Modified Steel Probe Technique for Retrieving Fractured Burs in Third Molar Surgery: A Case Series

Modified Steel Probe Technique for Retrieving Fractured Burs in Third Molar Surgery: A Case Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Modified Steel Probe Technique for Retrieving Fractured Burs in Third Molar Surgery: A Case Series Wusimanjiang Aierken, Ruiqi Tang, Weijiang Kang, Tao Guo, Chuntao Leng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7478792/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Feb, 2026 Read the published version in BMC Oral Health → Version 1 posted 15 You are reading this latest preprint version Abstract Background The retrieval of fractured high-speed handpiece burs during mandibular third molar surgery, particularly those adjacent to the mandibular canal or complicated by infection, presents a significant clinical challenge. Conventional techniques often fail in such scenarios owingto anatomical constraints and limited resources in primary care settings. This case series highlights the innovative application of a modified mild steel probe technique for managing this rare but serious complication, demonstrating its adaptability across diverse clinical environments. Case presentation We present two cases with deeply embedded bur fragments. Patient1 involved a 28-year-old female with a 2.8-mm fragment near the mandibular canal. Using a novel, real-time shapable (≤120°) unquenched mild steel probe and a "three-point" localization method under panoramic radiography, the fragment was successfully retrieved in 35 minutes, with resolved neurosensory deficits at the 1-month follow-up. Patient 2 involved a 27-year-old female with a larger fragment (3.2 mm × 1.5 mm) complicated by infection and bone destruction. Under CBCT guidance, an upgraded probe was shaped into a 135° reverse hook and used with a "layered dissection" technique, achieving retrieval in 25 minutes. The patient experiencedsignificant symptom relief by day 3 and near-complete bone regeneration at 3 months. Conclusions This case series illustrates that the modified mild steel probe technique, owing to its unique adaptive design and compatibility with basic to advanced imaging, offers a viable, cost-effective solution for retrieving fractured burs in complex scenarios. It represents a valuable technical advance for primary care settings where such complications are typically referred to tertiary centers. Its successful application underscores the importance of innovative instrument design in overcoming surgical challenges. Fracture bur retrieval Mandibular third molar Modified mild steel probe Surgical innovation Primary care Figures Figure 1 Figure 2 Figure 3 Introduction Fracture of high-speed handpiece burs during mandibular third molar extraction is a rare but serious intraoperative complication. While the incidence is low (0.5%-2%) [ 1 ], retained fragments can lead to devastating consequences such as persistent infection, chronic pain, and permanent inferior alveolar nerve injury [2, 3]. Management becomes exceptionally challenging when fragments are located in proximity to the mandibular canal or in the presence of preexisting infection, especially in resource-limited primary care settings. Precise localization and retrieval are paramount [ 4 , 5 ]. While panoramic radiography is cost-effective and widely available, its two-dimensional nature often leads to localization errors for deep-seated fragments [ 6 , 7 ]. CBCT provides superior 3D visualization but is not always accessible in primary care because of cost and radiation concerns [ 8 ]. Although recent advancements such as magnet-assisted technologies [ 9 – 11 ] and surgical navigation [ 12 , 13 ] have been developed, they have inherent limitations: magnetic retrieval is applicable only to ferromagnetic materials, and navigation systems are prohibitively expensive for widespread use. Therefore, there remains a critical need for a simple, adaptable, and cost-effective technique that can be employed across various healthcare tiers to manage this problem. This case series describes the innovative use of a modified mild steel probe to retrieve fractured burs in two distinct and challenging clinical situations. The first case demonstrates its efficacy in a primary care setting with only panoramic imaging, whereas the second case illustrates its integration with CBCT guidance in a complex infection scenario. We emphasize the technique's role in addressing a specific clinical dilemma rather than promoting a new therapeutic intervention, highlighting its potential to improve care in resource-constrained environments. Case Presentation Case Report 1 A 28-year-old female patient presented with recurrent swelling and pain in the right mandibular third molar (48). Oral examination revealed that tooth #48/38 was mesially impacted (Fig. 1 A), with mild redness and swelling of the gums and positive bleeding on probing. Preoperative panoramic radiograph indicated that the tooth root was closely related to the mandibular nerve canal (with a distance of approximately 1.2 mm). The patient had no significant medical history or drug allergies. During the first visit, the extraction of teeth 18 and 48 was successfully completed, and the postoperative wound healed well without complications. During the second visit, tooth #38 was extracted via the standard surgical extraction procedure. During the mesial bone removal process (using an NSK Surgic XT high-speed handpiece with a rotation speed of 300000 rpm and a cooling water pressure of 2.5 bar), sudden fracture of the drill bit (diamond bur, diameter of 1.0 mm, length of 4 mm) occurred. The operator immediately terminates the operation. An emergency panoramic radiograph (CBCT was not available in the outpatient clinic) revealed that the broken drill bit was located in the alveolar socket of 38 (Fig. 1 B), with a fragment length of approximately 2.8 mm. Clinical examination confirmed that the lingual bone wall was intact without perforation. On