Magnification in endodontics: A review of its application and acceptance among dental practitioners

Evaluation of primary teeth root canal orifices with naked eye and using magnifying loupes - An in vivo study

Background

Knowledge of the anatomy and morphology of root canal orifices and variations are vital elements affecting treatment outcomes.

Aim

The objective of this study was to evaluate variations in the number of root canal orifices and their patterns in primary teeth, as identified by both the naked eye and under magnifying loupes.

Materials and methods

Total of 173 primary teeth was scheduled for pulpectomy over a period of 18 months. Two examiners assessed the number and pattern of the root canal orifices. After access cavity preparation, the operator recorded the number of root canal orifices with naked eye, and examiner recorded the same using magnifying loupes (3.5×). After cleaning and shaping, the same protocol was used. Collected data were statistically analyzed using SPSS version 23.0 and compared using a paired t-test.

Results

The overall variation in the in the identification of root canal orifices between the naked eye and magnifying loupes (3.005 ± 0.971) was statistically significant after access cavity preparation (P ≤ 0.05).

Conclusion

Magnifying loupes significantly enhances the determination of the number and pattern of root canal orifices in primary teeth. Therefore, the application of magnifying loupes is essential for accurately assessing variations in root canal orifices in primary dentition.

Assessment of Bacterial Load and Post-Endodontic Pain after One-Visit Root Canal Treatment Using Two Types of Endodontic Access Openings: A Randomized Controlled Clinical Trial

The need for controlling bacteria and pain during root canal therapy is undeniable. This clinical trial aimed to assess whether there is a difference in colony-forming unit (CFU) reduction after instrumentation and post-endodontic pain after root canal treatment (RCT) using a traditional endodontic cavity (TEC) versus a conservative endodontic cavity (CEC). This clinical study was conducted on 89 patients designated for a single-visit RCT. Patients were allocated randomly (TEC n = 45 and CEC n = 44). The access opening was gained accordingly in each group by a single operator. A pre-instrumentation sample of root canal dentin was collected using an endodontic file; the second sample was collected similarly, right after shaping and cleaning the root canal. The CFU was calculated based on the samples collected. The pain level was recorded preoperatively and at 1, 7, and 21 days postoperatively utilizing a visual analog scale (VAS). There were no statistically significant differences in the CFU reduction between the TEC and CEC groups (p > 0.05). Additionally, there were no statistically significant differences found in postoperative pain levels between the TEC and CEC at 1, 7, and 21 days (p > 0.05). Despite the limitations of this study, both the CEC and TEC demonstrate a decrease in bacteria within the root canals and alleviate postoperative pain with no difference between them.

Impact of using magnifying dental loupes on clinical performance during tooth preparation: A systematic review

Background

To assess whether using magnification loupes affects tooth preparation working posture performed by undergraduate students and dentistry professionals and whether it influences the quality of the preparation, operator satisfaction and procedure time.

Material and Methods

This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in the International Prospective Register of Systematic Review (CRD42023482377). Electronic searches were conducted in PubMed/Medline, Cochrane Library, Web of Science, and Scopus databases for relevant articles published up to August 2023. Clinical or laboratory studies evaluating cavities or dental preparations performed with and without magnification loupes were considered eligible. The outcomes were operator working posture, dental preparation quality, operator satisfaction, and procedure time. The quality of the studies was evaluated using the JBI Critical Appraisal tools for Quasi-Experimental Studies.

Results

The searches retrieved 1493 articles. Based on the eligibility criteria, 11 laboratory studies were included, where 410 undergraduate and graduate dental students conducted dental preparations in 1851 dental specimens. Of the 11 selected studies, 6 evaluated the working posture, 6 assessed the quality of the dental preparations, 5 reported operator satisfaction, and 2 assessed procedure time. The results showed that magnifying loupes significantly improved operator working posture, but did not influence the quality of tooth preparations. Although satisfaction reports about experiences with magnifying loupes were favorable, no significant difference was found.

Conclusions

Magnification loupes improved operator working posture. However, clinical studies with more scientific evidence are needed for steady conclusions regarding operator satisfaction and procedural time. Key words:Magnification, dental loupes, tooth preparation, cavity preparation, dental education.

