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Pattern of endodontic instrument separation and factors affecting its retrieval: a 10-year retrospective observational study in a postgraduate institute
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Velmurugan Natanasabapathy, Aswathi Varghese, Paul Kevin Abishek Karthikeyan, Srinivasan Narasimhan
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Restor Dent Endod 2025;50(1):e7. Published online February 19, 2025
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DOI: https://doi.org/10.5395/rde.2025.50.e7
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 Abstract
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- Objectives
This study aimed to assess the pattern of endodontic instrument separation, their retrievability, and factors affecting its retrieval, in a postgraduate institute.
Methods
Cases referred for the management of separated endodontic instruments (SEI) from 2013 to 2023 were considered for this study. Data related to demographics, tooth type, file type, and retrieval were documented in an Excel sheet. Eight prognostic factors assumed to influence the retrieval were analyzed in this study. The secondary aim was to compare the pattern of SEI and retrievability between conventional nickel-titanium files and newer generation heat-treated nickel-titanium files. Retrieval was attempted by a senior endodontist under the dental operating microscope. Various ultrasonic tips and a Broken Tool Removal loop system were used during retrieval. Simple descriptive statistics were performed. Binomial logistic regression was done to identify the effect of the eight prognostic factors on the retrieval outcome.
Results
A total of 190 SEI was reported. SEI occurred more often in posterior teeth than anterior teeth, mandibular arch than maxillary arch, and in larger files than smaller files. Separation occurred more often in the apical third compared to the other levels. Retrieval was attempted in 88 cases and successful in 70 cases (79.5%). The larger taper and apical position of the SEI negatively influenced the retrieval by 1.4 and 8.7 times, respectively.
Conclusions
Retrieval of SEI was successful in the majority of the cases. An increase in taper and apically placed SEI negatively impacted the retrieval. There was no difference in the pattern of separation nor retrievability between conventional nickel-titanium files and newer generation heat-treated nickel-titanium files.
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The influence of sodium hypochlorite concentration on the fibrin structure of human blood clots and transforming growth factor-beta 1 release: an ex vivo study
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Anisha Mishra, Velmurugan Natanasabapathy, Nandini Suresh
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Restor Dent Endod 2022;47(4):e42. Published online October 31, 2022
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DOI: https://doi.org/10.5395/rde.2022.47.e42
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Abstract
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- Objective
This study investigated the effects of various concentrations of sodium hypochlorite (NaOCl) on human whole-blood clotting kinetics, the structure of the blood clots formed, and transforming growth factor (TGF)-β1 release. Materials and MethodsHuman whole blood was collected from 5 healthy volunteers and divided into 4 groups: CG (control, 0.5 mL of blood), BN0.5 (0.5 mL of blood with 0.5 mL of 0.5% NaOCl), BN3 (0.5 mL of blood with 0.5 mL of 3% NaOCl), and BN5.25 (0.5 mL of blood with 0.5 mL of 5.25% NaOCl). The effects of NaOCl on clotting kinetics, structure of fibrin and cells, and release of TGF-β1 were assessed using thromboelastography (TEG), scanning electron microscopy (SEM), and enzyme-linked immunosobent assay, respectively. Statistical analysis was conducted using the Kruskal Wallis and Mann-Whitney U tests, followed by the post hoc Dunn test. A p value < 0.05 indicated statistical significance. ResultsThe blood samples in BN0.5 and BN3 did not clot, whereas the TEG of BN5.25 showed altered clot formation. Samples from the CG and BN3 groups could only be processed with SEM, which showed that the latter lacked fibrin formation and branching of fibers, as well as clumping of red blood cells with surface roughening and distortion. TGF-β1 release was significantly highest in BN3 when all groups were compared to CG (p < 0.05). ConclusionsEach concentration of NaOCl affected the release of TGF-β1 from blood clots and altered the clotting mechanism of blood by affecting clotting kinetics and cell structure.
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