Root Canal Treatment In Molars Research Articles

Molar root canal treatment performed by undergraduate dental students; an observational study of procedural errors and student perception

BackgroundMolar root canal treatment (RCT) is challenging and requires training and specific skills. Rotary instrumentation (RI) reduces the time needed for instrumentation but may increase the risk of certain procedural errors. The aims of this study were to evaluate the quality of molar RCTs provided by undergraduate students, to compare the prevalence of procedural errors following manual and RI, and to assess the students’ self-perceived confidence to perform molar RCT without supervision and their preference for either manual or RI.MethodsMolar RCTs performed by the final year students were evaluated radiographically according to predefined criteria (Appendix 1). The procedural errors, treatment details, and the students’ self-perceived confidence to perform molar RCT and their preference for either manual or RI were recorded. Descriptive statistics were performed, and the Chi-squared test was used to detect any statistically significant differences.Results60.4% of RCTs were insufficient. RI resulted in more sufficient treatments compared with MI (49% vs. 30.3% respectively. X2: 7.39, p = 0.007), required fewer visits to complete (2.9 vs. 4.6 respectively. X2: 67.23, p < 0.001) and was the preferred technique by 93.1% of students. The most common procedural errors were underextension of the root canal obturation (48.4%), insufficient obturation (45.5%), and improper coronal seal (35.2%) without a significant difference between the two techniques. 26.4% of the participating students reported that they did not feel confident to perform molar RCT without supervision.ConclusionThe quality of molar RCT provided by UG students was generally insufficient. RI partially improved the technical quality of RCT compared with MI. UG students need further endodontic training and experience before they can safely and confidently practise molar RCT.

A 1 year follow-up of a molar root canal treatment using periapical radiographs and CBCT

CBCT offers many significant advantages in dentistry, while the periapical radiographs provide a cheaper technique and a lower radiation compared to CT scan. The aim of this clinical case was to compare the outcome 1 year after root canal treatment, using digital periapical radiographs versus CBCT. Tooth 46 with necrotic pulp and periapical periodontitis was rotary prepared and filled using continuous wave condensation and AH Plus. X-rays and CBCT scans were made both before and after the treatment, at 1 year recall. On x-ray the lesion appeared to be healed, while on CBCT one can still see a smaller lesion, so the tooth is healing. The increased accuracy of CBCT offers the most relevant information for the outcome of endodontic treatment.

Evaluation of Mechanical Versus Manual Root Canal Preparation in Primary Molars-A Comparative In Vitro Study.

The endodontic treatment of primary teeth is to maintain the function of the tooth free of symptoms until its physiological exfoliation. A critical factor for success is how quickly and effectively the root canal preparation can be performed. Therefore, the aim of this comparative in vitro study was to analyze the efficiency of two mechanical root canal preparation systems FM (FlexMaster) and HF (HyFlex EDM) to manual KF (K-file) on extracted primary molars. A total of 45 teeth were divided into three groups (n = 15): KF (#15-35), FM (04#30) and HF (25/~ OneFile). Root canal preparation was performed, and the preparation time was measured. All root canals were non-destructively analyzed by micro-computed tomography in the cervical, middle and apical thirds before and after preparation with regard to the parameters of canal transport (in μm) and centering ratio (0-1). Statistical analysis was performed at a 5% significance level using non-parametric tests. HF caused the lowest canal transport in the apical third (p = 0.008). The centering ratio value of HF was significantly higher in the middle third of the root canals than in the other two groups (p < 0.01). The mean instrumentation time was significantly higher for KF (6.67 min) than for FM (4.69 min) and HF (4.03 min, p < 0.01). HF can be recommended for primary molar root canal treatment.

Nfluence of Apical Patency Concept Upon Postoperative Pain Following Single Session Primary Root Canal Treatment in Molars with Pulpal Disease

nfluence of Apical Patency Concept Upon Postoperative Pain Following Single Session Primary Root Canal Treatment in Molars with Pulpal Disease

Impact of an Enhanced Infection Control Protocol on the Microbial Community Profile in Molar Root Canal Treatment: An in Vivo NGS Molecular Study

