Impact of a Retained Instrument on Treatment Outcome: A Systematic Review and Meta-analysis

Introduction: Fracture of root canal instruments is one of the most troublesome incidents in endodontic therapy. This systematic review and meta-analysis aim to determine the outcome difference between retained fractured instrument cases and matched conventional treated cases. Methods: The MEDLINE database, EM-BASE, Web of Science, and the Cochrane Database were searched. Reference lists were scanned. A forward search was undertaken on identified articles. Papers citing these articles were identified through Science Citation Index to identify potentially relevant subsequent primary research. A systematic data extraction sheet was constructed. Data in these studies were independently extracted. Risk differences of included studies were combined by using the generic inverse variance data and fixed effects method. A 2-stage analysis was conducted. The first was limited to case-control studies, and the second included case series in which data were available for teeth with and without periradicular lesions. Results: Two case-control studies were identified and included, covering 199 cases. Weighted mean healing for teeth with a retained instrument fragment was 91%. The 2 studies were homogeneous. Risk difference of the combined data was 0.01, indicating that a retained fragment did not significantly influence healing. Overall, 80.7% of lesions healed when a periapical lesion was present, compared with 92.4% remaining healthy when no lesion was present initially (P < .02). Conclusions: On the basis of the current best available evidence, the prognosis for endodontic treatment when a fractured instrument fragment is left within a root canal is not significantly reduced. (J Endod 2010;36:775-780)