症例の難易度を評価することの価値と歯内療法のiatrogenic errorsへの影響：レトロスペクティブなクロスセクション研究

The value of assessing case difficulty and its effect on endodontic iatrogenic errors: a retrospective cross-sectional study.

• Ruaa A Alamoudi
• Afrah H Alharbi
• Ghada A Farie
• Omar Fahim

抄録

American Association of Endodontists（AAE）は、一般歯科医や学生が自分の専門分野内の症例を治療したり、高度な症例を紹介したりして、異所性エラーのリスクを減らすために、case difficulty assessment formを公開しました。本研究の目的は、case difficulty assessment formを使用した後の異所性合併症の発生率を明らかにすることであった。学年度（2016～2017年）に学部の診療所で根管治療を受けた1000症例のランダムサンプルを選択した。治療開始前に各症例に対して症例難易度評価を行った。症例が学部クリニックでの治療を承認された後、キング・アブドゥルアジーズ大学歯学部の歯内療法科が義務付けている標準的な手順に従って、歯内療法を実施した。通常の根管治療中にデジタルX線写真を撮影し，4人のオブザーバーが評価して異所性エラーを検出した後，データを統計的に分析した。Iatrogenic errorはcase difficultyと有意な相関があり（=0.003）、学部生のクリニックで治療された歯の22.1％で検出された。検出されたエラーの割合はUnderfillingが最も高く（8.4％）、次いでleadge formation（4.2％）であった。誤診の頻度は大臼歯が最も高く，上顎大臼歯の中頬側根が最も高い割合を示した。AAEが開発したツールは、学部の診療所で扱う各症例の難易度を判断する上で非常に有用であり、AAEの推奨事項に従うことで、異所性エラーのリスクを最小限に抑えることができると考えられる。

The American Association of Endodontists (AAE) released a case difficulty assessment form to help general dentists and students treat cases within their expertise or refer advanced cases to reduce the risk of iatrogenic errors. The purpose of this study was to determine the incidence of iatrogenic complications after the use of the case difficulty assessment form. Arandom sample of 1000 cases that received root canal treatment in undergraduate clinics during the academicyear (2016-2017) was selected. Case difficulty assessment was made for each case before treatment onset. Once the case was approved for treatment in the undergraduate clinics, the endodontic treatments were performed following the standard procedure the endodontic department of the Dentistry School of King Abdulaziz University mandates. Digital radiographs were obtained during routine root canal treatment and were evaluated by four observers to detect any iatrogenic errors, after which the data were analyzed statistically. Iatrogenic errors were correlated significantly with case difficulty (= 0.003), and were detected in 22.1% of all teeth treated in the undergraduate clinics. Underfilling accounted for the highestpercent of errors detected (8.4%), followed by ledge formation (4.2%). Molar teeth had the highest frequency of errors, and mesio-buccal roots of maxillary molars showed the highest percentage of errors. The AAE developed asignificantly useful tool to determine the difficulty of each case treated in undergraduate clinics, and following their recommendations will minimize the risk of iatrogenic errors.