Improved quality of root fillings provided by general dental practitioners educated in nickel-titanium rotary instrumentation

Mechanical performance of original; yellowish and blueish ProFile instruments: isolating heat-treatment as a variable

The present study aimed to perform two different heat-treatments in an austenitic NiTi ProFile instrument and to compare the mechanical performance of original and heat-treated instruments. Heat treatment of ProFile (tip size 25 and 0.06 taper) instruments were carried out in a furnace in argon atmosphere using a heating rate of 10° C/min. After reaching the programmed temperatures of 450 ºC or 500 ºC the system remained at a constant temperature for 10 minutes; followed by cooling in water at room temperature. Afterwards; the three groups (n=30 per group) of instruments were compared regarding their cyclic fatigue (n=10 per group); bending (n=10 per group); and buckling resistance (n=10 per group). After cyclic fatigue tests; a scanning electron microscope was used to analyze the fracture surfaces and observe the fracture mode. Statistical analysis was performed using One-way ANOVA and Student-Newman-Keuls test; with an alpha type error set at 0.05. Yellowish and blueish coloration was observed in the ProFile instruments after 450 ºC or 500 ºC heat treatments; respectively. Conventional ProFile instruments showed the lower cyclic fatigue; and the higher bending and buckling resistance (P<0.05). In contrast; yellowish ProFile instruments (heat treated at 500° C) showed the higher cyclic fatigue; and the lower bending and buckling resistance (P>0.05). It can be concluded that the different heat treatments performed on ProFile instruments increased its cyclic fatigue resistance and improved the flexibility and buckling resistance.

Adoption of change in endodontic practice after an educational program: A qualitative study

Objectives

The aim was to define the characteristics of successful implementation of new clinical endodontic routines within a public dental health organization, following an educational program.

Materials and Methods

Fifteen staff members were strategically selected for the interview. All had completed a theoretical educational intervention including a complementary endodontic treatment strategy and, for the dentists, comprising training in the nickel‐titanium‐rotary‐technique. All experienced the successful acceptance of new clinical routines. Two thematic in‐depth audiotaped interviews were conducted, wherein the informants described the implementation process in their own words. The interviews were transcribed verbatim and analyzed according to Qualitative Content Analysis.

Results

A theme was identified: A multiple flexible process with governance support and gradual reinforcement of motivation, with the following main categories: Firstly, contextual facilitation, with two subcategories (i) a multifaceted organizational foundation and (ii) a tolerance of flexibility. Secondly, emotional facilitation, with two subcategories (i) an experience of simplification and (ii) an experience of improvement.

Conclusion

The results improve the understanding of a multifaceted process underlying the acceptance of changes to clinical endodontic procedures by dentists in a public dental health organization. Important contributing factors identified were governance support, a committed resource person with contextual knowledge, tolerance of flexibility in implementation, and permissive informal communication channels within the local workplace. These findings might be a valuable contribution to an evidence base, facilitating the selection of the most appropriate educational strategy and structure for a specified purpose.

Patient record assessment of results and related resources spent during one year after initiation of root canal treatment in a Swedish public dental organisation

Aim

To document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start.

Methodology

The subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment‐specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis.

Results

Complete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated (n = 113, 47.1%). Most cases were completed with a root filling (n = 169, 70.4%). The remainder were extracted (n = 32, 13.3%) or were still uncompleted (n = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT‐related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period.

Conclusions

Patient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases.

Effects of an individualized training course on technical quality and periapical status of teeth treated endodontically by dentists in the Public Dental Service in Norway: An observational intervention study

AIM

To investigate the effect of a continuing education course on technical quality and treatment outcome for root filled permanent teeth in Møre and Romsdal County, Norway.

METHODOLOGY

Fifty-two dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, completed a two-day continuing education course in root canal treatment. Periapical radiographs of root filled teeth treated before and after the course, with at least one-year follow-up were identified and scored for technical quality and periapical status. Technical root filling quality was assessed by density and length and the treatment outcome by PAI scores. Treatment information was achieved from the county's electronic dental record system. Information regarding the dental practitioners' background and treatment procedure routines was collected by a questionnaire. Descriptive statistics analyses and mixed-effect logistic regression analyses were performed to evaluate the effect of the course.

