Effect of operators’ proficiency level and patients’ related factors on possible complications, using a high frequency polyamide sonic intracanal irrigation device: A prospective clinical cohort study

by Tobias Hahn, David W. Christofzik, Karim Fawzy El-Sayed, Sandra Freitag-Wolf, Jonas Conrad, Christian Graetz, Birte Größner-Schreiber, Christof Dörfer

Sonic/ultrasonic devices are essential tools in today’s endodontics. This prospective trial evaluated for the first time the impact of practitioners’ proficiency levels and patient-related factors on complications associated with a high frequency polyamide sonic irrigant activation device.

In total 334 patients (females:158, males:176; age:18–95 years) received in the course of their endodontic therapy an intracanal irrigation, using a high frequency polyamide sonic irrigant activation device, by practitioners of different proficiency levels (undergraduate students, general practitioners or endodontists). Intracanal bleeding (yes/no), postoperative pain (0–10 scale), emphysema (yes/no) and polyamide tip fractures (yes/no) were recorded and related to proficiency levels, age, gender, tooth type, smoking-status, systemic conditions affecting healing ability, baseline pain, swelling, fistula, sensitivity to percussion and diagnosis.

Intracanal bleeding was associated with patients’ age (p<0.05), baseline pain level (OR = 1.14, 95%CI = 0.91–1.22) and baseline swelling (OR = 2.73, 95%CI = 0.14–0.99; p<0.05) but not proficiency level, gender, tooth type, smoking, systemic conditions, baseline fistula or sensitivity to percussion (p>0.05). Postoperative pain development was related to proficiency level (p<0.05) and baseline pain level (p<0.001), with no influence of age, gender, tooth type, smoking, systemic conditions, baseline fistula, swelling or sensitivity to percussion (p>0.05). Emphysema and polyamide tip fractures were not reported.

Within the current study’s limitations, younger patients with higher baseline pain and swelling, were associated with higher intracanal bleeding. Apart from higher postoperative pain observed with less experienced practitioners, proficiency level had no influence on bleeding, polyamide tip fracture or emphysema, endorsing the high frequency polyamide sonic irrigation device as a safe therapeutic device.