IntroductionRecent findings demonstrated that 1-year cone-beam computed tomography–based outcomes of molar root canal treatment were improved through an enhanced infection protocol (EnP), when compared with a current best-practice standard infection control protocol (StP). The EnP comprised measures to reduce iatrogenic contamination from direct and indirect contact surfaces, including the replacement of the rubber dams, gloves, files, all instruments, and surface barriers before root canal obturation. The aim of this study was to investigate the effect of such an EnP on resident microbiome present after chemomechanical instrumentation and the protocol ability in reducing iatrogenic contamination in molar teeth during root canal treatment. MethodsMolar teeth were block-randomized to receive treatment under EnP or StP. To compare the differential effect of the protocol on the identity of bacteria present, 150 matched DNA extracts from 75 molar teeth samples (StP, n = 39; EnP, n = 36) were evaluated. Samples were taken before (S1) and after (S2) chemomechanical preparation and were subjected to next-generation sequencing of the V3-V4 region of the 16S rRNA gene before bioinformatical identification using the HOMD oral microbiome database and downstream taxonomic processing, providing measures of richness and diversity of bacteria and significant bacterial taxa during chemomechanical instrumentation and the effect of the 2 treatment groups. ResultsEighty-eight microbial taxa were significantly more abundant in StP S2 samples, including endodontically relevant contaminants taxa as Actinomyces, Cutibacterium, and Haemophilus. The S2 samples demonstrated fewer residual bacterial species in the EnP group, with 26.8 observed species compared with 38.3 in the StP. Reduced diversity and richness measures were noted in the EnP pre-obturation samples compared with the StP in OTU, Chao1, and ACE indices (P ≤ .05). Differential microbial identities between S1 and S2 samples and protocols demonstrated that the previously observed increased effectiveness of the EnP protocol was likely to prevent recontamination or de novo contamination of the root canal space during treatment. ConclusionsThe implemented EnP resulted in a specific reduction of microbial taxa often associated with recontamination or iatrogenic contamination, suggesting the basis for improved infection control measures during root canal treatment.

A Survey Of Dental Surgeons In Ghana On Their Utilization Of Supplemental Local Anaesthetic Methods During Root Canal Therapy

Background: Teeth with irreversibly inflamed pulps can be preserved with endodontic or root canal treatment (RCT). The primary methods used to manage pain during RCT are local infiltration injections and nerve blocks. When infiltrations are used, it is reasonable that the acidic nature of inflamed tissues, can reduce the availability of the active form of the local anaesthetic agent. In the case of nerve blocks, the acidity of the inflamed tissue is unlikely to play a significant role in the failure to achieve anaesthesia. Supplementalanaesthesia methods including periodontal ligament injection (intraligamentary), intraosseous injection, and intra-pulpal injection have been suggested as adjuncts to obtaining complete anaesthesia of the symptomatic irreversibly inflamed dental pulp.Aim: This study was to ascertain the types of supplemental anaesthesia techniques, and their levels of utilization during lower molar RCT in Ghana.Materials and methods: An online survey was done by e-mailing questionnaires to practicing dental surgeons registered on the Ghana Dental Association(GDA), google’s group platform. Data obtained was analyzed using SPSS version 21.Results: Eighty-five percent (34) of respondents indicated that they employ supplemental injections during RCT. Pulpal and intraligamentary techniques were the most commonly used, with 70.6% and 47.1% of dentists reporting utilization respectively.Conclusion: There is the need for update courses in the utilization of intraosseous supplemental local anaesthesia. Other supplemental injection techniques like the inferior alveolar nerve block (IANB) plus nitrous oxide inhalation have to be introduced to dentistscarrying out RCT, so they can add such techniques to their pain management portfolio.

MAXILLARY MUCOCOELE A RARE ENTITY

Abstract Mucoceles are accumulations of trapped mucus, forming cystic expansile lesions. Maxillary sinus mucoceles are rare amongst paranasal sinus mucoceles, usually being a late sequel of Caldwell-Luc surgery. We present a case of a maxillary sinus mucocele due to a molar root canal treatment in a middle aged patient, reported to highlight its unusual etiology. Keywords Mucocele

English

English

Structure bound guide to access cavity preparation for molar root canal treatment

A good access cavity preparation is the gateway to success in endodontic treatment. This article presents occlusal landmarks that can be used as the boundary for the endodontic access at the occlusal surfaces of maxillary and mandibular molars. Further this article gives a structure or landmark guided three simple stages of preparation to reach the pulp chamber. This assures an ideal access cavity reducing the risk of dentin gouging and eliminating iatrogenic deleterious events. All canal orifices will be within this boundary and can often be located easily.

Changes in anatomic position of root canal orifices in pluriradicular teeth following re-location during endodontic treatment

Direct access to the root canals in posterior teeth for endodontic treatment is most frequently facilitated by the straightening of the coronal parts of the root canals, having as a consequence the relocation of the canal orifices on the map of the floor of the pulp chamber (Christie and Thompson, 1994). This procedure intentionally moves the coronal aspect of a canal away from the center of the chamber, while simultaneously removing internal dentin from the pulp chamber walls. The aim of this study was to evaluate the displacement resulting from the relocation of root canal orifices during the initial phase of rotary root canal treatment in molars using the dental operating microscope (DOM) and digital image processing. Forty-three molars (17 maxillary and 26 mandibular) belonging to 43 patients (aged 18–62 years) with indications for root canal treatment were endodontically treated. The differences between the initial perimeter and the perimeter of the root canal orifices polygon after relocation varied between 2.7 and 3.4μm (mean 3.0μm), while the differences between the initial area and the area after relocation varied between 2,448,456.8 and 3,249,306.6μm2 (mean 2,848,881.7). The increase in access to the cavities and the alterations of the pulp chambers can be satisfactorily approximated by the variations of the perimeters and areas of the pulp floor polygons during root canal treatment. From a clinical perspective, these results indicate that there is a significant decrease in tooth substance in molars (except MB2).

