Dentist attempting removal after file breakage
"Attempts to remove fractured instruments from root canals should not take longer than 45–60 min. "Suter 2005.
Total patient time for specialist repair
Total time for patient (including travel).
Manual cleaning time for multi-use
No data except for KOL estimate of “a few minutes” – estimate of dental assistant time (including disinfection, manual cleaning, sterilization and organizing of the instruments).
Time reduction for single-use due to cutting efficiency
Estimate from Dentsply of 15-25 seconds on average (20 seconds used) i.e. 0.33 minutes.
Referral to specialist after file breakage
No data except KOL assumption of "a few per cent of cases where file breakage has occurred" – estimate at 4% of file breakages.
File breakage with multi-use
"Overall prevalence of retained fractured instruments was 3.3% of treated teeth" – Spili 2005 "...21 instruments (4.6% underwent intracanal fracture during treatment)". Al Fouzan 2003. 4% use.
File breakage with single-use
Shen (2009), found that when Nickel Titanium files were restricted to single-use, the rate of fracture could be as low as 0% to 0.26%. Higher rate used.
Dentist attempting removal
KOL made (very tentative) estimate that 5% of public and 25% of private dentists would make an attempt to repair if file breakage occurs (average = 15%).
You can modify the present values
Value of dentist time
Internal data: 95k euros annually – assuming 48 weeks worked and 35 hours per week.
Value of dental assistant
Internal data: 25k euros, 46 weeks, 36 hours per week – 15 euros per working hour used.
Value of patient time
From: Eurostat - Labour cost per hour (2011)
Cost of specialist repair
Pennington study of cost effectiveness of root canal treatment quotes a figure of £717 per RcT for a 55 year old male.
(single-use, per patient)
Number of files in treatment sequence multiplied by the cost per file.
(multi-use, per patient)
Number of files in treatment sequence divided by the number of uses (5) and multiplied by the cost per file.
Number of treatments
Additional cost for re-using the instruments
Find your balance between cost and clinical benefits