Investigating the technical quality of undergraduate endodontic treatment in a primary care-based dental school

Introduction The success of root canal treatment (RCTx) relies on the technical quality of the root canal filling, often assessed through radiographic evaluation.Aims This audit aims to evaluate the technical proficiency of Peninsula Dental School (PDS) undergraduate dental students in RCTx, comparing it with established European standards.Design Conducted as a retrospective study, this evaluation focuses on assessing the technical quality of RCTx performed by undergraduate dental students at PDS across various academic years.Setting PDS, a primary care-based dental school in the UK, serves as the focal point for this evaluation.Materials and methods Reviewed 2021-2022 endodontic cases by supervised undergraduates. Analysed radiographs for obturation, voids and errors based on established benchmarks. Randomly selected unbiased cases, assessing voids, filling proximity, missed canals and canal anatomy preservation.Interventions Comparative analysis of RCTx quality between PDS students and counterparts from other dental schools, exemplified by Dublin Dental University Hospital (DDUH).Results Findings revealed that 62.07% of single-rooted and 60% of multi-rooted teeth treated by PDS students met European standards.Discussion The implications highlight the proficiency of PDS students in RCTx, comparing favourably to DDUH.Conclusion Recommendations emphasise conducting regular educational audits in dental schools to continually enhance RCTx techniques and ensure high-quality clinical teaching.

Assessment of the quality of root canal fillings performed on extracted teeth by undergraduate dental students in a sample from Saudi Arabia

BACKGROUND

The educational process in the field of endodontics commences with preclinical exercises to enhance students' proficiency in cleaning, shaping, and performing root canal fillings. Therefore, this study aimed to radiographically evaluate the technical quality of root canal fillings performed by preclinical students on extracted teeth at the College of Dentistry, University of Ha'il, Saudi Arabia.

METHODS

A total of 788 extracted human teeth received root canal treatment by undergraduate students. The samples were then gathered and radiographically assessed using the three quality criteria of length, density, and taper. The category of root canal fillings was classified as either acceptable or unacceptable. The criteria for evaluating the acceptability of filling quality were defined based on the presence of adequate length, density, and taper. The effectiveness of root canal fillings was also evaluated in relation to the tooth type, sex, and treatment year. The agreement between the examiners was evaluated using Cohen's kappa test, and the relationship between the research variables was determined using the chi-squared test. The significance threshold was set at 0. 05.

RESULTS

The overall quality of root filling was determined to be satisfactory in 532 (67.5%) of 788 endodontically treated extracted teeth. The majority of the research sample (88.1%) had enough length, 89.6% had adequate density, and 86.4% had acceptable taper. The quality of anterior teeth was substantially better than that of posterior teeth (p < 0.001). Our findings showed that the quality of root canals was better in 2022 than it had been in earlier years (p = 0.001). The three RCT quality criteria differed significantly when compared between sexes (p = 0.002).

CONCLUSIONS

The quality of the root canal fillings completed by undergraduate students was rated as acceptable. The findings of the research suggest that the implementation of routine assessments to evaluate the technical competence of undergraduate dental students performing root canal treatments could provide significant insights into the efficacy of the curriculum requirements.

Quality of root canal treatment performed by undergraduate students using nickel-titanium reciprocating versus hand instruments

PURPOSE

To compare the technical quality of root canal treatment (RCT) depending on the incidence of procedural errors performed by undergraduate students using nickel-titanium reciprocating and conventional hand instrumentation techniques, and to assess the impact of case difficulty and localization of the teeth (maxillary or mandibular molars).

METHODS

Dental records and periapical radiographs of molars that were treated with either hand or reciprocating WaveOne (WO) instruments were evaluated retrospectively. The technical quality of RCTs, the incidence of ledge formation, perforation, instrument fracture, overinstrumentation, underfilling, overfilling, inadequate root canal filling, and the effects of case difficulty and tooth localization were compared using the chi-square test with a significance of 5% (α = 0.05).

RESULTS

While overinstrumentation was more frequent in the WO group (247 teeth), the incidence of inadequate root canal fillings was higher in the hand instrumentation group (245 teeth) (p < 0.01). No significant difference was observed in the incidence of other procedural errors (p > 0.05). The number of teeth with acceptable technical quality in preparation and obturation was 172 (69.6%) in the WO group, whereas it was 142 (58%) in the hand instrumentation group, presenting a significant difference between the instrumentation techniques (p < 0.01). Higher technical quality rates were observed with WO instrumentation in the high difficulty category and in maxillary teeth (p < 0.01).

CONCLUSION

Higher technical quality in preparation and obturation can be achieved with WO reciprocating instruments and file-matched greater tapered gutta-percha cones. No significant difference was observed between the groups in the incidence of procedural errors except for overinstrumentation and insufficient root canal filling. WO instrumentation and obturation with file-matched greater tapered gutta-percha cones provided better technical quality in the high difficulty category and in maxillary teeth.

The Assessment of Quality of the Root Canal Filling and the Number of Visits Needed for Completing Primary Root Canal Treatment by Operators with Different Experience

The main goal of root canal treatment (RCT) is to eradicate or essentially diminish the microbial population within the root canal system and to prevent reinfection by a proper chemo-mechanical preparation and hermetic final obturation of the root canal space. The aim of this study was to assess the quality of the root canal filling and the number of visits needed for completing RCT by operators with different experience, including dentistry students (4th and 5th year), general dental practitioners (GDPs), and endodontists. Data from medical records of 798 patients were analyzed, obtaining 900 teeth and 1773 obturated canals according to the inclusion and exclusion criteria. A similar number of teeth was assessed in each group in terms of density and length of root canal filling and number of visits. The larger number of visits and the lower quality of treatment was observed for 4th year students than for other groups (p < 0.05); in contrast, the endodontists needed the lowest number of visits to complete RCT and more often overfilled teeth than other operator groups (p < 0.05). Interestingly, no statistical difference in quality of root canal filling was noted between 5th year students, GPDs and endodontists. The treatment of lower teeth demanded statistically more visits than that of upper teeth (p < 0.05). The results of the study emphasize that most of the root canal filling performed by operators was considered adequate, regardless of tooth type, files used and number of visits.