General Dentists' Use of Isolation Techniques during Root Canal Treatment: From the National Dental Practice-based Research Network

IntroductionA preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified the use of all isolation techniques, including RD use. MethodsNetwork practitioners completed a questionnaire about isolation techniques used during RCT. Network enrollment questionnaire data provided practitioner characteristics. ResultsOne thousand four hundred ninety of 1716 eligible GDs participated (87%); 697 (47%) reported always using an RD. This percentage varied by tooth type. These GDs were more likely to always use an RD, do not own a private practice, perform less than 10 RCTs/month, and have postgraduate training. ConclusionsMost GDs do not use an RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics.

Current Trends in Endodontic Treatment by General Dental Practitioners: Report of a United States National Survey

IntroductionIn the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols. MethodsA paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE). ResultsCompleted surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P < .05), nickel-titanium rotary instrumentation (P < .001), apex locators (P < .001), and magnification (P < .01); in contradistinction, GPs in practice >20 years were more likely to perform retreatments (P < .05). Women were less likely to perform retreatment or molar RCT (both P < .05). GPs with >5 hours of CE were more likely to use rotary instrumentation (P < .001), irrigant activation devices (P < .01), and apex locators (P < .001) and perform molar RCT (P < .001) and retreatment (P < .05), but no more likely to use rubber dam. ConclusionsRecent GP graduates (≤10 years) were more likely to adopt new technologies and use rubber dam than those who practiced for >20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage.

Should Endodontists Place Dental Implants? A National Survey of General Dentists

Introduction The purpose of this study was to assess whether general dentists support the placement of dental implants by endodontists. Methods A 29-item written survey was developed and mailed to 1,500 randomly selected practicing general dentists within the United States to assess whether respondents supported implant placement by endodontists and whether they would refer patients to endodontists for implant placement. Univariate, bivariate, and logistic regression analyses were performed. Results Three hundred sixty-six subjects completed surveys. Sixty-six percent of respondents opposed endodontists placing implants, and 73% indicated they would not refer patients to an endodontist for implant placement. The following characteristics were associated with respondents who support implant placement ( P < .05): yes, willing to refer to an endodontist for implant placement; believes other specialists would support endodontists placing implants; never or sometimes refers patients for molar root canal treatment; and plans to retire in 5 years. Conclusions The majority of respondents did not support implant placement by endodontists. As the demand for implant therapy continues to grow, it may be necessary to increase the number of practitioners who place dental implants. However, general dentists’ and specialists’ attitudes should be further assessed before modifying the scope of endodontic practice to include implant placement.

General dental practitioners' confidence in performing molar root canal treatment

The objectives of this study were to assess the practice of molar root canal treatment (RCT) among general dental practitioners (GDPs), confidence level of GDPsin performing molar RCT and to identify factors that influence their confidence in managing molar RCI. One hundred questionnaires were distributed to GDPsin Kuala Lumpur and Selangor. Fifty questionnaires were delivered by mail and the remaining fifty were hand-delivered. All data was coded and verified. FiftysixOOPs responded to the questionnaires. Only fortyfive questionnaires were accepted (n=45) as eleven OOPs had never performed molar RCI. Most of the OOPs followed the standard quality guidelines while performing molar RCT except for vitality testing (36.4%) and rubber dam usage (27.3%). In this study, 100% of the GDPs were confident in making diagnosis&nbsp;of perinidicular diseases and 95.4% were confident in performing molar RCT from history taking until obturation. Patients' tolerance and availability of instruments and materials (97.7%) were two factors that most influence the GDPs' confidence level. The. least influencing&nbsp;factor was undergraduate training (78.1 %). Attending seminars and lectures on endodontic, large number of molar teeth treated for ReT, patLents' affordability to pay for RCT and postgraduate training also influence GDPs' confidence to a certain degree. From this study, it can be concluded that majority of OOPs complied standard quality guidelines except for vitality testing and rubber dam usage. Most of them were confident in performing molar RCT and were greatly influenced by the availability or"instruments and materials in their clinic and patients' tolerance in receiving molar RCI.

A Retrospective Study of Endodontic Treatment Outcome between Nickel-Titanium Rotary and Stainless Steel Hand Filing Techniques

Aim The purpose of this study was to compare the periapical healing of molar root canal treatment using two instrumentation techniques. Methods A total of 225 maxillary and mandibular first and second permanent molars endodontically treated by undergraduate or postgraduate students were randomly selected from a computerized hospital database of which 110 molars had been prepared using a hybrid rotary technique with nickel-titanium instruments (group NR) and 115 with hand stainless steel files (group HF). Patients were recalled and the teeth were examined both clinically and radiographically for signs of periapical inflammation. Results Some 19% and 39% of teeth in the NR and HF group, respectively, were judged to have some form of procedural errors. A higher rate of periapical healing was noted for NR (77%) than the HF group (60%) (p < 0.05). Factors contributing favorably to treatment outcome included the use of rotary technique, maxillary molar, experienced operator, and absence of preoperative radiolucent lesion. Conclusion There was a higher incidence of procedural errors and a lower success rate for primary root canal treatment of teeth prepared with stainless steel files compared with the use of NiTi instruments in a continuous reaming action.