An unusual case of maxillary first molar with seven canals and the successful surgical recovery of a separated instrument

This case report highlights the intricate anatomy of root canals and the challenges they pose for clinicians. A 26-year-old female patient presented to the department with a chief complaint of pain in her left upper back tooth region. After thorough clinical and radiographical examinations, the diagnosis of pulpal necrosis with symptomatic apical periodontitis in the maxillary left first molar was confirmed. An intraoperative cone-beam computed tomography was performed. The axial imaging unveiled that there were, two distal (DB1 and DB2) canals, two palatal (P1 and P2) canals, and three mesiobuccal (MB1, MB2, and MB3) canals. The appearance of a convoluted root canal configuration serves to highlight the inherent complexity that clinicians may encounter during endodontic procedures. However, when this complexity is further compounded by the incident of separation of root canal instruments, the challenges faced by clinicians become significantly more demanding. It exemplifies the increased difficulty posed by the combination of tortuous root canal morphology and the additional complication of instrument separation, highlighting the importance of careful management and precise techniques in such scenarios and the significance of modern adjuncts, into the diagnostic process and magnification in the surgical and endodontic therapy.

A novel simplified approach for endodontic retrograde surgery in short single-rooted teeth

BACKGROUND

High technical thresholds, long operative times, and the need for expensive and specialized equipment impede the widespread adoption of endodontic microsurgery in many developing countries. This study aimed to compare the effects of a simplified, cost-effective, and time-efficient surgical approach involving orthograde obturation using biological ceramic material greater than 6 mm combined with apicoectomy for single-rooted teeth with short lengths with those of the conventional and current standard methods.

MATERIALS AND METHODS

Forty-five premolars equally categorized into three groups: conventional surgery group, standard surgery group, and modified surgery group. A µCT scan was used to calculate the volume of voids. A micro-leakage test and scanning electron microscope (SEM) were performed to assess the sealing effect. Additionally, four cases of chronic periapical periodontitis in the anterior region were selected, and the patients received either the modified approach or the standard surgery for endodontic microsurgery.

RESULTS

The volumes of voids in the apical 0-3 mm of the modified group and the standard group were comparable. The micro-leakage test and SEM examination demonstrated closely bonded fillings in the dentinal walls in both the modified surgery group and standard surgery group. The outcomes of the preliminary application of this modified procedure on patients were successful at the time of the follow-up cutoff.

CONCLUSIONS

The modified surgery group exhibited similar root canal filling and apical sealing abilities with the standard procedure for single-rooted teeth with short lengths (< 20 mm). The preliminary application of this modified surgical procedure achieved favorable results.

Value of including loupes in prosthodontic and endodontic components of dental degrees: a systematic review

Background It is crucial dental students graduate with sound knowledge of endodontics and prosthodontics. The use of loupes is important for these due to their intricate nature, but there is currently no standardisation of curricula.Objective This systematic review investigates the value of including loupes in completing dental degrees and their benefits to dental students.Methods Literature was searched from inception to February 2022 in PubMed, Embase and Scopus. Articles included were primary studies of dental students studying endodontics or prosthodontics, which had outcomes related to the value of utilising loupes in learning, clinical application and ergonomics.Results A total of 1,489 articles were retrieved, of which 14 relevant articles were identified. These articles discussed student perceptions and the impact on visual acuity, ergonomic practices and dental procedures. Overall, students perceived that loupes increased self-confidence and allowed a greater operative view but were initially difficult to use. Using loupes resulted in greater visual acuity than no magnification and improved ergonomic practices by reducing neck angulation and improving posture. Students also received better grades when using loupes during cavity access preparation or root canal therapy.Conclusion The use of loupes by dental students can be beneficial if there is initial teaching on their use.

Middle mesial canal in mandibular first molar: A narrative review

Purpose

This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully.

Methods

Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references.

Results

The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures.

Conclusion

The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.

