Success Outcomes for Bypass or Retrieval of Fractured Endodontic Instruments: A Systematic Review

Abstract Introduction: Fractured endodontic instruments complicate root canal therapy. This systematic review and meta-analysis evaluated the effectiveness of bypassing or retrieving fractured files on treatment success. Aims: To assess clinical outcomes after bypassing or retrieving fractured endodontic instruments. Design: Systematic review and meta-analysis of studies from January 2000 to August 2023. Setting: Searches were conducted in MEDLINE/PubMed, Cochrane Central, DOAJ, and other databases. Materials and Methods: Clinical studies reporting treatment outcomes following bypass or retrieval were included. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale. Meta-analysis (RevMan 5.4) reported pooled odds ratios (OR) for success. Results: Five studies were included in the qualitative synthesis; four in the meta-analysis (492 participants). The pooled OR was 20.39 [95% CI: 2.68–155.18], favoring active management. Success rates rose from 68.1% to 95%, especially when fragments were visible, canals were straight, and magnification or ultrasonics were used. Heterogeneity was high (I² = 97%). Discussion: Active management improves outcomes, though success varies with anatomy, case selection, and clinician expertise. Conclusion: Bypassing or retrieving fractured instruments increases root canal success. More robust studies are needed to guide consistent clinical protocols.