A systematic review of bypass and retrieval techniques in the management of separated endodontic instruments
DOI:
https://doi.org/10.58342/MJ.V.3.I.1.5Keywords:
Bypass, Retrieval, Separated instruments, Root canalAbstract
Background and Objective: Management of separated instruments within the root canal is one of the major challenges in endodontic treatment, as it can significantly affect the final outcome. This complication not only increases technical difficulties but also requires careful selection of the appropriate management approach. Two commonly used techniques for handling separated instruments are bypass and retrieval. The present systematic review aimed to compare the success rate and effectiveness of these two approaches to provide evidence-based guidance for endodontists in clinical decision-making.
Materials and Methods: This study was conducted as a systematic review following the PRISMA guidelines and PICO framework. A comprehensive search was performed in PubMed, Google Scholar and Sciencedirect databases for studies published between 2010 and 2025. Articles including patients with separated instruments in root canals treated by either the bypass or retrieval technique were included. In total, 24 studies comprising 3,185 patients and involving molar, premolar, and anterior teeth were analyzed. Data were extracted and statistically compared to assess the success rates of both methods.
Results: The mean success rate for the bypass technique was 40.55% (median 37.5%, SD 20.89%), ranging from 15% to 81.2%. For the retrieval technique, the mean success rate was 48.01% (median 42.2%, SD 20.5%) with a range of 13% to 83.3%. Geographic variations were observed: for example, retrieval showed higher success in India, while bypass had greater success in Pakistan.
Conclusion: Both bypass and retrieval techniques are effective and reliable approaches for managing separated instruments within root canals. The choice between them should be based on tooth type, fracture location, available resources, and operator expertise. A judicious combination of both methods may further improve treatment outcomes. This systematic review provides valuable evidence to support more informed and optimized clinical decisions in endodontic practice.
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