An Audit of the Technical Quality and Iatrogenic Errors of Root Canal Treatment by Undergraduate Dental Students at the University of Sharjah

OBJECTIVES

 The aim of this study was to determine the technical quality of root canal fillings and the presence of iatrogenic errors in the cases treated by undergraduate dental students using radiographic images.

MATERIALS AND METHODS

 This study included 480 root-filled teeth, which were evaluated using intraoral periapical radiographic images. The technical quality of obturation was assessed by observing the length, density, and taperness of the root filling. Ledges, apical transportation, fractured instruments, zipping, and root perforation were recorded as iatrogenic errors. Teeth were classified as acceptable if the technical parameters were adequate and there were no iatrogenic errors.

STATISTICAL ANALYSIS

 Data were statistically analyzed using Pearson's chi-squared test.

RESULTS

 The quality of root filling was acceptable in 183 of the 480 teeth. The rate of acceptable quality was higher for the teeth treated by 4th-year students (41.9%) than for those treated by 5th-year students (27.4%; p = 0.004). Length and taperness were adequate in more of the patients treated by the 4th-year students (p<0.05). There was a significant difference in the incidence of ledge formation and apical transportation in relation to the student's level (p<0.05).

CONCLUSIONS

 The technical quality of root fillings performed without iatrogenic errors by undergraduate dental students was declared acceptable in 38.1% of the assessed teeth. There was a noticeable difference in the quality of root canal treatment between the 4th- and 5th-year students.

CLINICAL RELEVANCE

 The findings demonstrate that periodic assessment of the technical quality of root filling performed by undergraduate dental students provides feedback on curriculum standards.

Microcomputed Tomographic Assessment of the Single Cone Root Canal Fillings Performed by Undergraduate Student, Postgraduate Student and Specialist Endodontist

The present study evaluated the obturation quality of root canals filled with BioRoot RCS sealer and single gutta-percha point by undergraduate student (US), postgraduate student (PS) and endodontist (ED). Twenty-one plastic models of upper premolars were enlarged with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into three groups (7 teeth/14 canals per group): US, PS and ED. After the obturation of root canals with BioRoot RCS and one HyFlex EDM size 40 gutta-percha point, plastic models were scanned using micro-computed tomography scanner (µCT) SkyScan 1272 at isotropic resolution of 10 µm. The porosity distribution was evaluated separately for the apical, middle and coronal thirds. The Kruskal–Wallis, Mann–Whitney, Friedman and Wilcoxon tests with the significance level set at 5% were used for data analysis. The µCT evaluation revealed open pores being the dominant type of porosity in all experimental groups and root canal thirds, with the highest percentage of pores in the apical third of root canal fillings. The quality and homogeneity of single cone root canals fillings remained similar between the groups in the apical and middle thirds (p > 0.05). Significant differences were observed only in the coronal third (p < 0.05).

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes

AIMS

This work discusses the procedures and outcomes of restorative and endodontic treatments performed under general anesthesia, with examples from the Unit of Special Care Dentistry at the University Hospital of Clermont-Ferrand.

METHODS AND RESULTS

The restorative and endodontic treatment techniques used in the Special Care Unit are described. These techniques are compared to existing reports in the literature of treatment procedures under general anesthesia. Little evidence was found in the literature regarding sealants or restorative protocols. A few studies described root canal treatment and pulpotomy protocols carried out under general anesthesia, and the results of these met academic outcome standards.

CONCLUSION

Patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment. The provision of restorative treatment under general anesthesia is essential to avoid an excessive number of extractions in patients unable to receive treatment in the chair. Restorative care provided under general anesthesia should be standardized and evaluated in the same way as treatment performed under local anesthesia. In this way, the provision of conservative dental care under general anesthesia could be promoted and the maintenance of a functional dentition encouraged.

The "Plan" phase of a Deming cycle: Measurement of quality and outcome of root canal treatments in a university hospital

INTRODUCTION

In many countries, dental students are taught in private or university hospitals where they treat patients under the supervision of teachers. Assessing the quality of root canal treatments (RCT) would provide information about the quality of care patients receive when treated by students.

METHODS

This study describes the six-step "Plan" phase of a Plan-Do-Check-Act (PDCA) cycle that identifies and analyses clinical practices in endodontics in a university dental hospital service.

RESULTS

Step 3 reported that the proportion of RCTs of adequate quality reached 57.1% and this proportion was significantly decreased when specific indicators for treatment difficulties were present. The proportion of successful RCTs after 1 year was 65.6%, and its variation was influenced by the preoperative periapical status rather than the quality of RCTs. The consensual meeting in Step 6 proposed to introduce three new procedures for the further Do, Check and Act phases of the PDCA cycle.

CONCLUSION

This study encourages systematic evaluation of RCTs and provides the first step of the methodology that can be reproduced in private and hospital practices where students are asked to treat patients.

Radiographic Assessment of the Quality of Root Canal Fillings Performed by Senior Dental Students

Objective:

To evaluate the radiographic technical quality of root canal fillings performed by senior dental students at Alfarabi colleges for dentistry, Kingdom of Saudi Arabia.

