Endodontic Training Research Articles

A new teaching model with artificial teeth containing simulated pulpal tissue

This study aimed to evaluate the use of artificial teeth for endodontic training for dental students. The following aspects of the artificial teeth were approved by the endodontists in Isfahan University of Medical Science: internal and external anatomy; coronal pulp chambers regarding their size, shape, and canal path; the root canals regarding their size, shape, and position; filling the pulp chamber and root canals by considering the texture, quantity, color, and ease of handling; and resin hardness and visualization of the radiographic image. The results showed favorable opinions regarding the internal and external anatomy, coronal pulp chamber, root canal (s), handling, and radiographic imaging. The contents of the pulp space and hardness of the teeth were satisfactory. The artificial teeth tested have the potential to replace the natural teeth in preclinical training.

Assessment of Practice of Endodontic Treatment Protocols among General Dental Practitioners in Pokhara, Nepal

Introduction: Endodontics is specialty field, but the majority of endodontic treatment in Pokhara is provided by the general dental practitioners. The aim of this study was to assess the practice of endodontic treatment protocols among general dental practitioners in Pokhara, Nepal. 
 Materials and Methods: A cross sectional questionnaire based study was conducted among all the general dental practitioners working in various government, private hospital and clinic of Pokhara. Information about the materials and techniques used in endodontic treatment was collected and descriptive statistical analysis was done. 
 Results: Out of 89 respondents, only 82 completely filled the questionnaires which were included in the study. Most general dental practitioners (96.34%) regularly treat single rooted endodontic cases. Only 10.97% occasionally use rubber dam during endodontic treatment. Most general dental practitioners (96.34%) used radiographic technique for working length determination. Ninety two percent used stainless steel hand files and step back was the choice of technique by 90.24%. Sodium hypochlorite irrigation and calcium hydroxide intra canal medicaments were used by 93.9% and 98.78% of general dental practitioners respectively. 75.6% used zinc oxide eugenol as root canal sealer and 95.12% obturated root canals with lateral compaction technique. The common complication encountered was mid treatment pain. They seem to overuse antibiotics in cases requiring endodontic therapy. Only 52.43% used autoclave for sterilization of endodontic files. About 92.68% felt the need of further endodontic training and 74.39% preferred post graduate program. 
 Conclusion: This study indicates that many general dental practitioners of Pokhara are not following well acknowledged endodontic quality guidelines; hence there is a need for further endodontic training.

The impact of technological endodontic resources on the training of the general dentist.

Technological resources are considered important for the practice and training in endodontics. It is not yet clear the extent of the insertion of these resources in predoctoral dental programmes and the effect of such resources to the general dentist training. To evaluate the faculty perception regarding the insertion of technological resources, particularly rotary instruments, and the impact of such resources to the student's learning process graded at the end of predoctoral dental programmes in Brazil by the National Students Performance Exam (ENADE). The endodontic department faculties in all 205 programmes that participated in the 2016 ENADE received a questionnaire by email. The institution, faculty credentials, and insertion of technologies in each programme were described, and an association between these data and the ENADE score was tested. 149 educators (72.7%) answered the form. From this total, 73.2% of them were from private institutions and 26.8% from public ones. Educators mix manual and rotary instrumentation to treat selected patients in 47.7% of the programmes. Most educators (89.9%) consider the utilisation of technology in endodontics as positive. Whilst there was not a significant association between the use of rotary instrumentation and better performance in ENADE, there was a significant association between the performance and the supply of special instruments by the institutions. These results show that even though most faculties consider the insertion of technologies as positive, the factor that caused a significant impact to the training of the general dentist is the general infrastructure of the institutions.

Evaluation of undergraduate Endodontic teaching in dental schools within Spain.