Benefits of using magnification in dental specialties - a narrative review

An increased number of clinicians are using magnification to facilitate their vision when carrying out dental examinations and treatments. The best instrument for this purpose is the microscope, which has proven to enhance quality, longevity and outcome of clinical work. Its use in some dental specialties (such as endodontics) is now well established, but there is also a role for this equipment in other branches of dentistry. To anticipate the contribution of magnification to dentistry in general, recent research and experimental data on the importance of magnification devices will be considered, from the perspectives of optical issues, diagnosing methods and treatment options. It will be shown that, while the microscope is vital to certain specialties (such as endodontics, periodontics, restorative dentistry and prosthodontics), it has little effect on others (orthodontics, for example). This synthesis of current researchattempts to shed light on the optimal magnification used in certain clinical situations, the distinctive benefits of loupes and microscopes for each dental branch, as well as their drawbacks.

Nationwide Trends of Modern Endodontic Practices Related to Working Length, Instrumentation, Magnification, and Obturation: A Comparative Cross-Sectional Survey Comparing Endodontic and Non-Endodontic Specialties Practicing Root Canal Treatment in India

Aim

The present study was designed to assess trends in contemporary endodontic practice regarding the techniques and materials used in endodontic therapy among dental practitioners from various regions of India.

Methods

A cross-sectional questionnaire-based study was conducted amongst dentists who were pursuing postgraduates in endodontics (PG Endo) and other branches (PG-OB), specialists from other branches (MDS-OB) and specialists in endodontics (MDS-Endo) in various dental colleges representing East, West, North, South, and Central zones through an e-survey using Google forms. State-wise postgraduate dental college lists were obtained from the Dental Council of India (DCI) website. Using a multistage cluster random sampling method and considering the unanticipated response rate, emails were sent to 2100. A 29-item close-ended questionnaire, framed according to different aspects of endodontic treatment, was used to record the responses.

Results

When the distribution of the groups of dentists was compared, the central zone had the highest number of PG-OB (44.2%) and the lowest number of MDS-Endo (8.4%). The electronic apex locator (EAL) method of working length determination has been reported less among MDS-Endo than MDS-OB. The difference between the usage of various methods for working length determination was significant among the different groups in all the zones. (p < 0.0001) Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. The majority of dental practitioners preferred a combination method of instrumentation.

Conclusion

Zone-wise comparisons among dentists showed the majority of general dental practitioners preferred the combination method (radiographs and electronic apex locator) for working length determination. Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. All dental practitioners did not so commonly use magnification in all the zones. The single cone technique was the most opted by dental practitioners of all the zones.

Which endodontic access cavity is best? A literature review

The preparation of an access cavity is the first part of endodontic treatment and is a key stage in the healing of both periapical and pulpal infections. It should allow endodontists to remove obstructions in the pulp chamber, locate all canal orifices and clean the entire root canal system with minimum coronal tooth structure removed. This has been done traditionally through establishing straight line access. The development of minimally invasive endodontics aimed to preserve as much of the natural tooth structure as possible, particularly dentine, while undertaking root canal treatment, resulting in the development of other access cavity preparations. This includes conservative, ultra conservative (ninja), truss, guided access, caries-orientated and restorative access cavities. These access cavity preparations also gained popularity due to increased magnification and enhanced lighting, allowing practitioners to visualise the pulpal space in greater detail throughout treatment.Our current recommendation is to conduct access cavities traditionally rather than conservatively. Ideally, conservative access cavities need magnification, which might not be available for all clinicians. With traditional access cavity, the procedure takes less time and it is more predictable to locate the canal orifices, deliver irrigation effectively, avoid iatrogenic damage with biomechanical preparation and achieve better obturation.

Bioceramics utilization for the repair of internal resorption of the root: A case report

BACKGROUND

The objective of this work is displaying a successful treatment for an internal resorption case under operating microscope using bioceramic material.

CASE SUMMARY

Periapical radiograph showed radiolucent lesion representing large internal resorption of the root. The respective defect was obturated using endoscquence bioceramic material follow up at the month 18 after treatment revealed no abnormal finings clinically and radiographically.

CONCLUSION

New generations bioceramics have many advantages that internal root resorption cases can benefit from. The use of operating microscope helps to apply obturating materials with precision. However, long term study on a large sample is required in future studies.

