Development of A New Comprehensive Classification for Iatrogenic Tooth Perforations

To develop a comprehensive classification system for unrepaired iatrogenic tooth perforations to improve diagnosis, treatment planning, communication, and standardisation in clinical practice and research.

A structured multi-phase consensus methodology was employed to develop a comprehensive classification of unrepaired iatrogenic tooth perforations. A steering committee consisting of international experts developed an initial draft classification comprising various domains, categories, codes, their descriptions, and explanatory notes. An online Delphi process involving a global community of academic and clinical endodontic specialists, general dental practitioners, and postgraduate students was conducted to evaluate the clarity of the text and whether each category should be included. A discussion on the feedback from the Delphi process and a general debate of the classification was held subsequently by a group of international experts during an online meeting. The steering committee then revised the classification based on the feedback.

A total of 26 international experts participated in the online Delphi process, which was completed in a single round as over 70% of members assigned a score between 7 and 9 for each domain, thus fulfilling the study design set out a priori. The subsequent online meeting was attended by 15 experts plus the steering committee. The classification consists of an alphanumeric coding system designed to allow consistent clinical characterisation of iatrogenic perforations and enhance communication between stakeholders. It consists of seven domains: endodontic status at the time of perforation, degree of infection, treatment stage at which perforation occurred, size of perforation, level of perforation, root surface of perforation, and pathosis in the periradicular tissues adjacent to the perforation.

A comprehensive classification system for iatrogenic tooth perforations was developed using a structured consensus process involving international experts. The classification integrates biological, procedural, and anatomical factors into a unified and comprehensive framework that has the potential to enhance clinical decision-making, communication, and standardisation in research and clinical practice. The classification enables standardised data collection to explore relationships between perforation characteristics, treatment strategies, and clinical outcomes. This will facilitate future research aimed at developing evidence-based treatment algorithms and prognostic models.