Endodontic Teaching Research Articles

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

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). 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. 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. 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.

Undergraduate endodontic education: what are the challenges?

To deliver the knowledge and skills required to equip undergraduate students for practice is a significant responsibility; graduates must be familiar with the diagnosis and treatment of pulpal and periradicular diseases and the preservation and restoration of pulpally compromised teeth. A greater understanding of the microbiological processes involved in endodontics and developments in instruments and materials have transformed our approaches to root canal treatment. Information technology has revolutionised certain aspects of education and has had an effect on endodontic teaching. Dental graduates will be expected to treat an increasingly elderly population and will enter a climate in which remuneration for root canal treatment could have a significant effect on the number of cases treated and the pattern of referral. Teachers of endodontics at the majority of dental schools are taxed by competing demands for time in packed curricula, a lack of availability of natural teeth for classroom exercise and a lack of suitable patients. The debate as to whether endodontics should be a specialist subject in its own right has rumbled on for three decades. Compared with the situation in the 1970s, there are now well defined curricula guidelines to which those involved in teaching can refer and map teaching in their schools against agreed norms. These create the potential for students to graduate with the knowledge and skills at a sound level of competence to carry out endodontic procedures and with a deeply engrained understanding of the need for continuing professional development.

Evaluation of an improved endodontic teaching model: do preclinical exercises have an influence on the technical quality of root canal treatments?

To investigate whether the preclinical application of an electronic root canal length measurement device (ERCLMD) leads to more accurate working length (WL) determinations in a preclinical endodontic course and if this exercise effects the technical quality of root canal procedures when treatments are performed on patients for the first time. Root canal treatments performed by two consecutive groups of third year students (group 1: n = 39, group 2: n = 44) were compared in the preclinical course and when root canal treatments were performed on patients in the following term. Two different teaching models were applied in the preclinical endodontic course. WL in group 1 was determined with radiographs only. The teaching model applied in group 2 allowed the application of an ERCLMD. When treatments were performed on patients, both groups used the same technique to determine WL. It was first determined using an ERCLMD and verified radiographically. Master cone and root filling lengths were evaluated using radiographs, and comparisons between both groups were made using Fischer's exact test. Root fillings performed by students of group 2 were more often classified as acceptable. This observation was made in the preclinical endodontic course and when treatments were performed on patients. The application of an ERCLMD in combination with radiographs is more accurate to determine WL than radiographs alone. Students practiced the use of ERCLMDs with the new model and benefited from this experience when performing their first root canal treatments on patients.

Learning Experience in Endodontics: Brazilian Students’ Perceptions

Including students' perceptions in the educational process is considered a key component in monitoring the quality of academic programs. This study aimed to evaluate the concept of one's learning experience in endodontic teaching from the perspective of a group of Brazilian students. A total of 126 self-administered, structured questionnaires were distributed to undergraduate dental students enrolled in endodontics courses during the second semester of the 2009 academic year. The questionnaires were administered during final examinations and focused on students' opinions concerning learning during endodontic treatments, time spent during endodontic treatments, difficulties found during endodontic treatments, quality of endodontic treatments performed, characteristics of the technique employed, and suggestions to improve endodontic teaching. Ninety-one percent of the questionnaires were returned for evaluation. The obtained answers were discussed and analyzed, thereby generating quantitative and qualitative data showing students' perceptions of their experiences in endodontics courses. The main points that can affect the teaching of endodontics, according to the undergraduate students, included patients' absences and delays, selection of patients, preclinical and clinical training, difficulties found, type of technique employed, and teachers' orientation during endodontic treatment. The students' perceptions provided valuable information about the development of the course and the teacher-student relationship, together with the added intention of enhancing the teaching of endodontics as well as other courses.