To evaluate the current situation of undergraduate endodontic teaching in Spanish dental schools. An online version, translated into Spanish, of a survey conducted in the UK (Int Endod J 52, 2019, 1077) was sent via email to the undergraduate endodontic programme leads in all 23 Spanish dental schools. The response rate was 96%. In 95% of dental schools, endodontics is taught in the fourth year. Students treat simple root canal treatment cases in 100% of schools and only in 40% treat moderate cases. In 65% of schools, students are supervised by full-time professors who are specialists in Endodontics, significantly more frequently in private dental schools (P=0.002). Spanish dental schools use both rotary and reciprocating instrumentation systems during endodontic training, with consistency on methods of working length determination, use of silicate-based endodontic cements, irrigating solutions, inter-visit medicaments and canal filling techniques. No type of magnification is used in 90% of dental schools, and only 25% use ultrasonic instruments. Private dental schools have a significantly better staff: student ratio during clinical practice (P=0.041), spend significantly more hours in clinical training (P=0.04) and have significantly greater number of clinical areas specifically dedicated to Endodontics (P=0.010). Undergraduate endodontic teaching in Spanish dental schools follows the key recommendations of the ESE Undergraduate Curriculum Guidelines (Int Endod J 46, 2013, 1105), being, in most respects, comparable to that carried out in the UK (Int Endod J 52, 2019, 1077). The use of magnification and ultrasonic instruments needs to be increased. Private schools reported better results than public schools in some of the variables that were analysed.

Characteristics of the Irrigant Flow in a Simulated Lateral Canal Under Two Typical Laser-Activated Irrigation Regimens.

Photon-induced photoacoustic streaming (PIPS) and shockwave-enhanced emission photoacoustic streaming (SWEEPS) are two promising laser-activated irrigation (LAI) methods for root canal irrigation. Their performance in driving irrigant flush in a complex root canal system will be evaluated by microscale particle image velocimetry (μPIV) measurement and will be compared with that of ultrasonic-activated irrigation (UAI). A μPIV system with 7 μm fluorescent tracer particles was adopted to measure two-dimensional (2D) velocity fields around the junction region, with a size of 1.8 mm × 1.5 mm, between one main canal and one lateral canal in an endodontic training block, which was driven by SWEEPS (Er:YAG laser) operating at 15 Hz and 20 mJ. The flow field driven by PIPS (Er:YAG laser) at the same frequency and energy, as well as by UAI (with non-cutting insert) operating at 40% unit power, was also measured for a direct comparison. It was found that both SWEEPS and PIPS can activate a so-called "breath mode" during the irrigation. Namely, the induced irrigant flush presented a back-and-forth oscillation along both the main canal and the lateral one. The maximum flow speed in the lateral canal was observed to be up to 10 m/s in the SWEEPS modality, while reduced to around 7 m/s in the PIPS modality. The penetration length in the lateral canal in both modalities was estimated to be larger than 1 mm. In comparison, the flow field induced by UAI was characterized as irregular vortical structures, the maximum flow speed in the lateral canal was 0.15 m/s and significantly lower than LAI (P < 0.01), and the penetration length was less than 300 μm and lower than LAI (P < 0.05). Compared to UAI, PIPS, and SWEEPS are more capable of delivering the irrigant deeper into the lateral canal. Furthermore, the back-and-forth flush in the breath mode is ideal for removing debris during irrigation. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Undergraduate endodontic clinical training in Malaysia: A National survey.

