Endodontic Training Research Articles

New Multipurpose Endodontic Device Developed in Germany for Use in Predoctoral and Continuing Dental Education and Science

The purpose of this article is to describe a simple and versatile aid for the endodontic treatment of extracted teeth and its possible applications. The Med*-box is a new endodontic multipurpose device made of transparent acrylic that permits all elements of root canal treatment to be performed and evaluated either visually or radiologically. The Med*-box represents a valuable addition to the spectrum of educational and practical means in endodontic training. It is well suited for students, dentists, and endodontists for learning the handling of new materials, methods, and instruments in endodontics before they work clinically upon a patient. Also in the context of scientific endodontic issues, the Med*-box represents a simple, economical, and easily manageable aid.

Precisione nella determinazione della lunghezza di lavoro mediante localizzatori elettronici d’apice, radiologia digitale e prova visiva: presentazione di una nuova metodica sperimentale di indagine – uno studio ex-vivo

Objectives This study compared: 1) the accuracy of three different electronic apex locators (EALs) in detecting the apical foramen ex-vivo under clinical conditions; 2) the accuracy of digital radiography and EALs in determining the K-file position in the root canal; 3) the accuracy of two different radiographic planes; (4) the precision of #10, #15, and #20 K-files in electronic measurements; 5) the precision of EALs in relation to the dental anatomy classification (anterior, bicuspids, and molars). Materials and methods The length of 101 extracted human teeth was measured with three different EALs (Endex, Propex II and Root ZX), with RVG and compared to the actual length. Experimental procedures were performed using an endodontic training kit (Pro-Train). Results The statistical analysis showed that Endex and Propex II were more accurate than Root ZX in determining the working length (WL). The t-test showed no statistically significant difference of accuracy between the two radiographic planes examined. The t-test showed no significant difference between the three different K-file size measurements. EALs and RVG are less accurate in anterior teeth. Conclusions To prevent overestimation of the root canal length using the EALs tested, 1 mm should be subtracted from the measurement on the “APEX” mark. Instrument sizes did not affect the accuracy of EALs. EALs showed to be more accurate in determining the WL than RVG.

Accuracy of Three Electronic Apex Locators in Anterior and Posterior Teeth: An Ex Vivo Study

Introduction The aim of this study was to determine in anterior teeth, bicuspids, and molars (1) the accuracy of 3 different electronic apex locators (EALs) in detecting the apical foramen and (2) the accuracy of digital radiography in determining the working length (WL), compared with visible control under a microscope. Methods By using radiovideography (RVG), we measured the lengths of 120 root canals with 3 different EALs (Endex, ProPex II, and Root ZX) and compared them with the actual lengths. The accuracy of EALs and RVG was related to each dental category. An endodontic training kit (Pro-Train) was used during experimental procedures. Results Statistical analysis showed that the 3 EALs and RVG were less accurate in anterior teeth and molars than in bicuspids. The paired-sample t test showed no statistically significant difference between mesiodistal plane and buccolingual plane digital radiography in all groups. Conclusions The 3 EALs tested were more accurate in detecting the apical foramen in bicuspids than in both molars and anterior teeth. Radiographic measurements were not reliable for determining WL in all dental groups in both radiographic planes.

Quality of root canal treatment performed by undergraduate dental students at the University of Khartoum, Sudan

The aim of the present study was to evaluate the quality of root canal treatment performed by undergraduate dental students at the University of Khartoum. Assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by undergraduate dental students. A total of 166 postoperative periapical radiographs compromising 265 roots were included. The quality of endodontic treatment was examined in relation to the length of the root filling in relation to the radiographic apex, the density of the obturation according to presence of voids and the taper of root canal fillings. Adequate length of the root filling was found in 34.7% of the maxillary teeth and in 10.9% of mandibular teeth in this study. Adequate density was found in 38.87% of maxillary and 16.98% of mandibular teeth and appropriate taper was found in 40% of maxillary and 16.6% of mandibular teeth. Overall 24.2% in all evaluated teeth were found to have a root filling of an acceptable quality. This result may be because of insufficient preclinical endodontic training of the students' operators or because of the introduction of students to endodontic clinical practice late in their program.

Accuracy of Three Electronic Apex Locators Compared with Digital Radiography: An Ex Vivo Study

Introduction This study compared (1) the accuracy of three different electronic apex locators (EALs) in detecting the apical foramen ex vivo under clinical conditions; (2) the accuracy of digital radiography and EALs in determining the working length (WL) with visible control under a microscope; and (3) the precision of #10, #15, and #20 K-files in electronic measurements. Methods The length of 101 extracted human teeth was measured with three different EALs (Endex [Osada Electric Co, Tokyo, Japan], ProPex II [Dentsply-Maillefer, Ballaigues, Switzerland], and Root ZX [J. Morita Co, Tustin, CA]), with radio videography (RVG) and compared with the actual length. An endodontic training kit (Pro-Train; Simit Dental, Mantova, Italy) was used during the experimental procedures. Results Statistical analysis showed that Endex and ProPex II were more accurate than Root ZX in determining the WL. The paired sample t test showed no statistically significant difference between the accuracy of the two radiographic planes examined. The t test showed no significant difference between the three different K-file sizes measurements. Conclusions Endex and ProPex II were more accurate than Root ZX in determining the actual WL. Instrument sizes of hand files did not affect the accuracy of EALs. EALs showed to be more accurate in determining the WL than RVG.