RESULTS

Radiographs were available for 224 teeth root filled before and for 221 teeth after the course. The proportion of teeth with adequate root filling quality was significantly lower after the course (p = .006), associated mainly with short root fillings (p < .001). No significant differences were observed in treatment outcome. There were, however, large differences in treatment outcome amongst subgroups of dentists. Further, there was evidence of effect modification by the continuing education course on periapical outcome by patient's age (p_interaction  = .0023) suggesting that teeth in patients ≤18 years healed relatively better post-course compared to patients >18 years.

CONCLUSIONS

A two-day continuing education course in root canal treatment attended by Public Dental Service dentists in Norway did not improve the technical quality of root fillings or periapical status associated with root filled teeth.

Continuing education meetings and workshops: effects on professional practice and healthcare outcomes

BACKGROUND

Educational meetings are used widely by health personnel to provide continuing medical education and to promote implementation of innovations or translate new knowledge to change practice within healthcare systems. Previous reviews have concluded that educational meetings can result in small changes in behaviour, but that effects vary considerably. Investigations into which characteristics of educational meetings might lead to greater impact have yielded varying results, and factors that might explain heterogeneity in effects remain unclear. This is the second update of this Cochrane Review.

OBJECTIVES

• To assess the effects of educational meetings on professional practice and healthcare outcomes • To investigate factors that might explain the heterogeneity of these effects SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ERIC, Science Citation Index Expanded (ISI Web of Knowledge), and Social Sciences Citation Index (last search in November 2016).

SELECTION CRITERIA

We sought randomised trials examining the effects of educational meetings on professional practice and patient outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias. One review author assessed the certainty of evidence (GRADE) and discussed with a second review author. We included studies in the primary analysis that reported baseline data and that we judged to be at low or unclear risk of bias. For each comparison of dichotomous outcomes, we measured treatment effect as risk difference adjusted for baseline compliance. We expressed adjusted risk difference values as percentages, and we noted that values greater than zero favour educational meetings. For continuous outcomes, we measured treatment effect as per cent change relative to the control group mean post test, adjusted for baseline performance; we expressed values as percentages and noted that values greater than zero favour educational meetings. We report means and 95% confidence intervals (CIs) and, when appropriate, medians and interquartile ranges to facilitate comparisons to previous versions of this review. We analysed professional and patient outcomes separately and analysed 22 variables that were hypothesised a priori to explain heterogeneity. We explored heterogeneity by using univariate meta-regression and by inspecting violin plots.

MAIN RESULTS

We included 215 studies involving more than 28,167 health professionals, including 142 new studies for this update. Educational meetings as the single intervention or the main component of a multi-faceted intervention compared with no intervention • Probably slightly improve compliance with desired practice when compared with no intervention (65 comparisons, 7868 health professionals for dichotomous outcomes (adjusted risk difference 6.79%, 95% CI 6.62% to 6.97%; median 4.00%; interquartile range 0.29% to 13.00%); 28 comparisons, 2577 health professionals for continuous outcomes (adjusted relative percentage change 44.36%, 95% CI 41.98% to 46.75%; median 20.00%; interquartile range 6.00% to 65.00%)) • Probably slightly improve patient outcomes compared with no intervention (15 comparisons, 2530 health professionals for dichotomous outcomes (adjusted risk difference 3.30%, 95% CI 3.10% to 3.51%; median 0.10%; interquartile range 0.00% to 4.00%); 28 comparisons, 2294 health professionals for continuous outcomes (adjusted relative percentage change 8.35%, 95% CI 7.46% to 9.24%; median 2.00%; interquartile range -1.00% to 21.00%)) The certainty of evidence for this comparison is moderate. Educational meetings alone compared with other interventions • May improve compliance with desired practice when compared with other interventions (6 studies, 1402 health professionals for dichotomous outcomes (adjusted risk difference 9.99%, 95% CI 9.47% to 10.52%; median 16.5%; interquartile range 0.80% to 16.50%); 2 studies, 72 health professionals for continuous outcomes (adjusted relative percentage change 12.00%, 95% CI 9.16% to 14.84%; median 12.00%; interquartile range 0.00% to 24.00%)) No studies met the inclusion criteria for patient outcome measurements. The certainty of evidence for this comparison is low. Interactive educational meetings compared with didactic (lecture-based) educational meetings • We are uncertain of effects on compliance with desired practice (3 studies, 370 health professionals for dichotomous outcomes; 1 study, 192 health professionals for continuous outcomes) or on patient outcomes (1 study, 54 health professionals for continuous outcomes), as the certainty of evidence is very low Any other comparison of different formats and durations of educational meetings • We are uncertain of effects on compliance with desired practice (1 study, 19 health professionals for dichotomous outcomes; 1 study, 20 health professionals for continuous outcomes) or on patient outcomes (1 study, 113 health professionals for continuous outcomes), as the certainty of evidence is very low. Factors that might explain heterogeneity of effects Meta-regression suggests that larger estimates of effect are associated with studies judged to be at high risk of bias, with studies that had unit of analysis errors, and with studies in which the unit of analysis was the provider rather than the patient. Improved compliance with desired practice may be associated with: shorter meetings; poor baseline compliance; better attendance; shorter follow-up; professionals provided with additional take-home material; explicit building of educational meetings on theory; targeting of low- versus high-complexity behaviours; targeting of outcomes with high versus low importance; goal of increasing rather than decreasing behaviour; teaching by opinion leaders; and use of didactic versus interactive teaching methods. Pre-specified exploratory analyses of behaviour change techniques suggest that improved compliance with desired practice may be associated with use of a greater number of behaviour change techniques; goal-setting; provision of feedback; provision for social comparison; and provision for social support. Compliance may be decreased by the use of follow-up prompts, skills training, and barrier identification techniques.

