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Naderian A, Baghaie H, Satchithanandha V. Accidental ingestion of an endodontic file: a case report. J Med Case Rep 2022; 16:151. [PMID: 35418307 PMCID: PMC9008955 DOI: 10.1186/s13256-022-03363-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Ingestion of dental instruments is rare during dental surgery but can result in serious complications. Here we describe a case in which an endodontic hand file was accidentally misplaced in situ during endodontic (root canal) therapy. Plain radiographs were used to identify its location, and serial imaging was used to monitor passage of the endodontic file through the gastrointestinal tract, and it ultimately passed without intervention. We conclude by describing methods for surveillance and management of ingested dental instruments. CASE REPORT A 62-year-old Caucasian male presented to the Emergency Department approximately 2 hours after suspected ingestion or inhalation of an endodontic hand file. He had experienced two episodes of excessive coughing and dyspnea while undergoing endodontic therapy, and was promptly referred by his dentist for further investigation. On admission, plain abdominal radiographs confirmed the position of the file in the duodenum, and serial radiographs were used to monitor its transition and clearance through the gastrointestinal tract. During this time, the patient did not demonstrate any clinical signs of bowel perforation, nor was there any radiographic evidence of pneumoperitonium. The patient was discharged after a final radiograph confirmed the absence of the foreign body. CONCLUSION Ingestion and inhalation of dental instruments can be life threatening and should be managed cautiously, with early input from general surgeons, gastroenterologists, or respiratory physicians for possible endoscopic retrieval, emergent laparotomy, or surgical intervention. Imaging studies are useful for discerning the position of the foreign body and to determine whether retrieval is possible, and the management will ultimately depend on the position and characteristics of the foreign body, as well as risk factors from the patient which may increase the likelihood of perforation, obstruction, or impaction.
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Affiliation(s)
- Ashkun Naderian
- Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia.
| | - Hooman Baghaie
- Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
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Vodoriz YY, Tkachenko IM, Nazarenko ZY, Pisarenko OA, Gurzhiy OV. THE PREVALENCE OF RUBBER DAM AMONG DENTISTS IN DIFFERENT COUNTRIES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2252-2255. [PMID: 36378704 DOI: 10.36740/wlek202209213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To assess the actual prevalence of rubber dam usage among general dentists. PATIENTS AND METHODS Materials and methods: Surveyed participants were offered a questionnaire containing 14 questions about gender, country of origin, clinical experience, time and place of acquisition of skills of rubber dam, as well as the frequency of its usage. RESULTS Results: 30.69% of dentists always use rubber dams for direct restorations; 74.26% always use rubber dams during root canals treatment; 36.3% always use rubber dam for bonding indirect restorations. CONCLUSION Conclusions: The prevalence of rubber usage among general dentists shows positive growth dynamics, but the frequency is still considered insufficient.
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Leinonen S, Vehkalahti MM. Compliance with Key Practices of Root Canal Treatment Varies by the Reward System Applied in Public Dental Services. J Endod 2021; 47:1592-1597. [PMID: 34343591 DOI: 10.1016/j.joen.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess clinical practices in root canal treatments (RCTs) performed by general dental practitioners under 2 different reward schemes applied in public dental services. METHODS This study used a retrospective design with tooth as the observation unit. The data included all teeth (n = 547) with nonsurgical primary RCT completed in 2016. Electronic documents included treatment details and radiographs. RCT assessment covered 4 key items: taking pre- and postoperative radiographs, using a rubber dam, measuring working length. Assessed dichotomies indicated whether practices were adequate. Dentists' reward schemes were "salaried" and "fee-for-service." Chi squared tests analyzed frequency differences. RESULTS RCTs formed 2 groups by the reward scheme: 305 RCTs were performed by salaried dentists and 242 by fee-for-service dentists. Preoperative radiographs were diagnosable for 76.1% and postoperative radiographs, for 95.1% of all RCTs. Rubber dam use was documented for 28.9% of the RCTs, more frequently when performed by salaried than by fee-for-service dentists (43.9% vs 9.9%, P < .001). Working length measurement was documented for 72.9% of the RCTs, more frequently for RCTs performed by salaried than by fee-for-service dentists (85.2% vs 57.4%, P < .001). All 4 key items were assessed as adequate in 19.0% of all RCTs, more frequently when performed by salaried than by fee-for-service dentists (29.5% vs 5.8%, P < .001). CONCLUSIONS Deficiencies in RCTs, particularly underuse of rubber dams call for further research to understand the reasons for noncompliance with good clinical practice guidelines.