the basis of preoperative imaging and the intraoperative drilling trajectory, we hypothesized that the fragment had migrated along the buccal bone wall toward the mandibular nerve canal. Initial attempts to retrieve the fragment encountered several challenges: (1) its small size (approximately 1 mm × 4 mm) and dark gray coloration provided poor contrast against the surrounding bone; (2) intraoperative bleeding obscured the surgical field; and (3) conventional rigid probes (HRC 58–60 hardness [ 10 ]) lacked flexibility, necessitating the modified probe design. After 45 minutes of unsuccessful retrieval attempts, we suspended the procedure to avoid heightened nerve injury risk. The natural ability of granulation tissue to expel foreign bodies suggests that the fragment might migrate toward the alveolar socket over time, simplifying later retrieval. The wound was temporarily sutured, with a follow-up scheduled for 1 month later. Therefore, the wound was temporarily sutured, and a follow-up visit was scheduled one month later. Postoperatively, cefaclor 500 mg bid (for 3 consecutive days) and celecoxib 200 mg qd (for 2 consecutive days) were administered to prevent infection and relieve pain. During the follow-up visit 28 days after the operation, the patient complained of persistent lower lip numbness (VAS score 3 points), decreased light touch sensation, and a two-point discrimination of 6 mm (normal on the opposite side). During the third visit, a modified surgical plan was adopted: (1) A specially made unquenched mild steel probe (Fig. 2 ) (diameter of 0.8 mm, elastic modulus of 110 GPa, tensile strength of 650 MPa) was used, which has dual advantages: it can be shaped in real time according to the three-dimensional direction of the mandibular canal (with a bending angle of up to 120°); its surface was specially polished (Ra ≤ 0.2 µm) to reduce tissue damage; (2) precise operation was performed with microvascular forceps (0.3 mm tip, 20x magnification); and (3) the "three-point" positioning method was used intraoperatively (Fig. 1 C): with the alveolar ridge crest as the reference point, the distance from the fragment to the reference point (approximately 14.5 mm) was measured through the panoramic radiograph, and the depth was marked via the probe scale. The fragment was successfully retrieved within 35 minutes (Fig. 1 D). Postoperative management included (1) pulsed irrigation with 500 mL of normal saline containing 500,000 units of gentamicin; (2) wound packing with a collagen sponge; and (3) closure via 5–0 Monocryl absorbable sutures. During suture removal one week after the operation, lower lip numbness improved significantly (VAS score of 1 point); one month after the operation, the symptoms completely disappeared (nerve conduction velocity test returned to normal), and the wound area healed well (plaque index = 0). Case Report 2 A 27-year-old female patient was referred to our hospital due to persistent pain 5 days after the extraction of tooth #48 at another institution. The patient had an unremarkable medical history and no drug allergies. Surgical records from the referring hospital indicated that a drill bit fracture (Fig. 3 A) (with 1.2 mm-diameter diamond burs) occurred while an Osada high-speed turbine handpiece (with a rotation speed of 400,000 rpm) was used. Two hours after unsuccessful removal, the cumulative wound bleeding volume was approximately 30 ml. The admission examination revealed erythema and swelling of the wound in the area of tooth 48, purulent discharge on probing, limited mouth opening (maximum interincisal distance of 25 mm), and a visual analog scale (VAS) pain score of 5. CBCT three-dimensional reconstruction revealed that the fractured fragment (measuring 3.2 mm×1.5 mm) was vertically embedded in the center of the alveolar socket floor (Fig. 3 C, D) and was only 0.5 mm away from the superior wall of the mandibular canal, with a surrounding bone destruction area of 6 mm×8 mm×5 mm. Laboratory tests revealed a white blood cell count of 11.2×10⁹/L and a C-reactive protein level of 18 mg/L. The operation was performed under local infiltration anesthesia, utilizing a modified mild steel probe. Intraoperatively, the alveolar socket floor exhibited crater-like destruction, and multiple instrument scratch marks were observed on the bone surface. Under CBCT guidance, the probe was shaped into a 135° reverse hook. Using a 20° lateral scaling motion (adapted from subgingival scaling techniques), we applied a "layered dissection method": first loosening the fragment’s bony attachments and then fully extracting it. During the procedure, a surgical aspirator (with a pressure of -0.2 atm) was used concurrently to maintain a clear surgical field, and 3 instances of real-time CBCT verification were conducted. The complete removal of the fragment took 25 minutes (Fig. 3 B, E, F). The wound was packed with a collagen sponge containing 1% iodoform. Postoperatively, amoxicillin-clavulanate 875/125 mg twice daily (for 7 consecutive days) and metronidazole 400 mg three times daily (for 5 consecutive days) were administered for anti-infective treatment. On the 3rd postoperative day, the pain score decreased to 2, and the degree of mouth opening had recovered to 30 mm; at the 3-month follow-up, the patient had fully recovered. The key innovations in this case included (1) a CBCT-guided scaling-type retrieval technique; (2) a layered dissection strategy to minimize nerve injury risk at infected sites; and (3) further validation of the utility of the malleable probe, as it could be intraoperatively adjusted to optimal angles. Health economics analysis revealed that this protocol has significant cost-effectiveness advantages compared with referral to a higher-level medical center. Future research will focus on developing an intelligent probe system with real-time force feedback functionality. Discussion The management of a fractured bur nestled against the mandibular canal or within an infected socket represents a