The Hidden Anatomy of a Lower Premolar With Two Canals

Variations in the root canal configuration are a great challenge for the endodontist during endodontic procedures. This necessitates the understanding of canal morphology before initiating the treatment. Mandibular second premolars have been always studied to have only a single canal in their root. The present case reported shows an unusual, rare occurrence of an extra canal in the single-rooted second premolar. The patient reported pain associated with #35 which was due to deep distant proximal caries. The second canal was revealed during the intraoperative phase and was successfully treated. The current case adds an important insight to the existing literature related to diverse canal configurations in lower premolars.

A computational modeling method for root canal endoscopy using a specific CBCT filter: A new era in the metaverse of endodontics begins

A contemporary technological revolution has started a new era in the metaverse of Endodontics, a world of virtual operational possibilities that use an exact replica of the natural structures of the maxillofacial complex. This study describes a modeling method for root canal endoscopy using modern cone-beam CT (CBCT) software in a series of clinical cases. The method consists in acquiring thin CBCT slices (0.10mm) in the coronal, sagittal, and axial planes. A specific 3D volume filter, the pulp cavity filter of the e-Vol DX CBCT software, was used to navigate anatomical root canal microstructures, and to scan them using root canal endoscopy. The pulp cavity filter should be set to synchronize CBCT scans from 2D mode - multiplanar reformations (MPR) - to 3D mode - volumetric reconstruction. This filter, when adopting the option of volumetric reconstruction, the developed algorithm leaves the dentin density in transparent mode so that the pulp cavity may be visualized. The algorithm applied performs the suppression (visual) of areas with dentin density. This ensures 3D visualization of the slices and the microanatomy of the root canal, as well as a dynamic navigation throughout the pulp cavity. This computational modeling method adds new resources to Endodontics, which may impact the predictability of root canal treatments positively. The virtual visualization of the internal anatomy of an exact replica of the canal ensures better communications, reliability, and clinical operationalization. Root canal endoscopy using this novel CBCT filter may be used for clinical applications together with innovative digital and virtual-reality resources that will be naturally incorporated into the principles of Endodontics.

Guided Endodontics in Root Canals with Complex Access: Two Case Reports

This article reported two clinical cases in which the guided endodontics was used to perform the access to the root canals. The first case presents a 40-year-old female with a history of pain related to the left maxillary canine. After radiographic examination, the presence of severe calcification up to the apical third of the root canal, associated with a periapical radiolucency, was noted. In the second case, an 85-year-old male was referred to our service with pain upon palpation, at the right mandibular first molar. The radiographic images revealed the presence of endodontic treatment and a fiberglass post in the distal root canal, which was associated with extrusion of the filling material and a periapical lesion. The 3D-guides were planned based on cone beam computed tomography and intraoral digital scanning, which were aligned using a specific software. Therefore, implant drills could be guided up to the root canal length required for each case. In the first case, a surgical root canal was created and the patient was free of signs and symptoms after the treatment was completed. In the second case, it was observed that the fiber post was worn by the drill, allowing free access to the filling material. It was possible to perform the endodontic reintervention in a more predictable way and in less time. In both cases, the use of the guided endodontics allowed the preservation of a large part of the dental structure. The procedures were performed faster, without the occurrence of fractures and perforations.

Perception and practices of Operative and Endodontic specialists in Pakistan towards the use of dental magnification

BACKGROUND

The perceptions and trends of magnification use in dentistry need to be determined since magnification significantly enhances clinical practice.

OBJECTIVE

To assess perception and practices of Operative and Endodontic specialists currently working in Pakistan, regarding use of magnification.

METHODS

A structured questionnaire administered for this analytical cross-sectional study recorded demographics, trends of magnification devices used in practice and their perceived advantages and disadvantages by the specialists with close-ended questions and three-point Likert scale.

RESULTS

Out of 91 forms, 77 responses were received (response rate of 84%). Most participants had 1-4 years of practical experience, were employed at both faculty and clinical positions, were more interested in operative/restorative procedures and used TLL (through the lens loupes) at low magnification. Use of magnification devices was learnt mostly during post-graduate training and was used daily or weekly for complicated cases. Noteworthy perceptions included improved treatment quality and standard of care. However, they were also perceived as irritating, increasing treatment time, with adverse effect on eyesight with prolonged use. No statistically significant correlation was found between the variables recorded (p > 0.05).