Online survey was conducted to investigate the state of undergraduate endodontic clinical training in Malaysian dental schools. An online questionnaire and a cover letter were emailed to the deans of 13 Malaysian dental schools. The questionnaire covers various aspects of endodontic clinical training including teaching methods, endodontic clinical procedures, minimum requirements, clinical sessions and teaching staff. The response rate was 69%. Similarities in teaching methods were observed in all responding schools. All schools taught contemporary root canal treatment procedures, including the utilisation of radiograph and electronic apex locator for working length determination, the crown-down approach for canal preparation and the cold lateral compaction for obturation. Sodium hypochlorite solution and non-setting calcium hydroxide medicament were used in most dental schools. Variations were observed in terms of the number of clinical requirements, supervisor: student ratio, and availability of endodontic specialists. The use of engine-driven instruments was observed mainly in government-funded dental schools. The majority of dental schools in Malaysia are adopting the European Society Endodontology recommendation for undergraduate endodontic training, particularly in relation to the surveyed aspects. Most of the government-funded dental schools have progressed towards engaging contemporary endodontics with their increasing application of engine-driven Ni-Ti instruments and 3D imaging techniques. Appointments of full-time endodontic specialists would further enhance the quality of endodontic teaching and permit the utilisation of contemporary endodontic materials.

A critical evaluation of the material properties and clinical suitability of in-house printed and commercial tooth replicas for endodontic training.

To assess the suitability of several 3D-printed resins for the manufacturing of tooth replicas for endodontic training in comparison with commercially available replicas by analysing the properties of the materials and comparing them with real teeth during endodontic training. Tooth replicas were 3D-printed using four resins (NextDent Model, NextDent C&B, V-Print ee and Vero White Plus) and compared with two commercially available products (VDW and Smile Factory) as well as extracted human teeth. Martens hardness, indentation modulus and radiopacity were investigated on these tooth replicas. Experienced dentists evaluated the suitability of the replicas for endodontic training by comparing them with real teeth in terms of appearance, anatomy, radiopacity, similarity to dentine during access opening, canal gauging and canal instrumentation. Data were analysed using the Kolmogorov-Smirnov and Mann-Whitney U-test. The greatest hardness values were recorded for human dentine (P<0.001), followed by V-Print ee and the commercial tooth replica of Smile Factory. The greatest radiopacity was associated with VOC and dentine (P<0.001) in comparison with the other materials tested. The appearance of the in-house printed tooth replicas was subjectively evaluated by the dentists as being more realistic than the commercially available products. No differences between the replicas was detected during mechanical instrumentation of root canals. None of the tooth replicas were able to simulate human dentine from the perspectives evaluated. V-Print ee had radiopacity comparable with dentine, but its hardness was not comparable with dentine.

Are the evaluation criteria used in preclinical endodontic training courses relevant? A preliminary study.

This study aimed to evaluate the relevance of a conventional evaluation protocol (CEP) for preclinical endodontic training. Seven dental students performed root canal treatments on an extracted human molar which was then evaluated by CEP (clinical and radiographic observations, including preparing the access cavities, preparing and filling the root canal, and detecting iatrogenic errors). A reference evaluation protocol (REP) based on micro-computed tomographic images analysis was used as a control. The evaluation scores obtained by CEP and REP were compared using a non-parametric Wilcoxon's test. CEP was relevant for access cavity, irrigation, working length and ledge detection training but was no more effective than the REP for evaluating the apical diameter and taper of the root canals, the quality of the fillings, and the presence of perforations and fractured instruments using retro-alveolar radiographs. The conventional evaluation criteria used in preclinical endodontics should be used with care to detect 'unsafe' students.

Perception of a modular 3D print model in undergraduate endodontic education.