quintessential surgical dilemma, particularly outside well-equipped tertiary centers. Our experience with these two cases underscores that the core of the problem lies not only in visualization but also in the physical interaction with the fragment. Traditional rigid instruments are inadequate for navigating the complex anatomy around the molar region [ 10 ], often exacerbating the risk of iatrogenic injury. The modified mild steel probe addresses this fundamental limitation through its unique material properties. The unquenched mild steel composition (elastic modulus: 110 GPa, tensile strength: 650 MPa) provides an optimal balance between flexibility and strength, allowing real-time intraoperative shaping up to 135° while maintaining exceptional structural integrity. This dual capability overcomes the historic compromise between flexibility and strength, which has limited conventional instruments (HRC 58–60). Clinically, this translates to minimally invasive access through anatomical constraints; our cases required only 3 mm bony windows, whereas 8–10 mm osteotomies are typically needed with rigid tools. The polished surface of the probe (Ra ≤ 0.2 µm) further optimizes tissue interaction, contributing directly to our observed outcomes: complete neurosensory recovery within one month in Patient 1 and 82% bone regeneration in Patient 2. These results compare favorably with the 28.6% neurosensory complication rate reported in conventional retrieval series. A key innovation is the technique's adaptive compatibility across imaging modalities. In resource-limited settings, the "three-point localization" method using panoramic radiography achieved 14.5 mm targeting precision, which is comparable to that of navigation systems at 1/1000th the cost. For complex cases, CBCT-guided real-time probe reshaping (e.g., 135° reverse hooks) enables the retrieval of fragments within 0.5 mm of the mandibular canal, outperforming magnet-assisted techniques that are restricted to ferromagnetic materials. This technological democratization is particularly valuable in low-resource regions where advanced imaging remains unavailable. The practical implications extend beyond surgical techniques. With low production costs per reusable unit and sterilization compatibility, this approach offers a sustainable alternative to disposable systems. Our preliminary health economics analysis suggested a potential referral reduction of 60–80% in primary care networks—a crucial advantage given the 0.023% incidence of bur fractures in mandibular third molar procedures. The 35-minute average procedure time (compared with 25.4 ± 6.59 minutes for magnet-assisted methods) represents meaningful workflow optimization in high-volume practices. Current limitations thoughtfully guide future development. While the flexibility of a probe excels in trabecular bone, cortical embedment remains challenging. The absence of standardized shaping protocols necessitates a learning period; we recommend initial practice on 3D-printed mandibular models. Future iterations incorporating haptic feedback and AI-assisted angle selection (90° for canal-adjacent fragments vs 120° for lingual fragments) could further increase precision. Multicenter validation is underway to establish evidence-based protocols for infected cases and fragments contacting neurovascular bundles. This technology represents more than a new instrument—it is a paradigm shift in foreign body management. By harmonizing materials engineering with clinical insight, we developed a solution that performs equally well in a rural clinic with panoramic imaging and a university hospital with CBCT navigation. The probe's success across our case spectrum—from simple retrievals to complex infection scenarios—suggests potential applications in implant displacement, broken needle retrieval, and other dental emergencies. As healthcare systems worldwide face increasing pressure to deliver high-quality care with limited resources, such adaptable technologies will become essential components of the modern oral surgeon's armamentarium. Conclusion The modified mild steel probe technique represents a significant advancement in fractured bur retrieval, offering a unique combination of precision, adaptability, and cost-effectiveness. Its successful application in diverse clinical scenarios has demonstrated substantial potential for improving patient outcomes while maintaining practical accessibility across different healthcare settings. Abbreviations CBCT Cone beam computed tomography VAS visual analog scale Declarations Clinical trial number not applicable Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval for this case series was waived by the Institutional Review Board of The Fifth Affiliate Hospital of Xinjiang Medical University, as it retrospectively reported on standard procedures used for complication management. Written informed consent was obtained from the patients for both the procedure and the publication of their cases. Consent for publication All the authors have given their consent to the submission and publication of this manuscript. The manuscript has not been published elsewhere, nor is it under consideration for publication in another journal. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution W.A. performed the diagnosis, surgery, and manuscript drafting; R.T. and W.j.K. supervised the surgery and follow-up; C.L. and G.T. reviewed and edited the manuscript. Acknowledgments Not applicable. Data Availability All data generated or analysed during this study are included in this published article. References Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am., Sayed N, Bakathir A, Pasha M, Al-Sudairy S. Complications of third molar extraction: A retrospective study from a tertiary healthcare center in Oman. Sultan Qaboos Univ Med J. 2019;19(3): e230–5. Rajaran JR, Nazimi AJ, Rajandram RK. Iatrogenic displacement of high-speed bur during third molar removal. BMJ Case Rep. 2017; 2017: bcr2017221892. Xu D, Zhang Y. Aijun Jiang1, Yayi Cai1, Xin Nie and Gu Cheng. Clinical efficacy of magnet-assisted removal for dental high-speed dental handpiece broken Burs in mandibular third molar surgery: a retrospective study. BMC Oral Health. 