Methods:

Radiographic assessment was conducted for 246 teeth (390 root canals) endodontically treated by senior dental students to evaluate the quality of root canal fillings. Three criteria were evaluated to assess the technical quality of root canal fillings: length, density, and taper. The root canal filling was considered acceptable if it had an adequate length with no voids and consistent taper from the orifice to the apex. Statistical analysis was conducted using Kruskal–Wallis, Mann–Whitney, and chi-square tests (P=0.05).

Results:

Acceptable root canal fillings were detected in 127 (32.6%) patients. The frequency of an acceptable root canal filling was the highest for the upper anterior teeth (40%). There were significant differences in the length and density among the types of teeth (P<0.05). However, there was no significant difference in the taper among the types of teeth (P>0.05).

Conclusion:

The quality of root canal fillings performed by senior undergraduate dental students at AlFarabi colleges for dentistry was acceptable in 32.6% of patients. This outcome enhanced the poor performance of undergraduate dental students in the area of endodontics.

Method of teaching undergraduate students to perform root canal treatment: It's influence on the quality of root fillings

INTRODUCTION

This study aimed to assess whether the method of teaching endodontology influenced the quality of root fillings made by undergraduate students.

MATERIALS AND METHODS

The method of teaching endodontology at our institution was revised. Changes concerned: the programme (ie method of clinical training and summative assessment), and the supervision whilst performing root canal treatment on patients. An intermediate cohort (N=91) comprised partly students attending the former programme (involving patients) and partly students attending the revised programme (without patients). After succeeding in the summative assessment, the quality of the first root filling made by the student in a patient under supervision of either a general dental practitioner or an endodontist was evaluated according to pre-determined criteria. Data were analysed using Cohen's Kappa, Chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Sixty-two per cent (47 of 76) of root fillings made by students who attended the revised programme were of good quality, in comparison with 47% (seven of 15) of those made by students who attended the former programme (P=.274). Less complex treatments had better quality root fillings if students were supervised by endodontists (88% (14 of 16) good quality) than supervised by general dental practitioners (59% (22 of 37) good quality) (P=.045). Complex treatments did not differ in quality of root fillings for the supervision types (P=.825).

CONCLUSION

The quality of root fillings made by students who attended the revised programme seems at least as high as that of those who attended the former programme. Higher quality root fillings might be obtained under supervision of endodontists than under supervision of general dental practitioners.

Technical Quality of Root Canal Treatment Performed by Undergraduate Clinical Students of Isfahan Dental School

Introduction:

The aim of the present study was to evaluate the radiographic quality of RCTs performed by undergraduate clinical students of Dental School of Isfahan University of Medical Sciences.

Methods and Materials:

In this cross sectional study, records and periapical radiographs of 1200 root filled teeth were randomly selected from the records of patients who had received RCTs in Dental School of Isfahan University of Medical Sciences from 2013 to 2015. After excluding 416 records, the final sample consisted of 784 root-treated teeth (1674 root canals). Two variables including the length and the density of the root fillings were examined. Moreover, the presence of ledge, foramen perforation, root perforation and fractured instruments were also evaluated as procedural errors. Descriptive statistics were used for expressing the frequencies of criteria and chi square test was used for comparing tooth types, tooth locations and academic level of students (P<0.05).

Results:

The frequency of root canals with acceptable filling was 54.1%. Overfilling was found in 11% of root canals, underfilling in 8.3% and inadequate density in 34.6%. No significant difference was found between the frequency of acceptable root fillings in the maxilla and mandible (P=0.072). More acceptable fillings were found in the root canals of premolars (61.3%) than molars (51.3%) (P=0.001). The frequency of procedural errors was 18.6%. Ledge was found in 12.5% of root canals, foramen perforation in 2%, root perforation in 2.4% and fractured instrument in 2%. Procedural errors were more frequent in the root canals of molars (22.5%) than the anterior teeth (12.3%) (P=0.003) and the premolars (9.5%) (P<0.001).

Conclusion:

Technical quality of RCTs performed by clinical students was not satisfactory and incidence of procedural errors was considerable.

Evaluation of complications of root canal treatment performed by undergraduate dental students

This study evaluated the technical quality of root canal treatment (RCT) and detected iatrogenic errors in an undergraduate dental clinic at the College of Dentistry, Taibah University, Saudi Arabia. Dental records of 280 patients who received RCT between 2013 and 2016 undertaken by dental students were investigated by retrospective chart review. Root canal obturation was evaluated on the basis of the length of obturation being ≤2 mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as furcal perforation, ledge, canal transportation, strip perforation, root perforation, instrument separation, voids in the obturation, or underfilling or overfilling of the obturation. In 193 (68.9%) teeth, RCT was adequate and without procedural errors. However, in 87 (31.1%) teeth, RCT was inadequate and contained procedural errors. The frequency of procedural errors in the entire sample was 31.1% as follows: underfilling, 49.9%; overfilling, 24.1%; voids, 12.6%; broken instruments, 9.2%; apical perforation, 2.3%; and root canal transportation, 2.3%. There were no significant differences (p > 0.05) in the type or frequency of procedural errors between the fourth- and fifth-year students. Lower molars (43.1%) and upper incisors (19.2%) exhibited the highest and lowest frequencies of procedural errors, respectively. The technical quality of RCT performed by undergraduate dental students was classified as ‘adequate’ in 68.9% of the cases. There is a need for improvement in the training of students at the preclinical and clinical levels.

Influence of Method of Teaching Endodontics on the Self-Efficacy and Self-Perceived Competence of Undergraduate Dental Students

Objective:

This study assessed whether self-efficacy and the self-perceived competence of undergraduate dental students had been influenced by the method of teaching endodontics.

