Endodontic Research Articles

Learning from Mistakes—Dental Students’ Learning Experiences from Adverse Clinical Events

Clinical training in the teaching practice is essential for developing patient-specific skills, yet the transition from preclinical to clinical training presents significant challenges for students. This study aimed to comprehend the challenges and issues faced by students at the onset of clinical training. It retrospectively investigated adverse events presented at the advanced dentistry course by third-year pre-doctoral students from classes 202A, 202B, and 202C during their initial ten months of clinical practice at the teaching institution. In this study, adverse events were defined as any undesirable experiences or incidents associated with a clinical treatment and administrative procedures. A total of 279 adverse events presented were categorized into eight disciplines: Treatment planning (TP), Operative (OP), Periodontics (PER), Endodontics (EN), Oral Surgery (OS), Fixed Prosthodontics (FP), Removable Prosthodontics (RP), and Patient Management (PM). The distribution of events was as follows: TP (11.5%), OP (17.7%), PER (13.1%), EN (6.9%), OS (6.2%), FP (24.2%), RP (5.0%), and PM (15.4%), with FP, OP and PM experiencing the highest rates of adverse events. The distribution pattern within the disciplines was consistent, and no statistical difference was observed. Across these disciplines, a lack of clinical skill competency was identified as a primary cause of adverse events. Other contributing issues included miscommunication, insufficient explanations to patients, a lack of administrative support, case complexity, and a deficit in diagnostic examinations and skills. The frequency of causes varied across the three classes, but no significant differences was noted in OP, FP and OS, in which over 80% of causes were related to clinical skill competency. Adverse events in clinical settings are frequent. Knowing these beforehand can aid students’ performance. Students should prepare thoroughly before clinical practice and understand common causes of errors. Educators should recognize the challenges inexperienced students encounter. Awareness of typical mistakes can enhance success in demanding clinical scenarios.

Guidelines for radiographic examination in cariology and endodontics

Endodontic diseases, due to the high incidence rate, affect the life quality and aesthetics of patients. As an auxiliary examination method, oral radiographic examination is of great significance for the preoperative diagnosis, treatment and postoperative evaluation of endodontic diseases. The principle of choosing oral radiology methods is to provide accurate and necessary information for diagnosis and treatment while protecting the patients' interests to the greatest extent. The Society of Cariology and Endodontics, Chinese Stomatological Association, based on extensive solicitation of opinions and reference to relevant literature, has set an application guideline after extensive discussions and revisions. This guideline covers the common clinical scenarios of application of radiographic examination in the diagnosis and treatment of endodontic diseases and provides recommendations for radiological methods. Hopefully, the guideline may help the clinicians to solve the important clinical problems and to provide a scientific foundation for the application of radiographic examination in the diagnosis and treatment of endodontic diseases.

New partnership heralds easier endodontics for GDPs

New partnership heralds easier endodontics for GDPs

An introduction to endodontics

An introduction to endodontics

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).

Evaluation of Smear Layer Removal and Antimicrobial Efficacy of HybenX Against Enterococcus Faecalis Biofilm.

To evaluate the antibacterial efficacy of HybenX, an endodontic irrigant against Enterococcus faecalis biofilm and determine its efficacy in removal of smear layer. Forty root canals were inoculated with E. faecalis for three weeks, divided into 4 groups and irrigated with: Group1: 5 ml 2.5% sodium hypochlorite; Group2: 5 ml 2% chlorhexidine gluconate; Group3: 5 ml HybenX; Group4: 5 ml distilled water (control). Dentin shavings were collected and plated on agar plates, followed by colony forming unit (CFU) determination. For smear layer removal examination, 30 single rooted teeth were instrumented and divided into 3 groups and treated with: GroupI: 5 ml of 17% EDTA; GroupII:5 ml of HybenX; and GroupIII: 5 ml of distilled water. Samples were then subjected to SEM examination. All irrigants showed a significant reduction in CFUs compared to the control group (P⟨ .001), but none compared to each other. Regarding smear layer removal in the apical third, EDTA removed smear layer more effectively than HybenX (P = .014). HybenX demonstrated good antimicrobial efficacy against E. faecalis biofilm and removed the smear layer effectively in coronal and middle third of the root canal system. HybenX can be considered as a promising irrigating agent in root canal treatment of infected teeth.