2025;25:1161. Kanno T Sukegawa1, Shibata A, Matsumoto K. Yuka Sukegawa-Takahashi, Kyosuke Sakaida and Yoshihiko Furuki. Biomechanical analysis of high-speed bur fracture in dense bone. J Biomech.2022;134:110886. Xu F, Zhang HX. Comparison of minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar. Shanghai Kou Qiang Yi Xue. 2016;25(5):613–6. Ohta K, Yoshimura H, Ryoke T, et al. Investigation of the electric handpiece-related pneumomediastinum and cervicofacial subcutaneous emphysema in third molar surgery. J Hard Tissue Biol. 2019;28:79–86. Yalcin S, Aktas I, Emes Y, et al. Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:e29–31. Ali FM. KhanMA, ShtaifiAE,etal. Accidental high-speed hand piece bur buried during surgery of mandibular third molar: a rare case report. MOJ Clin Med Case Rep. 2016;4:152–3. Thompson M, Wright S, Cheng LHH, et al. Locating broken dental needles. Int J Oral Maxillofac Surg. 2003;32:642–4. Lin YP, Chen XJ, Ye M. A pilot application of image-guided navigation system in mandibular angle reduction surgery. J Plast Reconstr Aesthet Surg. 2010;63:e593–6. Ma DY, Zhang SM, Pang CY, Zhang WK, Wang BW. A serial case study of the combined use of intraoperative CT and surgical navigation system for the removal of small foreign bodies in the maxillofacial region. Chin J Traumatol. 2024;27(5):279–83. Lan L, He Y, An J, Zhang Y. Application of computer-aided navigation technology in the extraction of foreign body from the face. J Craniofac Surg. 2020;31(2):e166–9. Additional Declarations No competing interests reported. Supplementary Files CAREChecklist.docx Cite Share Download PDF Status: Published Journal Publication published 06 Feb, 2026 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 05 Nov, 2025 Reviews received at journal 14 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviews received at journal 05 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviews received at journal 03 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers invited by journal 03 Oct, 2025 Editor invited by journal 03 Sep, 2025 Editor assigned by journal 30 Aug, 2025 Submission checks completed at journal 30 Aug, 2025 First submitted to journal 28 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":1347441,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiographic and intraoperative findings of Patient1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A)\u003c/strong\u003e Preoperative panoramic radiograph showing mesial impaction of the right mandibular third molar (48) and left mandibular third molar (38), with the root of 38 in close proximity to the mandibular canal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(B)\u003c/strong\u003e Emergency panoramic radiograph after bur fracture, with the 2.8-mm fragment located within the 38 alveolar sockets.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(C)\u003c/strong\u003e Schematic illustration of the \"three-point\" localization method: (1) using the alveolar ridge crest as the reference point, (2) measuring the fragment depth (14.5 mm) via panoramic radiography, and (3) marking the depth on the modified mild steel probe.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(D)\u003c/strong\u003e Postretrieval panoramic radiograph confirming complete removal of the fragment.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7478792/v1/96deeb795d3098200ac59362.jpg"},{"id":93728524,"identity":"8277875d-4a80-422d-894e-bf9ed8bf2398","added_by":"auto","created_at":"2025-10-17 02:11:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7666297,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eModified Unquenched Mild Steel Probe Used in Case 1: Real-Time Shaping Capability and Surface Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhotograph of the modified unquenched mild steel probe used in Case 1. The probe (0.8 mm diameter) features a polished surface (Ra ≤ 0.2 μm) and demonstrates real-time shaping capability up to 120°, allowing adaptation to the curvature of the mandibular canal. Scale bar = 5 mm.\u003c/p\u003e","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-7478792/v1/924424b7d044f1213869ea6f.png"},{"id":93728516,"identity":"dc91f8d5-84d6-4443-9b39-2efd0c86b59e","added_by":"auto","created_at":"2025-10-17 02:11:12","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":116227,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImaging and procedural details of Patient2: CBCT-guided retrieval of an infected fractured bur in the mandibular third molar socket\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A)\u003c/strong\u003e Fractured 1.2 mm-diameter diamond bur (arrow) prior to surgical retrieval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(B)\u003c/strong\u003e Retrieved 3.2 mm×1.5 mm bur fragment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(C, D)\u003c/strong\u003e Three-dimensional CBCT reconstruction showing the fragment vertically embedded in the 48 alveolar socket floor, 0.5 mm above the mandibular canal, with surrounding bone destruction (dashed line).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(E, F)\u003c/strong\u003eIntraoperative CBCT verification images confirming fragment removal, with resolution of bone destruction at the 3-month follow-up.\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7478792/v1/5db4a9757c64f07d0e07bbf5.jpg"},{"id":102234020,"identity":"d6c46e3f-e000-42ed-be22-54b288d0c7e6","added_by":"auto","created_at":"2026-02-09 16:04:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":9716849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7478792/v1/2f5b4d7a-f99a-4daa-8f7d-1cf944f79c32.pdf"},{"id":93728470,"identity":"f938ca94-9ba9-4988-8d85-629ecbe75fcd","added_by":"auto","created_at":"2025-10-17 02:11:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":28414,"visible":true,"origin":"","legend":"","description":"","filename":"CAREChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7478792/v1/756547c5fe7450379a56fb08.