Methods:

Certain modules of the undergraduate endodontic programme at the Academic Centre for Dentistry Amsterdam (ACTA) including the tutorials, the clinical training and the assessment were revised. The self-efficacy and self-perceived competence close to graduation of an intermediate cohort of 24 students who attended all or some of the former modules or the revised modules were assessed. Additionally, the performance of students in performing root canal treatments was assessed according to predetermined criteria. Data were analysed using Cohen’s Kappa, Cronbach’s Alpha, Mann-Whitney and T-tests.

Results:

Self-efficacy and the self-perceived competence of students who followed the former modules of clinical training and assessment were similar to those of students who followed the revised modules. The revised module with higher number of tutorials increased students’ self-perceived competence, but did not influence their self-efficacy statistically significantly. Not the entire number, but the number of root canal treatments performed under supervision of endodontists was related with an increase in students’ self-efficacy and self-perceived competence. The performance of students in performing root canal tretaments was not statistically significantly related to their self-efficacy and self-perceived competence.

Conclusion:

Among the modules and their components assessed in the present study, only the number of tutorials and the number of root canal treatments performed under supervision of endodontists influenced the self-efficacy and the self-perceived competence of students.

Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta-analysis

The technical quality of root canal treatment (RCT) may impact on the outcome. The quality of education received during undergraduate school may be linked to the quality of treatment provided in general dental practice. In this context, the aim of this systematic review was to answer the following focused questions: (i) What is the frequency of acceptable technical quality of root fillings, assessed radiographically, performed by undergraduate students? (ii) What are the most common errors assessed radiographically and reported in these treatments? For this purpose, articles that evaluated the quality of root fillings performed by undergraduate students were selected. Data were collected based on predetermined criteria. The key features from the included studies were extracted. GRADE-tool assessed the quality of the evidence. MAStARI evaluated the methodological quality, and a meta-analysis on all studies was conducted. At the end of the screening, 24 articles were identified. Overall frequency of acceptable technical quality of root fillings was 48%. From this total, 52% related to anterior teeth, 49% to premolars and 26% to molars. The main procedural errors reported were ledge formation, furcation perforation, apical transportation and apical perforation. The heterogeneity amongst the studies was high (84-99%). Five studies had a high risk of bias, eight had a moderate risk, and 11 had low risk. The overall quality of evidence identified was very low. The conclusion was that technical quality of root fillings performed by undergraduate students is low, which may reveal that endodontic education has limited achievement at undergraduate level. A plan to improve the quality of root fillings, and by extrapolation the overall quality of root canal treatment, should be discussed by the staff responsible for endodontic education and training.

A Comparative Study of ProTaper Universal and ProTaper Next Used by Undergraduate Students to Prepare Root Canals

INTRODUCTION

The purpose of this study was to determine whether final-year undergraduate dental students achieved better shaping outcomes using the new ProTaper Next (PTN; Dentsply Sirona, Ballaigues, Switzerland) system to prepare root canals for the first time compared with the existing ProTaper Universal (PTU, Dentsply Sirona) system on which they had trained. A secondary aim was to explore the attitudes and preferences of the students toward both systems.

METHODS

Forty students prepared 1 simulated S-shaped canal using PTN and another with PTU. Images of the canals were saved before and after preparation, and the outcomes assessed included the formation of aberrations and the amount of resin removed at specific points along the canal length. Student opinions relating to PTN and PTU were collected via a questionnaire completed immediately after using the systems. For statistical analysis, the McNemar test was used to compare the incidence of aberrations, and a paired t test was used to analyze the width measurements. Responses to the questionnaire were analyzed using frequencies. Thus, the McNemar test was used for paired binary data and the marginal homogeneity test for categoric data when more than 2 categories were used. Finally, the overall preferences (either PTN or PTU) were analyzed using the sign/binomial test, which is a standard statistical test that allows us to determine if the proportion preferring one or the other is equal or not.

RESULTS

Canal ledges were formed in 30% of the canals prepared with PTU, whereas no ledges were formed with PTN (P < .001). A middle constriction, a form of canal aberration, was created by both systems although it occurred significantly (P = .006) more often with PTN. The "number of files" was judged by students to be significantly higher (P < .001) for PTU compared with PTN. Even though using PTN for the first time, students were more likely to recommend the system to other students for preparing S-shaped canals than PTU (P = .018) and preferred to use PTN in the future (P < .001).

CONCLUSIONS

The students who had previous experience with the use of PTU were able to produce comparable shaping outcomes when they used PTN for the first time. For the preparation of S-shaped canals, the students preferred PTN over PTU in terms of the number of files and would prefer to use it in the future.

A re-audit of the technical quality of undergraduate root canal treatment after the introduction of new technology and teaching practices

AIM

To revaluate through re-audit the technical quality of undergraduate nonsurgical root canal treatment (RCTx) in a dental teaching hospital as a result of recommended changes to teaching practices.

METHODOLOGY

The technical quality of undergraduate RCTx was evaluated radiographically after educational changes and the mandatory introduction of new technologies (nickel-titanium files, apex locators, greater taper gutta-percha points) in 182 root canals. Evaluation was based on four criteria: presence of voids, root canal filling termination (0-2 mm of radiographic apex), all roots filled and the prepared canal contained the original anatomy. Chi-squared analysis was used to determine statistically significant improvements in quality between the respective audits (P < 0.05).

RESULTS

Twenty-three of the 40 canals in single-rooted teeth (57.5%) and 68 of the 129 (52.7%) canals in multirooted teeth analysed had an acceptable root filling. This compared with 48% of canals in single-rooted teeth and 38% of canals in multirooted teeth in the original audit. Specifically, the frequency of root canal voids and unsatisfactory apical root filling termination were reduced in multirooted teeth by 23% and 14% and in single-rooted teeth by 11% and 12%, respectively, compared with the original audit. When multirooted teeth were taken as one unit, 45.2% were considered to be acceptable, significantly better than the 18.8% multirooted teeth in the original audit (P = 0.042). Deviations from the canal anatomy on radiographic examination were rare findings in both audits.