Consensus of Chinese stomatological multidisciplinary experts on maintaining periodontal health (First edition)

Periodontal disease is the main cause of tooth loss in adults, and it is also one of the major factors affecting oral and general health. In the process of diagnosing and treating the oral diseases, many subspecialties of stomatology will involve in the maintenance of periodontal tissue health. The Chinese Stomatological Association organized a number of experts in related disciplines to thrash out the present expert consensus in order to enhance the awareness of dental clinicians to maintain the health of periodontal tissues and to standardize the procedures of diagnosis and treatment. The clinicians' abilities in prevention and treatment of oral diseases will be hopefully elevated if the clinicians, especially in such disciplines as prosthodontics, orthodontics, oral implantology, operative dentistry and endodontics, can early recognize and identify the periodontal disease and the damage degree of periodontal tissues, adopt the appropriate intervention measures and predict the prognosis scientifically.

Etiologies of Complications during Endodontic Treatment: A Survey among Dentists of the Town of Abidjan

Objective: This study aimed to identify the etiologies of complications linked with the various stages of the operating procedure for endodontic treatment by means of a survey among dentists in the town of Abidjan so as to better understand and prevent such complications. Materials and Methods: This was a prospective and descriptive study. A data collection form was devised for this purpose. The following variables were collected: the type of practice, the number of years in practice, the frequency of root canal treatments performed, the complications encountered and identification of the etiological factors. Results: The questionnaire was completed by 135 dentists. Among them, 65.9% performed up to 10 endodontic treatments per month. The majority (92.7%) stated that they encountered between 1 and 4 cases of complications per month in the course of endodontic treatment. The absence of preoperative radiography was the most often cited reason (64.44%) followed by erroneous diagnoses (14.07%). Conclusion: Altogether, the results show non-adherence to the procedures for performing endodontic treatments, which is the source of most complications. There is an urgent need to realign practitioners with the rules of good practice during endodontic procedures.

A survey over the undergraduate students' approaches toward the management of endodontic emergencies at the Dakar Dental School: A descriptive cross-sectional study

Introduction: Endodontic emergencies are characterized by violent or disabling pain. The management of these emergencies requires a precise diagnosis and an emergency act with or without a prescription. This study primarily aimed to determine undergraduate students' knowledge on the management of endodontic emergencies at the dental school. Materials and Methods: In this cross-sectional descriptive study, students of the dental school have received questionnaires with two main parts: a first part dealing with students' identification and a second part dealing with students' knowledge and attitudes on endodontic emergency management. Participants were asked to choose the appropriate option (s) for the appropriate management of each type of endodontic emergency. Data were statistically analyzed. Results: Of the 176 students included in this study, 171 questionnaires (97.2%) were completed and returned to the authors. For each emergency, most of the respondents recommended options that are consistent with the standard protocol. The statistical analysis showed a significant correlation between correct responses according to the standard protocol and academic levels of students who attended a conference or training on endodontic emergencies and students who dealt with endodontic emergency during their training (P Conclusion: The study showed that the students' level of knowledge is high. However, they recommended inappropriate antibiotic prescriptions. This shows the need to improve student-training programs on endodontic emergencies.

Do didactics improve clinical skills: A retrospective educational study

Introduction: As predoctoral dental students navigate through the dental curriculum, the knowledge of clinical dentistry is progressively gained from didactic lecture courses. The goal of this study was to evaluate whether there is an association between endodontic didactic knowledge and endodontic preclinical skills. Methods: The study utilized the existing preclinical endodontic assessments of 2nd-year dental students (105 students). Using ExamSoft, the nonclinical questions (e.g., microbiology and pulp biology) were excluded from the final didactic assessment, and a new didactic grade was calculated and assigned to each student. Each endodontic skill (access preparation, instrumentation and obturation, and combined) was matched with corresponding clinically related questions in the didactic assessment. For each student, the matched didactic grade was weighted against the practical grade using Kendall's τ correlation coefficient. To determine the effect of each predictor variable (didactic score and gender), an ordinal logistic regression was used. Results: For all portions of the examination, the correlation between preclinical and didactic grades was significant, P Conclusion: Only a weak association was found between didactic performance and preclinical skills. Lectures on clinical topics should be improved and sequenced accordingly to better link the theory of endodontic technique to the hands-on simulation laboratory.