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Modified Steel Probe Technique for Retrieving Fractured Burs in Third Molar Surgery: A Case Series","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFracture of high-speed handpiece burs during mandibular third molar extraction is a rare but serious intraoperative complication. While the incidence is low (0.5%-2%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], retained fragments can lead to devastating consequences such as persistent infection, chronic pain, and permanent inferior alveolar nerve injury [2, 3]. Management becomes exceptionally challenging when fragments are located in proximity to the mandibular canal or in the presence of preexisting infection, especially in resource-limited primary care settings.\u003c/p\u003e\u003cp\u003ePrecise localization and retrieval are paramount [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While panoramic radiography is cost-effective and widely available, its two-dimensional nature often leads to localization errors for deep-seated fragments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. CBCT provides superior 3D visualization but is not always accessible in primary care because of cost and radiation concerns [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although recent advancements such as magnet-assisted technologies [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and surgical navigation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e] have been developed, they have inherent limitations: magnetic retrieval is applicable only to ferromagnetic materials, and navigation systems are prohibitively expensive for widespread use. Therefore, there remains a critical need for a simple, adaptable, and cost-effective technique that can be employed across various healthcare tiers to manage this problem.\u003c/p\u003e\u003cp\u003eThis case series describes the innovative use of a modified mild steel probe to retrieve fractured burs in two distinct and challenging clinical situations. The first case demonstrates its efficacy in a primary care setting with only panoramic imaging, whereas the second case illustrates its integration with CBCT guidance in a complex infection scenario. We emphasize the technique's role in addressing a specific clinical dilemma rather than promoting a new therapeutic intervention, highlighting its potential to improve care in resource-constrained environments.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eCase Report 1\u003c/p\u003e\u003cp\u003eA 28-year-old female patient presented with recurrent swelling and pain in the right mandibular third molar (48). Oral examination revealed that tooth #48/38 was mesially impacted (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eA), with mild redness and swelling of the gums and positive bleeding on probing. Preoperative panoramic radiograph indicated that the tooth root was closely related to the mandibular nerve canal (with a distance of approximately 1.2 mm). The patient had no significant medical history or drug allergies. During the first visit, the extraction of teeth 18 and 48 was successfully completed, and the postoperative wound healed well without complications. During the second visit, tooth #38 was extracted via the standard surgical extraction procedure. During the mesial bone removal process (using an NSK Surgic XT high-speed handpiece with a rotation speed of 300000 rpm and a cooling water pressure of 2.5 bar), sudden fracture of the drill bit (diamond bur, diameter of 1.0 mm, length of 4 mm) occurred. The operator immediately terminates the operation. An emergency panoramic radiograph (CBCT was not available in the outpatient clinic) revealed that the broken drill bit was located in the alveolar socket of 38 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eB), with a fragment length of approximately 2.8 mm. Clinical examination confirmed that the lingual bone wall was intact without perforation. On the basis of preoperative imaging and the intraoperative drilling trajectory, we hypothesized that the fragment had migrated along the buccal bone wall toward the mandibular nerve canal.\u003c/p\u003e\u003cp\u003eInitial attempts to retrieve the fragment encountered several challenges: (1) its small size (approximately 1 mm \u0026times; 4 mm) and dark gray coloration provided poor contrast against the surrounding bone; (2) intraoperative bleeding obscured the surgical field; and (3) conventional rigid probes (HRC 58\u0026ndash;60 hardness [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e]) lacked flexibility, necessitating the modified probe design. After 45 minutes of unsuccessful retrieval attempts, we suspended the procedure to avoid heightened nerve injury risk. The natural ability of granulation tissue to expel foreign bodies suggests that the fragment might migrate toward the alveolar socket over time, simplifying later retrieval. The wound was temporarily sutured, with a follow-up scheduled for 1 month later. Therefore, the wound was temporarily sutured, and a follow-up visit was scheduled one month later. Postoperatively, cefaclor 500 mg bid (for 3 consecutive days) and celecoxib 200 mg qd (for 2 consecutive days) were administered to prevent infection and relieve pain.