruments. J Endod 2003;29:466-7.

Thirumalai AK, Sekar M, Mylswamy S. Retrieval of a separated instrument using Masserann technique. J Conserv Dent 2008;11:42-5.

Nagai O, Tani N, Kayaba Y, Kodama S, Osada T. Ultrasonic removal of broken instruments in root canals. Int Endod J 1986;19:298-304.

Panitvisai P, Parunnit P, Sathorn C, Messer HH. Impact of a retained instrument on treatment outcome: A systematic review and meta-analysis. J Endod 2010;36:775-80.

Hülsmann M. Removal of fractured root canal instruments using the canal finder system. Deutsch Zahnarztl Z 1990;45:229-32.

Al‐Fouzan K. Incidence of rotary ProFile instrument fracture and the potential for bypassing in vivo. Int Endod J 2003;36:864-7.

Rambabu T. Management of fractured endodontic instruments in root canal: A review. J Sci Dent 2014;4:40-8.

Crump MC, Natkin E. Relationship of broken root canal instruments to endodontic case prognosis: A clinical investigation. J Am Dent Assoc 1970;80:1341-7.

Tang Y, Li X, Yin S. Outcomes of MTA as root-end filling in endodontic surgery: A systematic review. Quintessence Int 2010;41:557-66.

Nagy CD, Bartha K, Bernáth M, Verdes E, Szabó J. The effect of root canal morphology on canal shape following instrumentation using different techniques. Int Endod J 1997;30:133-40.

Kapalas A, Lambrianidis T. Factors associated with root canal ledging during instrumentation. Dent Traumatol 2000;16:229-31.

McKendry DJ, Krell KV, McKendry LL. Clinical incidence of canal ledging with a new endodontic file. (abstract) J Endod 1988;14:194-5.

Zmener O, Marrero G. Effectiveness of different endodontic files for preparing curved root canals: A scanning electron microscopic study. Endod Dent Traumatol 1992;8:99-103.

Greene KJ, Krell KV. Clinical factors associated with ledged canals in maxillary and mandibular molars. Oral Surg Oral Med Oral Pathol 1990;70:490-7.

Stadler LE, Wennberg A, Olgart L. Instrumentation of the curved root canal using filing or reaming technique--a clinical study of technical complications. Swed Dent J 1986;10:37-43.

Eleftheriadis GI, Lambrianidis TP. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J 2005;38:725-34.

van der Vyver PJ, Vorster M, Paleker F, de Wet FA. Errors in root canal preparation: A review of the literature and clinical case reports. S Afr Dent J 2019;74:246-54.

Jafarzadeh H, Abbott PV. Ledge formation: Review of a great challenge in endodontics. J Endod 2007;33:1155-62.

Lambrianidis T. Ledging and blockage of root canals during canal preparation: Causes, recognition, prevention, management, and outcomes. Endod Top 2006;15:56-74.

Young G, Parashos P, Messer HH. The principles of techniques 7 for cleaning root canals. Aust Dent J 2007;52:52-63.

Burklein S, Schafer E. Apically extruded debris with reciprocating single-file and full-sequence rotary instrumentation systems. J Endod 2012;38:850-2.

Attar OH, Chogle SM, Hsu TY. Part 5: Instrumentation related complications. In: Jain P, editor. Common Complications in Endodontics: Prevention and Management. Chandler Drive, Hanover Park: Quintessence Publishing Co., Inc.; 2018.

Hülsmann M, Peters OA, Dummer PM. Mechanical preparation of root canals: Shaping goals, techniques and means. Endod Top 2005;10:30-76.

Peters OA, Paqué F. Current developments in rotary root canal instrument technology and clinical use: A review. Quintessence Int 2010;41:479-88.

Duigou C. Discuss the prevention and management of procedural errors during endodontic treatment. Aust Endod J 2004;30:74-8.

Elmsallati EA, Wadachi R, Suda H. Extrusion of debris after use of rotary nickel‐titanium files with different pitch: A pilot study. Aust Endod J 2009;35:65-9.

Bargholz C. Part 17: Perforations. In: Hülsmann M, Schäfer E, editor. Problems in Endodontics; Etiology, Diagnosis and Treatment. Chicago, IL: Quintessence Publishing Co., Inc.; 2009. p. 385-400.

Fuss Z, Trope M. Root perforations: Classification and treatment choices based on prognostic factors. Endod Dent Traumatol 1996;12:255-64.

Bryan EB, Woollard G, Mitchell W. Nonsurgical repair of furcal perforations: A literature review. Gen Dent 1999;47:274-8.

Saed SM, Ashley M, Darcey J. Root perforations: Aetiology, management strategies and outcomes. The hole truth. Br Dent J 2016;220:171-80.


  • There are currently no refbacks.