Combined surgical and nonsurgical endodontic therapy for the retreatment of a root canal with a broken round bur in the apical third: A case report with a 4-year follow-up

Management of endodontic lesions in previously treated teeth might be challenging due to the presence of procedural mishaps such as metallic objects that have been broken accidently by the previous treating dentist. A 36-year-old female complaining of pain with biting was referred for endodontic retreatment of her maxillary left central incisor. The involved tooth was sensitive to percussion, and the periapical radiographic examination revealed the presence of an apical radiolucency, a lateral radiolucency, and a separated round bur in the apical third. Cone-beam computed tomographic imaging was performed to provide a detailed assessment of the tooth and the surrounding structures. The tooth was diagnosed as previously treated with symptomatic apical periodontitis. Root canal retreatment was completed using a combined surgical and nonsurgical approach under an operating microscope. At 1-year follow-up, the patient was asymptomatic, and the two-dimensional radiographic examination revealed complete healing and remained so for the 4 years of follow-up. The presence of a broken bur in a previously filled root canal is unusual. Endodontic management of such cases requires careful evaluation and good clinical management.

Knowledge-, attitude-, and practice-based survey on instrument separation and its management among endodontists and postgraduates in India - A cross-sectional web-based questionnaire

Introduction: The aim of this survey was to investigate the current knowledge and attitude toward intracanal instrument separation and the most common modality of treatment employed among endodontists and postgraduates in India. Materials and Methods: A validated web-based questionnaire that comprised close-ended and partially close-ended questions in four categories was circulated by e-mail along with the informed consent to 1100 endodontists and postgraduates. The participants were asked about the frequency of instrument separation, possible etiological factors, management, and techniques used for instrument retrieval. Reliability was checked by asking ten random participants to fill the forms twice within a time frame of 15 days. Statistical Analysis: The validity and reliability scores for the survey were calculated using content validity ratio and kappa test, respectively. All the analyses were performed using SPSS 16.0 software. Results: A total of 499 responses were received, yielding a response rate of 45.3%. The content validity ratio was 0.9 and kappa scores for reliability were 0.98. The survey respondents comprised 47.6% of endodontists and 52.4% of postgraduates. Majority of the respondents (59.5%) opted to bypass, clean, and shape the canal and incorporate the separated instrument in the obturation. Ultrasonics (60.9%) was the most preferred technique for instrument retrieval of which 28.5% of the respondents used direct ultrasonic vibrations, 23.1% used indirect vibrations, and 48.4% used both direct/indirect vibrations. Conclusions: The respondents of the survey were aware of the possible etiological factors and management techniques used for retrieval of the separated instrument. Majority of them chose to bypass the separated instrument. Ultrasonics under a dental operating microscope was the most commonly employed technique for retrieval.

Evaluation of the surface nanoscale changes of R-phase, M-wire nickel-titanium instruments after use in extracted molars: An in vitro study

Introduction: The objective was to explore the impact of root canal instrumentation on the surface nanoscale characteristics of M-wire (ProTaper Next®[PTN]) and R-phase (twisted file [TF]) nickel–titanium (NiTi) instruments. Materials and Methods: Endodontic cleaning and shaping was performed on the curved canals of the mesial roots of mandibular extracted molars (n = 32). Canal curvatures ranged from 20° to 30° according to the Schneider method. PTN and TF NiTi instruments were used for this purpose. The surface parameters of NiTi instruments were evaluated before and after the root canal instrumentation using a Dektak three-dimensional nanoscale surface profiler. An analysis of variance and Student's t-test were used to determine the significance of various parameters of the NiTi instruments before and after the root canal instrumentation. The statistical significance level was set at P Results: There were no significant differences in the root mean square roughness (Sq), average roughness value (Sa), and peak to valley height (Sz) in flutes between the instruments (P > 0.05) or in the Sq in blade location. However, the Sa and Sz in blade location were significantly greater for TF than PTN. The TF instruments had greater surface roughness than PTN. The PTN instruments exhibited minor surface cracks, while TF instruments exhibited cracks and microcavities. Conclusion: Endodontic instrumentation altered the surface characteristics; the surface distortion was significantly greater for the TF instruments than the PTN instruments.

