Clinical ResearchThe Impact of Instrument Fracture on Outcome of Endodontic Treatment
Section snippets
Study Design
This study was divided into two parts: 1) a retrospective survey of all cases treated nonsurgically (including retreatment) over some 13.5 yr in two endodontic practices involving seven endodontists. The main objective was to determine the prevalence of retained fractured instruments following treatment; 2) the second part was based on all cases from part 1 for which clinical and radiographic follow-up for at least 1 yr was available. Specifically, it entailed a retrospective, case-control
Cohen's Kappa Values
The Kappa value for the interobserver agreement was κ = 0.73. The intraobserver Kappa values for the two raters were κ = 0.68 and 0.78. All three Kappa values were in the “substantial agreement” category (22).
Fracture Prevalence
Overall, 277 teeth from 8460 teeth were identified as containing one or more instrument fragments (total = 301 fragments), yielding a prevalence of all types of retained fractured endodontic instruments of 3.3%, from two specialist practices screened for the period January 1990 to May 2003
Discussion
The prospective, randomized controlled clinical trial is the gold standard by which all clinical research is judged because it represents the highest grade of evidence that can be used for the provision of evidence-based health care (9). However, the best level of evidence that can be realistically achieved for an evaluation of the impact of a procedural complication such as a fractured instrument on endodontic treatment outcome, is a case-control study; although, some would argue that a
Conclusions
a) The overall frequency of fractured endodontic instruments left in the root canal after treatment was found to be 3.3% of treated teeth and comprised 78.1% rotary NiTi files, 15.9% SS hand files, 4.0% paste fillers, and 2.0% lateral spreaders. The frequency of rotary NiTi instrument breakage was comparable to that previously reported for hand files.
b) In the hands of experienced operators, endodontic instrument fracture, in particular rotary NiTi, had no adverse influence on the outcome of
Acknowledgments
The authors would like to thank the following for their valuable assistance in the research project: Associate Professor Ian Gordon of the Statistical Consulting Centre, University of Melbourne, Drs. Vivian Jeng and Pairoj Linsuwanont of the School of Dental Science, University of Melbourne, and all the endodontists—in particular, the practice principals Drs. Garry Nervo and Peter Parashos—of the participating endodontic practices for their cooperation, patience, and contribution of cases to
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