Consideraciones clínicas y técnicas que contribuyen a la fractura de sistemas rotatorios utilizados en terapia endodóntica. Revisión sistemática 2015-2020

Abstract

The main objective of this review was to establish the evidence in the scientific literature published between 2015-2020, on clinical and technical conditions that contribute to rotational system fracture during endodontic therapy. The search was carried out in the different databases such as Google scholar, Scopus, Springer Link, Web Of Science, Dentistry Oral, Scielo, Embase, PubMed, and Science Direct in English, using the following keywords: Root canal preparation, Endodontics, Fracture, File Separation, Glide Path, Root Curvature, Cyclic Fatigue, Torsional Fatigue, Reuse, Operator Experience, Rotary Files. Based on these, the search strategy was created and, according to the established inclusion and exclusion criteria, eighty-nine articles were included in the systematic review. The clinical conditions that contribute to instrument fracture are cyclical and torsional fatigue, root angle and radius of curvature, operator experience, instrument reuse, temperature, and different properties of rotary systems. Cyclic fatigue was the clinical condition with the most reported NiTi file separation in this review, many factors affect the resistance of this condition. Reciproc, Hyflex EDM, R-Pilot, Reciproc Blue, Wave One Gold, Protaper Next, Hyflex CM and Wave One are the rotary systems reported with the best resistance to fracture. It is important to know the properties of the different systems to apply in each case, since the risk of separation of the instrument within the canal is not eliminated but rather helps to minimize it. The root canal anatomy is the starting point in the selection of rotary instruments due to its complex variations, mainly root curvatures. Lower molars, upper molars and premolars are reported as higher risk of fracturing rotary systems in endodontics.