Radiographic evaluation of the quality of root canal filling performed by undergraduate students at Riyadh Elm University: A retrospective study

Introduction: The aim was to assess the quality of root canal filling and the frequency of procedural errors in endodontic treatment performed by undergraduate students at Riyadh Elm University, Riyadh, Saudi Arabia. Materials and Methods: Radiographic record of 306 postroot canals treated anterior and posterior teeth done by female undergraduate students between 2013 and 2019 were randomly selected. The root canal filling was evaluated using the following criteria: acceptable treatment comprises the following characteristics: uniform density, no voids, root canal filling 0–2 mm from the radiographic apex, and tapered: overfilling, underfilling, and inadequate density were considered unacceptable. Data were statistically analyzed. Results: A total of 116 root canal fillings were done in the anterior teeth and 190 in the posterior teeth. In which 69.9% of root canal fillings were acceptable, and 66% of the treated teeth were in the maxilla. Patients with abscess and periapical pathology in radiograph had 2.11 times higher odds of unacceptable root canal fillings compared to patients with normal periapical radiographs, and the association was significant with 95% (confidence interval: 1.27–3.50) after adjusting for age, number of canals, tooth position, and location. About 13.7% of the unacceptable root canal fillings were underfilled. Conclusion: The quality of root canal filling performed by female undergraduates was considered acceptable. Underfilling was the mostly identified treatment error. Hence, additional preparation is needed to improve the clinical aptitudes of the undergraduates for better endodontic treatment results.

Survey based assessment of diagnosis through periapical radiograph and CBCT and treatment of root resorption with Brazilian and American dentists and endodontists.

BackgroundThis study assesses and compares the knowledge level of endodontists (ENDs) and general dental practitioners (GPs) from Brazil and United States of America (USA) in the diagnosis and treatment of internal and external inflammatory root resorptions through periapical radiographic (PA) and cone beam computed tomography (CBCT) examinations. Material and MethodsA cross-sectional online questionnaire-based survey was presented to the volunteers containing questions regarding personal and professional profile, as well as three clinical cases of internal and external inflammatory root resorption. A series of multiple-choice questions about the diagnosis and treatment options were surveyed. The data collected was analysed by the Chi-square test with Yates correction with a significance level of 5 %. ResultsMost answers were considered adequate when all three questions about the diagnosis and all two questions relating to the treatment were answered accurately. A total of 374 dentists answered the survey (n: 229 from Brazil vs. 145 from USA) being 41% END and 59% GP. END presented higher level of knowledge than GP regarding to diagnosis and treatment of inflammatory root resorptions both in Brazil and USA (p<0.05); USA presented higher level of adequate responses than Brazil (p<0.05). ConclusionsEND achieved a level of knowledge of the diagnosis and treatment of root resorption superior to the GP. Comparing the results obtained in both countries, it was observed that the USA had a higher correct response rate than Brazil. Key words:Internal root resorption, external root resorption, management, diagnosis, treatment.

For all your endodontic referrals

For all your endodontic referrals

A comparative assessment of apical debris extrusion by various glide path establishing endodontic instruments: An in vitro study

Introduction: A reproducible glide path provides guidance to fulfil the mechanical objective of cleaning and shaping root canals with minimal procedural errors. Debris expelled during this procedure contributes to inter-appointment flare-up. The objective of this in vitro study was to estimate and compare the quantity of debris extruded by; hand, rotary and reciprocating glide path preparation instruments. Materials and Methods: Seventy-five human single rooted, matured mandibular incisors with single canal and comparable lengths were randomly allocated into three groups (n = 25): group A – Stainless steel (SS) K-file (No 15), Group B – ProGlider, and Group C –WaveOne Gold Glider. Customized apparatus using Meyers and Montgomery method was utilized to accumulate the debris expelled apically in the Eppendorf tubes weighed priorly in digital analytical balance of 10−6 g accuracy. All groups were instrumented as per the manufacturer's guidelines. After instrumentation, teeth were detached from the Eppendorf tubes and tubes incubated at 70°C for 5 days to vaporize the irrigating solution. The tubes with dry debris were later weighed in the same weighing balance. The collected information was analyzed by one-way ANOVA and Tukeys honest significant difference post hoc test at significance level (P Results: The ProGlider group expressed statistically significant result with least quantity of extruded debris in the comparison to other groups (P Conclusion: Glide path preparations with rotary ProGlider resulted in the minimal extrusion of debris in comparison to the reciprocating WaveOne Gold Glider and the manual stainless-steel K-files.