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Affiliation(s)
- Sini Leinonen
- Department of Social Services and Healthcare, The City of Porvoo, Porvoo, Finland
| | - Miira M Vehkalahti
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
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Edwards D, Bailey O, Stone S, Duncan H. The management of deep caries in UK primary care: A nationwide questionnaire-based study. Int Endod J 2021; 54:1804-1818. [PMID: 34089184 DOI: 10.1111/iej.13585] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
AIM To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). METHODOLOGY Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case-based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p ≤ .2 were selected for binary logistic regression modelling. RESULTS A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01-3.20), periapical radiography (1.43, 1.01-2.03), cold pulp testing (2.079, 1.46-2.97) and electric pulp testing (1.65, 1.02-2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non-NHS practitioners were much more likely to use rubber dam (3.40, 2.15-5.37), as were those that had completed PGQ (2.24, 1.48-3.38). Non-selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97-7.15), whilst non-NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71-6.38) as were non-UK graduates (5.63, 2.47-12.86) and those with PGQ (2.12, 1.17-3.87). CONCLUSIONS This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non-selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.
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Affiliation(s)
- David Edwards
- Restorative Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Oliver Bailey
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hal Duncan
- Division of Restorative Dentistry and Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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Karobari MI, Khijmatgar S, Noorani TY, Assiry A, Alharbi T. Is there a justification of conducting clinical audit in the endodontic treatment outcomes? J Conserv Dent 2020; 23:518-521. [PMID: 33911363 PMCID: PMC8066672 DOI: 10.4103/jcd.jcd_220_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 04/27/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the role of clinical audit in improving endodontic treatment outcomes. MATERIALS AND METHODS An audit at the department of endodontics at dental specialty centre kingdom of Saudi Arabia was carried out. The audit was conducted by developing endodontics treatment and success predictors based on evidence, that can be measured for endodontic care. A total of 12 months' data was examined from the previous dental records. Ten clinical cards were which included root canal treatment were selected. The audit was carried out for a minimum of 50 teeth and a maximum of 200 teeth. The radiographs of record cards were studied and a single dentist completed the audit tool. RESULTS The vitality test was performed in 1.98% cases, intra-canal medicament was used and named in 3.96% cases, 3.96% the teeth were extracted due to endodontic failure. Further, in 6.93% of the cases that were identified had certain spaces but overall root canal filling was evaluated as satisfactory. CONCLUSION The vitality test, type of intracanal medicament, and assessment of root canal filling were not done, but there was an overall performance of predictors for endodontic treatment.
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Affiliation(s)
- Mohmed Isaqali Karobari
- Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia
| | - Shahnawaz Khijmatgar
- Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Department of Oral Biology and Genomic Studies, Mangalore, Karnataka, India
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tahir Yusuf Noorani
- Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia
| | - Ali Assiry
- Department of Preventive Dental Science, Faculty of Dentistry, Najran University, Saudi Arabia
| | - Tariq Alharbi
- Deparment of Endodontic, Ministry of Health, Fahad Hospital in Medina, Medina, Saudi Arabia
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Virdee SS, Ravaghi V, Camilleri J, Cooper P, Tomson P. Current trends in endodontic irrigation amongst general dental practitioners and dental schools within the United Kingdom and Ireland: a cross-sectional survey. Br Dent J 2020:10.1038/s41415-020-1984-x. [PMID: 32855518 DOI: 10.1038/s41415-020-1984-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α <0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (>0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation; >0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P <0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.
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Affiliation(s)
- Satnam Singh Virdee
- Clinical Lecturer & Speciality Registrar in Restorative Dentistry, PhD Student, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK; Part-Time General Dental Practitioner, Abbey House Dental Practice, 9 Abbey Street, Stone, ST15 8PA, UK.
| | - Vahid Ravaghi
- Lecturer in Dental Public Health, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK
| | - Josette Camilleri
- Reader in Restorative Dentistry, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK
| | - Paul Cooper
- Professor of Oral Biology, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Phillip Tomson
- Senior Clinical Lecturer & Consultant in Restorative Dentistry, University of Birmingham, Mill Pool Way, Birmingham, B5 7EG, UK
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Knowledge, Attitude, and Practice (KAP) of Radiographic Protection by Dental Undergraduate and Endodontic Postgraduate Students, General Practitioners, and Endodontists. Int J Dent 2020; 2020:2728949. [PMID: 32399032 PMCID: PMC7201738 DOI: 10.1155/2020/2728949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to evaluate the knowledge, attitude, and perception of radiation hazard and preventive measures among dental undergraduate students, general practitioners, endodontic postgraduate students, and endodontists in Saudi Arabia. Multiple choice questions questionnaires were distributed among undergraduate and endodontic postgraduate dental students, general practitioners, and endodontists in the colleges of dentistry in Saudi Arabia, government hospitals, and private clinics. The questionnaire included sociodemographic data, assessment of the knowledge of radiation physics and biology, assessment of the practice of dental radiography, and assessment of knowledge of radiation protection. Chi-square test was used for individual and multiresponse analysis. Level of statistical significance was set at P ≤ 0.05. Three hundred and twenty-nine responded to the questionnaire. More than half of the respondents agreed that dental X-ray is hazardous to health (60.79%), and 68.1% were familiar with ALARA (as low as reasonably achievable) principle. However, only 34% are familiar with the recommendations of the National Council on Radiation Protection (NCRP) and International Commission on Radiological Protection (ICRP). The use of lead apron and thyroid collar for patients' protection from X-ray radiation was practiced among endodontic postgraduate students more frequently as well as those who are proactive in the academic field. Undergraduate students, endodontic postgraduate students, and endodontists in the academic field were the most aware towards radiation reduction measures. The use of the preventive measures needs to be emphasized more among general practitioners, endodontic postgraduate students, and endodontists especially in governmental hospitals and private sectors.
