Ingle, Leif K. Bakland, Edward E. Beveridge, Dudley H. Glick and Anthony E. Hoskinson 2. Pashley, Richard E.
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This retrospective cohort study was conducted in one academic center with a large homogenous sample size, which facilitates studying the correlation between single-visit treatment and endodontic mishaps.
Multivariate analysis demonstrated that multiple-visit is statistically a significant risk factor leading to more mishaps while considering tooth type, preoperative conditions, and clinical training as risk factors. There are no previous studies to compare the study findings.
Figure 1 demonstrates the increase of mishaps with the increase in the number of dental visits. However, the correlation coefficient value was 0. The most likely explanation is the presence of other significant risk factors such as tooth type and preoperative conditions. Randomized clinical trials RCTs provide the highest level of evidence in evidence-based dentistry .
Because there are situations where they might not be ethical or feasible , for example, with iatrogenic errors such as endodontic mishaps. Multiple-visit treatment with intra-canal medicament was excluded from the study sample to minimize the confounding variables that might leads to inaccurate working length determination . Tooth type was hypothesized as a risk factor of mishaps. Which is in agreement with a recent retrospective study reported that molars were associated with more mishaps compared to anterior teeth .
The presence of preoperative conditions such as root curvature, extensive coronal restoration, and previous root canal treatment is common clinically [24,25].
Therefore, the effect of preoperative conditions on the incidence of endodontic mishaps was included in the study analysis. The results showed that the type and incidence of mishaps was significantly less in teeth without preoperative conditions, which in agreement with earlier reports [26,27]. The study sample included teeth treated by undergraduates, and the cases were arranged by practitioner and chronologically along two years of clinical training.
Therefore, analyzing the effect of clinical training was possible. Theoretically, one would assume that more clinical practice would lead to fewer mishaps.
However, the study results showed that clinical training, two years versus one year, had no significant effect on the incidence of mishaps, because tooth type and preoperative conditions had a leading influence compared to clinical training. The positive effect of clinical training on mishaps was not reported in previous studies [28,29].
Whether multiple-visit root canal treatment ensures a better outcome compared with single-visit treatment is one of the most debated topics in the field of endodontics, assessed using different indices such as periapical healing , postoperative pain , operator  and patient preferences . In this study, single-visit treatment associated with significantly less mishaps compared to multiple-visit treatment.
Single-visit treatment using stainless steel hand files was achievable by novice operators. The duration of dental visits was three hours in KSU undergraduate clinics and is considered adequate for the completion of treatment in one visit . However, only The most probable explanation was the lack of preclinical training in single-visit root canal treatment in King Saud University.
Recent advances in endodontics, including electronic apex locators, digital radiography, magnification, and the use of rotary nickel—titanium systems, have decreased the time for root canal treatment . Therefore, including recent advances in academic centers would promote the practice of single-visit root canal treatment .
In the present study, the frequency of mishaps was lower with singlevisit root canal treatment using stainless steel files. This can be explained by the fact that the operator is already oriented with the long axis of the tooth and root curvature during instrumentation and root canal obturation.
On the other hand, the repeated use of stainless steel files during multiple treatment sessions might explain the increase in mishaps. Apical transportation was the most common mishap observed in this study. In vitro studies have presented controversial results about the relationship between the use of stainless steel files and canal transportation [2,34]. The use of rotary nickel-titanium NiTi files have become popular due its superelastic property .
However, there is no clinical data on how the use of NiTi files reduced the number of visit or the incidence of mishaps in comparison to stainless steel files. Moreover, new endodontic instruments are still compared to stainless steel files . The study findings were limited to teeth treated by undergraduates and the use of stainless steel hand files.
Therefore, the study findings are limited to academic centers using stainless steel files and future studies should provide information from teeth treated by endodontists and using nickel—titanium files. In conclusion, single-visit treatment using stainless steel file amongst dental students in King Saud University reduced the incidence of mishaps compared to multiple-visit treatment.
Multiple-visit treatment, tooth type and preoperative conditions are risk factors associated with endodontic mishaps. Clinical training did not reduce the incidence of endodontic mishaps. Acknowledgement The study was supported by King Saud University FR , which played no role in the study design, data collection, analysis and interpretation of data, writing of the report, and the decision to submit the article for publication.
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Endod Dent Traumatol J Contemp Dent Pract Status report for the Am J Dent. Am J Dent
Table 2 Distribution of errors in right and left maxilla and mandible. The right permanent mandibular first molar was particularly prone to errors, showing a greater overall percentage of errors than any other tooth, and was the only tooth in which errors superseded the acceptable cases see Figure 6. Figure 6 Overall distribution of errors in individual teeth. Percentage of overfill and underfill in individual teeth has been elaborated in Figures 7 and 8. Figure 7 Percentage of overfill in individual teeth. Figure 8 Percentage of underfill in individual teeth.
The John I. Ingle International Endodontic Symposium
This retrospective cohort study was conducted in one academic center with a large homogenous sample size, which facilitates studying the correlation between single-visit treatment and endodontic mishaps. Multivariate analysis demonstrated that multiple-visit is statistically a significant risk factor leading to more mishaps while considering tooth type, preoperative conditions, and clinical training as risk factors. There are no previous studies to compare the study findings. Figure 1 demonstrates the increase of mishaps with the increase in the number of dental visits. However, the correlation coefficient value was 0.