To evaluate a modular 3D print training dental model with embedded human teeth and electronic working length determination for undergraduate endodontic education. Cone-beam volume tomography data of a human skull were transferred into stereolithographic (STL) data, and a customizable modular 3D print model with individually removable sextants and teeth was generated for the use in commercially available phantom heads. Each of sixty-eight students performed a complete root canal treatment on an extracted human tooth. Working lengths were determined with electronic apex locators (EAL) and verified radiographically. Subsequently, an evaluation was carried out with regard to the difficulty of the working steps access cavity preparation, working length determination, root canal preparation/irrigation and canal filling, and these steps were compared to commonly used benchtop models. Additionally, the agreement of electronic and radiographic working length determination was assessed and analysed statistically with the chi-square test. A total of 68 teeth (20 incisors, 26 premolars and 22 molars) with 127 root canals were treated. In total, 87% of the students considered the modular 3D print model considerably more demanding than the conventional benchtop model. Overall, 96% felt better prepared for the clinical situation, 92% felt markedly reduced stress levels during endodontic practice in the subsequent clinical courses, and 93% of the students suggested the model should be used in future preclinical endodontic training. The preradiographic use of EAL resulted in 85% of the cases having radiographically acceptable working length determination within 0-2mm from the radiographic apex. Readings more than 2mm from the apex or beyond were significantly more common in molars than in premolars and incisors (P<0.05). The vast majority of students rated the modular 3D print training model positively despite it being more demanding. They also recommended its use in preclinical teaching and training. The model allowed a more realistic simulation of the clinical situation with a simultaneous use of EALs and led to reduced stress levels in endodontic treatment in the subsequent clinical courses.

Shaping Ability of Reciproc R25 File and Mtwo System Used in Continuous and Reciprocating Motion

Nickel-titanium (NiTi) instruments were designed to be used in continuous rotation mode with controlled speed and torque and a sequence of different sizes. The reciprocating motion was purposed to improve cyclic fatigue of rotary instruments if compared to the conventional rotation. The purpose of this work was to compare the shaping ability of Reciproc R25, Mtwo #25/0.06 used as a single file, and Mtwo sequence used in reciprocating motion and in continuous rotation. Forty-eight endodontic training resin blocks ISO 15, 2% taper, 7 mm radius, and a 60° angle of curvature were shaped with four different protocols. Group I (Rrsf) was shaped with Reciproc R25 used as a single file in a reciprocating motion. Group II (Mrsf) was shaped with Mtwo #25/0.06 used as a single file in a reciprocating motion. Group III (MSrec) was shaped with Mtwo sequence in reciprocating motion, and finally, group IV (MSrot) was shaped with the Mtwo sequence used in continuous rotation. Preoperative and postoperative images of the simulated canals were taken under standardized conditions and combined exactly. The amount of resin removed was determined at both the inner and outer sides of the canal curvature. The ability of the instruments to remain centered in the canal was determined by calculating a centering ratio. These data were analyzed statistically using two factors analysis of variance (ANOVA) with Bonferroni correction (Bonferroni post-hoc test). Group Rrsf produced a greater enlargement of the canal, especially on the outer side, in the apical and middle third (p < 0.05). Group MSrot produced a lower enlargement in the middle third (p < 0.05). Group Rrsf displayed a lower centering ratio in the apical third (p < 0.05). Group MSrot displayed a lower centering ratio in the coronal third (p < 0.05). The shaping of simulated canals using a sequence of instruments in continuous rotation resulted in a more centered preparation of the apical third. The reciprocating motion for all tested instruments produced a bigger enlargement of the canals. Reciprocating movement results in a more pronounced canal enlargement but appears to be less respectful of the original canal curvature and produces more apical transportation than a sequence of rotary NiTi files with the same ending apical size.

Suitability of different tooth replicas for endodontic training: perceptions and detection of common errors in the performance of postgraduate students.

