Significance of Endodontic Case Difficulty Assessment: A Retrospective Study

OBJECTIVES: The present study aimed to evaluate the significance of the American Association of Endodontics (AAE) Case Difficulty Assessment on the occurrence of endodontic mishaps in an undergraduate student clinic at the Dental College at King Saud University. METHODS: All teeth endodontically treated by undergraduate dental students in their fourth year at the College of Dentistry, Girls University Campus at King Saud University over 2 years (2018-2019) were selected. Four investigators (3 dental interns and 1 endodontist) recorded the AAE case difficulty level, mishap occurrence, number of treatment visits, type of teeth, and type of instrumentation technique. The associations amongst these variables were analysed. STATISTICAL ANALYSIS: A point-biserial correlation was used to determine the relationship between the number of visits and the AAE case difficulty and the instrumentation technique. Spearman's rank-order correlation was used to assess the relationship between the number of visits and mishaps. A Mann-Whitney U test was applied to determine any differences in mishaps amongst cases with different difficulty levels. RESULTS: A total of 586 teeth were included (54.1% moderate- to high-difficulty cases), and 34.98% of cases experienced mishaps. Molars were significantly more often found in the moderate- to high-difficulty category. The moderate- to high-difficulty cases experienced more mishaps (64.8%; P = .000) and a greater number of treatment visits (3.49 ± 1.27; P = .000) compared to minimal-difficulty cases (35.12%, 2.38 ± 1.24, respectively). The type of instrumentation technique was not associated with mishap occurrence. CONCLUSIONS: Undergraduate students should use the AAE case classification assessment tool to reduce the number of endodontic treatment mishaps and the number of visits.