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Gemmell A, Stone S, Edwards D. Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England. Br Dent J 2020; 228:521-526. [DOI: 10.1038/s41415-020-1419-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Madarati AA. Factors influencing incidents of complications while using nickel-titanium rotary instruments for root canal treatment. BMC Oral Health 2019; 19:241. [PMID: 31711474 PMCID: PMC6849290 DOI: 10.1186/s12903-019-0938-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 10/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background To investigate the complications associated with the use of nickel titanium rotary instruments (NiTi-RIs) for root canal treatments (RCTs), in Saudi Arabia dental practice, and to explore the influencing factors. Methods After obtaining an ethical approval, two pilot studies were conducted to formulate the final questionnaire. The sample size was measured taking into consideration 60% expected response rates and confidence level of 99.9%. The questionnaire was emailed to 600 general dentists (GDs) randomly selected from the dental register and all of the endodontists (175). The email’s introduction clarified objectives of the study and guaranteed that all of the collected information would remain confidential. A reminder was sent after 10 weeks. The data were collected and analyzed using the chi-squared test at a 0.05 significance level. Results With a 51% overall response rate, 71.9% off the respondents used NiTi-RIs. The majority (83.1%) experienced complications while using NiTi-RIs; with the instruments’ fracture being significantly the most common complication (52.7%) (p < 0.001). The majority (87.7%) experienced NiTi-RIs’ fractureat least once; with more endodontists (94.3%) than GDs (83.3%) (p < 0.001). The greater the number of weekly performed RCTs and participants’ experiences, the more NiTi-RIs fractures and the greater the number of fracture incidents (p < 0.001). While 60% of those who performed 1–3 RCTs per week experienced NiTi-RIs fractures, 100% of those who performed more than 12 RCTs per week did so. The highest percentage of those who experienced more than 10 fractured NiTi-RIs (60%) was within the group who performed more than 12 RCTs per week. Although fracture incidents decreased with a smaller number of reuses, there was no significant correlation between the number of fractured instruments and NiTi-RIs discard strategy (p ≥ 0.05). Conclusion Fracture incidence was the most common complication while using NiTi-RIs, regardless of the clinicians’ experiences and skills. While the single use may reduce NiTi-RIs fractures, to some extent, the greater number of RCTs performed per week was the most influential factor.
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Affiliation(s)
- Ahmad A Madarati
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, P.O Box 2898, Madina, 43353, Saudi Arabia. .,Restorative Dentistry Department, Faculty of Dentistry, Aleppo University, Aleppo, Syria.
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Endodontic Tendencies in a Very-Low-Income Population Area of Northeastern Brazil. Int J Dent 2019; 2019:9543593. [PMID: 31582980 PMCID: PMC6748203 DOI: 10.1155/2019/9543593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022] Open
Abstract
Aim To gather information regarding endodontic treatment protocols and continuing education attendance of dentists in some cities located in Northeastern Brazil (Sergipe and Bahia States), a region that comprises a very-low-income population. Methods A questionnaire containing different questions (e.g., routine treatment protocols, the use of new technologies, time required to conclude the treatment, and attendance in an endodontic continuing education) was distributed to 250 dentists. The collected data were analyzed through descriptive statistics and Poisson regression (p < 0.05). Results A total of 199 dentists practicing endodontic treatment in the cities of Aracaju (n = 58), Salvador (n = 83), and towns of Estância (n = 8), Itabaiana (n = 16), Itabaianinha (n = 5), Lagarto (n = 10), Ribeirópolis (n = 3), Simão Dias (n = 6), and Tobias Barreto (n = 10) participated in this research. Most of the respondents have concluded their graduation in Dentistry in less than 10 years (62.3%), with nearly 75.4% of the sample having attended postgraduation education in the field. Regarding treatment protocols, the frequency for using rotary/reciprocating systems and for always using rubber dam isolation during root canal treatment (RCT) was 78% and 62%, respectively, which was also more prevalent among dentists who attended a continuous education program (p < 0.05). Lastly, the professionals who attended (p < 0.05) to a continuous education program in Endodontics were more frequently associated to performing incisors and molars RCT in one clinical appointment (p < 0.05). Conclusions The results of this survey indicated that even in an area where most of the population has low-income conditions, the professionals are seeking for knowledge by attending to postgraduation programs, following the new tendencies in Endodontics with most of the professionals having employed technological resources.