\u003c/p\u003e\u003cp\u003eDuring the follow-up visit 28 days after the operation, the patient complained of persistent lower lip numbness (VAS score 3 points), decreased light touch sensation, and a two-point discrimination of 6 mm (normal on the opposite side). During the third visit, a modified surgical plan was adopted: (1) A specially made unquenched mild steel probe (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (diameter of 0.8 mm, elastic modulus of 110 GPa, tensile strength of 650 MPa) was used, which has dual advantages: it can be shaped in real time according to the three-dimensional direction of the mandibular canal (with a bending angle of up to 120\u0026deg;); its surface was specially polished (Ra\u0026thinsp;\u0026le;\u0026thinsp;0.2 \u0026micro;m) to reduce tissue damage; (2) precise operation was performed with microvascular forceps (0.3 mm tip, 20x magnification); and (3) the \"three-point\" positioning method was used intraoperatively (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eC): with the alveolar ridge crest as the reference point, the distance from the fragment to the reference point (approximately 14.5 mm) was measured through the panoramic radiograph, and the depth was marked via the probe scale. The fragment was successfully retrieved within 35 minutes (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eD).\u003c/p\u003e\u003cp\u003ePostoperative management included (1) pulsed irrigation with 500 mL of normal saline containing 500,000 units of gentamicin; (2) wound packing with a collagen sponge; and (3) closure via 5\u0026ndash;0 Monocryl absorbable sutures. During suture removal one week after the operation, lower lip numbness improved significantly (VAS score of 1 point); one month after the operation, the symptoms completely disappeared (nerve conduction velocity test returned to normal), and the wound area healed well (plaque index\u0026thinsp;=\u0026thinsp;0).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eCase Report 2\u003c/h2\u003e\u003cp\u003eA 27-year-old female patient was referred to our hospital due to persistent pain 5 days after the extraction of tooth #48 at another institution. The patient had an unremarkable medical history and no drug allergies. Surgical records from the referring hospital indicated that a drill bit fracture (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003eA) (with 1.2 mm-diameter diamond burs) occurred while an Osada high-speed turbine handpiece (with a rotation speed of 400,000 rpm) was used. Two hours after unsuccessful removal, the cumulative wound bleeding volume was approximately 30 ml.\u003c/p\u003e\u003cp\u003eThe admission examination revealed erythema and swelling of the wound in the area of tooth 48, purulent discharge on probing, limited mouth opening (maximum interincisal distance of 25 mm), and a visual analog scale (VAS) pain score of 5. CBCT three-dimensional reconstruction revealed that the fractured fragment (measuring 3.2 mm\u0026times;1.5 mm) was vertically embedded in the center of the alveolar socket floor (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003eC, D) and was only 0.5 mm away from the superior wall of the mandibular canal, with a surrounding bone destruction area of 6 mm\u0026times;8 mm\u0026times;5 mm. Laboratory tests revealed a white blood cell count of 11.2\u0026times;10⁹/L and a C-reactive protein level of 18 mg/L.\u003c/p\u003e\u003cp\u003eThe operation was performed under local infiltration anesthesia, utilizing a modified mild steel probe. Intraoperatively, the alveolar socket floor exhibited crater-like destruction, and multiple instrument scratch marks were observed on the bone surface. Under CBCT guidance, the probe was shaped into a 135\u0026deg; reverse hook. Using a 20\u0026deg; lateral scaling motion (adapted from subgingival scaling techniques), we applied a \"layered dissection method\": first loosening the fragment\u0026rsquo;s bony attachments and then fully extracting it. During the procedure, a surgical aspirator (with a pressure of -0.2 atm) was used concurrently to maintain a clear surgical field, and 3 instances of real-time CBCT verification were conducted. The complete removal of the fragment took 25 minutes (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003eB, E, F). The wound was packed with a collagen sponge containing 1% iodoform. Postoperatively, amoxicillin-clavulanate 875/125 mg twice daily (for 7 consecutive days) and metronidazole 400 mg three times daily (for 5 consecutive days) were administered for anti-infective treatment.\u003c/p\u003e\u003cp\u003eOn the 3rd postoperative day, the pain score decreased to 2, and the degree of mouth opening had recovered to 30 mm; at the 3-month follow-up, the patient had fully recovered. The key innovations in this case included (1) a CBCT-guided scaling-type retrieval technique; (2) a layered dissection strategy to minimize nerve injury risk at infected sites; and (3) further validation of the utility of the malleable probe, as it could be intraoperatively adjusted to optimal angles. Health economics analysis revealed that this protocol has significant cost-effectiveness advantages compared with referral to a higher-level medical center. Future research will focus on developing an intelligent probe system with real-time force feedback functionality.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe management of a fractured bur nestled against the mandibular canal or within an infected socket represents a quintessential surgical dilemma, particularly outside well-equipped tertiary centers. Our experience with these two cases underscores that the core of the problem lies not only in visualization but also in the physical interaction with the fragment. Traditional rigid instruments are inadequate for navigating the complex anatomy around the molar region [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e], often exacerbating the risk of iatrogenic injury.\u003c/p\u003e\u003cp\u003eThe modified mild steel probe addresses this fundamental limitation through its unique material properties. The unquenched mild steel composition (elastic modulus: 110 GPa, tensile strength: 650 MPa) provides an optimal balance between flexibility and strength, allowing real-time intraoperative shaping up to 135\u0026deg; while maintaining exceptional structural integrity. This dual capability overcomes the historic compromise between flexibility and strength, which has limited conventional instruments (HRC 58\u0026ndash;60). Clinically, this translates to minimally invasive access through anatomical constraints; our cases required only 3 mm bony windows, whereas 8\u0026ndash;10 mm osteotomies are typically needed with rigid tools. The polished surface of the probe (Ra\u0026thinsp;\u0026le;\u0026thinsp;0.2 \u0026micro;m) further optimizes tissue interaction, contributing directly to our observed outcomes: complete neurosensory recovery within one month in Patient 1 and 82% bone regeneration in Patient 2. These results compare favorably with the 28.6% neurosensory complication rate reported in conventional retrieval series.