CONCLUSIONS

Most specialists used magnification devices in some form and were abreast with their advantages. Proper training and continued dental education courses can help dispel any observed misapprehensions.

Characterization of Reinforced and Unreinforced Glass-Ceramic Veneers

This study aimed to characterize the surface topography, effect of polishing on surface roughness, residual stresses, and hardness in two glass-ceramic veneers. Fifty-two (52) upper incisors were collected, prepared, and scanned for ceramic veneers. Half of the teeth were restored with veneers made up of feldspathic ceramic (FE), and the other half with zirconia-reinforced lithium silicate ceramic (SZ). All the veneers were designed and milled using a CAD/CAM system and later cemented following the manufacturer's guideline. An optical microscope analyzed the topography of the specimens before and after polishing. The surface roughness was measured using the roughness meter (n=12) and the topographical analysis was carried out using an atomic force microscope (n=6). The residual stresses and Vickers' hardness were evaluated by the indentation method in a micro-hardness indenter (n=6). The surface roughness was analyzed using a three-way analysis of variance (ANOVA) followed by a post hoc Tukey test. The Student t-test was used to compare the residual stresses and hardness between the two ceramics. The topographical analysis revealed that both glass-ceramic veneers had similar percentages of specimens with cracks, before (34.6%) and after (42.3%) polishing. The surface roughness decreased after polishing (p<0.001), and the polishing smoothed out the surface of the veneers. The zirconia-reinforced lithium silicate veneer had a lower roughness as compared to the feldspathic one after polishing, while the residual stresses (p=0.722) and hardness (p=0.782) were statistically similar for both ceramic veneers.

Assessment of Damage of Endodontic Instruments with Naked Eye and Optical Instruments

OBJECTIVES

To determine the accuracy of visual damage evaluation of rotating and reciprocal endodontic instruments with the naked eye and optical devices.

MATERIAL AND METHODS

Four examiners were involved, divided into two age groups: I. 20-30 years, n = 2, II. 40-50 years, n = 2. They visually assessed the existence of damage to rotating or reciprocal endodontic instruments by their naked eye and with two types of optical aids. A total of 239 instruments from different manufacturers were evaluated by each examiner. Before damage estimation, each examiner calibrated the eye on a new instrument. Sensitivity of the detection method was calculated as by the naked eye. When an instrument was detected as damaged by the naked eye, the damage assessment was stopped and the instrument was considered to be damaged by the other two methods, as well.

RESULTS

Damage was found in 178 instruments. Sensitivity of the naked eye was calculated to be 49.7%, for the loupe 66.2% and for the operating microscope 76.5%. The three methods of damage assessment had significant differences (p < 0.05) in sensitivity.

CONCLUSION

It was concluded that there is a significant difference between age groups in estimating instrument damage. Also, it was noted that the damage assessment with the naked eye and optical aids were different. Finally, in terms of ease of damage recognition, significant differences between the types of engine-driven endodontic instruments were found. However, no type of instrument was more prone to damage than any other type of instrument.

Multispectral SWIR images of the pulp-chamber of posterior teeth in vitro

Intraoral imaging of teeth with SWIR light provides increased contrast of dental caries and restorative materials compared to visible inspection and digital radiography. The objective of this study was to investigate the SWIR optical properties of the dental pulp-chamber floor, walls and canal orifices. We imaged in vitro extracted human posterior teeth at 1300-nm and 1500-1700-nm in reflectance and transillumination and compared the tissues properties with visible light images and quantitative light fluorescence. Transillumination of posterior teeth at both 1300-nm and 1500-1700-nm yielded significantly higher contrast between the pulp-chamber floor and walls than all other methods tested.

Comparison of optical performance among three dental operating microscopes: A pilot study

Introduction:

Two important aspects of the dental operating microscope (DOM) that factor into its overall effectiveness are resolution and depth of field. Therefore, the objective of this study was to evaluate and compare the resolution and depth of field of DOMs from three well-known manufacturers using standardized test targets.

