An audit of root canal filling quality performed by undergraduate pre-clinical dental students, Yemen

Assessment of dental students' knowledge and performance of master gutta-percha cone selection and fitting during root canal treatment: a pilot study

BACKGROUND

Misconceptions should be detected early in dental students' training to improve their clinical performance. Accordingly, this study aimed to assess undergraduate dental students' knowledge and performance of master gutta-percha (GP) cone selection and fitting during clinical endodontic courses at the College of Dentistry, King Saud University.

METHODS

Ninety-nine undergraduate dental students completed an online survey about their knowledge of master GP cone selection. Forty-five of these students were observed by faculty members in clinical endodontic courses while they fitted master GP cones during root canal treatments. The observers recorded the details of each student's cone-fitting techniques. The data were analysed using t-tests, one-way analysis of variance, and chi-square tests (p < 0.05). Inter- and intra-observer reliability were tested using Fliess' Kappa.

RESULTS SURVEY

All participants had good knowledge of over-extended cone management, while 80.8% knew how to properly manage a short cone. The proper flaring assessment method was selected by 86.9% of the female and 34.2% of the male students, and this difference was statistically significant (p = 0.0001).

OBSERVATION

The students labelled the working length on the master GP cone with an indentation in 64.4% of the cases and by bending the cone 35.6% of the time. Of all students, 84.4% encountered an apical stop, and this rate correlated significantly with the length of the cone on the master apical cone radiograph (p = 0.001). Improper shaping of the canal was the most common cause of ill-fitting cones (83.3%), while 16.7% of the students chose the wrong cone size. The final obturation length was adequate in 80% of the cases; 57.8% of the students were helped by instructors.

CONCLUSIONS

Most students had the basic knowledge required to solve problems related to the selection of master GP cones. However, in the clinical setting, more than half of the students required the assistance of an instructor to adjust their cone's fit. The presence of an apical stop had the most significant effect on the length of the fitted master GP cone on radiography. The most common cause of ill-fitting master cones was improper shaping of the canal.

Mixed reality guided root canal therapy

Root canal therapy (RCT) is a widely performed procedure in dentistry, with over 25 million individuals undergoing it annually. This procedure is carried out to address inflammation or infection within the root canal system of affected teeth. However, accurately aligning CT scan information with the patient's tooth has posed challenges, leading to errors in tool positioning and potential negative outcomes. To overcome these challenges, a mixed reality application is developed using an optical see-through head-mounted display (OST-HMD). The application incorporates visual cues, an augmented mirror, and dynamically updated multi-view CT slices to address depth perception issues and achieve accurate tooth localization, comprehensive canal exploration, and prevention of perforation during RCT. Through the preliminary experimental assessment, significant improvements in the accuracy of the procedure are observed. Specifically, with the system the accuracy in position was improved from 1.4 to 0.4 mm (more than a 70% gain) using an Optical Tracker (NDI) and from 2.8 to 2.4 mm using an HMD, thereby achieving submillimeter accuracy with NDI. 6 participants were enrolled in the user study. The result of the study suggests that the average displacement on the crown plane of 1.27 ± 0.83 cm, an average depth error of 0.90 ± 0.72 cm and an average angular deviation of 1.83 ± 0.83°. Our error analysis further highlights the impact of HMD spatial localization and head motion on the registration and calibration process. Through seamless integration of CT image information with the patient's tooth, our mixed reality application assists dentists in achieving precise tool placement. This advancement in technology has the potential to elevate the quality of root canal procedures, ensuring better accuracy and enhancing overall treatment outcomes.

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 endodontic record-keeping and root canal obturation performed by final year undergraduate dental students: An audit during the COVID-19 pandemic

BACKGROUND

To assess the quality of endodontic record-keeping and root canal obturation performed by undergraduate final year dental students during the COVID-19 pandemic.

MATERIALS AND METHODS

Dental records and dental radiographs of patients who received endodontic treatments between March 2020 and March 2022 by undergraduate students during the COVID-19 pandemic were included. The audit data were collected based on the European Society of Endodontology guidelines retrospectively via assessing the patient's clinical records and intraoral periapical radiograph. Root canal obturation quality was evaluated based on the following parameters: adaptation, length, taper, and mishap. A root filling is defined as satisfactory only when all four parameters were graded as acceptable. Subsequently, the data were recorded and analysed using Chi-Square test with the level of significance set at p = 0.05.

RESULTS

A total of 111 patient records with 111 root canal-treated teeth were evaluated. The highest percentage of documented evidence was noted in the patient's general records, while the endodontic treatment records showed the lowest percentage of documented evidence. 78 (70.3%) of root canal-treated teeth were deemed satisfactory with acceptable adaptation, length, taper, and absence of mishap. Moreover, no statistical significance in terms of root canal filling quality was noted between anterior and posterior teeth, and between maxillary and mandibular arch.

CONCLUSIONS

Although patient records and root canal fillings quality were deemed satisfactory in most cases, strict documentation requirements and continuing dental education in audit training are necessary for quality assurance.

A Comparative Study of Two Martensitic Alloy Systems in Endodontic Files Carried out by Unskilled Hands

The aim of this study was to compare the behavior of two heat-treated file systems on resin blocks in unskilled hands. For this purpose, an in vitro, randomized, cross-sectional study was conducted to compare ProTaper Gold (PTG) with BlueShaper (BS) files. A total of 81 resin blocks were used and analyzed photographically to assess the amount of material removed during instrumentation. PTG removed more material on the outside of the curve in the coronal and apical third, while BS removed more material on the inner part of the curve in the middle third. The procedural errors observed in the total sample were apical transportation (33.8%), blockages (4.9%), ledges (3.7%), and canal perforation. PTG produced more apical transportation, and there were no statistically significant differences between the groups in the formation of ledges, canal perforations, or blockages. No file fractures were recorded during the study. Within the limitations of this study, we can affirm that neither file excessively deformed the artificial canals, and the PTG file produced more apical transportation.