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Madarati AA, Habib AA. Modalities of using endodontic nickel-titanium rotary instruments and factors influencing their implementation in dental practice. BMC Oral Health 2018; 18:192. [PMID: 30463557 PMCID: PMC6249782 DOI: 10.1186/s12903-018-0660-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To establish the extent of using nickel titanium rotary instruments (NiTi-RIs), to identify reasons for using / not using NiTi-RIs, to explore usage modalities and to identify factors and measures that can increase implementation of NiTi-RIs in general dental practice. METHODS Two pilot questionnaires were conducted on academic staff members at College of Dentistry, Taibah University, general dentists (GDs) and endodontists to finalise the questionnaire. A sample size was calculated considering the expected and minimum accepted response rates (60 and 48%, respectively) and a 99.9% Confidence Level. The online-questionnaire was sent to 600 GDs and all endodontists (175) working in Saudi Arabia. A reminder was emailed after 10 weeks to encourage non-respondents to complete the questionnaire. Responses, were collected and converted into numerical data which were analysed using the Chi-square test (p = 0.05). RESULTS Significantly most respondents (71.9%) used NiTi-RIs (p < 0.001); with more endodontists (96.9%) than GDs (60%). Most users (62.5%) had been using NiTi-RIs for More than 3 years (p < 0001). The trend of using NiTi-RIs increased as participants' experience and the number of root-canal treatments performed per week increased (p = 0.021). While most respondents (45.3%) used NiTi-RIs because of faster root-canal preparation, the majority of non-users (85.3%) didn't do so because of high cost. The highest proportion (43.3%) reported better undergraduate education as the most important factor that can significantly increase NiTi-RIs usage. The majority (91.8%) prepared glide-path before using NiTi-RIs; especially with stainless steel hand-files (63.3%). CONCLUSIONS NiTi-RIs are relatively well adopted in Saudi dental practice. However, better education, especially during undergraduate training and lower cost can increase their usage. Overall, clinicians showed good awareness of NiTi-RIs usage aspects which reflected on usage modalities.
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Affiliation(s)
- Ahmad A Madarati
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, P.O Box 2898, Madina, 43353, Saudi Arabia. .,Restorative Dentistry Department, Faculty of Dentistry, Aleppo University, Aleppo, Syria.
| | - Adnan A Habib
- Restorative Dentistry Department, Faculty of Dentistry, Aleppo University, Aleppo, Syria.,Al-Farabi College of Dentistry, Riyadh, Saudi Arabia
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Eliyas S, Briggs PFA, Gallagher JE. Assessing a training programme for primary care dental practitioners in endodontics of moderate complexity: Pilot data on skills enhancement and treatment outcomes. Br Dent J 2018; 225:617-628. [PMID: 30310203 DOI: 10.1038/sj.bdj.2018.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/09/2022]
Abstract
Aims To explore the impact of dedicated training to extend the skills of primary care practitioners on the quality of endodontic care, using clinical, radiographic and patient-related outcomes. Methods The quality of endodontic treatment performed at the beginning and end of training to become dentists with extended skills (DES) in endodontics was assessed in vitro and in vivo from endo-training blocks and self-reported logbooks containing clinical notes and radiographs respectively. The quality of endodontic care delivered by DES post-training was measured using clinical and radiographic outcomes. Patient-related outcomes were assessed using a self-report questionnaire, including the Oral Health Impact Profile – Endodontic Outcome Measure (OHIP-EOM). Results Data on eight dentists were examined pre-and post-training, five of whom participated in further follow-up investigations on the quality of endodontic care delivered to their patients. Significant improvements in skills were seen for all domains in vitro (p <0.05), and for all domains of the clinical treatment process, and achieving the correct working length of the root filling as seen by radiography in vivo (p <0.05). The quality of the clinical process was maintained following training. Positive patient outcome (OHIP-EOM) scores were recorded (mean score of 34.72, SD = 10.74, n = 120 pre-treatment and 25.85, SD = 7.74, n = 47 representing reduced impact at follow-up). The majority of patients reported being satisfied, or very satisfied, with the service they received (72.5%, n = 98); would use the service again (68.1%, n = 92); and would recommend the service to friends and family (74.8%, n = 101). Conclusions Findings suggest that training for dentists working in practice can be successful in enhancing skills and changing practice, with evidence of high patient satisfaction and good clinical and patient-related outcomes. Pilot results must be interpreted with caution and further research is required.