Teaching Model for Artificial Teeth and Endodontic Apex Locators

Artificial teeth are a useful teaching aid during endodontic education. This article describes the development of a simple and inexpensive model that can be equipped with artificial teeth. It shows that working length determination in artificial root canals using electronic apex locators is possible and that the embedding media has no influence on measurements. The model supports the application of current endodontic techniques and facilitates a validated evaluation of the treatments between students. Artificial teeth can be removed for visualization and replaced for further endodontic exercises.

Irrigation protocol among endodontic faculty and post-graduate students in dental colleges of India: A survey

Background:Irrigation protocol is the most critical step during the disinfection of an infected root canal system.Aim:The purpose of this study was to determine the root canal irrigation trends being practiced among the endodontic teaching faculty and post-graduate students in the dental colleges present in India.Materials and Methods:A postal invitation to participate in this national survey was sent to the Department of Conservative Dentistry and Endodontic of 294 Dental Colleges present in India. A total of 2389 forms were successfully delivered out of which 794 duly filled forms were received back. Survey participants were asked about their irrigant selection, irrigant concentration, smear layer removal protocol, and use of adjuncts during irrigation.Results:This survey elicited a positive response rate of 33.23%. Our data indicated that 92.8% of respondents use sodium hypochlorite (NaOCl) as the primary endodontic irrigant, with 26 gauge needle being most preferred for syringe irrigation, with 49.3% of them using it at a concentration of 2.6-4.0%. 68% of our respondents aim to remove the smear layer during the endodontic treatment while 47% reported using ultrasonic activation as an adjunct during their irrigation protocol.Conclusions:The findings of this survey are that the majority of teaching institutions in India are employing NaOCl (2.6-4.0%) as the primary endodontic irrigant. The concept of smear layer removal is high (68%), and there is a general trend (78%) to modify the irrigation protocol according to the status of the pulp, status of the periapex and in retreatment cases.

The acceptance of dental operating microscope among advance education specialty programs in endodontics in the middle east

Aim: To present the current situation of dental operating microscopy (DOM) training in the available Advance Specialty Education Programs in Endodontics in Arab Middle-Eastern countries. Materials and Methods: A web-based survey was sent to the electronic mail address of Advance Specialty Education programs of 15 Arab and middle east countries. The questions were limited to those who have an advanced specialty education program in Endodontics at their University if they are using an operating microscope? Results: Out of 15 countries, only 4 countries have microscopic technology in their Advance Education Programs in Endodontics. Conclusion: Few Arab Middle-Eastern countries have DOM in their advance education programs in endodontics. The highest authority in advancing endodontic education in the Arab Middle-East should consider in the near future the importance of this technology as standard care in teaching advance endodontics. An advance workshops should be organized regularly to provide enough knowledge about this standard educational technology.

An improved model for teaching use of electronic apex locators

To develop a simple, practical and inexpensive model, which enables the use of electronic apex locators (EALs) during pre-clinical and continuing education. Extracted teeth were placed in a mould and embedded in acrylic resin. The resin was applied in two consecutive steps to form a cavity around the root apices. A closable plastic tube serves as a valve, and a steel wire connects to the EAL. With its semi-closed reservoir for conductive fluids surrounding the root apices, the new model enables working length measurements of root canals using EALs. The model simulates the clinical situation for endodontic teaching purposes, as it allows working length determination of root canals as recommended. The measuring results of the EAL can be verified by radiography. At the same time, the roots are not directly visible and accessible to the user, allowing a precise evaluation and grading of the treatment.