Current endodontic practice and training needs in primary care: north west England

This month's research summary focuses on endodontic practice in a primary care setting, and whether new technologies have been adopted to improve the treatment of patients.

Should Endodontists Place Implants? A Survey of U.S. Endodontists

Introduction The purpose of this national study was to assess endodontists' opinions regarding whether endodontists should place dental implants. Methods A written survey was developed and mailed to 1505 randomly selected practicing endodontists within the United States. Results The response rate was 46%. Univariate, bivariate, and logistic regression analyses were performed. Fifty-seven percent of respondents supported endodontists placing implants. Currently 5.7% of respondents place implants. Regression analyses identified the following variables as being positively associated with endodontists placing implants: graduation from an endodontic training program ≥10 years ago ( p = .002); interest in placing implants in the future ( p = .0001); the belief that implant placement should be incorporated into the endodontic residency curriculum ( p < .0001); the belief that general dentists would support endodontists placing implants ( p < .0001); and the desire to continue the rapport with a referred patient by placing an implant if the patient's tooth is nonrestorable ( p < .0001). Conclusions The majority of responding endodontists believed that dental implant placement is within the scope of endodontic practice. Governing bodies of the specialty of endodontics might consider discussing whether formal implant training should be incorporated into future curricula.

An investigation of current endodontic practice and training needs in primary care in the north west of England

To investigate current endodontic clinical practice in the north west of England and evaluate practitioner's training needs. A questionnaire was posted to 702 primary care dentists in the north west of England in January 2006. The questionnaire investigated aspects of dentists' endodontic clinical practice, the provision of endodontics within their practice, their recent postgraduate training in endodontics and their training needs. Responses to the questionnaire were received from 498 (70.9%) primary care dentists, of which 449 questionnaires contained useful information. Only 30% of respondents use rubber dam for isolation in all endodontic cases. The majority used radiographs either as the only method for establishing the working length (57.3%) or in conjunction with an apex locator (34.5%). Most dentists used sodium hypochlorite solution as an irrigant during the root canal treatment. Almost 55% used a combination of conventional hand files and rotary files to prepare root canals. Fifty-eight percent used the crown down technique while 35% used the step back technique for canal preparation. Almost two-thirds routinely used non-setting calcium hydroxide as an intra-canal medicament. Lateral condensation technique was the popular obturation method and the vast majority of respondents routinely took postoperative radiographs. Almost 25% of respondents had not received any teaching or training in endodontics in the past two years. The results of this study suggest that primary care dentists in the north west of England have embraced modern techniques and follow most aspects of accepted endodontic practice. Despite the majority having postgraduate training in the last two years, only a minority used rubber dam routinely for endodontic treatment.

Use of the Microscope in Endodontics: Results of a Questionnaire

The purpose of this study was to investigate the frequency and characteristics of operating microscope (OM) utilization among endodontists in the United States. The study also investigated how OM use has changed since a similar study was published nearly a decade ago. A web-based survey regarding OM usage was e-mailed to 2340 active members of the American Association of Endodontists (AAE) in the United States. Data from 1091 questionnaires indicated that 90% of the endodontists surveyed have access to and use the OM in their practice. The frequency of use as a function of years since completing endodontic training was as follows: <10 years, 95%; 10–15 years, 90%; 16–20 years, 82%; >21 years, 78%. Previous studies found that shorter operators needed to adopt a strained position to view mandibular molars. Our results indicated with strong correlation ( r = 0.90) that shorter endodontists used the microscope more often than taller endodontists. The OM was used most frequently for root-end inspection, locating canal orifices, and root-end filling, respectively. Of the practitioners who used the OM, 59% used it without limitation, 86% used it equally between the maxillary and mandibular arch, and 84% used it as often as anticipated. The most common limitations to OM use were positional difficulty, limited field of view, and inconvenience, respectfully. The use of the OM by endodontists increased from 52% in 1999 to 90% in 2007.

Undergraduate training as preparation for vocational training in England: a survey of vocational dental practitioners' and their trainers' views

To compare the views of new vocational dental practitioners (VDPs) and their trainers regarding how undergraduate dental education has prepared them for their vocational training (VT) in England. This study also aims to identify areas of relative weakness in dental undergraduate education that could influence the future training needs of vocational trainees. Structured postal questionnaires were completed by VDPs and trainers from five Deaneries in England. The usable response rate was 71% (n = 186 VDPs and 186 trainers). The vast majority of VDPs and trainers perceived the undergraduate training in history taking, diagnosis and treatment planning for general practice to have been covered 'well' or even 'very well'. Undergraduate training in routine restorative dentistry, oral pathology and paediatric dentistry was also perceived to have been covered well. However, a large proportion of VDPs and trainers reported that they felt that undergraduate training in orthodontics, molar endodontics, surgical endodontics and surgical extraction of teeth had not adequately prepared them for VT. Newly qualified dentists appear to lack certain competencies recommended by the General Dental Council in The First Five Years. This has implications for dental undergraduate education, but also highlights current training needs during VT.