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Affiliation(s)
- S Eliyas
- St George's University Hospital's NHS Foundation Trust and Hodsoll House Specialist Practice, Kent
| | - P F A Briggs
- Barts Health NHS Trust, Whitechapel, London, UK.,Health Education England London and South East, Stewart House, Russell Square London, UK
| | - J E Gallagher
- King's College London Dental Institute, Population and Patient Health Division, London, UK
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Calcium Hydroxide Treatment Does Not Alter the Susceptibility of Enterococcus faecalis Biofilms to Sodium Hypochlorite. Eur Endod J 2017; 2:1-5. [PMID: 33403351 PMCID: PMC7757968 DOI: 10.14744/eej.2017.17022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/04/2017] [Accepted: 08/31/2017] [Indexed: 11/20/2022] Open
Abstract
Objective: To investigate the influence of calcium hydroxide (Ca(OH)2) on susceptibility to disinfection with sodium hypochlorite (NaOCl) of biofilm bacteria. Methods: Monospecies biofilms of eight Enterococcus faecalis strains were subjected to a 2-h challenge with Ca(OH)2. After a recovery phase, the biofilms were treated with a concentration of NaOCl that was lower than the minimum inhibitory concentration. In a metabolic assay, the efficacy of NaOCl disinfection in Ca(OH)2-challenged biofilms and unchallenged biofilms was evaluated. The data were analyzed with Mann-Whitney U and Kruskall- Wallis tests. A P value of less than 0.05 was considered statistically significant. Results: There were marginal differences in susceptibility to NaOCl among the E. faecalis strains. After the Ca(OH)2 challenge, seven strains remained equally susceptible to NaOCl disinfection whereas one strain became more resistant to NaOCl (P=0.03). Conclusion: After a Ca(OH)2 challenge, in general E. faecalis remained equally susceptible to disinfection with NaOCl.
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Biel P, Mohn D, Attin T, Zehnder M. Interactions between the Tetrasodium Salts of EDTA and 1-Hydroxyethane 1,1-Diphosphonic Acid with Sodium Hypochlorite Irrigants. J Endod 2017; 43:657-661. [DOI: 10.1016/j.joen.2016.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 10/19/2022]
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Balancing the risks and benefits associated with cosmetic dentistry - a joint statement by UK specialist dental societies. Br Dent J 2016; 218:543-8. [PMID: 25952437 DOI: 10.1038/sj.bdj.2015.345] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/08/2022]
Abstract
Cosmetic dentistry has become increasingly popular, largely as a result of social trends and increased media coverage. This understandable desire for the alleged 'perfect smile' needs to be tempered with an appropriate awareness of the significant risks associated with invasive cosmetic procedures such as veneers and crowns. Patients need to be properly informed that elective removal of healthy enamel and dentine can result in pulpal injury and poorer periodontal health in the longer term, particularly if they are young. The duty of candour means that they ought to be informed that aggressive reduction of sound tooth tissue is not biologically neutral and results in structural weakening of their teeth. Less invasive procedures such as bleaching on its own or for example, combined with direct resin composite bonding, can satisfy many patient's demands, while still being kinder to teeth and having much better fall-back positions for their future requirements. It is the opinion of the British Endodontic Society, British Society for Restorative Dentistry, Restorative Dentistry UK, Dental Trauma UK, British Society of Prosthodontics and the British Society of Paediatric Dentistry that elective invasive cosmetic dental treatments can result in great benefit to patients, but that some aggressive treatments used to achieve them can produce significant morbidities in teeth which were previously healthy. This is a worrying and growing problem with many ethical, legal and biologic aspects, but many adverse outcomes for patients who request cosmetic dental improvements are preventable by using biologically safer initial approaches to treatment planning and its provision.
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Abstract
This article provides an overview of some of the issues in the assessment and management of endodontic patients which may lead to dento-legal problems. It covers assessment, the appropriate use of radiographs, special tests and the importance of following the correct consent process. It outlines why record-keeping is particularly important, and looks at problems that occur, such as perforation, fractured instruments and hypochlorite accidents.
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Affiliation(s)
- Shreeti Patel
- Practice limited to Endodontics, Dento-legal Adviser, Dental Protection, London, UK
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17
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Why dentists don't use rubber dam during endodontics and how to promote its usage? BMC Oral Health 2016; 16:24. [PMID: 26916426 PMCID: PMC4766746 DOI: 10.1186/s12903-016-0175-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/29/2016] [Indexed: 11/26/2022] Open
Abstract
Background This survey study aimed at investigating the frequency of rubber dam use during root canal treatment, identifying influencing factors for not using it by Saudi general dental practitioners (GDPs) and endodontists. It also aimed at identifying measures that increase rubber dam usage. Methods After obtaining an ethical approval, two pilot studies were conducted on staff members at Taibah University College of Dentistry and a group of GDPs. A final online survey was constructed comprising 17 close-ended questions divided into six categories: demographics, endodontic practice, rubber dam use, alternative isolation methods, reasons for not using rubber dam, and measures and policies that increase its usage. The survey was emailed to 375 GDPs randomly selected from the dental register and all endodontists (n = 53) working in the western province, Saudi Arabia. Data were analyzed using the Chi-square and Linear-by-Linear association tests at p ≤ 0.05. Results The proportion of endodontists who used rubber dam (84.8 %) was significantly greater than that of GDPs (21.6 %) (p < 0.001). Significantly the highest proportion (40.5 %) did not use rubber dam because of unavailability at working place. Most rubber dam none-users (69.25 %) used a combination of other isolation means. The highest proportion of those who used rubber dam were working in the governmental sector (54.3 %). Among rubber dam users, the greatest proportion graduated from Saudi Arabia (57.8 %) compared to those graduated from Egypt (34.3 %) and Syria (22.4 %). There was a significant correlation between the patterns of rubber dam use during undergraduate training and its usage after graduation (p = 0.001). The highest proportion of participants (48.1 %) reported better undergraduate education as the most important factor that would increase rubber dam use in dental practice. Conclusions Using of rubber dam was not common in Saudi general dental practice. Dentists must follow the recommended standards of care. Place of work and patterns of using rubber dam during undergraduate study were the most influencing factors. Better undergraduate education was the most important proposed measure to increase its usage. The combination of cotton rolls and saliva high-volume ejector or gauze was the most common alternative to rubber dam isolation.