A Clinical Study Determining Pulp Vitality in Oropharyngeal Cancer Patients Undergoing Radiotherapy Using Diagnostic Tool-Pulse Oximetry.

Pulse oximetry is an equipment that evaluates pulp vitality for concrete endodontic diagnosis and treatment plan. One of the treatment methods of oropharyngeal cancer is radiotherapy. Radiotherapy has some harmful effects on dental pulp that affects pulp vitality. The objective of study was to assess pulp vitality before, at the end of radiotherapy and six months after radiotherapy (RT) in oropharyngeal cancer patients undergoing radiotherapy. 25 patients who were diagnosed with oropharyngeal cancer having asymptomatic intact crowns were selected for the study. Pulp vitality was checked before the commencement of radiotherapy (PV1), immediately after radiotherapy (PV 2) and six months post radiotherapy (PV 3). Pulp vitality of first posterior tooth was selected of each patient and was checked with pulse oximetry. Paired t-test was used as statistical analysis. Statistically significant difference was observed when PV 1 and PV 2, PV 1 and PV 3 and PV 2 and PV 3 were compared amongst each other. There was reduction noted in mean SpO2 value when groups PV 2 and PV1 were compared. This was statistically significant. Statistically significant increase in mean SpO2 value was observed six months post radiotherapy (PV 3). Thus, it can be concluded that statistically significant reduction in mean SpO2 level post radiotherapy recovers after six months.

Cone-beam computed tomography evaluation of the root morphology of the maxillary and mandibular premolars in a Moroccan subpopulation: Number of roots and tooth length (part 1)

Introduction: The aim of the study was to evaluate the number of roots and tooth length of the maxillary and mandibular premolars of a Moroccan subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: The number of roots and tooth length of 919 maxillary and mandibular premolars (358 maxillary and 561 mandibular) examined by CBCT was evaluated using “Planmeca viewer” software. Statistical analysis was carried out using the Epi info software. Results: The study showed a high prevalence of two roots for maxillary first premolars, and single root for maxillary second premolars and mandibular first and second premolars. The mean length of the maxillary first premolars (single rooted) was 21.74 mm, that of the buccal roots was 21.92 mm, and that of the lingual roots of the two-rooted teeth was 20.67 mm. The maxillary second premolars (21.4 mm) and the mandibular premolars (21.5 mm) exhibited the same mean length. Conclusion: All premolars had a single root in most cases, except for the maxillary first premolars where two-rooted teeth were more frequent with an average length of 21.4 mm. CBCT is an exciting tool for endodontic diagnosis and treatment planning.

Intracanal delivery of calcium hydroxide: A literature review

Introduction: Intracanal medication with calcium hydroxide is an important adjunct to disinfection after the chemomechanical preparation. A dense and homogeneous filling up to the working length positively influences the outcome of endodontic treatment in infected cases. The optimum placement of intracanal medicament can many times become a challenging task, owing to the lack of usage of the appropriate instruments and techniques. Aim: The aim is to gather and assess available literature on the rationale of calcium hydroxide placement, instruments, and techniques for effective delivery. Materials and Methodology: An electronic search was conducted using the PubMed Database from 1970 to 2019 using the keywords “delivery of calcium hydroxide,” “placement of calcium hydroxide,” “density of calcium hydroxide.” The articles pertaining to the comparison between the placement techniques of calcium hydroxide dressing were analyzed. Results: The search identified 433 articles, from which 419 articles that did not fulfill the inclusion criteria were excluded from the study and eventually 13 research articles were analyzed for the review. Conclusion: The density of calcium hydroxide and the technique of placement may affect the healing outcome especially in cases of pulp necrosis with apical periodontitis. The use of lentulo spirals at lower speeds seems effective in intracanal delivery of calcium hydroxide.