(PO20) Use of an Evidence-Based Protocol to Reduce Endodontic Perforations in a Dental School Practice

Abstract: To determine if a treatment protocol introduced in July 2019 reduced endodontic perforations, a retrospective analysis from electronic dental records in a dental school practice was performed. The database was searched for nonsurgical endodontic procedures conducted between January 2011 and September 2022. Inclusion criteria were as follows: any patient undergoing a nonsurgical endodontic procedure, a follow-up exam or odontogram, subsequent endodontic therapy, perforation repair, or an extraction code for the treated tooth. Cases were defined as those patients who experienced a perforation occurrence during a nonsurgical endodontic procedure. The final cohort included 53 cases; 4 teeth were excluded from the analysis because the patients left the practice immediately after the endodontic treatment was completed. A total of 7,098 patients met the inclusion criteria. The study group consisted of 28 female and 25 male patients, ranging in age from 12 to 79 years. Perforations occurred in 10 anterior and 43 posterior teeth. The overall perforation incidence was 0.75%. The difference in the proportion of perforated teeth between anterior and posterior teeth was significant (p = .001). Kaplan-Meier survival curves showed mean survival rates of 2,326 days for student cases and 2,191 days for resident cases. Before the perforation reduction protocol was introduced, the perforation incidence was 0.97%. After the protocol's introduction, the perforation incidence decreased to 0.40%. A chi-squared test showed this reduction was statistically significant (p = .0066).A retrospective analysis of existing data from an academic dental setting revealed a 0.75% incidence of perforation during endodontic treatment. The introduction of a new protocol significantly reduced endodontic perforations.