A tribute to Professor Seyyed Behrouz Mousavi, D.D.S, MSc, Endodontist

It is an unfortunate event in the world of dental sciences, as dentistry has now lost one of its most eminent and respected icons. Professor Seyyed Behrouz Mousavi passed away on 23 June 2011 following a sudden episode of cerebrovascular accident. Respected Dr. Mousavi was a Professor of Endodontics, and the Chairman of the Torabinejad Dental Research Center at the Isfahan University of Medical Sciences, of which he was one of the main founders. He also held the license to the fi rst English dental journal in Iran, the Dental Research Journal (DRJ). He reigned as the dean of Isfahan Dental School from 1988 to 1997. It was under his exemplary guidance, that the Isfahan School of Dentistry grew into one of the most respected sites for dental training in Iran. Professor Mousavi became the chairman of the Isfahan School of Dentistry Endodontic Department during the period of 1985-1988, and held the position of the president of the Iranian board of Endodontics from 1988. He has been honored by numerous national and international organizations for his contribution to Endodontic education and research. Another feather in his cap was being the head of the Isfahan Dental School Technical Committee on Stem Cell Research. Those of us who were fortunate to meet him came away greatly impressed with his genuine and humble nature. A man of his stature and importance and having his down to earth mannerisms, is indeed a rare combination to see! Professor S. Behrouz Mousavi has trained, mentored and befriended many Endodontists and researchers worldwide. He has added to the scope, knowledge and image of research more than one can imagine, gifting us with invaluable contributions and novel methods in his fi eld. He endeared himself to us all, and his presence will be greatly missed in every forward step that we take. Farewell Dear Professor S.B. Mousavi

A practical model for endodontic radiography teaching

Aim: To manufacture a clinical simulation apparatus for the undergraduates' endodontic radiography teaching Objectives: ? To provide a model for teaching of parallax method using Kelly's forcep ? To provide a model for undergraduates to practice radiographic localization employing parallax method. ? To allow students to practice taking radiographs in a way that simulates the clinical situations with a good diagnostic quality Methods: Impressions of a dentate arch (maxillary and mandibullary) were used to form a stone cast. A section of the cast, in the area where the natural teeth were to be placed, is sectioned and removed. Three maxillary extracted teeth (canine, first and second premolar) were selected and mounted with acrylic resin at the sectioned area. The resin was cured in a light box. The arches were mounted in a phantom head with a placement of rubber cheek. The first premolar was isolated with rubber dam. The intraoral holder (Kelly's forcep) was attached to a robotic arm. The students were taught the correct angulations of the x-ray cone for the paralleling technique and parallax method using Kelly's forcep during root canal treatment. Results: All students managed to complete the exercise and were considered competent when they produced acceptable quality of radiographs. Conclusion: The model described was improvised from a model that has been used during the past 2 years for undergraduates' endodontic courses. It has been well accepted as it simulates the clinical situation more closely than was possible previously.

Pre‐clinical endodontics: a survey amongst German dental schools

To evaluate the state and level of pre-clinical endodontic education in German dental schools and to evaluate differences with regard to intensity and extent of teaching, time devoted to teaching pre-clinical endodontics, personnel resources in teaching and technical equipment. Twenty-eight questionnaires were e-mailed to those in charge of pre-clinical endodontic education in German dental schools. The extent of education, the student-teacher ratio, the teaching content as well as the application of teaching materials and technologies were asked. If, after 4 weeks, no response had been received, the questionnaire was sent out by e-mail again. In the absence of a reply, a phone call was made to the corresponding university to conduct the survey by phone. With feedback from 27 of 28 dental schools, the response rate was 96%. Pre-clinical endodontic education at German universities varied considerably. Theory classes ranged from 5 to 30 h (13.3 h mean), practical classes from 12.5 to 60 h (45.4 h mean). The student to staff ratio varied between 9 : 1 and 30 : 1 (16 : 1 mean). Forty-eight per cent of the universities had a specialist in endodontics or a teacher with a special interest. A dental microscope was available for pre-clinical teaching purposes in 38% of the universities. The majority (63%) of universities taught root canal preparation with rotary nickel titanium instruments. Pre-clinical endodontic education varied considerably between German universities because of differences in programme design, staff and course content.

