TECHNIQUES FOR REMOVING FRACTURED FILES IN ENDODONTIC TREATMENT

Abstract

The fracture of endodontic instruments within the root canal system constitutes a challenging complication in clinical practice, capable of compromising adequate cleaning, disinfection, and three-dimensional obturation, directly affecting the overall prognosis of the treatment. This study aimed to analyze the main techniques used for the retrieval of fractured files, highlighting their indications, limitations, and clinical efficacy. To this end, an integrative literature review of a descriptive and qualitative nature was conducted, searching articles indexed in the PubMed and Virtual Health Library (VHL) databases published between 2023 and 2025, using controlled descriptors and the PICO strategy for study selection. The results demonstrate that structural failure of Nickel-Titanium (NiTi) instruments stems from the combined effect of cyclic and torsional fatigue mechanisms, intensified by complex root canal anatomy and inappropriate instrument use. It was found that combining optical magnification via operating microscopy with ultrasonic tips represents the conservative gold standard for the detachment and mechanical removal of fragments located in the coronal and middle thirds. Conversely, when retention occurs in the apical third or presents an imminent risk of perforation and root weakening, alternative strategies such as the bypass technique or clinical and radiographic monitoring prove to be safe and biologically sound approaches. It is concluded that the success of endodontic treatment is not restricted to the removal of the metallic fragment, but rather to the efficacy in disinfecting and sanitizing the canal space while preserving the structural integrity of the dental element.