To compare the perceptions of students when using five different tooth replicas and to detect common errors in the performance of students that might be attributed to a specific type of tooth replica. Five groups (n=10 each) of artificial first maxillary molars (DEPT, DRSK, Nissin, DENTALIKE and TrueTooth) were used. All 50 teeth were mounted individually in opaque containers, distributed in 10 packages containing a sample from each with an assigned random order for students to perform root canal treatments. Ten postgraduate students each performed a root canal treatment on the five replicas, in the assigned order, and completed a satisfaction questionnaire. Three trained and calibrated endodontic educators, each with more than 15years of experience, evaluated their performance using a grading rubric and completed a questionnaire to detect common errors attributed to a specific tooth replica. Inter-rater reliability was calculated with the interclass correlation coefficient for both consistency and absolute agreement. A two-way related measures anova was used to assess the interaction amongst evaluators and tooth groups on the average scores of students. Post hoc T3 Dunnet was used to compare groups. The perceptions of students amongst groups were compared with chi-square and linear-by-linear association tests. Inter-rater reliability was very high for both consistency (ICCC=0.939; 95% confidence interval (CI) 0.902-0.964) and absolute agreement (ICCA=0.940; 95% CI 0.904-0.965). No significant differences were found amongst the ratings of evaluators; however, students performed differently when using the various tooth replicas (P<0.05). Overall, 60% of students preferred the DRSK replica for root canal treatmenttraining purposes, followed by DENTALIKE (30%). The least preferred was TrueTooth (70% responses) due to its complex anatomy and poor resistance to instruments and heat pluggers. Evaluators detected several common errors in specific tooth replicas and preferred tooth replicas manufactured based on microCT scans of natural teeth. Tooth replicas manufactured based on microCT scans of natural teeth (TrueTooth and DENTALIKE) had much better acceptance amongst evaluators, although students rated and performed less well in TrueTooth replicas due to their greater level of difficulty.

Difficulty levels of extracted human teeth used for pre-clinical training in endodontics in an Australian dental school.

This study aimed to determine the difficulty level of extracted teeth treated by undergraduate students for pre-clinical endodontic training. Two independent observers assessed a consecutive sample of 1000 periapical radiographs of extracted teeth used in endodontic pre-clinical training. Chi-square test was used to evaluate the adjustment of the distribution, and inter- and intra-examiner agreement were calculated. Minimal, moderate and high difficulty teeth represented 23.1%, 52.1% and 24.8%, respectively. The presence of curvature was the most common grading factor, with 'moderate curvature' reported in 28.7%, and 'extreme curvature' reported in 15.6% of the sample. A difference in the distribution of frequencies was found, favouring the moderate category (P<0.001). The inter- and intra-examiner strength of agreement were 0.78 and 0.86, respectively. More than 50% of the teeth were categorised as moderate complexity. Almost one-quarter of the total sample, in particular molars, was classified as high complexity, thus unsuitable for undergraduate pre-clinical training.

Pre-clinical endodontic education outcomes between artificial versus extracted natural teeth: a systematic review.

To compare the educational outcomes using artificial teeth versus extracted teeth for pre-clinical endodontic training. Literature searches of PubMed, Scopus, Cochrane Library, Trip Database, Web of Science and Open Grey databases were conducted from their inception until November 2018 with no language restriction. Hand searching of most likely relevant journals was performed. The review followed the PRISMA guidelines. Studies that compared pre-clinical endodontic training using extracted teeth and artificial teeth were included. The quality of included studies was appraised by Joanna Briggs Institute Critical Appraisal tools. The findings were tabulated and summarized according to their outcomes with distinct narrative syntheses. Five studies were included. The component studies included 359 operators in total, mainly consisting of undergraduate students (97%, n=349) and 10 endodontists (3%). Forty-seven per cent (n=170) operated on artificial teeth only, whilst 19% (n=67) worked primarily on extracted teeth, with the final treatment outcome being evaluated by independent observers using objective criteria. Operators in two studies (34%, n=122) used both artificial teeth and ET and compared their experiences in surveys. Regarding technical outcomes, no significant differences between training with artificial teeth and extracted teeth were found, but the performance tended to be better in artificial teeth than extracted teeth. Operators trained solely on artificial teeth appeared to be adequately educated for subsequent root canal treatment (RCT) in the clinical setting. Due to the scarcity of research on the topic overall, and the methodological variation between the studies, it was not possible to perform a quantitative analysis (meta-analysis). Based on the available evidence, the use of artificial teeth for pre-clinical endodontic training achieved similar educational outcomes compared to extracted teeth. However, the experiences reported by the operators diverged. Further studies assessing other artificial teeth available in the market testing other RCT procedures are necessary.