AUTHORS' CONCLUSIONS

Compared with no intervention, educational meetings as the main component of an intervention probably slightly improve professional practice and, to a lesser extent, patient outcomes. Educational meetings may improve compliance with desired practice to a greater extent than other kinds of behaviour change interventions, such as text messages, fees, or office systems. Our findings suggest that multi-strategy approaches might positively influence the effects of educational meetings. Additional trials of educational meetings compared with no intervention are unlikely to change the review findings; therefore we will not further update this review comparison in the future. However, we note that randomised trials comparing different types of education are needed.

Effects of an individualised training course in endodontics on the knowledge and insights of dentists in Public Dental Service in Norway

OBJECTIVE

To evaluate the knowledge and insights of general dental practitioners regarding endodontic diagnosis and treatment principles before and after attending a 2-days continuing education course.

MATERIALS AND METHODS

Sixty-seven dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, were invited to a continuing education course in endodontics. Before and after the course, they answered a questionnaire weighing the importance of factors influencing the prognosis of endodontic treatment. The same questionnaire was answered by specialists in endodontics (n = 56; Spec Group) and a reference group consisting of general dental practitioners from both private and public practice (n = 21; Ref Group). The Test Group answered both before and after the course, while the Spec and Ref Groups completed the questionnaire once. The responses were compared using the Wilcoxon Sign test and Mann-Whitey U test.

RESULTS

Of the 67 dentists in the Test Group, 49 (73%) completed the course and answered both questionnaires. Before attending the course, the Test Group differed significantly from the Spec Group in 18 out of 27 prognostic factors (p ≤ .05). After the course, there was only moderate improvement in the Test Group responses. On only three factors, they agreed significantly more with the specialists than before attending the course (p ≤ .05). After the Test Group participants had attended the course, their responses were comparable to the responses of the Ref Group.

CONCLUSIONS

A two-days continuing education course only marginally improved dentists' level of knowledge and insights regarding the influence of prognostic factors in endodontics.

Survival of root filled teeth in general dentistry in a Swedish county: a 6-year follow-up study

OBJECTIVE

The purpose of the present study was to investigate the survival rate of root filled teeth in general dentistry in a Swedish county and to identify risk predictors with a significant influence on the survival rate.

MATERIALS AND METHODS

This is a retrospective 6-year follow-up study on 1642 recall patients with 1720 teeth root filled in general dentistry in the Public Dental Service in the county of Stockholm, Sweden. Background variables were collected from the database at baseline as potential predictors of tooth loss. The outcome variables were extraction during the 6-year follow-up period and the reason for the extraction. Stepwise Cox regression analysis was adopted in order to investigate the influence of the potential risk predictors on the risk for tooth extraction.

