Endodontic procedural errors and their reporting and referral among dental graduates working at dental institutes in Punjab: a cross-sectional study

Main Article Content

Hammad Hassan
Syed Moiz Ali
Ahmed Amer Chaudhry
Sidra Riaz
Baneen Khawar
Salman Aziz


OBJECTIVES: To find the frequency and type of endodontic procedural errors encountered by the dental graduates and their reporting and referral in cases of failure.

METHODS: This cross-sectional study was conducted from 1st January 2022 to 15th July 2022. Data was collected through online questionnaires using Google-forms distributed among dental graduates working in the operative department of four private and two public dental institutes in Punjab, Pakistan. Out of 269 graduates, 255 (94.7%) participated in the study. Data was analyzed by SPSS version-25.   

RESULTS: Procedural errors were experienced by 222/255 (87.1%) respondents. Errors reported by male and female were 95% and 83.1% respectively. Most errors occurred during canal preparation (n=228; 89.4%), followed by access opening (n=208; 81.6%) and obturation (n=192; 75.3%) stage. Overall, most common errors were over- or under-extended obturation (n=192; 75.3%), ledge (n=161; 63.1%) and access cavity perforation (n=136 (53.3%). About 86.2% (n=220/255) of respondents tried to handle errors on their own. 19 (7.4%) and 48 (18.8%) rarely/never informed the department. In case of failure, 121 (47.4%) referred their case to their supervisor and 87 (34.1%) sought help from a colleague. Patients were not informed about the error in 29 (11.3%) cases.

CONCLUSION: Most errors occurred during canal preparation, access opening and obturation. Most common errors were over- or under-extended obturation & ledge. Majority of graduates prefer to handle the errors on their own. Help-seeking from supervisors and informing patients need to be improved. A system for reporting errors and a hierarchical management structure should be established.

Article Details

How to Cite
Hassan, H., S. M. Ali, A. A. Chaudhry, S. Riaz, B. Khawar, and S. Aziz. “Endodontic Procedural Errors and Their Reporting and Referral Among Dental Graduates Working at Dental Institutes in Punjab: A Cross-Sectional Study”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 15, no. 2, June 2023, pp. 96-100, doi:10.35845/kmuj.2023.23006.
Original Articles


Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD. Characterization of successful root canal treatment. Braz Dent J 2014;25:3-11. https://doi.org/10.1590/0103-6440201302356

Haug SR, Solfjeld AF, Ranheim LE, Bårdsen A. Impact of case difficulty on endodontic mishaps in an undergraduate student clinic. J Endod 2018;44(7):1088-95. https://doi.org/10.1016/j.joen.2018.03.012

Lin LM, Rosenberg PA, Lin J. Do procedural errors cause endodontic treatment failure? J Am Dent Assoc 2005;136(2):187-93. https://doi.org/10.14219/jada.archive.2005.0140

Alrahabi M, Zafar MS, Adanir N. Aspects of clinical malpractice in endodontics. Eur J Dent 2019;13(03):450-8. https://doi.org/10.1055/s-0039-1700767

Baaij A, Özok AR. Influence of method of teaching endodontics on the self-efficacy and self-perceived competence of undergraduate dental students. Eur Endod J 2018;3(1):31-7. https://doi.org/10.5152/eej.2017.17048

Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical outcome of non-surgical root canal treatment using a single-cone technique with EndoSequence bioceramic sealer: A retrospective analysis. J Endod 2018;44(6):941-5. https://doi.org/10.1016/j.joen.2018.02.019

Siqueira Junior JF, Rôças I das N, Marceliano-Alves MF, Pérez AR, Ricucci D. Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Braz Oral Res 2018;32(suppl 1):e65. https://doi.org/10.1590/1807-3107bor-2018.vol32.0065

Almohaimede AA, AlShehri BM, Alaiban AA, AlDakhil RA. Significance of endodontic Case Difficulty Assessment: A retrospective study. Int Dent J 2022;72(5):648-53. https://doi.org/10.1016/j.identj.2022.01.001

Alghamdi NS, Algarni YA, Ain TS, Alfaifi HM, AlQarni AA, Mashyakhi JQ, et al. Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study: An observational study. Medicine (Baltimore) 2021;100(47):e27757. http://doi.org/10.1097/MD.0000000000027757