Wear of Nickel-Titanium Endodontic Instruments Evaluated by Scanning Electron Microscopy: Effect of Ion Implantation

The present work analyzes possible increases in resistance to wear of nickel-titanium endodontic instruments that have undergone a process of ionic implantation. ProFile .04 taper #25 instruments were subjected to ionic implantation with bands of nitrogen ions of 250 KeV, currents in the order of 10 microA/cm2, and doses of 2 x 10(17) ions/ cm2. The instruments were used to make preparations in acrylic endodontic training blocks. Scanning electron microscopic investigations showed that after 60 s of work inside the endodontic training blocks nonionic implanted control instruments showed small modifications in their blades, and their tips showed the first signs of wear. After 240 s the control instruments showed consistent signs of wear and frequent changes to their surfaces. After 240 s of use the ionic-implanted instruments did not present any significant changes in the micromorphology of their surfaces. The implanted instruments did not manifest the typical signs of wear and did not show the surface changes that quickly affect the working life of untreated endodontic instruments manufactured from nickel-titanium.

Use of the microscope in endodontics: A report based on a questionnaire

A survey regarding operating microscope (OM) usage and training was mailed to 3356 active members of the American Association of Endodontists (AAE) in the United States. Data from 2061 questionnaires indicate that 52% of the endodontists surveyed have access to and use the OM in their practice. The frequency of use as a function of years since completing endodontic training was as follows: < 5 yr, 71%; 6 to 10 yr, 51%; and > 10 yr, 44%. The OM was used most often for retrieval of separated instruments, root-end preparations, and root-end fillings. Of the respondents who use the OM, 36% report they do not use it as often as anticipated. The most common reasons reported were positional difficulties, inconvenience, and increased treatment time. The information collected from the survey reveals that the more training the operator has on the microscope, the more likely he or she is to use it for all procedures.

Barriers to improving endodontic care: the views of NHS practitioners.

Concerns have been expressed about the technical quality of NHS endodontic treatment. Bringing performance into line with guidelines for good practice needs to be underpinned by an understanding of barriers to compliance. To this end, our research involved an exploratory investigation of the factors influencing the behaviour of general dental practitioners in their practice of endodontics. Subjects 12 dental practitioners, representative of varying levels of professional experience and status, and of compliance with good practice guidelines. Data collection In-depth interviews, following a topic guide. Analysis Identification, abstraction and charting of major themes. Informants' responses suggested that general dental practitioners' endodontic practice is influenced by a complex web of factors. A key barrier to high quality treatment is the NHS remuneration scheme. Undergraduate and postgraduate education and training are also highly influential on practice. Dentists reported employing a range of strategies to manage the time-cost tensions imposed by the remuneration system. Perceived deficiencies in the content and delivery of postgraduate training were highlighted by our informants. There was a perception among our informants that the NHS fee structure needs to be revised. Their views suggest that a system which rewards quality rather than volume may be more appropriate, but, we believe, such a system would need to take into account efficiency as well as effectiveness. Modification of the current system of postgraduate training in endodontics is also indicated by the views expressed in the interviews. From the diversity of views and from a critical review of the literature, we conclude that flexibility is the key note in changing practice, with no single strategy likely to be universally appropriate.

Some factors that endodontists may consider when selecting a practice location

The distribution of endodontists per population is considered in terms of the ranking of states by the availability of a graduate endodontic training program and selected population demographic characteristics. Statistically significant positive relationships were found for the endodontist to population ratios, and (i) overall health and social conditions, (ii) per capita income, (iii) per capita spending for health care, and (iv) percentage of the population that is Hispanic and Asian-American. Negative relationships were found for (i) increases in the population that is underserved by dentists, (ii) higher levels of out-of-pocket spending for health care, and (iii) increases in the population below the poverty level. Further analysis at the local level (and for individual practitioners) is needed to better understand the decision process in the selection of a practice site.

Vocational trainees' views of their undergraduate endodontic training and their vocational training experience

By means of a questionnaire, the views of recently qualified graduates, who were participating in vocational training schemes, on their undergraduate endodontic training and postqualification experience were examined. On the basis of these finding suggestions are made as to what changes are necessary in their undergraduate training and how their skills can be further improved after qualification.

A course in physical, clinical, and laboratory diagnosis for dental education

A basic knowledge of physical diagnosis techniques and an understanding of those parts of clinical medicine (including laboratory diagnosis) most closely related to dentistry are recognized to be important parts of dental education. The course in physical, clinical, and laboratory diagnosis for dentists pursuing specialty training in oral surgery, endodontics, periodontics, oral diagnosis, prosthodontics, and general practice at The University of Michigan School of Dentistry is described.

Undergraduate training in endodontics. Report of a training method.

Undergraduate training in endodontics. Report of a training method.