CONCLUSIONS

Changes to endodontic teaching practices significantly improved the technical standards of undergraduate root filling in multirooted teeth. The regular auditing of undergraduate teaching practice is necessary to inform current teaching, instigate change and improve standards.

Undergraduate Confidence When Undertaking Root Canal Treatment and Their Perception of the Quality of Their Endodontic Education

The General Dental Council expects graduating dentists to be competent at treating pulpal disease. Previous studies have found dental undergraduates to have low levels of confidence with respect to endodontic treatments. The aim of this study was to investigate the confidence of undergraduate dental students at the University of Bristol when performing root canal treatment, and to investigate their perception of the quality of their endodontic education. An anonymous questionnaire, based upon one used in a 2015 study at Cardiff University, was distributed to all (n = 204) undergraduate students in Years 3–5 at the University of Bristol. The results were analysed using the Statistical Package for the Social Sciences software (SPSS). There was a 59% (n = 120) response rate and a significant (p < 0.01) difference in confidence levels for root canal treatments (RCTs) completed between these students. All (100%) Year-5 students felt confident in completing anterior RCTs, and 91% felt confident in completing posterior RCTs. The majority (93%) of Year-4 students felt confident in completing anterior RCTs, and 77% felt confident in completing posterior RCTs. Over one-half (56%) of Year-3 students felt confident in anterior RCTs and 17% in posterior RCTs. With respect to the individual stages of RCT (access cavity, cleaning and shaping of root canal system, and obturation/filling), results showed that there was a significant difference (p < 0.01) in confidence levels between year groups. Many students thought the amount of time spent on endodontic teaching and the quality of teaching to be satisfactory. Improvements suggested for future endodontic teaching included higher numbers of staff supervision and additional endodontic practice on extracted teeth before seeing patients. There was a strong association between students’ clinical experience and their levels of confidence when completing RCT. Increasing the amount of clinical experience of RCTs could enhance students’ confidence further.

Technical quality assessment of root canal treatment performed by preclinical dental students at Taibah University, KSA

Objectives

The aim of this study was to evaluate the technical quality of root canal treatment (RCT) performed by preclinical undergraduate dental students at the Dental College of Taibah University KSA.

Methods

In this study, 259 extracted teeth were treated endodontically by preclinical students of the College of Dentistry, Taibah University, KSA, from 2013 to 2015. The evaluation criteria were root canal obturation length, root canal obturation density (homogeneity), and root canal obturation taper. A specific score (0, 1, or 2) was assigned to each parameter.

Results

Of 259 endodontically extracted teeth, 138 (53.3%) had RCT of unacceptable technical quality, 42 (16.2%) had treatment of slightly acceptable technical quality, 50 (19.3%) had treatment of acceptable technical quality, and 29 (11.2%) teeth had RCT of perfectly acceptable technical quality. There were no significant differences (p > 0.05) in the technical quality of root canal obturation among types of teeth.

Conclusion

The results of this study showed that there were varied levels of technical quality of root canal treatment performed by preclinical undergraduate dental students, and the outcome varied between unacceptable, slightly acceptable, acceptable, and perfectly acceptable. The unacceptable cases were the most common, representing more than half of all cases, and the perfectly acceptable cases were the least common. There is an urgent need to improve the endodontics teaching programmes in the College of Dentistry of Taibah University. This research should be repeated in the future to evaluate improvement in the performance of RCT by undergraduate dental students in Taibah University.

Experimental polyethylene-hydroxyapatite carrier-based endodontic system: an in vitro study on dynamic thermomechanical properties, sealing ability, and measurements of micro-computed tomography voids

The dynamic thermomechanical properties, sealing ability, and voids formation of an experimental obturation hydroxyapatite-reinforced polyethylene (HA/PE) composite/carrier system were investigated and compared with those of a commercial system [GuttaCore (GC)]. The HA/PE system was specifically designed using a melt-extrusion process. The viscoelastic properties of HA/PE were determined using a dynamic thermomechanical analyser. Human single-rooted teeth were endodontically instrumented and obturated using HA/PE or GC systems, and then sealing ability was assessed using a fluid filtration system. In addition, micro-computed tomography (μCT) was used to quantify apparent voids within the root-canal space. The data were statistically analysed using one-way anova and post hoc tests. The HA/PE composite exhibited important modulus and damping changes with an increase of temperature. The HA/PE system was more flexible than GC as the modulus of GC appeared to be significantly higher than that of HA/PE as a result of the high positive glass transition temperature (Tg ). However, HA/PE and GC presented similar sealing abilities. In conclusion, because sealing ability and voids formation were comparable between the tested materials, the experimental HA/PE system may be considered a suitable alternative material for root-canal obturation. Moreover, HA/PE possesses specific viscoelastic behaviour and lower melting points, which may facilitate root-canal retreatments.

Effects of Clinical Training and Case Difficulty on the Radiographic Quality of Root Canal Fillings Performed by Dental Students in Saudi Arabia

Introduction:

The aim of this study was to evaluate the effects of training duration and case difficulty on the radiographic quality of root canal fillings performed by dental students in Saudi Arabia.