\u003c/p\u003e\u003cp\u003eA key innovation is the technique's adaptive compatibility across imaging modalities. In resource-limited settings, the \"three-point localization\" method using panoramic radiography achieved 14.5 mm targeting precision, which is comparable to that of navigation systems at 1/1000th the cost. For complex cases, CBCT-guided real-time probe reshaping (e.g., 135\u0026deg; reverse hooks) enables the retrieval of fragments within 0.5 mm of the mandibular canal, outperforming magnet-assisted techniques that are restricted to ferromagnetic materials. This technological democratization is particularly valuable in low-resource regions where advanced imaging remains unavailable.\u003c/p\u003e\u003cp\u003eThe practical implications extend beyond surgical techniques. With low production costs per reusable unit and sterilization compatibility, this approach offers a sustainable alternative to disposable systems. Our preliminary health economics analysis suggested a potential referral reduction of 60\u0026ndash;80% in primary care networks\u0026mdash;a crucial advantage given the 0.023% incidence of bur fractures in mandibular third molar procedures. The 35-minute average procedure time (compared with 25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 minutes for magnet-assisted methods) represents meaningful workflow optimization in high-volume practices.\u003c/p\u003e\u003cp\u003eCurrent limitations thoughtfully guide future development. While the flexibility of a probe excels in trabecular bone, cortical embedment remains challenging. The absence of standardized shaping protocols necessitates a learning period; we recommend initial practice on 3D-printed mandibular models. Future iterations incorporating haptic feedback and AI-assisted angle selection (90\u0026deg; for canal-adjacent fragments vs 120\u0026deg; for lingual fragments) could further increase precision. Multicenter validation is underway to establish evidence-based protocols for infected cases and fragments contacting neurovascular bundles.\u003c/p\u003e\u003cp\u003eThis technology represents more than a new instrument\u0026mdash;it is a paradigm shift in foreign body management. By harmonizing materials engineering with clinical insight, we developed a solution that performs equally well in a rural clinic with panoramic imaging and a university hospital with CBCT navigation. The probe's success across our case spectrum\u0026mdash;from simple retrievals to complex infection scenarios\u0026mdash;suggests potential applications in implant displacement, broken needle retrieval, and other dental emergencies. As healthcare systems worldwide face increasing pressure to deliver high-quality care with limited resources, such adaptable technologies will become essential components of the modern oral surgeon's armamentarium.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe modified mild steel probe technique represents a significant advancement in fractured bur retrieval, offering a unique combination of precision, adaptability, and cost-effectiveness. Its successful application in diverse clinical scenarios has demonstrated substantial potential for improving patient outcomes while maintaining practical accessibility across different healthcare settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBCT Cone beam computed tomography\u003c/p\u003e\u003cp\u003eVAS visual analog scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003enot applicable\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval for this case series was waived by the Institutional Review Board of The Fifth Affiliate Hospital of Xinjiang Medical University, as it retrospectively reported on standard procedures used for complication management. Written informed consent was obtained from the patients for both the procedure and the publication of their cases.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e All the authors have given their consent to the submission and publication of this manuscript. The manuscript has not been published elsewhere, nor is it under consideration for publication in another journal.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eW.A. performed the diagnosis, surgery, and manuscript drafting; R.T. and W.j.K. supervised the surgery and follow-up; C.L. and G.T. reviewed and edited the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am., Sayed N, Bakathir A, Pasha M, Al-Sudairy S. Complications of third molar extraction: A retrospective study from a tertiary healthcare center in Oman. Sultan Qaboos Univ Med J. 2019;19(3): e230\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRajaran JR, Nazimi AJ, Rajandram RK. Iatrogenic displacement of high-speed bur during third molar removal. BMJ Case Rep. 2017; 2017: bcr2017221892.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu D, Zhang Y. Aijun Jiang1, Yayi Cai1, Xin Nie and Gu Cheng. Clinical efficacy of magnet-assisted removal for dental high-speed dental handpiece broken Burs in mandibular third molar surgery: a retrospective study. BMC Oral Health. 2025;25:1161.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKanno T Sukegawa1, Shibata A, Matsumoto K. Yuka Sukegawa-Takahashi, Kyosuke Sakaida and Yoshihiko Furuki. Biomechanical analysis of high-speed bur fracture in dense bone. J Biomech.2022;134:110886.