A Comparative Evaluation of Endodontically Treated Root Canals Obturated Using Gutta-percha with Two Different Protocols: An In-vitro Study

OBJECTIVE

The aim of this article is to evaluate the quality of filling in endodontically treated root canals using the lateral condensation technique and modified lateral condensation technique.

MATERIALS AND METHODS

Thirty-two single-rooted teeth were divided into two groups that were assigned by simple randomization according to the filling technique. Once the endodontic treatment was performed, a periapical radiograph was taken to assess the quality according to the radiographic density and tomography was taken to evaluate the quality according to the tomographic volume of spaces, compared with the post-preparation biomechanical tomography. Finally, we performed a statistical analysis (Student's t-test) to evaluate whether there were differences between the types of filling.

RESULTS

Radiographic radiodensity was 182.89 ± 9.81 and 186.72 ± 6.97 HU for teeth treated with the lateral condensation technique and modified lateral condensation technique, respectively. The void volume was 3.75 ± 2.35 and 2.43 ± 1.18 mm³ for teeth treated with the lateral condensation technique and modified lateral condensation technique, respectively.

CONCLUSION

No significant differences were found between the techniques for both filling quality parameters.

Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study

Endodontic mishaps during root canal treatment (RCT) are considered to be one of the most commonly encountered errors, which affect the quality of treatment and may have dangerous health implications for patients.The present study was conducted to assess the frequency and types of endodontic mishaps in root canal-treated teeth performed by undergraduate dental students.A total 404 endodontically treated teeth were performed by undergraduate dental students of King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia. The radiographs of the endodontically treated teeth were studied for a period of 6 months, and the related demographic data were collected from patient files.The most commonly identified mishaps were related to obturation, where the maximum number of cases (68.1%) had under-obturated root canals. More endodontic mishaps were performed by students in level 9 education. The upper left 2nd molar teeth had a higher frequency of mishaps, and molars were found to have more access-related mishaps. Lastly, access-related and instrument-related mishaps had a low frequency of occurrence.The majority of endodontic mishaps found in the study sample were related to root canal obturation. The undergraduate students at level 9 were less proficient in conducting RCTs with many endodontic mishaps when compared to the cases performed by students at higher levels. The study suggests relevant guidance for dental students while performing RCTs, especially during obturation of the root canals.

Retrospective audit for quality assessment of root fillings performed by undergraduate dental students in clinics

Objectives

To evaluate the technical quality of root canal obturations performed by undergraduate students.

Methods

The records of 347 patients who underwent endodontic treatment by undergraduate students of Qassim University between 2018 and 2020 were assessed using standardised criteria based on obturation length, density and taper. All teeth that received primary endodontic treatment and had post-obturation periapical radiographs depicting the entire radicular length and the 2–3-mm periradicular area were included in the study.

Results

A total of 653 canals of 397 teeth were evaluated. The maxillary central incisor was the most commonly assessed tooth (15.1%). Overall, 80.2% of the evaluated canals were deemed acceptable based on all three assessment criteria. Maxillary teeth had significantly better obturation quality than the mandibular teeth. The mesio-lingual canal had the lowest quality in all three criteria.

Conclusions

The technical quality of root canal obturations performed by undergraduate students in Qassim University was acceptable in the majority of the evaluated cases. Among the evaluated parameters of obturation quality, length control was the most frequently observed deficiency. Additional measures are therefore required to improve the quality of the obturation length.

Evaluation of new endodontic tooth models in clinical education from the perspective of students and demonstrators

BACKGROUND

The quality of root canal treatments performed by undergraduate students is often unsatisfactory questioning the current methods of teaching. Based on treatment errors made by students participating the endodontic courses at RWTH Aachen University (Germany), new radiopaque artificial root canal treatment models (DRSK RCT; incisor, premolar, molar) were designed and developed. The aim of the study was to evaluate these models by groups of students and demonstrators.

METHODS

A total number of 60 students and seven demonstrators from a single institution (RWTH Aachen) participated in this study. They performed endodontic treatments on either initial versions of the DRSK RCT or modified versions. The initial versions were evaluated by students (n = 25) and demonstrators (n = 7). The obtained questionnaire was conducted as 7-point Likert-Scale covering the topics material properties, feeling while performing exercises and perception of its closeness to reality via 19 items (students) and 21 items (demonstrators). According to the evaluations several alterations were applied to the DRSK RCT, the whole study was repeated and evaluated by different students (n = 35) and the same demonstrators (n = 7). Additionally, the demonstrators blindly evaluated the quality of root canal treatments performed by the students (n = 35) on the modified DRSK RCT. Comparisons between the initial versions and the modified versions were calculated using Chi-squared tests.

RESULTS

Students as well as demonstrators positively evaluated both variants of the DRSK RCT with especially high ratings in the overall evaluation. Students' rating of the pulp anatomy significantly increased from 5.4 ± 1.1 (mean ± SD) to 5.9 ± 0.9 (mean ± SD; p < 0.05) for the modified model. Likewise, students felt that the ability to flare root canals improved after alterations have been applied. Ratings significantly increased from 4.8 ± 1.6 (mean ± SD) to 5.6 ± 1.0 (mean ± SD; p < 0.05).

CONCLUSION

The results indicate that the DRSK RCT is a promising candidate to be used as an alternative to extracted teeth or as an additional tool for improving dental education. However, some limitations of our analysis have to be considered.