Methods and Materials:

A longitudinal cohort study was conducted at King Saud University. Root canal treatments performed by 55 dental students from 2012-2014 were included in the study. Each student treated at least five teeth during the first year of clinical endodontic training and another five teeth during the second year. Case difficulty was assessed based on tooth position in the dental arch and preoperative conditions. The radiographic quality of the root canal filling was evaluated by two endodontists blinded to treatment completion date. The evaluation criteria were adequate obturation, presence of mishaps and preparation taper. The data were statistically analysed using univariate and multivariate logistic regression analyses; and the level of significance was set at 0.05.

Results:

Inadequate obturation and mishaps were significantly less prevalent in teeth treated after 2 years of clinical training. The odds ratios for inadequate obturation and mishaps increased significantly as tooth position moved posteriorly. Inadequate obturation and more mishaps were significantly more prevalent in teeth with preoperative conditions. Preparation taper was not significantly affected by training duration or case difficulty.

Conclusion:

The quality of root canal fillings performed by Saudi students was adversely affected by case difficulty. The radiographic quality of root canal fillings improved significantly after 2 years of clinical training. Preparation taper outcome is likely dependent on the preparation technique and instrument taper.

The confidence of undergraduate dental students when performing root canal treatment and their perception of the quality of endodontic education

AIM

This article aims to gain understanding into the perception of undergraduate dental students in terms of their confidence and competence at performing root canal treatment and their perception of the quality of endodontic education.

METHODS

An online questionnaire was distributed to all 3rd, 4th and 5th year dental students at Cardiff University via their academic e-mail addresses. The questionnaire utilised both scaled response and open questions to gain an insight into undergraduate opinion.

RESULTS

Out of a possible 208 students, 98 responses were obtained (response rate = 47%). Perception of competence and confidence were significantly greater amongst the more senior year groups (P < 0.01). However, 49% (n = 38) of participants did not feel competent performing root canal treatment on anterior, single-rooted teeth, whilst 74% (n = 70) did not feel competent performing root canal treatment on posterior, multirooted teeth. Free comments from participants indicated that this was due to a lack of clinical experience. Approximately, 80% of participants ranked education in endodontics at Cardiff University as ≤5 on a Likert scale (1 = inadequate to 10 = good), indicating that improvement was required. Improvements that were suggested by the students included the provision of further information within lectures, a broader range of lecturers, an increased number of shorter, more organised practical sessions, additional training equipment, greater supervision and online reference guides to root canal treatment.

CONCLUSION

Enhancing undergraduate education in endodontics is necessary to increase students' perception of their confidence and competence when performing root canal treatment.

Technical quality of root canal therapies performed by novice dental students in preclinical practice

Background:

For improving the quality of endodontic performance of practitioners in clinical practice, their basic, preclinical performance and knowledge must be taken into consideration. This study aimed to radiographically evaluate the technical quality of preclinical molar root canal treatments (RCTs) performed by undergraduate dental students at a dental school in Iran. Further, the effect of using Gates-Glidden (GG) drills on the final quality of RCTs was evaluated.

Materials and Methods:

In this retrospective cross-sectional study, 315 roots of 105 endodontically treated teeth in preclinical practice were evaluated radiographically. The analyzed quality parameters included length, taper and density of fillings, which were scored as S2 (adequate standard), the S1 (slight deviation), or S0 (considerable deviation). For all the parameters, acceptable, moderate and poor fillings received total scores of 6, 3-5 and 0-2, respectively. There were two groups of students: One group had used only K-files, and the other had used K-files along with GG drills. The quality of RCTs between these groups was evaluated using the aforementioned scoring protocol. The results were analyzed using Chi-square, Mann–Whitney and Fisher's exact tests (α = 0.05).

Results:

Under-fillings (P = 0.001) and under-shapings (P = 0.007) occurred mostly in mandibular root fillings. A lower density was found in maxillary fillings (P < 0.001). No relationship was observed between the technique used (irrespective of GG drills usage) and length (P = 0.499) and taper of fillings (P = 0.238). The roots instrumented with GG drills had a higher filling density (P = 0.004). The quality mean score of RCTs was improved when GG drills were used (P = 0.008).

Conclusion:

The technical quality of preclinical molar RCTs performed by undergraduate dental students was considered acceptable in 35.6% of the cases. When GG drills were used along with K-files, the technical quality of RCTs was enhanced.

Technical quality of root fillings performed by undergraduate students: a radiographic study

AIM

The aim of this study was to evaluate the radiographic technical quality of endodontic treatment performed by undergraduate students at the School of Dentistry, Faculty of Medicine, University of Novi Sad, Serbia.

MATERIALS AND METHODS

Electronic records of 220 patients treated by final-year undergraduate students during the school year 2011/2012 were examined, and the final sample consisted of 212 patients, 322 teeth, and 565 root canals. The criteria for overall radiographic adequacy of root canal fillings were defined as the presence of adequate length and density and absence of iatrogenic errors (ledge, fractured instrument, untreated canal, and apical transportation). Chi-square test was used to determine statistical significance between different parameters.

RESULTS

Adequate root canal fillings were found in 74.22% of the teeth. The percentage of root fillings with adequate length and density was 89.73% and 92.6%, respectively. Fractured instruments and ledges were present in 16 root canals (2.8%), while the presence of missed canal and apical transportation was observed in 2 cases, each (0.3%).

CONCLUSIONS

Overall, the technical quality of root canal fillings performed by undergraduate students was satisfactory.