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Lawson NC, Gilbert GH, Funkhouser E, Eleazer PD, Benjamin PL, Worley DC. General Dentists' Use of Isolation Techniques during Root Canal Treatment: From the National Dental Practice-based Research Network. J Endod 2015; 41:1219-25. [PMID: 26015159 DOI: 10.1016/j.joen.2015.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/24/2015] [Accepted: 04/19/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified the use of all isolation techniques, including RD use. METHODS Network practitioners completed a questionnaire about isolation techniques used during RCT. Network enrollment questionnaire data provided practitioner characteristics. RESULTS One thousand four hundred ninety of 1716 eligible GDs participated (87%); 697 (47%) reported always using an RD. This percentage varied by tooth type. These GDs were more likely to always use an RD, do not own a private practice, perform less than 10 RCTs/month, and have postgraduate training. CONCLUSIONS Most GDs do not use an RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics.
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Affiliation(s)
- Nathaniel C Lawson
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ellen Funkhouser
- Division of Preventive Medicine, Department of Medicine, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul D Eleazer
- Department of Endodontics, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
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Ahmed HMA, Cohen S, Lévy G, Steier L, Bukiet F. Rubber dam application in endodontic practice: an update on critical educational and ethical dilemmas. Aust Dent J 2014; 59:457-63. [PMID: 25091028 DOI: 10.1111/adj.12210] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 01/28/2023]
Abstract
Proper isolation is an essential prerequisite for successful endodontic treatment. This article aims to provide an update on the prevalence of rubber dam (RD) use, and the role of education along with attitudes of general dental practitioners (GDPs) and patients towards the application of RD in endodontics. Critical ethical issues are also highlighted. Using certain keywords, an electronic search was conducted spanning the period from January 1983 to April 2013 to identify the available related investigations, and the pooled data were then analysed. The results show that although RD is the Standard of Care in endodontic practice, there is a clear discrepancy in what GDPs are taught in dental school and what they practice after graduation. There is little scientific evidence to support the application of RD; however, patient safety and clinical practice guidelines indicate that it is unnecessary and unethical to consider a cohort study to prove what is already universally agreed upon. A few clinical situations may require special management which should be highlighted in the current guidelines. This would pave the way for clear and straightforward universal guidelines.
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Affiliation(s)
- H M A Ahmed
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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20
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Simons D, Williams D. Can audit improve patient care and treatment outcomes in endodontics? Br Dent J 2014; 214:E25. [PMID: 23660929 DOI: 10.1038/sj.bdj.2013.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 12/15/2022]
Abstract
Clinical audit is part of the NHS clinical governance framework for dentistry and is recommended as a quality improvement process for patient care, yet there is very mixed evidence supporting audit's ability to produce change in practice. Findings show evidence of changes following audit which improved patient care and practice efficiency. However, there is a general lack of dissemination of audit results, little useful feedback provided to participants, limited use of formal re-auditing of a particular topic and little reported on whether audit improves outcomes for patients. As part of its clinical governance responsibility, the Community Dental Service (CDS) is committed to ensuring that its clinical audit is robust, strategic and measures patient outcomes in its evaluation. The aim of this paper is to present a complete endodontic audit cycle; its recommendations and effects on the process and on outcomes of clinical patient endodontic care; and to evaluate if audit was a useful tool in this case.
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Affiliation(s)
- D Simons
- St. Leonards Hospital, Nuttall Street, London, UK.
