Abstract
Introduction: Fracture of endodontic instruments is a challenge and deserves the spotlight in endodontics. Fracture rates for stainless steel instruments can reach 6%, while nickel-titanium rotary instruments can have a 10% fracture rate. Fractured files can be removed using bypass and ultrasound techniques, for example. Objective: The present study developed a concise systematic review to present the main considerations for removing file fractures in root canals, in order to inform the current state of the art in techniques. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from March to April 2025 in Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 138 articles were found, 34 articles were evaluated in full and 16 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. It was concluded that fracture can occur for various reasons, such as factors related to the experience and capacity of the operator, anatomical characteristics of the tooth, and also the instrument used. The first approach to use is the bypass system in order to bypass the instrument, which is less invasive and more accessible to operators. Another possible technique is the use of ultrasound, but with care to avoid dentin wear. And finally, there are microtube systems that in turn also wear away the dentin and can weaken the tooth.