Radiographic technical quality of root canal treatment performed ex vivo by dental students at Valencia University Medical and Dental School, Spain

Objectives: To evaluate radiographically the quality of root canal fillings and compare manual and rotary preparation performed on extracted teeth by undergraduate dental students. Study Design: A total of 561 premolars and molars extracted teeth were prepared using nickel-titanium rotary files or manual instrumentation and filled with gutta-percha using a cold lateral condensation technique, by 4th grade undergraduate students. Periapical radiographs were used to assess the technical quality of the root canal filling, evaluating three variables: length, density and taper. These data were recorded, scored and used to study the “technical success rate” and the “overall score”. The length of each root canal filling was classified as acceptable, short and overfilled, based on their relationship with the radiographic apex. Density and taper of filling were evaluated based on the presence of voids and the uniform tapering of the filling, respectively. Statistical analysis was used to evaluate the quality of root canal treatment, considering p < 0.05 as a statistical significant level. Results: The percentage of technical success was 44% and the overall score was 7.8 out of 10. Technical success and overall score were greater with rotary instruments (52% against 28% with a manual one, p < 0.001; 8.3 against 6.7 respectively, p < 0.001). Conclusions: It appears that inexperienced operators perform better root canal treatment (RCT) with the use of rotary instrumentation.

Key words:Dental education, endodontics, rotary instrumentation, radiographs, root canal treatment, undergraduate students.

Dental students' perceptions about the endodontic treatments performed using NiTi rotary instruments and hand stainless steel files

This study evaluated the perceptions of Brazilian undergraduate dental students about the endodontic treatments performed using NiTi rotary instruments and hand stainless steel. Data were collected using a questionnaire administered to undergraduate dental students enrolled in endodontic disciplines. The students were divided into 3 groups: G1, students who had treated straight canals with SS hand instruments; G2, students who had treated curved canals with SS hand instruments; and G3, students who had treated both straight and curved canals with NiTi rotary instruments. The number of endodontic treatments performed, types of treated teeth, students' learning, time spent, encountered difficulties, quality of endodontic treatment and characteristics of the employed technique were analyzed. There was a 91.3% rate of return for the questionnaires. Mandibular molars were the most frequently treated teeth, followed by maxillary incisors. The Kruskal-Wallis test showed no differences in learning (p=0.528) or in the characteristics of the technique employed (p=0.560) among the three groups. G3 students performed a greater number of endodontic treatments (p<0.001) in a smaller time (p<0.001) than did G1 and G2 students. Difficulties were reported primarily by students in G2 and G3 compared with G1 (p=0.048). The quality of endodontic treatments differed only between G1 and G2 (p=0.045). The use of NiTi rotary instruments should be included in undergraduate dental curriculum, contributing to the increase of patients assisted and consequently to improve the clinical experience of the students.

Technical quality of root canal fillings done in a Nigerian general dental clinic

Background

Previous reports indicate that worldwide, the technical quality of root canal fillings is poor. There are few reports from sub-Saharan Africa and none yet from Nigeria where most patients access treatment from non-specialists especially at general dental clinics. The aim of this study was to evaluate the technical quality of root canal fillings done in a general dental clinic with emphasis on the effects of professional experience of the operator, whether tooth was anterior or posterior and whether it was a maxillary or mandibular tooth.

Methods

Retrospective study of case notes and periapical radiographs of patients with completed root canal fillings seen between 2008 and 2011. Inclusion criteria included cases of primary treatment with available case notes, good quality pre-operative and post-operative periapical radiographs. Technical quality that was assessed was root canal length and homogeneity. Root canal fillings were classified either as Good Quality Endodontic Work (GQEW) or Non- Good Quality Endodontic Work (NGQEW).

Results

Fifty-one patients aged between 8 and 54 years (mean 28) fulfilled the inclusion criteria for this study. From these, there were 62 root filled teeth giving a ratio of 1.2 root canal filled teeth per person. There were acceptable length of root canal fillings in 71% of teeth, 58.1% were homogeneous while 53.2% were GQEW. There was no statistically significant difference in whether tooth was root filled by junior or senior dentist (p = 0.43), anterior or posterior (p = 0.11). There was significant association between GQEW and maxillary teeth (p = 0.03).

Conclusion

This study showed that the overall technical quality of root canal fillings done by non-specialists was better than earlier reports but lower than that done by endodontists. Since many patients receive treatment from non-specialists in developing countries, it is necessary to improve technical quality of root canal fillings done in general dental clinics. These could be through improvement in the quality of undergraduate training and more post graduate continuing education courses for skills update.

A clinical trial of cold lateral compaction with Obtura II technique in root canal obturation

INTRODUCTION

The purpose of obturation of the prepared root canal space is to prevent coronal leakage and bacterial contamination and to seal the apex from the periapical tissue fluids. Cold lateral technique has been considered to be a gold standard, however considering its limitations various thermoplasticized gutta-percha techniques have been recommended. This study compares radiographic quality of obturation in molar teeth, obturated with cold lateral condensation and thermoplasticized injectable gutta-percha technique (Obtura II system).

MATERIALS AND METHODS

Sixty patients were equally divided into two groups, Group A obturated with Cold lateral condensation technique and group B with Obtura II. Periapical radiographs were obtained immediately after the obturation using paralleling device method. The radiographs were examined by an observer, who was blinded to the group allocation. Data was compared using χ(2) (Chi square) test and Independent sample t test was used to compare the mean ages.

RESULTS

Both groups were comparable in all respects such as tooth type, preoperative diagnosis and preoperative pain (P>0.05); however, more pre-operative radiolucency cases were allocated to Obtura II (P<0.05). There was no difference between the two groups, both in terms of postoperative voids as well as apical termination of the obturation (P>0.05).

CONCLUSION

Within the limitations of the study, it was found that statistically there was no significant difference between cold lateral and obtura II technique, in terms of post obturation voids and apical termination, as observed in radiographs.