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21
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Eick S, Strugar T, Miron RJ, Sculean A. In vitro-activity of oily calcium hydroxide suspension on microorganisms as well as on human alveolar osteoblasts and periodontal ligament fibroblasts. BMC Oral Health 2014; 14:9. [PMID: 24475753 PMCID: PMC3915246 DOI: 10.1186/1472-6831-14-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/20/2014] [Indexed: 01/22/2023] Open
Abstract
Background Findings from animal and human studies have indicated that an oily calcium hydroxide suspension (OCHS) may improve early wound healing in the treatment of periodontitis. Calcium hydroxide as the main component is well known for its antimicrobial activity, however at present the effect of OCHS on the influence of periodontal wound healing/regeneration is still very limited. The purpose of this in vitro study was to investigate the effect of OCHS on periodontopathogenic bacteria as well as on the attachment and proliferation of osteoblasts and periodontal ligament fibroblasts. Methods Human alveolar osteoblasts (HAO) and periodontal ligament (PDL) fibroblasts were cultured on 3 concentrations of OCHS (2.5, 5 and 7.5 mg). Adhesion and proliferation were counted up to 48 h and mineralization was assayed after 1 and 2 weeks. Furthermore potential growth inhibitory activity on microorganisms associated with periodontal disease (e.g. Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans) as well as the influence of periodontopathogens and OCHS on the HAO and PDL fibroblasts counts were determined. Results More than a 2-fold increase in adherent HAO cells was observed at 4 h following application of OCHS when compared to the control group (p = 0.007 for 2.5 mg). Proliferation of HAO cells at 48 h was stimulated by moderate concentrations (2.5 mg; 5 mg) of OCHS (each p < 0.001), whereas a high concentration (7.5 mg) of OCHS was inhibitory (p = 0.009). Mineralization was observed only for HAO cells treated with OCHS. OCHS did not exert any positive effect on attachment or proliferation of PDL fibroblasts. Although OCHS did not have an antibacterial effect, it did positively influence attachment and proliferation of HAO cells and PDL fibroblasts in the presence of periodontopathogens. Conclusions The present data suggests that OCHS promotes osteoblast attachment, proliferation and mineralization in a concentration-dependent manner and results are maintained in the presence of periodontal pathogens.
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Affiliation(s)
| | | | | | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, CH-3010, Bern, Switzerland.
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A survey of adoption of endodontic nickel-titanium rotary instrumentation part 2: community and hospital dental practitioners in Wales. Br Dent J 2013; 214:E7. [PMID: 23392052 DOI: 10.1038/sj.bdj.2013.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess adoption of endodontic nickel-titanium rotary technology (NiTi) by community and hospital dental clinicians within Wales and identify factors that may restrict uptake. DESIGN Postal questionnaire. SETTING Community and hospital-based dentists in Wales. METHODS Community and hospital-based dentists with a remit for provision of restorative dentistry (community dental setting = 32; hospital dental setting = 36) were approached regarding their usage or otherwise of nickel-titanium rotary instrumentation for endodontic treatments. The postal questionnaire took the form of an anonymous survey comprising 12 questions. These questions covered usage parameters, satisfaction and training and broached reasons for NiTi avoidance. RESULTS The response rate was 77%. NiTi rotary instruments were used routinely by an encouraging 82% of those in the hospital-based restorative dental services but only 13% of community staff. Factors cited as being implicated in the decision to avoid their use included cost (62% of responses) lack of training and the perceived lack of benefit. CONCLUSION The adoption of rotary NiTi endodontic technology by the hospital dental practitioners of Wales is encouraging with the majority having converted to such systems in excess of three years prior to the survey. There was, however, a significant disparity in NiTi usage between community and hospital settings, the implications for which and possible solutions for increased training and uptake are discussed.
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A survey of adoption of endodontic nickel-titanium rotary instrumentation part 1: general dental practitioners in Wales. Br Dent J 2013; 214:E6. [DOI: 10.1038/sj.bdj.2013.108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/08/2022]
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Kaptan RF, Haznedaroglu F, Kayahan MB, Basturk FB. An investigation of current endodontic practice in Turkey. ScientificWorldJournal 2012; 2012:565413. [PMID: 23251103 PMCID: PMC3518046 DOI: 10.1100/2012/565413] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022] Open
Abstract
Objectives. The aim of this study was to gather information about the quality and quantity of root canal treatments carried out by general dental practitioners in Turkey. Methods. Questionnaires were given to 1400 dentists who attended the 16th National Congress organized by the Turkish Dental Association. The participants were asked to answer 34 multiple-choice questions. The questions were subdivided into 3 main topics; general information; general approach to endodontic treatment; and cleaning, shaping, and obturation of root canals. The statistical analysis was carried out by an χ2-test to compare the means at a significance level of P < 0.05. Results. The response rate for this study was 43%. There was a wide variation in the number of root canal treatments completed per month. Nearly 92% of practitioners stated that they never used rubber dam. The most commonly used working length determination technique was radiographic evaluation (P < 0.05). Sodium hypochlorite was the irrigant of choice with varying concentrations and AH Plus was the sealer of choice (P < 0.05). Resin composite was the most frequently used material for final restorations. Conclusions. Endodontic procedures in general practice in Turkey have differences from widely acknowledged quality guidelines. Despite the introduction of new instruments and techniques, most of the general practitioners chose conventional methods.