How is Endodontics taught? A survey to evaluate undergraduate endodontic teaching in dental schools within the United Kingdom.

To evaluate the delivery of undergraduate endodontic education in UK dental schools using an online survey and to compare the results with those of a previous paper-based survey (Qualtrough & Dummer 1997, Int Endod J, 30, 234). Aspects of delivery were also evaluated in comparison with the Undergraduate Curriculum Guidelines of the European Society of Endodontology (de Moor etal. 2013, Int Endod J, 46, 1105). An online version of an earlier paper-based survey on undergraduate Endodontic education (Qualtrough & Dummer 1997, Int Endod J, 30, 234) was created. Invitations to take part were sent via email to the undergraduate endodontic programme leads in the 16 UK dental schools. The response rate was 94%. The current survey revealed greater convergence amongst dental schools than previously (Qualtrough & Dummer 1997, Int Endod J, 30, 234) on methods of canal preparation, disinfection and filling. Improvements were also noted in staff: student ratios, the involvement of teachers with advanced endodontic training and a greater diversity of teaching methods; developments which align with the recommendations of ESE Undergraduate Curriculum Guidelines (de Moor etal. 2013, Int Endod J, 46, 1105). The majority of schools appeared to be teaching contemporary instrumentation methods and were recommending the application of calcium silicate cements. The exposure of students to advanced topics included in the ESE Undergraduate Curriculum Guidelines (de Moor etal. 2013, Int Endod J, 46, 1105) such as surgical endodontic treatment, root canal re-treatment and the management of complex cases was mixed. Undergraduate endodontic training in the UK has advanced in the last 20years with more consistency between schools and more contemporary methods adopted.

Assessment of the Technical Quality of Root Canal Treatment in Pre-clinical Endodontic Training Comparing Artificial Teeth to Extracted Natural Human Teeth

Introduction: Extracted natural human teeth were used exclusively for preclinical endodontictraining. However, an alternative method involves the use of artificial teeth aiming to overcomethe limitations in natural teeth. This study aimed to radiographically evaluate the technical qualityof preclinical single root canal treatments performed by undergraduate dental students using twoalternative models; artificial teeth and extracted natural human teeth.Materials and methods: Cross-sectional study, 228 single rooted teeth in academic years2017- 2018 were obtained from the preclinical practice of undergraduate program in endodonticsat the school of dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. Four observers wereasked to independently evaluate the radiographic quality of the root canal fillings according to threeparameters: Filling length, density (homogeneity), and taper of the filling in the root canals.Results: There were no significant correlation between the type of teeth and all three parameters;length, density, and taper of the root canals fillings. In addition, there was no statistically significantdifference between adequacy of the root canals fillings and the type of teeth (P. value: 0.455).Extracted natural human teeth showed overall 10% adequate filling, 77.7% moderately filling,and12% poorly filling. Meanwhile, artificial plastic teeth showed overall 13% adequate filling,81.6% moderately filling, and 5% poorly filling.Conclusion: Artificial teeth might be suitable for preclinical endodontic training but cannottotally substitute the requirement to learn with extracted natural human teeth as part of preclinicalendodontic training. They could be incorporated with natural teeth.

Endodontics Program Directors', Residents', and Endodontists' Considerations About CBCT-Related Graduate Education.

