Fracture of Rotary Instruments in Third Molar Extraction: Evidence from a Scoping Review

TL;DR

This review examines the rare but important issue of rotary instrument fractures during third molar extractions, summarizing causes, symptoms, and management strategies.

Contribution

The study provides a comprehensive overview of clinical cases and management approaches for rotary bur fractures during third molar surgery.

Findings

All fractures occurred during mandibular third molar extractions.

Pain was the most common symptom (45%), followed by swelling and trismus.

Management strategies ranged from immediate surgical retrieval to conservative observation.

Abstract

Background: Rotary instrument fracture during third molar extraction is rare but clinically relevant, presenting diagnostic and therapeutic challenges. Aim: This scoping review summarizes available evidence on bur breakage and displacement during third molar surgery, focusing on causes, clinical manifestations, and management strategies. Materials and Methods: A systematic search of PubMed, Virtual Health Library, and Google Scholar was conducted for studies published from January 2008 to March 2025 reporting rotary instrument fracture during third molar extraction. Extracted data were qualitatively analyzed. Results: Eight studies reporting eleven clinical cases were included. All fractures occurred during mandibular third molar extractions. Pain was the most frequent symptom (45%), followed by swelling (27%) and trismus (18%). Management varied from immediate surgical retrieval to conservative observation. Conclusions: Although uncommon, rotary bur fracture during third molar extraction requires preventive attention and accurate reporting. Adherence to manufacturer recommendations, single-use bur policies, and adequate irrigation should be considered. Prospective multicenter and mechanical studies are needed to establish standardized management protocols.

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