Mark Allen, General Manager at COLTENE, discusses the causes of endo file fractures and how to avoid them
Root canal surgery is among the most disquieting procedures for dental patients, mostly due to the fear of pain during and after the repair of the infected tooth. Amid the rising trend for complaints and legal recourse by patients toward dental professionals, root canal surgery presents a number of different scenarios for litigation, especially when the dentist has not fully informed the patient about the possibility of risks. These range from an incorrect diagnosis of the tooth to be treated to failure to use a dental dam, vital to create an aseptic environment and prevent the ingestion of instruments.
There is also the issue of a possible fracture or breakage of instruments during treatment, which as we are well aware can occur when the metal is pushed beyond its modulus of flexibility. To avoid the separation of instruments, due to cyclical fatigue or torsional overload, the practitioner must closely follow the guidelines for their correct use.
Even so, breakages can occur, and predisposing factors include the design of the instruments, with larger diameter equipment shown to succumb to flexural fatigue earlier than those with smaller diameters, or they might suffer from irregularities caused during the manufacturing process, such as cracks, milling grooves and pits.
Although some believe that the widespread use of rotary nickel titanium instruments – chosen for their biocompatibility, super flexibility and corrosion resistance – has led to higher rates of separation, this has not been proven conclusively. Recommendations to reduce the likelihood of breakage include ensuring straight line access and good finger rests and using a crown-down shaping technique, depending on the instrument system.
Professionals are also advised to choose a touch-retract movement with relaxed instrumentation and avoidance of rapid jerking movements and clicking. They should replace files after use in very narrow and curved canals, and examine files regularly during use.
Breaking a file during endodontic treatment is not malpractice, but failure to provide full disclosure when it happens puts the dental professional at risk of being sued by any patient aware of the treatment procedure.
Despite the stereotypical view of dental litigants as having an axe to grind and seeking lucrative financial settlements, research shows that only 30-39% of litigants were seeking financial compensation. The vast majority simply wanted to know what happened in the hope it would not be repeated.
Accidents can occur during root canal surgery and accepting that fact and trying to avoid it means thorough preparation and the use of the highest-quality instruments – for example, our COLTENE HyFlex EDM NiTi Files have been designed with up to 700% greater fracture resistance when compared to their competitors, plus a specially hardened surface. Extra care is taken during their manufacture to avoid potential problems caused by flaws, cracks, and pits. Hopefully, the care we take will help guard against problems arising during surgery.