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Affiliation(s)
- R F Kaptan
- Department of Endodontics, Faculty of Dentistry, Yeditepe University, 34755 Istanbul, Turkey
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Leonardi DP, Haragushiku GA, Tomazinho FSF, Furuse AY, Volpato L, Baratto-Filho F. Undergraduate students introduction to manual and rotary root canal instrumentation. THE BULLETIN OF TOKYO DENTAL COLLEGE 2012; 53:155-9. [PMID: 23124306 DOI: 10.2209/tdcpublication.53.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to evaluate the performance of undergraduates in their first contact with manual and rotary root canal instrumentation. Forty-two students who had never worked on a root canal before instrumented 42 extracted lower-incisors. Participants were assigned to one of two groups: Rotary instrumentation or manual instrumentation. Pre- and post-operative computed tomography scans were obtained with a 3-dimensional dental imaging system. Starting and finishing times of preparation were recorded. The cross-sectional area of the root canal was analyzed with 2-mm-below-the-apex initial and final transverse images recorded through a digital imaging system and analyzed with software to measure the initial and final area of the root canal in mm(2). Data from the cross-sectional area of the root canal and time spent were subjected to the Mann-Whitney's U-test (p<0.05). The rotary instrumentation group showed smaller time for preparation (p=0.0204). No differences between rotary and manual instrumentation regarding the cross-sectional area of the root canal were observed (p=0.25). No accidents occurred. Undergraduate students showed good performance in their first contact with the manual and rotary instrumentation with regard to time spent and cross-sectional area of the root canal, with no operative accidents.
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Affiliation(s)
- Denise Piotto Leonardi
- Master Program in Clinical Dentistry, School of Dentistry, Positivo University, Curitiba, PR, Brazil.
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Orafi I, Rushton VE. The use of radiography and the apex locator in endodontic treatment within the UK: a comparison between endodontic specialists and general dental practitioners. Int Endod J 2012; 46:355-64. [PMID: 23094654 DOI: 10.1111/j.1365-2591.2012.02127.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 07/10/2012] [Indexed: 11/30/2022]
Affiliation(s)
- I. Orafi
- School of Dentistry; University of Benghazi; Benghazi; Libya
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Clarkson RM, Kidd B, Evans GE, Moule AJ. The Effect of Surfactant on the Dissolution of Porcine Pulpal Tissue by Sodium Hypochlorite Solutions. J Endod 2012; 38:1257-60. [DOI: 10.1016/j.joen.2012.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/12/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
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Clarkson RM, Podlich HM, Moule AJ. Influence of Ethylenediaminetetraacetic Acid on the Active Chlorine Content of Sodium Hypochlorite Solutions When Mixed in Various Proportions. J Endod 2011; 37:538-43. [DOI: 10.1016/j.joen.2011.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 01/14/2011] [Accepted: 01/15/2011] [Indexed: 10/18/2022]
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30
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Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson CW, Gordan VV. Rubber dam use during routine operative dentistry procedures: findings from the Dental PBRN. Oper Dent 2010; 35:491-9. [PMID: 20945739 DOI: 10.2341/09-287c] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rubber dam use during operative dentistry procedures has been quantified based on questionnaires completed by dentists. However, based on the knowledge of the authors of the current study, there are no reports based on use during actual clinical procedures other than in dental materials studies and none based on routine care. The objectives of the current study were to: 1) quantify how commonly the rubber dam is used during operative dentistry procedures; 2) test the hypothesis that certain dentist, restoration and patient-level factors are associated with its use. A total of 229 dentist practitioner-investigators in The Dental Practice-Based Research Network (DPBRN) participated. DPBRN comprises five regions of the USA: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates and Scandinavia. Practitioner-investigators collected data on 9,890 consecutive restorations done in previously unrestored tooth surfaces from 5,810 patients. Most dentists (63%) did not use a rubber dam for any restoration in this study. A rubber dam was used for only 12% of restorations, 83% of which were used in one DPBRN region. With regions accounted for, no other dentist characteristics were significant. A multi-level multiple logistic regression of rubber dam use was done with restoration and patient-level variables modeled simultaneously. In this multi-variable context, these restoration-level characteristics were statistically significant: tooth-arch type, restoration classification and reason for placing the restoration. These patient-level characteristics were statistically significant: ethnicity, dental insurance and age. These results, obtained from actual clinical procedures rather than questionnaires, document a low prevalence of usage of the rubber dam during operative dentistry procedures. Usage varied with certain dentist, restoration and patient-level characteristics.
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Affiliation(s)
- Gregg H Gilbert
- Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA.
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31
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Orafi I, Worthington HV, Qualtrough AJE, Rushton VE. The impact of different viewing conditions on radiological file and working length measurement. Int Endod J 2010; 43:600-7. [DOI: 10.1111/j.1365-2591.2010.01744.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Rubber dam has been available to the dental profession for over 140 years. During this time, the use of rubber dam has been perfected, universally taught and recommended by professional organizations. Unfortunately, its consistent use has been rejected by many in the profession. The literature suggests that rubber dam is not used routinely by dental practitioners for root canal treatment. Many unfounded reasons have been cited for its lack of use, including concerns over patient acceptance, time required for application, cost of equipment and materials, insufficient training, difficulty in use and low treatment fees. Failure to use rubber dam has been shown to influence the choice of root canal irrigant, has a negative impact on treatment outcome and places the patient at risk of swallowing or aspirating materials and instruments. Methods to popularize rubber dam amongst general practitioners are discussed.
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Affiliation(s)
- I A Ahmad
- Private Dental Practice, Amman, Jordan.
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