Mohammad N, Abd Fatah F, Ghazali N, Muhamad AZ, Hamir N. Endodontic root canal treatment performed by undergraduate dental students: Identification of technical standard and post-endodontic restorations. Malays J Fundam Appl Sci 2019;15(4):600-3. https://doi.org/10.11113/mjfas.v15n4.1527

Yousuf W, Khan M, Mehdi H. Endodontic procedural errors: Frequency, type of error, and the most frequently treated tooth. Int J Dent 2015;2015:673914. http://doi.org/10.1155/2015/673914

Ali SA, Hussain M, Shahzad M, Nafees H. Frequency of Procedural Errors during Root Canal Treatment Performed by House Officers in Private Teaching Dental Hospital. J Liaquat Univ Med Health Sci 2019;18(01):55-9. http://doi.org/10.22442/jlumhs.191810601

Abdulrab S, Alaajam W, Al-Sabri F, Doumani M, Maleh K, Alshehri F, et al. Endodontic procedural errors by students in two Saudi dental schools. Eur Endod J 2018;3(3):186-91. http://doi.org/10.14744/eej.2018.29491

Kowalczuck A, Silva Neto UX, Fariniuk LF, Westphalen VP, Laurindo CA, Carneiro E. Electrochemical dissolution of fractured nickel–titanium instruments in human extracted teeth. Int Endod J 2017;50(6):578-85. http://doi.org/10.1111/iej.12654

Shah PK, Zhang Q, Chong BS. Get Smart–technological innovations in endodontics part 2: case-difficulty assessment and future perspectives. Dent Update 2021;48(7):556-62. https://doi.org/10.12968/denu.2021.48.7.556

Das D, Barai S, Kumar R, Bhattacharyya S, Maity AB, Shankarappa P. Comparative evaluation of incidence of dentinal defects after root canal preparation using hand, rotary, and reciprocating files: An ex vivo study. J Int Oral Health 2022;14(1):78. http://doi.org/10.4103/JIOH.JIOH_136_21

Ibhawoh LO, Enyinnaya NS, Enabulele JE. Radiographic assessment of endodontic accidents at a Nigerian tertiary health institution: A one-year retrospective study. Ibom Med J 2020;13(3):206-13.

Grayli E, Peyvandi A, Mallahi M, Naeemi S, Afshari E. Radiographic Evaluation of Iatrogenic Errors of Root Canal Treatments Performed in an Undergraduate Dental Clinic. J Dent Mater Tech 2021;10(1):16-21. http://doi.org/10.22038/JDMT.2021.17655

Miccoli G, Seracchiani M, Zanza A, Del Giudice A, Testarelli L. Possible complications of endodontic treatments. J Contemp Dent Pract 2020;21(5):473-4. http://doi.org/10.5005/jp-journals-10024-2811

da Cunha LZ, Solda C, Padoin K, Rigo L. Endodontic procedural errors: Analysis of images from cone beam computed tomography. Forensic Imaging 2022;28:200493. https://doi.org/10.1016/j.fri.2022.200493

Obadan EM, Ramoni RB, Kalenderian E. Lessons learned from dental patient safety case reports. J Am Dent Assoc 2015;146(5):318-26. http://doi.org/10.1016/j.adaj.2015.01.003

Pemberton MN. Developing patient safety in dentistry. Br Dent J 2014;217(7):335-7. http://doi.org/10.1038/sj.bdj.2014.856

Ensaldo-Carrasco E, Sheikh A, Cresswell K, Bedi R, Carson-Stevens A, Sheikh A. Patient safety incidents in primary care dentistry in England and Wales: a mixed-methods study. J Patient Saf 2021;17(8):1383-93. http://doi.org/10.1097/PTS.0000000000000530

Hiivala N, Mussalo-Rauhamaa H, Murtomaa H. Patient safety incident prevention and man - agement among Finnish dentists. Acta Odontol Scand 2013;71:1663–70. http://doi.org/10.3109/00016357.2013.797103

Ramugade MM, Sagale AA. A review of medicolegal considerations of endodontic practice for general dental practitioners. J Int Soc Prevent Communit Dent 2018;8(4):283. http://10.4103/jispcd.JISPCD_206_18