Abstract
Background: Instrument separation is a frequent issue in root canals, often complicated by intriguing anatomical variations that make treatment more challenging. These variations in canal structure can lead to various iatrogenic complications, such as missed canals, instrument separation, gouging, perforation, and overextension of obturation materials. One such complication is instrument breakage, which can disrupt the cleaning and shaping processes and potentially cause pain or discomfort. Materials and Methods: The present systematic review was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The present systematic review aimed to identify all clinical trials focused on the removal of separated instruments from endodontic canals using an endodontic surgical approach. Results: A total of 21 studies were included, reporting 22 cases involving surgical approaches for separated instrument removal. Conclusions: The analysis of available evidence, although prim Information added.arily based on clinical cases and case series, emphasizes that surgical approaches for removing separated endodontic instruments are a viable therapeutic option when non-surgical treatments are ineffective or not feasible. Techniques such as apicoectomy, intentional replantation, surgical removal, and the technique provide innovative, customized solutions for addressing complications related to separated instruments, showing favorable clinical and radiographic success rates in follow-up assessments.