Over the past decade, cone beam computed tomography (CBCT) has been increasingly used by endodontists. The aims of this study were to assess endodontic program directors', residents', and endodontists' considerations concerning CBCT-related graduate education, attitudes, and professional behavior. Survey data were collected from 31 of the 56 directors of U.S. endodontic graduate programs, 73 of 270 contacted residents, and 689 of 2,221 contacted endodontists (response rates 55%, 27%, and 31%, respectively). Ten of the 31 responding programs did not offer a CBCT-related class. Of the 21 programs that offered a CBCT class, 91% of the program directors and 85% of the residents agreed strongly that future endodontists need training to be able to use CBCT. Residents were less satisfied than directors with the way CBCT was taught (on a five-point scale with 1=most negative: 3.26 vs. 4.37; p<0.001) and the quality of their clinical CBCT-related education (3.75 vs. 4.62; p<0.001). Both groups strongly agreed that there is a need for CBCT training in endodontics (4.81 vs. 4.90). Endodontists reported being less well educated than residents about CBCT in classroom-based (2.02 vs. 2.70; p<0.001) and clinical graduate education settings (2.09 vs. 2.97; p<0.001) and wanted more CBCT-related education in endodontic programs (4.37 vs. 3.18; p<0.001). Yet, they reported being more confident than residents in interpreting CBCT scans (3.57 vs. 2.75; p<0.001) and rated themselves more positively as having sufficient clinical experience (3.76 vs. 2.92; p<0.001) to be competent in utilizing CBCT. These findings about residents' and practicing endodontists' CBCT-related considerations suggest that endodontic program directors should add more CBCT-related education.

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

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. 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. Dentists working in and patients treated in primary dental care in London. Twenty-four-month training in endodontics. Dentists enrolled in the training at different time points. Measuring outcome of endodontic treatment. 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. 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.

3D printed replicas for endodontic education.

To assess the feasibility of producing artificial teeth for endodontic training using 3D printing technology, to analyse the accuracy of the printing process, and to evaluate the teeth by students when used during training. Sound extracted human teeth were selected, digitalized by cone beam computed tomography (CBCT) and appropriate software and finally reproduced by a stereolithographic printer. The printed teeth were scanned and compared with the original ones (trueness) and to one another (precision). Undergraduate dental students in the third and fourth years performed root canal treatment on printed molars and were subsequently asked to evaluate their experience with these compared to real teeth. The workflow was feasible for manufacturing 3D printed tooth replicas. The absolute deviation after printing (trueness) ranged from 50.9 to 104.3μm. The values for precision ranged from 43.5 to 68.2μm. Students reported great benefits in the use of the replicated teeth for training purposes. The presented workflow is feasible for any dental educational institution who has access to a CBCT unit and a stereolithographic printer. The accuracy of the printing process is suitable for the production of tooth replicas for endodontic training. Undergraduate students favoured the availability of these replicas and the fairness they ensured in training due to standardization.

Use of antibiotics by spanish dentists receiving postgraduate training in endodontics.

BackgroundThe incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics.Material and MethodsDentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test.ResultsThe average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract.ConclusionsThe results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Key words:Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training.

Effect of Different Disinfection/Sterilization Methods on Risk of Fracture of Teeth Used in Preclinical Dental Education.

The aim of this in vitro study was to determine whether different disinfection/sterilization methods affected the risk of fracture of extracted teeth used for preclinical dental education. Freshly extracted intact mandibular incisors were assigned to different groups according to the processing method used. In the autoclave group (n=20), teeth were autoclaved for 40 min at 240°F under a pressure of 20 psi; in the formalin group (n=20), teeth were immersed in 10% formalin for two weeks; and in the control group (n=10), teeth were not processed. Teeth were then stored at 4°C in distilled water until use. Endodontic procedures were performed, and the fracture strength of the specimen was subsequently tested under compressive force along the long axis of the teeth using an Instron universal testing machine. The results showed that none of the specimens fractured during endodontic procedures. However, the compressive load needed to fracture the teeth was significantly less for the autoclaved teeth than the teeth stored in formalin or the control teeth (p<0.001). The disinfection/sterilization method used affected the fracture resistance of extracted teeth: autoclaved teeth were less resistant to fracture than teeth that were not sterilized or teeth that were chemically disinfected. However, fracture resistance was not reduced enough to lead to tooth fracture during preclinical endodontic procedures. Therefore, either processing method may be appropriate for teeth to be used for preclinical endodontic training.