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

Technical Quality of Root Fillings Performed by Undergraduate Dental Students in Single-Canal Teeth: A 10-Year Retrospective Study

OBJECTIVE

This study assessed the radiographic technical quality of root fillings in single-canal teeth performed over a decade (June 2013 to June 2023) by undergraduate dental students of the Federal University of Campina Grande.

METHODS

All teeth underwent chemomechanical preparation using Gates-Glidden drills and hand instrumentation with stainless steel files up to 1 mm short of the root apex. Apical expansion was performed with up to two or three instruments above the initial anatomical apical diameter. The canal was filled in the absence of signs and symptoms of infection using gutta-percha cones and Sealer 26 or MTA Fillapex. A post-filling radiograph was routinely taken to assess the quality of root filling and coronal restoration. An experienced researcher trained and calibrated an examiner to evaluate post-operative periapical radiographs considering root-filling length, lateral adaptation and taper using ImageJ 1.52q software. Root filling was satisfactory when reaching acceptable classifications for the three parameters. The chi-squared test compared tooth type, dental arch and pulpal diagnosis at a 5% significance level.

RESULTS

The study assessed 124 canals, showing 90 (72.6%) satisfactory root fillings. The sub-analysis of individual parameters demonstrated that 105 (84.7%) root fillings had acceptable length, 113 (91.1%) adapted well to lateral canal walls, and 109 (87.9%) had proper taper. Most cases occurred in maxillary teeth (n = 99), pulp necrosis was the most frequent pulpal diagnosis (n = 89), and root-filling quality showed no association with tooth type, dental arch or pulpal diagnosis.

CONCLUSION

The technical quality of root fillings in single-canal teeth treated by dental students was predominantly satisfactory.

A Comparative Analysis of the Quality of Root Canal Fillings of In Vivo Studies Conducted in Saudi Arabia and Worldwide: A Systematic Review

Aim

Root canal treatment (RCT) is a common procedure practiced daily by dentists worldwide. The current systematic review aimed to evaluate and compare clinical studies on the quality of root canal fillings (RCFs) carried out by dentists with different levels of experience conducted worldwide with those conducted specifically in Saudi Arabia (SA).

Materials and Methods

A full literature search was conducted in Clarivate Analytics' Web of Science, Elsevier's Scopus, Embase, CINHAL, and PubMed, without a restriction to studies published before January 2015. Also, a manual search was carried out by checking papers that may have been missed during the electronic search. The following keywords were used: [(quality of root canal filling(s)) OR (quality of root canal obturation)) and dental practitioners as (general dental practitioners; final year students; endodontist; specialist) AND (root canal obturation) OR (endodontic treatment)]. Parameters of the quality of RCFs, such as length, density, and taper, were assessed and counted.

Results

A total of 13 worldwide and nine SA studies were included in this review, published between 2015 and 2023. Molars were the most treated teeth, at 42.3% and 40.2% for the worldwide and SA studies, respectively. Cases treated by final year students had the highest percentage, at 60.0% for both study groups. The percentages of acceptable quality, with regard to the length, density, and taper of RCFs, were 70.9%, 77.6%, and 84.3%, and 73.2%, 64.6%, and 67.8% for the worldwide and SA studies, respectively.

Conclusion

The overall acceptable quality of RCFs was marginally higher in worldwide studies than in SA studies. Both prevalences can be considered as good, which indicates that the quality of RCFs is moving in the right direction.

Quality of Root Canal Fillings and Procedural Errors for In Vivo Studies Prepared in Different Clinical Settings and with Rotary Systems: A Systematic Review

