An Audit of the Technical Quality and Iatrogenic Errors of Root Canal Treatment by Undergraduate Dental Students at the University of Sharjah

Evaluation and comparison of mandibular molar root canal filling quality performed by undergraduate preclinical dental students

The present study aims to evaluate the quality of root canal fillings (RCFs) on extracted mandibular molars performed by undergraduate students during their preclinical training which spans 2 academic years. Endodontics records and periapical radiographs of 260 extracted human first and second mandibular molars without site specification consisted the sample of this retrospective cross-sectional study. All root canal fillings were performed by undergraduate students during the preclinical phase of their training The samples collected were assessed using radiographs based on three quality criteria: length, density, and taper. Chi-square test was used for statistical analysis and Cohen's Kappa coefficient was implemented to assess inter-rater reliability. The majority of the evaluated RCFs were of inadequate quality. Of the 260 mandibular molars included in the study, 67 (25.8%) were deemed sufficient in terms of overall technical quality across both academic years. 3rd-year students (44.5%) were significantly more efficient compared to their 2nd- year counterparts (12.0%) regarding the overall technical quality of RCFs (p < 0.05). RCFs performed by the 3rd -year students, were of relatively higher quality compared with those performed by the 2nd-year trainees. However, the overall technical quality of RCFs was inadequate. Improvement of the current curriculum should be considered by incorporating contemporary techniques and materials to enhance the performance of undergraduate students on RCFs, before entering the clinical phase of their training.

Impact of using single-file reciprocating system on the quality of root canal treatment treated by undergraduate students

Background

This study aimed to evaluate the use of a single-file reciprocating system on the technical quality of root canal filling and treatment by radiographic assessment of cases treated by undergraduate dental students.

Materials and methods

This was a retrospective cross-sectional clinical study of endodontically treatments conducted by fourth-year undergraduate students during the academic year 2021-2022. Root canal preparation was performed using the WaveOne Gold system with matching single-cone gutta-percha. The collected data included sex, tooth position, number of canals, and treatment time (first or second semester). The quality of the root canal filling was assessed based on the root canal filling length, density, and taper. The presence of ledges, apical transportation, perforation, and instrument separation were recorded. Data were analyzed using SPSS version 28. Chi-square tests were used, and the statistical significance level was set at P < 0.05.

Results

A total of 601 teeth were included. The length of the root canal filling was adequate in 93.51 % of the teeth, underfilled in 2.82 %, and overfilled in 3.66 %. The density and taper were adequate in 96.5 % and 98.16 % of the teeth, respectively. There were no significant differences among the parameters of length, taper, density, or procedural errors relative to the arch type. However, there was a significant difference between the anterior and premolar teeth in terms of taper, density, and overall quality of the root canal filling. The overall quality of root canal treatment was acceptable in 527 teeth (87.68 %), with no significant difference between teeth (P = 0.256).

Conclusion

The quality of root canal treatment performed by undergraduate students using a single-file reciprocating system is good or acceptable.

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.

Endodontic Procedural Errors and Associated Factors among Undergraduate Dental Students: A Cross-sectional Study

AIMS AND BACKGROUND

To assess the procedural errors committed by undergraduate students at RAK College of Dental Sciences, during root canal treatments and the factors associated with these errors.

MATERIALS AND METHODS

In this cross-sectional study, 180 self-administered questionnaires were distributed, each comprising 26 questions, among 4th and 5th-year students. Participants were requested to report their endodontic mishaps based on feedback from their supervisors. The questionnaire assessed the frequency and types of procedural errors, considering patient, operator, and tooth-related factors. Data were collected tabulated and analyzed using the Chi-square test.

RESULTS

A total of 124 root canal-treated teeth exhibiting iatrogenic errors done by students were assessed. Out of which, 53% were performed by 5th-year students, and 69% were conducted by female operators. About 62% of errors occurred in the upper teeth and 68% in the posterior teeth. The most prevalent errors during the rubber dam isolation step were soft tissue trauma (21%) and isolation leakage (20%), significantly associated with limited mouth opening, excessive salivation, and tooth malalignment (p < 0.05). Apical blockage (15%) emerged as the most frequent error during instrumentation phase, showing a significant association with canal dimension and curvature (p < 0.05). For access cavity and obturation phases, under-extended cavity (9%), and under-extended filling (11%) were the most reported errors, respectively.

CONCLUSION

Tooth isolation emerges as a particularly challenging aspect for dental students, particularly when dealing with patients exhibiting limited mouth opening and excessive salivation.

CLINICAL SIGNIFICANCE

Clinical instructors should caution the undergraduates about the heightened risk of endodontic procedural errors when dealing with patients exhibiting limited mouth opening, excessive salivation, tooth misalignment, and narrow canals. Addressing these challenges is crucial for enhancing the proficiency of undergraduate students in performing successful root canal treatments. How to cite this article: Elsayed MA, Islam MS, Saleh DR, et al. Endodontic Procedural Errors and Associated Factors among Undergraduate Dental Students: A Cross-sectional Study. J Contemp Dent Pract 2023;24(12):998-1007.

Comparison of Endodontic Failures between Nonsurgical Retreatment and Endodontic Surgery: Systematic Review and Meta-Analysis with Trial Sequential Analysis

Background and Objectives: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic surgery, which consists in the surgical removal of the root apices with retrograde closure of the endodontium. The objective of this systematic review and meta-analysis was to provide an updated value of the Risk Ratio between the two types of treatment in order to offer to clinicians who propose a non-surgical endodontic retreatment or an endodontic surgery a direct comparison. Materials and Methods: The revision was performed according to PRISMA indications: three databases (PubMed, Scopus and Cochrane register) were consulted through the use of keywords relevant to the revision topic: surgical endodontic retreatment, endodontic retreatment, apicoectomy. This search produced 7568 records which, after eliminating duplicates and applying the inclusion and exclusion criteria, resulted in a total of seven included articles. The meta-analyses were conducted by applying fixed-effects models, given the low percentage of heterogeneity. In addition, trial sequency analysis (TSA) was performed for the analysis of the statistical power of the results and GRADE for the quality of the evidence. Results: The results of the meta-analyses' data report an aggregate risk ratio (RR) between non-surgical endodontic retreatment and surgical endodontic retreatment of: 1.05 [0.74, 1.47] at one year of follow-up; RR 2.22 [1.45, 3.41] at two years of follow-up; an RR 1.08 [0.73 1.62] for a follow-up period of 3-4 years; and an RR 0.92 [0.53, 1.61] for a follow-up period of 8-10 years. Conclusions: The results of the present meta-analysis show that in the long term, the risk of failure is identical for the two groups, and there is only a slightly higher risk of failure for non-surgical endodontic retreatments, when only two years of follow-up are considered.