Abstract

Objectives

To assess occurrence and its variation over time of serious accidental perforations during endodontic treatment and the fate of perforated teeth by tooth type and characteristics of patients and dentists.

Materials and methods

Data, based on patient documents on healthcare malpractice claims, comprised all endodontic injuries (n = 970) verified by the Patient Insurance Centre in Finland in 2002–2006 and 2011–2013. Two specialists in endodontics scrutinized the documents. Accidental perforations were recorded by location (tooth type, chamber/canals) and dichotomized as avoidable (could have been avoided by following good clinical practice) or unavoidable (normal treatment-related risks). Fate of perforation cases was recorded as treatment discontinued, root canal(s) filled, or tooth extracted. Background information included patients’ and dentists’ sex and age and the service sector. Statistical evaluation used Chi-square tests.

Results

Serious accidental perforations comprised 29% of all verified injuries. Most perforations were judged as avoidable: 93% in patients aged below 35 years, 87% when located in the pulp chamber or in molars (84%); 70% of all perforations and 75% of those in molars resulted in tooth extraction. The overall rate of serious accidental perforations was 17.6 cases per 100,000 endodontic patients per year.

Conclusions

The rate of serious accidental perforations increased over time. The majority was in molars and resulted in tooth extraction.

Clinical relevance

Accidental perforations comprise almost a third of serious injuries during root canal treatment. However, four of five perforations could be avoided by following good clinical practice. Therefore, training is needed before adopting new working equipment and methods.

中文翻译：

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根管治疗过程中的意外穿孔：全国范围内对医疗事故索赔的8年观点。

摘要

目标

通过牙齿类型和患者以及牙医的特征来评估牙髓治疗期间严重意外穿孔的发生及其随时间的变化以及穿孔牙齿的命运。

材料和方法

根据患者关于医疗保健不良索赔的文件，数据包括 2002-2006年和2011-2013年由芬兰患者保险中心验证的所有牙髓损伤（n = 970）。两名牙髓治疗专家检查了这些文件。记录意外穿孔的位置（牙齿类型，腔室/根管），并将其分为可避免的（可通过遵循良好的临床实践避免）或不可避免的（与治疗相关的正常风险）。穿孔病例的命运记录为治疗中断，牙根管已充满或拔牙。背景信息包括患者和牙医的性别和年龄以及服务部门。统计评估采用卡方检验。

结果

严重的意外穿孔占所有已验证伤害的29％。大多数穿孔被认为是可以避免的：年龄在35岁以下的患者占93％，位于牙髓腔或臼齿中占87％（84％）；所有穿孔的70％和臼齿的75％导致拔牙。严重意外穿孔的总发生率是每年每100,000个牙髓患者17.6例。

结论

严重的意外穿孔率随时间增加。多数是磨牙，导致拔牙。

临床相关性

意外穿孔占根管治疗期间严重伤害的近三分之一。但是，遵循良好的临床实践可以避免五个穿孔中的四个。因此，在采用新的工作设备和方法之前，需要进行培训。