Molar root canal treatment performed by undergraduate dental students; an observational study of procedural errors and student perception

BACKGROUND

Molar root canal treatment (RCT) is challenging and requires training and specific skills. Rotary instrumentation (RI) reduces the time needed for instrumentation but may increase the risk of certain procedural errors. The aims of this study were to evaluate the quality of molar RCTs provided by undergraduate students, to compare the prevalence of procedural errors following manual and RI, and to assess the students' self-perceived confidence to perform molar RCT without supervision and their preference for either manual or RI.

METHODS

Molar RCTs performed by the final year students were evaluated radiographically according to predefined criteria (Appendix 1). The procedural errors, treatment details, and the students' self-perceived confidence to perform molar RCT and their preference for either manual or RI were recorded. Descriptive statistics were performed, and the Chi-squared test was used to detect any statistically significant differences.

RESULTS

60.4% of RCTs were insufficient. RI resulted in more sufficient treatments compared with MI (49% vs. 30.3% respectively. X2: 7.39, p = 0.007), required fewer visits to complete (2.9 vs. 4.6 respectively. X2: 67.23, p < 0.001) and was the preferred technique by 93.1% of students. The most common procedural errors were underextension of the root canal obturation (48.4%), insufficient obturation (45.5%), and improper coronal seal (35.2%) without a significant difference between the two techniques. 26.4% of the participating students reported that they did not feel confident to perform molar RCT without supervision.

CONCLUSION

The quality of molar RCT provided by UG students was generally insufficient. RI partially improved the technical quality of RCT compared with MI. UG students need further endodontic training and experience before they can safely and confidently practise molar RCT.

Dentinal Microcracks after Root Canal Preparation in Primary Root: An In Vitro Evaluation of ProTaper Gold and Kedo-S Rotary File Systems

Context

There is a possibility of dentinal crack formation in primary teeth after root canal preparation using rotary files.

Aims

To evaluate and compare the effect of ProTaper-Gold and Kedo-S rotary files on crack formation after root canal preparation in primary molars.

Settings and design

A total of 120 freshly extracted mandibular primary molars (6-9 years) were randomly divided into three groups of 40 each: ProTaper-Gold, Kedo-S, and Hand H-files, respectively.

Materials and methods

The roots were covered with a snuggly fitting surgical glove and stabilized in the teeth slot of a silicone mold of mandibular mixed dentition. Dental casts were obtained in a mixture of plaster of paris and sawdust. A screw system was incorporated in the cast for stabilization of the cast into the phantom head. All the root canals were instrumented in a standard operating position till 1 mm short of the radiographic apex. All roots were then stained and sectioned perpendicular to the long axis at the furcation level and 2 mm below the furcation to obtain one section per tooth. Sections were examined under a stereomicroscope at 25× magnification for any crack formations and recorded. Data were analyzed using Wilcoxon signed-rank and Kruskal-Wallis tests (p = 0.05).

Results

The total number of cracks in terms of percentage following the use of ProTaper Gold, Kedo-S, and H-files were 35, 10, and 0%, respectively, on the upper surface and 15, 5, and 0% on the lower surface. Within the group, there was a statistically significant difference in ProTaper-Gold (p = 0.001).

Conclusion

The use of ProTaper-Gold resulted in a greater number of dentinal cracks compared to Kedo-S and H-files.

How to cite this article

Patil MB, Mandroli PS, Jalannavar P, et al. Dentinal Microcracks after Root Canal Preparation in Primary Root: An In Vitro Evaluation of ProTaper Gold and Kedo-S Rotary File Systems. Int J Clin Pediatr Dent 2023;16(5):692-697.

Comparative in vitro evaluation of remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars: a systematic review

PURPOSE

The aim was to compare the remaining dentine thickness (RDT) following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars. Research question was 'Is there any difference between the remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars?'.

METHODS

Electronic Databases like MEDLINE PubMed, Cochrane Library, EBSCOhost, Google scholar and grey literature were searched between January 1, 2006 and August 31, 2022 for in vitro and ex vivo studies that compared hand and rotary endodontic instrumentation to evaluate the RDT in primary molars. Articles published in English or which could be translated into English were searched. Two reviewers independently selected studies, extracted data, assessed risk of bias using the Revised, validated version of MINORS criteria.

RESULTS

Twelve studies were included in qualitative analysis. All included studies showed low risk of bias. Six studies showed more RDT with rotary instrumentation compared to manual instrumentation. Whereas, five studies showed variable results for RDT with manual and rotary instrumentation at different levels of root canals. One study showed no significant difference between manual and rotary instrumentation. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted.

CONCLUSION

High quality of evidence based on low risk of bias was found in all the included studies. Statistically, rotary instrumentation showed more RDT than manual instrumentation according to majority of studies. Despite the shortcomings of this systematic review, it is possible to infer that the use of rotary instrumentation provides more RDT and thus there is considerable conservation of tooth structure.

Treatment Outcome and Root Canal Preparation Techniques: 5-Year Follow-Up

OBJECTIVE

This study aims at comparing treatment outcome and tooth survival of root canal-filled teeth following manual vs rotary instrumentation techniques over a 5-year period.

METHODS

This was a single-centre study conducted as a follow-up to a short-term parallel-arm randomised controlled noninferiority trial in which root canal treatment was performed on teeth using either rotary or manual instrumentation. Patients were monitored at post 6-month, 1-year, 4-year, and 5-year review periods by blinded evaluators. Treatment outcome was categorised as favourable, uncertain, and unfavourable (employing European Society of Endodontology categorisation based on strict clinical and radiographic criteria), and 5-year tooth survival was determined by assessing whether tooth was in situ in the oral cavity or extracted. The Kaplan-Meier method and log rank test evaluated tooth survival. P value <.05 was considered statistically significant.

RESULTS

Ninety of 120 treated teeth were assessed in 37 men and 40 women with mean age of 30.6 ± 10.99 years. Treatment outcome was significantly more favourable in the rotary group compared to the manual group at post 6-month (P = .021) and 1-year (P = .043) review periods. The differences in favourable outcome (P = .498) and tooth survival (P = .296) between the 2 groups were, however, not significant at the 5-year review period.

CONCLUSIONS

The rotary instrumentation technique was shown to be more effective in resolving clinical symptoms and promoting periapical healing after the post 6-month and 1-year review compared to the manual instrumentation technique; however, both groups had similar favourable outcomes and survival rates after an extended 5-year review period.

For pulp treatment in primary teeth, rotary canal instrumentation may be modestly time efficient, but otherwise similar to manual canal instrumentation

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. Manchanda S, Sardana D, Yiu CKY. Int Endod J. 2020;53(3):333-353.

SOURCE OF FUNDING

Information not available.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.