Cone-beam Computed Tomography Volumetric Analysis and Comparison of Dentin Structure Loss after Retrieval of Separated Instrument by Using Ultrasonic EMS and ProUltra Tips

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Introduction:A separated instrument within the root canal may interfere in the successful outcome of endodontic treatment. The retrieval of fractured instruments might compromise the remaining tooth structure and subsequently resistance to tooth fracture. The aim of this study was to compare the change in volume of root canal and dentin thickness after retrieval of separated instrument by 2 different endodontic ultrasonic tips.Methods:Each of the instruments (EMS Endochuck and ProUltra #6, #7, and #8 tips) was used to remove 40 separated rotary ProTaper F2 instruments from the mesiobuccal roots of mandibular molar under ×15 magnification. Cone-beam computed tomography analysis of the samples was done to evaluate the change in volume, dentin thickness, weight, time taken, and success.Results:Paired sample t test showed statistically significant (P < .05) difference in volume before and after instrument retrieval in both the EMS group, where the increase was 112.52%, and in the ProUltra group, where the increase was by 55.35%. Intergroup comparison showed statistically significant (P < .05) decrease in dentin thickness; it was more for EMS as compared with ProUltra. Overall decrease in the mean weight of EMS group (18.42%) was more than that of ProUltra group (9.36%). The overall success rate for removal of fractured instrument in this study was 87.5%; however, the difference in success rate was not statistically significant. The mean time taken for retrieval by ProUltra system was 63.89 minutes, whereas it was significantly less (P < .05) for EMS system (50.22 minutes).Conclusions:Removal of separated instrument with EMS resulted in more significant tooth structure loss as compared to ProUltra.Highlights:The aim of the study was to compare the changes in root canal volume and dentin thickness after retrieval of separated instrument by 2 ultrasonic tips.Statistically significant increase in canal volume and decrease in dentine thickness was seen after retrieval. EMS exhibited greater change compared to ProUltra.Retrieval leads to decreased dentin thickness, irregular canal shape, formation of irregularities, and increase in canal volume resulting in decreased tooth structure, which may make the tooth susceptible to fracture.

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