Clinical effectiveness of basic root canal treatment after 24 months: a randomized controlled trial

Clinicians' perspectives, inducements, preferences, and clinical experiences regarding the use of electronic apex locator and apex locator integrated engine-driven instrumentation: a cross-sectional study

BACKGROUND

This study aimed to investigate the perspectives, preferences, and clinical experiences regarding using electronic apex locator and apex locator integrated instrumentation of dentists and endodontists.

METHODS

A web-based questionnaire consisting of 3 parts and 23 closed-ended questions to achieve the objective of the study was carried out in ethical conditions between August and October 2023. The first part of survey included demographic information, while the second part was about evaluating electronic apex locator usage. In the last part, only participants' use of apex locator-integrated instrumentation was evaluated. Data were analyzed at a significance level of p < 0.05.

RESULTS

A total of 297 clinicians, including 59 endodontists and 34 endodontic residents/Ph.D. students participated in the questionnaire. Endodontists and endodontic residents/Ph.D. students perform statistically significantly more root canal treatments per week on average (p = 0.001). For the working length determination method (multiple option question), 78.5% of participants use an electronic apex locator and 39.7% apex locator-integrated engines. However, the preference rate for electronic apex determination technique was generally 95.6%, with the full rate confirmation of endodontists and endodontic residents/Ph.D. students (100%). A total of 21 endodontists out of 59 prefer apex locator integrated engine-driven instrumentation. Although many of these specialized clinicians use this technique, they stated that they measure electronic working length passively for confirmation of the working length before (90.5%) and after the preparation (66.7%).

CONCLUSIONS

Dentists, as well as endodontists, are skeptical about apex locator-integrated engine-driven instrumentation. Using this technique as a supporter rather than a primary way for preparation within safe limits may give safer results in terms of treatment outcomes.

Tactile working length determination for root canal therapy in underserved settings

DESIGN

Multicentre randomised controlled clinical trial in a rural underserved African setting.

INTERVENTION

The technical and electrical infrastructure still remains unstable in Gambia. Therefore, block randomisation was chosen. Patients included in 2010 were treated according to the original BRT method with tactile working length determination, whereas patients included in 2011 were treated with radiographic working length control. During the latter study period and the 24-month evaluation, a generator was provided to ensure sufficient power supply to run a radiographic unit.

OUTCOME MEASURE

The primary end point was the apical extension score of the radiographic quality parameter of root canal fillings. The secondary radiographic end point was the periapical index, and the secondary clinical end point was tooth tender to percussion. The safety end point was tooth loss as a consequence of endodontic failure.

RESULTS

BRT with tactile working length determination compared with standard radiographic working length control did not significantly differ in terms of radiographic and clinical outcomes after 24 months. The apical extension of the root canal fillings and the periapical anatomic structures showed no significant differences according to radiographic analyses (P = 0.5). Corresponding results were found in clinical aspects of tooth tender to percussion (P = 0.6) and tooth loss (P = 0.7).

CONCLUSIONS

Within the limits of this randomised controlled trial it was shown that tactile working length determination in BRT resulted in comparable treatment outcomes in radiographic and clinical aspects compared with standard endodontic treatment with radiographic working length determination. Tactile working length determination turned out to be an accurate method in BRT.