RESULTS

Nine percent of the root filled teeth were lost after 6 years. The most frequent reason for tooth loss was fracture and/or cracks (58%). The survival rate of the root filled teeth increased significantly for younger patients, root filled teeth with metal crowns (96%) and high quality of the root filling (93%). The survival rate differed significantly between tooth groups with the lowest survival for molars (83%). Composite fillings were significantly associated with lower quality of the root fillings.

CONCLUSIONS

Ninety-one percent of the root filled teeth survived after 6 years. The survival rate was significantly higher for teeth with root-fillings of high quality and metal crowns as well as for root filled teeth in younger patients. The lowest survival rate was found for molars.

Microcomputed Tomographic Assessment of the Single Cone Root Canal Fillings Performed by Undergraduate Student, Postgraduate Student and Specialist Endodontist

The present study evaluated the obturation quality of root canals filled with BioRoot RCS sealer and single gutta-percha point by undergraduate student (US), postgraduate student (PS) and endodontist (ED). Twenty-one plastic models of upper premolars were enlarged with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into three groups (7 teeth/14 canals per group): US, PS and ED. After the obturation of root canals with BioRoot RCS and one HyFlex EDM size 40 gutta-percha point, plastic models were scanned using micro-computed tomography scanner (µCT) SkyScan 1272 at isotropic resolution of 10 µm. The porosity distribution was evaluated separately for the apical, middle and coronal thirds. The Kruskal–Wallis, Mann–Whitney, Friedman and Wilcoxon tests with the significance level set at 5% were used for data analysis. The µCT evaluation revealed open pores being the dominant type of porosity in all experimental groups and root canal thirds, with the highest percentage of pores in the apical third of root canal fillings. The quality and homogeneity of single cone root canals fillings remained similar between the groups in the apical and middle thirds (p > 0.05). Significant differences were observed only in the coronal third (p < 0.05).

Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative “Pain Intensity” (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

Reduction of an in vitro Intraradicular Multispecies Biofilm Using Two Rotary Instrumentation Sequences

Objective  The purpose of this research was to investigate the effect per se of two shaping and cleaning techniques on the reduction of an in vitro multispecies biofilm.

Materials and Methods  A total of 39 freshly extracted monoradicular teeth for periodontal reason were decoronated. Roots were sectioned longitudinally. After autoclaving, a specific stressed biofilm was grown on the root halves that were subsequently reassembled in a silicone index. Two treatments ( n = 9 each)—RaCe (Schottlander; Letchworth Garden City, United Kingdom) and ProTaper Gold ( PTG; Dentsply Maillefer, Baillagues, Switzerland)—were tested; three noninstrumented samples served as a control group and three were rinsed with saline. Posttreatment samples were taken at three different levels of the root. Colony-forming units were counted after incubations. Additionally, three treatments ( n = 5 each)—RaCe, PTG, and saline only—were evaluated under a confocal laser scanning microscope (CLSM).

Statistical Analysis  Statistical analysis was conducted using Tukey’s test and analysis of variance to evaluate the post-instrumentation bioburden.

Results  Both instrumentations were able to reduce the biofilm; however, differences were not present between them ( p > 0.05). CLSM showed biofilm killing and disruption through mechanical shaping alone.

Conclusions  Intraradicular biofilm is reduced with mechanical shaping. There was no difference between RaCe and PTG systems in biofilm reduction despite differences in design, file sequence, and rotational speed.

Recovering of Dizziness of a Patient with Sinusitis after Root Canal Therapy for Upper Second Molar

This case report illustrates the recovery of dizziness of a young healthy patient after root canal therapy of upper second molar. The patient developed dizziness and unbalanced walking four months ago. After cardiac, ENT, neurological, physiotherapy and medical investigations, his entire checkup showed no abnormalities. The patient visited a dental clinic for a routine checkup; after dental clinical and radiographical examination, a chronic abscess infection in an upper second molar region close to the sinus was diagnosed. Root canal therapy was performed that resulted in a disappearance of the dizziness and full recovery was achieved. Conclusion. Infected upper teeth with periapical lesion are associated with dizziness as a complication of odontogenic-related sinusitis. Dental and medical cooperation contributes to a better management diagnosis of the dizziness.