Critical analysis of artificial teeth for endodontic teaching

The purpose of this study was to evaluate the use of artificial teeth for endodontic teaching. A questionnaire was prepared and submitted to 18 professors of Endodontics from different Brazilian universities to evaluate the following features of five cloudy resin artificial teeth: internal and external anatomy; coronal chambers regarding their size, shape and canal path; root canal regarding their size, shape and position; fulfillment of the pulp chamber and root canals by considering the texture, quantity, color, and ease of handling; resin hardness and visualization of the radiographic image. The results presented favorable opinions, in terms of internal and external anatomy, coronal pulp chambers and root canal and handling and radiographic imaging. The contents of the pulp space and hardness of the teeth were considered satisfactory. The average grade assigned to the artificial tooth quality was 8.4, in a 0-10 scale. In conclusion, the artificial teeth have potential to replace the natural teeth in endodontic teaching; however, improvements are still necessary to reach a better quality model.

Personality Traits of Endodontic Residents Indicate Potential for Becoming Endodontic Faculty

Dental schools across America are challenged by the shortage of qualified faculty to fill vacant positions. This project, conducted through survey methodology, focused on obtaining a basic understanding of the personality types that seek out and maintain positions as full-time endodontic educators and compared those educators with endodontic residents to define similarities and differences that could lead to strategies to recruit those residents into academic endodontic education to assist in alleviating the faculty shortage in dentistry. All full-time endodontic faculty and residents were invited to participate. The Myers Briggs type indicator form M was administered electronically to faculty and postgraduates/residents. A 38.8% faculty and 21.3% resident response rate was achieved. Survey results were analyzed by using description statistics and chi-square tests. Results of the study indicate that there are parallel personality preferences of residents and faculty resulting in recommendations of early identification of academic interest, structured mentoring, faculty development of residents, and the implementation of debt-reduction strategies to ease entry into academic dentistry.

Analysis of Tooth Access Opening by Students Who Have Completed a Course in Endodontic Practice (Part II. Upper Premolars)

Our dental university has allocated time for endodontic practice to 4th-grade students who have completed a 3rd-grade course in endodontics. In this term, students to practice access opening of extracted upper and lower human molars. All the teeth are donated by students themselves, and the effectiveness of this approach for teaching has been analyzed. Students found 3 root canal orifices in 82.1% of upper molars with 3 root canal orifices, and 3 root canal orifices in 87.5% of lower molars with 3 root canal orifices and 2 root canal orifices in 87.1% of lower molars with 2 root canal orifices. No appreciable difference in ease of access opening was observed between upper and lower molars. Perforation occurred about 20% more frequently in upper than in lower molars. Knowledge of tooth anatomy is essential for students studying endodontic practice. Future efforts should be directed at improving endodontic education to ensure that failure does not occur in practice.

Analysis of Tooth Access Opening by Students Who Have Completed a Course in Endodontic Practice (Part I. Molars)

Our dental university has allocated time for endodontic practice to 4th-grade students who have completed a 3rd-grade course in endodontics. In this term, students to practice access opening of extracted upper and lower human molars. All the teeth are donated by students themselves, and the effectiveness of this approach for teaching has been analyzed. Students found 3 root canal orifices in 82.1% of upper molars with 3 root canal orifices, and 3 root canal orifices in 87.5% of lower molars with 3 root canal orifices and 2 root canal orifices in 87.1% of lower molars with 2 root canal orifices. No appreciable difference in ease of access opening was observed between upper and lower molars. Perforation occurred about 20% more frequently in upper than in lower molars. Knowledge of tooth anatomy is essential for students studying endodontic practice. Future efforts should be directed at improving endodontic education to ensure that failure does not occur in practice.

21st Century Endodontics: Part 3

Root canal treatment is often regarded as a simple technical exercise that results in a nice white line on the final radiograph. In fact nothing could be further from the truth, as may be seen from the case illustrated in Figure 1. It is hoped that the first two papers in this series have established that the rationale for modern root canal treatment is the removal of infection from the entire root canal system. This, of course, presumes correct diagnosis and treatment planning, and an essential knowledge of canal morphology. Endodontic preparation is a chemo-mechanical process and both the chemical and the mechanical components play an equal part. The term 'cleaning and shaping' may be associated with canal preparation from previous endodontic teaching. In the 21st century this has been subtly but essentially changed to 'shaping and cleaning'. Instruments are used to rapidly shape the canal to permit the ingress of chemical agents to the entire root canal system.