Materials and Methods:

A resolution test, using the 1951 USAF Hi-Resolution Target (Edmund Optics, Barrington, NJ), and a depth of field test, using the Depth of Field Target 5-15 (Edmund Optics, Barrington, NJ), were performed by two calibrated observers. Three DOM systems such as Seiler IQ (Seiler Instrument Inc., St. Louis, USA), Global G-Series 6 step (Global Surgical Corp., St. Louis, USA), and Zeiss Extaro 300 (Carl Zeiss Meditec AG, Oberkochen, Germany) were used to compare the resolution and depth of field.

Results:

The Zeiss Extaro 300 showed the highest maximum resolution and maximum DOF (64 lp/mm and 17mm, respectively). The Seiler IQ showed the lowest maximum resolution and maximum DOF (35.9 lp/mm and 11 mm, respectively).

Conclusion:

Within the limitations of this study, the Zeiss Extaro 300 was superior in terms of resolution and depth of field as compared to the other two DOMs.

Mandibular First Molar with Six Canals: Case Report of Radix Entomolaris and Middle Mesial Canal

The purpose of this article is to report a successful endodontic treatment of a mandibular first molar with six canals; three root canals in the mesial root, two root canals in the distal root, and one radix entomolaris. The incidence of two anatomical variations presented in this report, middle mesial canal and radix entomolaris, is generally low. Knowledge of the internal anatomy of the root canals and their possible variations, and use of magnification, such as the operating microscope or loupes, can increase the chances of finding additional canals, contributing to the success of endodontic treatment.

Knowledge, attitude and practice regarding the use of dental operating microscope in pediatric dentistry in India: An online survey

Background and aim

Literature search shows scarcity of information regarding the use of Dental Operating Microscope (DOM) in children. There are various factors that limit the use of this novel technology by Pediatric Dentists in their practice. The aim of this study is to assess the knowledge, attitude and practice of pediatric dentist regarding DOM use in children.

Method

The present study was a descriptive web based questionnaire study conducted among 363 Pediatric Dentists (PDs) of India. A close-ended questionnaire was prepared to test the KAP regarding microscope use among PDs. Results obtained were analyzed using descriptive analysis in SPSS software and correlation was studied using chi-square test where statistical significance was observed at p ​< ​0.05.

Results

A response rate of 82.1% was observed. Majority (88.9%) of the pediatric dentists were aware of Dental operating Microscope (DOM) usage in their field, however, only 61.4% were aware of its magnification levels. 76.5% participants responded 12^oclock position to be the ideal position. Majority (94.0%) agreed that DOM is helpful in locating canals in deciduous teeth. 70.5% think that DOM can increase apprehension of children. 85.2% believed that DOM can aid in behavior management of children through its live visual output. However, 84.2% of the pediatric dentists hadn't used DOM in their practice.

Conclusion

The knowledge, attitude and practice regarding dental operating microscope among pediatric dentists in India is limited. In the foreseeable future, the use of magnification is likely to become the standard of practice in dentistry.

German Dentists' Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

Currently, there is no standard treatment protocol for apical periodontitis (AP). Thus, restorable teeth might get extracted and replaced prosthetically. This study evaluated German dentists’ preferred AP treatment decisions and the influencing factors for selecting tooth retention by initial/repeated surgical/non-surgical root-canal treatment (RCT) or extraction with/without prosthetic replacement. Through an online-survey, participants (n = 260) rated different treatment options for four case scenarios with AP in anterior/posterior teeth without/with previous RCT. Statistical analysis included the Friedman test for intra-case comparisons and Chi-squared test for factor-associations (p ≤ 0.05). Tooth retention using initial/repeated RCT was ranked first in all scenarios and rated as (very) appropriate by most participants, while implant-supported crowns (ISC) and apicoectomy had the second ratings. ISC were preferred more on posterior teeth or previous root-canal-treated teeth. Rating levels of treatment options displayed significant differences for all case scenarios. Posterior tooth retention by RCT demonstrated a significant association with work experience. Tooth retention with previous RCT displayed a significant correlation with dentists’ privately insured patients. Most dentists preferred tooth preserving with initial/repeated RCT, while others selected non-evidence-based choices. This reflects a lack of consensus of AP treatment decisions in Germany. Fixed treatment guidelines and further evaluation of treatment–decision-correlated factors are recommended for correct treatment planning.