Assessing a training programme for primary care dental practitioners in endodontics of moderate complexity: Pilot data on skills enhancement and treatment outcomes

Aims

To explore the impact of dedicated training to extend the skills of primary care practitioners on the quality of endodontic care, using clinical, radiographic and patient-related outcomes.

Methods

The quality of endodontic treatment performed at the beginning and end of training to become dentists with extended skills (DES) in endodontics was assessed in vitro and in vivo from endo-training blocks and self-reported logbooks containing clinical notes and radiographs respectively. The quality of endodontic care delivered by DES post-training was measured using clinical and radiographic outcomes. Patient-related outcomes were assessed using a self-report questionnaire, including the Oral Health Impact Profile – Endodontic Outcome Measure (OHIP-EOM).

Results

Data on eight dentists were examined pre-and post-training, five of whom participated in further follow-up investigations on the quality of endodontic care delivered to their patients. Significant improvements in skills were seen for all domains in vitro (p <0.05), and for all domains of the clinical treatment process, and achieving the correct working length of the root filling as seen by radiography in vivo (p <0.05). The quality of the clinical process was maintained following training. Positive patient outcome (OHIP-EOM) scores were recorded (mean score of 34.72, SD = 10.74, n = 120 pre-treatment and 25.85, SD = 7.74, n = 47 representing reduced impact at follow-up). The majority of patients reported being satisfied, or very satisfied, with the service they received (72.5%, n = 98); would use the service again (68.1%, n = 92); and would recommend the service to friends and family (74.8%, n = 101).

Conclusions

Findings suggest that training for dentists working in practice can be successful in enhancing skills and changing practice, with evidence of high patient satisfaction and good clinical and patient-related outcomes. Pilot results must be interpreted with caution and further research is required.

Indications for root canal treatment in a Swedish county dental service: patient- and tooth-specific characteristics

AIM

To study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden.

METHODOLOGY

During a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics.

RESULTS

The material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%).

CONCLUSIONS

In the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning

Objectives

To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs.

Methods

Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training.

Participant

Dentists working in and patients treated in primary dental care in London.

Intervention

Twenty-four-month training in endodontics.

Comparison

Dentists enrolled in the training at different time points.

Outcome

Measuring outcome of endodontic treatment.

Results

Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1–36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up.

Conclusions

Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.

'It's good enough': Swedish general dental practitioners on reasons for accepting substandard root filling quality

AIM

The concept of 'good enough' is central and necessary in the assessment of root filling quality. The aim was to explore the concept by analysing reasons and arguments for the acceptance or rejection of substandard root filling quality as reported by general dental practitioners (GDPs) in Sweden.

METHODOLOGY

The study was designed as a qualitative and exploratory study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Thirty-three GDPs employed in the Public Dental Health Service in Gothenburg, Sweden, participated (4-6 GDPs/interview). In all, nine predetermined questions were followed. Before each focus group, the participants received radiographs of 37 root fillings and were asked to assess the root filling quality. The three cases representing the most divergent assessments served as a basis for the discussion. The cases were presented without clinical information; the dentists would relate to the cases as being just root filled by themselves.

RESULTS

The radiographs did not provide a sufficient basis for decisions on whether or not to accept the root filling. This study emphasized that dentists did not primarily look for these arguments in the technical details of the root filling per se, but instead, they considered selected features of the contextual situation. The GDPs constantly introduced relevant 'ad hoc considerations' to account for the decisions they made. These contextual considerations were related to aspects of pulpal and periapical disease, risks (e.g. technical complications) or to consumed resources (personal and/or economic).

CONCLUSIONS

It was obvious that the concept of 'good enough' does not exist as a general formula ready to be applied in particular situations. Instead, it is necessarily and irremediably tied to contextual properties that emerge from case to case.

Technical quality assessment of root canal treatment performed by preclinical dental students at Taibah University, KSA

Objectives

The aim of this study was to evaluate the technical quality of root canal treatment (RCT) performed by preclinical undergraduate dental students at the Dental College of Taibah University KSA.

Methods

In this study, 259 extracted teeth were treated endodontically by preclinical students of the College of Dentistry, Taibah University, KSA, from 2013 to 2015. The evaluation criteria were root canal obturation length, root canal obturation density (homogeneity), and root canal obturation taper. A specific score (0, 1, or 2) was assigned to each parameter.