Three-dimensional image contribution for evaluation of operative procedural errors in endodontic therapy and dental implants

Acceptable therapeutic protocol in dentistry depends on the outcomes obtained with follow up. Operative procedural errors (OPE) may occur and they represent risk factors able to compromise a tooth or a dental implant. The aim of this study was to detect the OPE in endodontically treated teeth and dental implants, using cone beam computed tomography (CBCT).Eight hundred and sixteen CBCT exams were performed between January 2009 and October 2010, and only those which presented endodontically treated teeth and/or dental implants were selected. The sample was as follows: 195 CBCT exams (n=200 teeth and 200 dental implants), 72 male, 123 female, with mean age of 51 years.In endodontically treated teeth, OPE included underfilling, overfilling, and root perforation; OPEin dental implants were thread exposures, contact with anatomical structures, and contact with adjacent teeth. Kolmogorov-Smirnov test was used for statistical analysis, with significance level set at α=0.05. Underfilling, overfilling, and root perforations were detected in 33.5%, 8% and 4.5% of the teeth, respectively. Dental implants with thread exposures, contact with important anatomical structures and contact with adjacent teeth were seen in 37.5%, 13% and 6.5% of the cases, respectively. OPE were detected in endodontically treated teeth and dental implants, and underfilling and thread exposures were the most frequent occurrences, respectively.

Radiographic quality of root fillings performed by undergraduate students

AIM

To evaluate the radiographic technical quality of root fillings and the incidence of iatrogenic errors in treatment provided by undergraduate students.

METHODOLOGY

Endodontic records and periapical radiographs of 759 root filled teeth were selected following exclusion of 25 (3.3%). A final total of 734 cases were used to assess the technical quality of root fillings in 1109 root canals performed by 4(th) and 5(th) undergraduate students. Two variables were examined: the length and the density of the fillings, categorized as acceptable and non-acceptable. The presence of ledges, root perforation, foramen perforation and fractured instruments were also investigated. Chi-square tests were used for statistical analysis.

RESULTS

Acceptable root fillings were found in 55% of canals. More ;acceptable' root fillings occurred in maxillary compared to mandibular teeth (58 and 51% respectively) (P < 0.05) and in anterior compared with premolar (71 and 61%) and molar root canals (39% respectively) (P < 0.05). Insignificantly more (5.4%) acceptable root fillings were provided by 5(th) year students. Most of the underfillings and iatrogenic errors were detected in molars for both academic years (53 and 65% respectively). Ledges were noted in 55% of cases treated by both academic years and significantly more foramen perforations were detected in the 5(th) compared with the 4(th) year students (P < 0.05).

CONCLUSIONS

There is a need to improve the technical quality of root fillings performed by the undergraduate students, especially in molar teeth.

Radiographic evaluation of the technical quality of root canal fillings performed by dental students

The objective of this study was to evaluate radiographically the technical quality of root canal fillings performed by dental students at the School of Dentistry, University of the West Indies. The school's database between 2000 and 2004 was investigated for patients with completed root canal treatment. The final sample consisted of 198 patients with 288 root-filled teeth and 460 canals. The length, presence of voids, taper, curvature of canal and fractured instruments were recorded and scored. Chi-squared analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type. Sixty-three per cent, 27.6% and 72.2% of root-filled canals had adequate length, density and taper respectively. The overall acceptability of root fillings having adequate length and taper, absence of voids and no fractured instruments was found in 10.9% of canals. Changes in teaching methods may be required to improve the technical quality of root canal treatment done by dental students.

Radiographic quality of root canal fillings performed in a postgraduate program in endodontics

The aim of this study was to evaluate the standard quality of 1,347 root fillings performed by postgraduate students in Endodontics according to 3 radiographic quality parameters. The analyzed quality parameters included apical extension (AE), taper (TA) and homogeneity (HO), which received scores S2 (ideal standard), S1 (slight deviation) or S0 (accentuated deviation). A perfect filling (PF) received S2 for all parameters. In the absence of one or two S2 score, the fillings were deemed as satisfactory (SF) or deficient (DF), respectively. The results showed 51.7%, 41.5% and 6.8% of PF, SF, and DF, respectively. AE, TA, and HO presented equivalent quality parameters in root-filled canals of mandibular incisors and mandibular premolars (p>0.05). Conversely, in maxillary incisors, canines and distal root of mandibular molars, significant differences (p<0.05) were found between 2 parameters. Besides, there were significant differences (p<0.05) among the measured parameters in root-filled canals of maxillary premolars, all root canals of the maxillary molars and mesial root of the mandibular molars. AE showed the lowest frequency of S2 score for all groups. In conclusion the prevalence of perfect, satisfactory and deficient fillings varied significantly according to the root canal group. The quality parameters categorized fillings in 3 complexity degrees. AE was the most critical parameter of quality in root canal fillings.

Technique acquisition in the use of two thermoplasticized root filling methods by inexperienced dental students: a microcomputed tomography analysis

INTRODUCTION

Limited endodontic experiences in dental schools suggest the need for easy-to-learn techniques. Therefore, two simplified root filling methods were assessed for adequacy and expediency when performed by inexperienced students.

METHODS

Eight students were trained (45-minute lecture and 90-minute practice) in use of ProTaper Obturators (PTO) and System-B/Calamus (SBC). They subsequently filled the root canals in two extracted, single-rooted teeth per method (n = 32). Canals were preshaped and prefitted with obturators and master cones. The volume of root-filling voids determined by microcomputed tomography imaging in 1-mm increments, time to complete fillings, and students' responses in questionnaires were analyzed (independent-sample t test and Mann-Whitney U test).

RESULTS

PTO had a significantly smaller void volume in the apical 6 mm of canals (P < 0.001), required significantly shorter time (P < 0.001), and was perceived as easier to learn and use but less likely to be favored after graduation than SBC.

CONCLUSION

These results suggested that the PTO root filling method was particularly suitable for teaching when endodontic experiences available for students are limited.