The impact of the use of magnifying dental loupes on the performance of undergraduate dental students undertaking simulated dental procedures

OBJECTIVES

This study aimed to evaluate the impact of the use of magnification (2.5x dental loupes) for third-year dental students in simulated endodontics and fixed prosthodontics assessments compared to those using no magnification.

METHODS

Upon institutional review board exemption, third-year dental students were assessed during endodontics and fixed prosthodontics exams in the simulation laboratory. The endodontic group (n = 93) consisted of students who made an endodontic access preparation on a plastic lower left first molar (Nissan). The prosthodontic group (n = 86) consisted of students who made porcelain fused to metal preparation (PFM) on a plastic lower right first molar mounted on an acrylic lower jaw model (Columbia Dentoform). The impact of the use of dental loupes was evaluated. Assessment of the tasks was undertaken by experts-calibrated, blinded examiners-using a standardized marking rubric for each task. The statistical analysis included Chi-square test, one-way ANOVA, and Logistic regression. The level of significance adopted was 5%.

RESULTS

Students' preparations using magnification were better compared with those without magnification. Students using magnification had a significantly higher pass rate than those not using magnification in both endodontic and prosthodontic groups (P < 0.05).

CONCLUSIONS

In conclusion, third-year dental students who used loupes in the endodontics and prosthodontics simulation laboratory had significantly higher scores at the assessments.

Implementing magnification during pre-clinical training: Effects on procedure quality and working posture

OBJECTIVE

The objective of this study was to evaluate the effects of magnification on the quality of two pre-clinical procedures, class I cavity preparations and composite resin restorations, and to evaluate the working posture.

METHODS

This was an experimental laboratory study. The response variables were the quality of cavity preparations and Class I restorations as well as the working posture adopted during the execution of these procedures. The independent variables were the magnification system under four levels (unaided visualisation, the use of a simple loupe, the use of a Galilean loupe and the use of a Keplerian loupe) and the artificial teeth treated. Class I cavity preparations and restorations (N = 320) were performed using standardised procedures, and the quality achieved was evaluated using pre-established criteria. Working posture was recorded using digital video cameras and was evaluated using the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). A two-factor analysis of variance (ANOVA) and multiple comparison test were performed (α = 0.05).

RESULTS

The quality of cavity preparation did not differ significantly amongst the different magnification systems (P = 0.082). Galilean and Keplerian systems had a positive impact on restoration quality only for the left mandibular first molar (P = 0.04). Higher posture scores were observed when Galilean and Keplerian loupes (P = 0.01) were used, regardless of the tooth being treated.

CONCLUSION

The use of Galilean and Keplerian magnification lenses did not affect the quality of the pre-clinical procedures performed whilst improved the scores of ergonomic posture.

Technical Quality of Root Canal Filling in Preclinical Training at Strasbourg University Using Two Teaching Protocols

Objectives  The aim of this study was to compare two teaching protocols according to the technical quality of root canal therapy (RCT) and the procedural errors occurred in preclinical training.

Materials and Methods  Two different groups of students were concerned. The first one (G1) performed a crown-down technique to shape the root canal systems and cold lateral condensation technique to fill them. The second one (G2) performed a step-down technique without initial manual scouting to shape the root canal systems, and cold hydraulic condensation technique, to fill them. G2 used clinical operative microscope to check the access cavity preparation.

Statistical Analysis  The quality of RCTs and procedural errors were recorded and analyzed using chi-squared test and t -test.

Results  Four hundred sixty-eight root canals from 152 maxillary molars were treated by the G1 students: 46.6% canals were judged as acceptable. Four hundred sixty-nine root canals from 152 mandibular molars were treated by G1: 58.8% canals were judged as acceptable. Five hundred fifteen root canals from 156 maxillary molars were treated by G2 students: 84.1% canals were judged as acceptable. Four hundred ninety-three root canals from 156 mandibular molars were treated by G2: 90.9% canals were judged as acceptable. Among the errors, the incidence of “ledges” and “fractured instruments” was statistically significant in G1 compared with G2, both on maxillary and on mandibular molars.

Conclusions  The molar RCTs performed by G2, who got benefit from the new teaching protocol, resulted in a better quality of root filling and in fewer procedural errors compared with the molar RCTs performed by G1.