Results

Of 259 endodontically extracted teeth, 138 (53.3%) had RCT of unacceptable technical quality, 42 (16.2%) had treatment of slightly acceptable technical quality, 50 (19.3%) had treatment of acceptable technical quality, and 29 (11.2%) teeth had RCT of perfectly acceptable technical quality. There were no significant differences (p > 0.05) in the technical quality of root canal obturation among types of teeth.

Conclusion

The results of this study showed that there were varied levels of technical quality of root canal treatment performed by preclinical undergraduate dental students, and the outcome varied between unacceptable, slightly acceptable, acceptable, and perfectly acceptable. The unacceptable cases were the most common, representing more than half of all cases, and the perfectly acceptable cases were the least common. There is an urgent need to improve the endodontics teaching programmes in the College of Dentistry of Taibah University. This research should be repeated in the future to evaluate improvement in the performance of RCT by undergraduate dental students in Taibah University.

Modern Endodontic Principles Part 3: Preparation

The purpose of instrumentation is to facilitate irrigation and allow controlled obturation. This article will revisit methods of instrumentation of the root canal system with consideration given to length determination, apical preparation and the concept of patency filing. It will discuss hand instrumentation and rotary preparation looking at emerging technology such as reciprocating systems and the self-adjusting file. CPD/CLINICAL RELEVANCE: Mechanical preparation of the root canal system is of fundamental importance in achieving success, creating a more easily managed environment from a biological perspective.

Satisfaction of undergraduate students at University of Jordan after root canal treatment of posterior teeth using rotary or hand preparation

The aim of this study was to report the satisfaction of fifth year undergraduate students on the clinical use of rotary endodontic preparation compared with stainless steel standard technique and to evaluate the impact of rotary nickel-titanium instruments on undergraduate teaching. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training program using a questionnaire to assess their satisfaction with these two techniques. The overall results indicated a statistically significant satisfaction of the undergraduate students with the use of the nickel-titanium system (P < 0.001) compared to stainless steel standard technique. Under the conditions of this study, the results showed a positive acceptance and consensus among novice dental students regarding the use of ProTaper rotary files and the need for undergraduate teaching of rotary nickel-titanium systems in Jordan.

Technical quality of root canal therapies performed by novice dental students in preclinical practice

Background:

For improving the quality of endodontic performance of practitioners in clinical practice, their basic, preclinical performance and knowledge must be taken into consideration. This study aimed to radiographically evaluate the technical quality of preclinical molar root canal treatments (RCTs) performed by undergraduate dental students at a dental school in Iran. Further, the effect of using Gates-Glidden (GG) drills on the final quality of RCTs was evaluated.

Materials and Methods:

In this retrospective cross-sectional study, 315 roots of 105 endodontically treated teeth in preclinical practice were evaluated radiographically. The analyzed quality parameters included length, taper and density of fillings, which were scored as S2 (adequate standard), the S1 (slight deviation), or S0 (considerable deviation). For all the parameters, acceptable, moderate and poor fillings received total scores of 6, 3-5 and 0-2, respectively. There were two groups of students: One group had used only K-files, and the other had used K-files along with GG drills. The quality of RCTs between these groups was evaluated using the aforementioned scoring protocol. The results were analyzed using Chi-square, Mann–Whitney and Fisher's exact tests (α = 0.05).

Results:

Under-fillings (P = 0.001) and under-shapings (P = 0.007) occurred mostly in mandibular root fillings. A lower density was found in maxillary fillings (P < 0.001). No relationship was observed between the technique used (irrespective of GG drills usage) and length (P = 0.499) and taper of fillings (P = 0.238). The roots instrumented with GG drills had a higher filling density (P = 0.004). The quality mean score of RCTs was improved when GG drills were used (P = 0.008).

Conclusion:

The technical quality of preclinical molar RCTs performed by undergraduate dental students was considered acceptable in 35.6% of the cases. When GG drills were used along with K-files, the technical quality of RCTs was enhanced.

Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice

AIM

To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR).

METHODOLOGY

A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fisher's exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression.

RESULTS

Follow-up data were available for 229 (55%) of teeth treated pre- and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both pre- and post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up.

CONCLUSIONS

Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status.