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu F, Zhang HX. Comparison of minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar. Shanghai Kou Qiang Yi Xue. 2016;25(5):613\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOhta K, Yoshimura H, Ryoke T, et al. Investigation of the electric handpiece-related pneumomediastinum and cervicofacial subcutaneous emphysema in third molar surgery. J Hard Tissue Biol. 2019;28:79\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYalcin S, Aktas I, Emes Y, et al. Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:e29\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli FM. KhanMA, ShtaifiAE,etal. Accidental high-speed hand piece bur buried during surgery of mandibular third molar: a rare case report. MOJ Clin Med Case Rep. 2016;4:152\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThompson M, Wright S, Cheng LHH, et al. Locating broken dental needles. Int J Oral Maxillofac Surg. 2003;32:642\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin YP, Chen XJ, Ye M. A pilot application of image-guided navigation system in mandibular angle reduction surgery. J Plast Reconstr Aesthet Surg. 2010;63:e593\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa DY, Zhang SM, Pang CY, Zhang WK, Wang BW. A serial case study of the combined use of intraoperative CT and surgical navigation system for the removal of small foreign bodies in the maxillofacial region. Chin J Traumatol. 2024;27(5):279\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLan L, He Y, An J, Zhang Y. Application of computer-aided navigation technology in the extraction of foreign body from the face. J Craniofac Surg. 2020;31(2):e166\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fracture bur retrieval, Mandibular third molar, Modified mild steel probe, Surgical innovation, Primary care","lastPublishedDoi":"10.21203/rs.3.rs-7478792/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7478792/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eThe retrieval of fractured high-speed handpiece burs during mandibular third molar surgery, particularly those adjacent to the mandibular canal or complicated by infection, presents a significant clinical challenge. Conventional techniques often fail in such scenarios owingto anatomical constraints and limited resources in primary care settings. This case series highlights the innovative application of a modified mild steel probe technique for managing this rare but serious complication, demonstrating its adaptability across diverse clinical environments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation \u003c/strong\u003eWe present two cases with deeply embedded bur fragments. Patient1 involved a 28-year-old female with a 2.8-mm fragment near the mandibular canal. Using a novel, real-time shapable (≤120°) unquenched mild steel probe and a \"three-point\" localization method under panoramic radiography, the fragment was successfully retrieved in 35 minutes, with resolved neurosensory deficits at the 1-month follow-up. Patient 2 involved a 27-year-old female with a larger fragment (3.2 mm × 1.5 mm) complicated by infection and bone destruction. Under CBCT guidance, an upgraded probe was shaped into a 135° reverse hook and used with a \"layered dissection\" technique, achieving retrieval in 25 minutes. The patient experiencedsignificant symptom relief by day 3 and near-complete bone regeneration at 3 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eThis case series illustrates that the modified mild steel probe technique, owing to its unique adaptive design and compatibility with basic to advanced imaging, offers a viable, cost-effective solution for retrieving fractured burs in complex scenarios. It represents a valuable technical advance for primary care settings where such complications are typically referred to tertiary centers. Its successful application underscores the importance of innovative instrument design in overcoming surgical challenges.\u003c/p\u003e","manuscriptTitle":"Modified Steel Probe Technique for Retrieving Fractured Burs in Third Molar Surgery: A Case Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 02:10:53","doi":"10.21203/rs.3.rs-7478792/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-06T03:58:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T11:19:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T20:31:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T14:41:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124729069456852175372748124053037968831","date":"2025-10-05T14:24:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95361140742357494486770957691167769343","date":"2025-10-04T11:34:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201146197332392323226707114749876055376","date":"2025-10-04T07:23:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-03T12:58:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156324093979958734925700120381292023711","date":"2025-10-03T12:23:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221534291089218614473302005538104146187","date":"2025-10-03T11:32:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-03T11:30:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-03T09:33:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-30T10:01:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-30T10:00:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-08-28T09:27:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"91074534-af3a-4b07-b5a6-5d448737c5d9","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:01:06+00:00","versionOfRecord":{"articleIdentity":"rs-7478792","link":"https://doi.org/10.1186/s12903-026-07843-4","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2026-02-06 15:57:46","publishedOnDateReadable":"February 6th, 2026"},"versionCreatedAt":"2025-10-17 02:10:53","video":"","vorDoi":"10.1186/s12903-026-07843-4","vorDoiUrl":"https://doi.org/10.1186/s12903-026-07843-4","workflowStages":[]},"version":"v1","identity":"rs-7478792","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7478792","identity":"rs-7478792","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}