BACKGROUND This systematic review of the literature aimed to identify published studies and evaluate them on the quality of root canal fillings (RCF) and procedural errors with rotary systems for in vivo studies prepared for different clinical settings. MATERIAL AND METHODS A full literature exploration was conducted in Clarivate Analytics' Web of Science, Elsevier's Scopus, Embase, and PubMed for studies published between January 2020 and March 2024. A manual search was also performed by reviewing the references of selected papers. The following keywords were used: quality of root canal filling(s) OR quality of root canal obturation, root canal obturation OR endodontic treatment, clinical setting (academic, private, governmental), AND/OR procedural errors and rotary instrumentation. RESULTS Sixteen clinical studies were included in this review. The acceptance percentages for obturation length, density, and taper were 76.3%, 74.7%, and 82.5%, respectively, indicating significantly high, good ratios. The overall RCF recorded showed that 68.2% of root canal obturations were considered acceptable. Acceptable rates remained higher than unacceptable rates in academic, hospital, and private settings, and percentages ranged from 65.2% to 93.0%. Only 5 studies reported procedural errors, namely, ledge formation, separated instruments, apical perforation, transportation, lateral perforation, and root/foramen perforation. CONCLUSIONS Using rotary instruments for different root canal treatment steps as instrumentation and obturations is highly recommended. Among different clinical setting and practice, these instruments resulted in a good and acceptable RCF, overall quality performed by those instruments, and few procedural errors.

Evaluation of radiographic quality of root canal obturation performed by undergraduate and postgraduate clinical dental students in a Nigerian hospital

Introduction

the three-dimensional fluid-tight obturation of the root canal system ends the endodontic treatment process and the technical quality of obturation of the root canal (RC) is a determinant of the outcome of the treatment. This final stage of RCT is critical in the outcome of treatment, thus the need to have adequate and quality obturation. The audit of the performance of students in this aspect evaluates performances and identifies where there is a need for improvement. Therefore, we set out to evaluate the quality of root canal obturation performed by undergraduate and postgraduate clinical dental students.

Methods

a cross-sectional study that evaluated the root canal obturation performed by undergraduate and postgraduate students in a teaching hospital, for 1 year. The radiographic evaluation was done by calibrated assessors. The radiographs were viewed under magnifying lenses (x3.5). The adequacy of length and homogeneity of the density of obturation were the outcome variables assessed in all the categories of teeth treated among patients who are 18 years and above, seen during the study period.

Results

eighty-four maxillary and 36 mandibular teeth were root-filled in 97 patients with a mean age of 37.6 years ± 14.7 SD. A good proportion (47.5%) of the root fillings were done by the postgraduate doctors. Most of the canals (69.4%) had acceptable lengths while density was acceptable in only 37.7%. Slightly over half of canals with acceptable length (64 out of 127; 50.4%) were reported in teeth with single canals (p=0.000) likewise with density (28;40.6%). Overall acceptable length and root filling density was 28.9% and there was no statistical significance in the performances of the operators in relation to the length of root filling (p=0.109), and density (p=0.55).

Conclusion

the overall acceptable length and root filling density was 28.9% among both undergraduate and postgraduate students. The adequacy of root canal filling may be dependent on experience, the complexity of the tooth, and the method of instrumentation.

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.

Influence of operator's experience on complications of root canal treatment using contemporary techniques: a retrospective study

BACKGROUND

Endodontic treatment has benefited from the development of new techniques and equipment. Few clinical studies have been published on the complications associated with root canal preparations performed by doctors with different working experiences using contemporary techniques. This study aimed to analyze the complications of endodontic treatment performed by residents and endodontic specialists in a teaching stomatology hospital using contemporary techniques.

METHODS

Cases of root canal treatment (RCT) and non-surgical root canal retreatment (ReRCT) performed by residents with 1-3 years of experience and endodontic specialists with 5-7 years of experience were collected from the electronic medical system of the Department of Endodontics, Beijing Stomatology Hospital, from September 1, 2020 to August 31, 2021. The cases were examined in terms of patient age, sex, type of tooth, diagnosis, treatment modality (RCT or ReRCT), number of appointments, whether an operating microscope was used, presence of ledges, canal transportation, perforations, missed canals, separated instruments, flare-ups and clinical incidence of second mesiobuccal (MB2) root canal in the maxillary molars.

RESULTS

In total, 859 teeth from 820 patients were included in the analysis. The overall incidence of complications in the resident group was significantly higher than that in the specialist group. More ledges and flare-ups were observed in the resident group (p < 0.05). The clinical incidence of MB2 was significantly higher in the specialist group (p < 0.05). There were no significant differences in root canal transportation, perforation, or instrument separation between the two groups (p < 0.05). Multivariate analysis showed that the incidence of root canal preparation complications was related to operator experience, tooth type and treatment modality.

CONCLUSIONS

Technical advancements could reduce the effect of working experience on RCT complications between residents and endodontic specialists in a teaching stomatology hospital.

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