The impact of a continuing education programme on the adoption of nickel-titanium rotary instrumentation and root-filling quality amongst a group of Swedish general dental practitioners

INTRODUCTION

The aim of the study was to test the hypothesis that a further education programme relating to nickel-titanium rotary instrumentation (NTRI), with the concurrent activation of social/professional networks amongst all general dental practitioners (GDPs) in a public dental service in Sweden, would increase the adoption rate and improve root-filling quality.

MATERIAL AND METHOD

To activate the networks, the GDPs at the 25 clinics elected training coaches from amongst themselves. The coaches were educated by a specialist and were then free to organise and conduct the training of the local GDPs. However, collective hands-on training and discussions were mandatory. Lectures were held by an endodontist. The rate of adoption and root-filling quality was evaluated just before and 6 months after the education. Statistical tests were performed with chi-square using a 95% confidence interval.

RESULTS

Nickel-titanium rotary instrumentation was adopted by 88%. Excellent root fillings (score 1) increased from 45% to 59% (P = 0.003). The rate of poor-quality root fillings (score 4 and score 5) was not affected. The quality ratio (score 1/score 5) increased from 5.36 (118/22) to 9.5 (133/14). Eleven dentists (17%) at nine different clinics produced 49% of the poor-quality root fillings (score 4 and score 5). Seventy-three per cent of these dentists stated that they had adopted NTRI.

CONCLUSIONS

The introduction of NTRI will increase the adoption rate and the frequency of good-quality root fillings. However, it will not overcome the problems associated with dentists producing a low-quality level, even if a local professional network is activated.

The self-adjusting file (SAF) system: An evidence-based update

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics.

Root canal treatment and special needs patients

AIM

To identify current trends of root canal treatment for patients with special needs.

METHODOLOGY

A postal questionnaire was sent to General Dentists in Victoria, Australia and Endodontists and Special Needs Dentists across Australia to determine the extent of root canal treatment performed on special needs patients.

RESULTS

Over a four-month period, 1120 questionnaires were distributed with an overall response rate of 63.9% (n = 716). Response rates were 63.2% (n = 655), 68.5% (n = 50) and 100.0% (n = 11) amongst General Dentists, Endodontists and Special Needs Dentists, respectively. Endodontists (95.7%) and Special Needs Dentists (100.0%) performed significantly more root canal treatment on adult patients with special needs compared with 51.2% of General Dentists, (P < 0.001 and P = 0.001 respectively; Fisher's exact test). The most common reasons for not undertaking root canal treatment included limited cooperation, poor oral hygiene and uncontrolled movement. Amongst General Dentists, 75.7% opted for extraction in preference to root canal treatment. Significantly, more specialist practitioners performed root canal treatment utilizing conscious sedation (P < 0.001) and general anaesthesia (P = 0.003). Most specialist practitioners (69.1%) had undertaken single-visit root canal treatment on special needs patients compared with only 29.7% of General Dentists (P < 0.001).

CONCLUSIONS

Root canal treatment in special needs patients was more likely to be carried out by specialist dental practitioners who were more likely to utilize a pharmacological approach for behaviour guidance and to perform single-visit root canal treatment compared with General Dentists. A multidisciplinary approach for special needs patients who require root canal treatment provides an opportunity for these patients to retain their dentition.

Discuss the impact technological advances in equipment and materials have made on the delivery and outcome of endodontic treatment

Recent advances in endodontic equipment and materials have considerably changed the manner in which endodontic treatment is delivered. Specific technological advances, including nickel-titanium instruments, ultrasonic instruments and the dental operating microscope have been associated with increased efficiency and efficacy of treatment and simplification of delivery. The effects of most of these changes have been tested via in vitro studies and case reports. Ongoing studies should constantly investigate what effects technological advances might have on the outcome of endodontic treatment.