Quality Evaluation of the Teaching of Endodontics at the School of Dentistry, Federal University of Ceará

O objetivo deste trabalho foi avaliar a qualidade de ensino na Disciplina de Endodontia do Curso de Odontologia da Universidade Federal do Ceará, utilizando-se de um questionário aplicado aos acadêmicos que cursaram a disciplina no ano de 2004. Foram avaliadas duas turmas de alunos, sendo uma referente ao semestre 2004.1 e a outra, ao semestre 2004.2. O questionário foi elaborado pela autora do trabalho, que idealizou 16 perguntas com objetivo de fornecer subsídios para se conhecerem as reais condições de ensino-aprendizagem em Endodontia. Dos sessenta e nove questionários enviados, quarenta e um foram respondidos e devolvidos, correspondendo a 59,42% da amostra. Não houve necessidade de identificação do aluno respondente. Os dados referentes a cada pergunta foram coletados e os resultados permitiram uma auto-avaliação das condições de ensino, que serão consideradas nos futuros planejamentos da referida disciplina, buscando-se assim um nível mais elevado de sua aprendizagem.

A resource guide for practice development through technology

A resource guide for practice development through technology

Undergraduate teaching and clinical use of rotary nickel-titanium endodontic instruments: a survey of French dental schools.

To evaluate the impact of rotary nickel-titanium (NiTi) instruments on undergaduate teaching and clinical use in French dental schools and to evaluate the impressions of dental students when learning and using these techniques. A questionnaire was mailed to all 16 French undergraduate dental schools. Data were gathered on a range of issues concerning teaching and use of NiTi endodontic techniques. The response rate was 100%. The need for teaching NiTi techniques to dental students was agreed by all schools. Lectures and laboratory courses for rotary NiTi techniques were organized in all of the schools. In 13 of the 16 teaching hospitals, students could use rotary NiTi techniques for canal preparation under the supervision of teaching staff. Similarities were observed in the majority of responses, e.g. type of rotary system taught and used clinically. Some differences were also observed, e.g. the association of hand files to rotary NiTi instruments and at what stage in the undergraduate curriculum rotary instruments were introduced. There was a national consensus over the need for undergraduate teaching of rotary NiTi systems in France. These techniques had made a substantial impact in endodontic teaching and were widely taught and used in French dental schools.

Endodontic teaching in Philippine dental schools.

The aim of this study was to evaluate the pattern of undergraduate endodontic teaching in Philippine dental schools. Data were gathered by sending questionnaires to the deans of the 23 dental schools in the country to determine details of the teaching of root canal treatment in permanent teeth. The covering letter requested that endodontic staff complete the questionnaire. Twenty of 23 dental schools returned completed questionnaires. Similarities were observed in the timing of undergraduate endodontic teaching, working length determination, and root canal preparation technique. Irrigating fluids recommended included one or a combination of the following: sodium hypochlorite, hydrogen peroxide, distilled water and EDTA. The root canal medicaments popularly employed were CMCP and eugenol. Most schools used slow-setting zinc oxide eugenol cement as sealer. Differences between schools were noted in the laboratory component of the course. The time allotted for the laboratory exercises, as well as the number of teeth used, differed greatly between each school. An inadequate tutor to student ratio was noted in the majority of schools. Teaching aids were limited and, in most instances, produced by faculty members. Most faculty members teaching endodontics had no specialist training. The results of this study have demonstrated that there is a need to review endodontic teaching in the majority of the Philippine dental schools to ensure that the course content and curriculum employed by all schools meet specified standards and that appropriate measures should be considered to enhance the learning experience of students.