Incidence of different types of intracanal fracture of nickel–titanium rotary instruments: a systematic review

Aim: The aim of this systemic review is to investigate these parameters by analyzing the characteristics of fractured instruments to determine which is the most relevant mechanical stress that induces intracanal separation in vivo. Background: The fracture of nickel–titanium (Ni–Ti) instruments is a result of flexural fatigue and torsional fatigue. An electronic search was conducted in MEDLINE database, Web of Science, and Cochrane following preferred reporting items for systematic reviews and meta-analyses guidelines. Data were collected and the key features from the included studies were extracted. Overview quality assessment questionnaire scoring assessed the quality of the articles. A total of 12 articles were selected, where the lowest score was 13. Review results: Considering Ni–Ti rotary instruments, this overall evaluation comprehends 939 broken instruments with an incidence of fracture of 5%. Out of the 12 selected articles, 10 studies revealed that flexural failure was the predominant mode (range of 62–92%). It appears that motion plays an important role when it comes to mechanisms of fracture. The majority of defects found in hand-operated instruments were in the form of torsional failure. Although the major cause of separation of rotary instruments is flexural fatigue, smaller instruments show more torsional fracture than the larger instruments. The average fragment length was found to be 2.5 mm and 3.35 mm, respectively, for torsional failure and flexural failure. The risk of bias depends on fractographic analysis. Conclusion: Flexural fatigue is the predominant mode of fracture in rotary Ni–Ti instruments. The type of motion and size of the instrument seem to affect the mechanism of fracture. Fragment length may show a strong association with the type of fracture mechanism. Clinical significance: This systemic review found that flexural fatigue is the most relevant mechanical stress that induces intracanal separation in vivo. Moreover, in clinical practice, the fragment length might be an excellent indicator of the type of fracture.