Quality-Shaping Factors and Endodontic Treatment amongst General Dental Practitioners with a Focus on Denmark

There is a gap between the endodontic outcome that can be achieved and the outcome observed on the basis of worldwide general dental practitioner data. The quality of root canal treatment (RCT) is shaped by the dentist's knowledge, attitude, and skills, but it may also be influenced by the patient's demands and degree of satisfaction. The topic has only been sparsely investigated. Although dental health has increased over the years in Denmark, the number of performed root fillings has also increased, probably because the number of tooth extractions have declined and more molar teeth have been treated. Caries appears to be the main cause for performing RCT and a preventive approach by employing stepwise excavation may reduce RCT, but this strategy does not remove the gap. Factors influencing RCT quality could be the status on adoption of nickel-titanium rotary technology, more focus on infection control (rubber dam use, knowledge of factors important for prognosis), as dentists often think that they are good at doing RCT, but often perform inadequately, an alteration of clinician's awareness of their performance in the context of dental practices, seems warranted. Finally, the development of new preventive modalities for pulp and apical inflammation are crucial.

Radiographic quality of root canal fillings performed in a postgraduate program in endodontics

The aim of this study was to evaluate the standard quality of 1,347 root fillings performed by postgraduate students in Endodontics according to 3 radiographic quality parameters. The analyzed quality parameters included apical extension (AE), taper (TA) and homogeneity (HO), which received scores S2 (ideal standard), S1 (slight deviation) or S0 (accentuated deviation). A perfect filling (PF) received S2 for all parameters. In the absence of one or two S2 score, the fillings were deemed as satisfactory (SF) or deficient (DF), respectively. The results showed 51.7%, 41.5% and 6.8% of PF, SF, and DF, respectively. AE, TA, and HO presented equivalent quality parameters in root-filled canals of mandibular incisors and mandibular premolars (p>0.05). Conversely, in maxillary incisors, canines and distal root of mandibular molars, significant differences (p<0.05) were found between 2 parameters. Besides, there were significant differences (p<0.05) among the measured parameters in root-filled canals of maxillary premolars, all root canals of the maxillary molars and mesial root of the mandibular molars. AE showed the lowest frequency of S2 score for all groups. In conclusion the prevalence of perfect, satisfactory and deficient fillings varied significantly according to the root canal group. The quality parameters categorized fillings in 3 complexity degrees. AE was the most critical parameter of quality in root canal fillings.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

BACKGROUND

Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

OBJECTIVES

To assess the effects of educational meetings on professional practice and healthcare outcomes.

SEARCH STRATEGY

We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

SELECTION CRITERIA

Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

MAIN RESULTS

In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

AUTHORS' CONCLUSIONS

Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

A clinical guide to endodontics - update part 1

This is the first of two opinion papers that aim to provide a review of changes and developments that have occurred within the field of root canal treatment for both permanent and primary teeth since the publication in 2004 of the BDJ's textbook A clinical guide to endodontics. This, the first part, considers the changes in thinking and practice that have occurred with regard to the treatment of permanent teeth, in particular the continued significant move toward the use of nickel titanium rotary instruments. Knowledge of the changes discussed in this paper is essential both for the best possible prognosis of treatment, and when obtaining informed or valid consent to treatment.

The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontists

AIM

To investigate the technical quality of nonsurgical root canal treatment performed by endodontists in Melbourne, Australia.

METHODOLOGY

Clinical and radiographic records of 100 sequential nonsurgical patients were obtained from each of six endodontists working in private practice. The following variables were analysed: proximity of root filling to radiographic apex; homogeneity and radiodensity of root filling; lateral adaptation of the root filling to the canal walls; taper; extrusion of material; small, appropriate or excessive apical enlargement; presence of lateral canals; transportation; procedural errors. The radiographs were assessed by three independent evaluators. Exploratory data analysis was undertaken using simple frequencies and cross-tabulations. A generalised linear mixed model (GLMM) was used for the formal statistical modelling.

RESULTS

Of the 1351 canals that were examined, 91.7% were filled within 2 mm of the radiographic apex and 74% were within 1 mm. Homogeneity and adequate density were found along the entire length of the canal in 86.1% and 88.6% of cases respectively. Lateral adaptation was adequate in 95.6% of cases and the taper was 'smooth and continuous' in 83.8% of roots. No and/or small extrusion of sealer was noted in 98.3% of cases. Apical enlargement was 'appropriate' in 85% of roots. Both transportation (1.1%) and procedural errors (1.3%) were rare occurrences.

CONCLUSIONS

The technical quality of root fillings performed by endodontists in Melbourne, Australia complied with current guidelines in 77.4%-91.0% of roots. All variables examined confirmed high levels of technical proficiency. There were very few instances of canal transportation and/or procedural errors.