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Aim:
To evaluate radiographically the technical quality of root fillings performed by undergraduate dental students and to assess whether students were exposed to an appropriate endodontic case mix during their clinical training.
Methodology:
A retrospective audit was undertaken evaluating the clinical records of patients who underwent endodonti...
Context in source publication
Context 1
... the majority of treatments (88%), sodium Figure 1 Representative radiographs of the parameters assessed in the audit according to criteria outlined in Table 1: (a) overfilled root, (b) acceptable length, density and taper (c) underfilled root and (d) unacceptable density. Following analysis of whether the quality of the root filling was related to tooth type, molars and premolars each had a higher percentage of acceptable canals (68% and 67%, respectively) when compared to anterior teeth (60%; Table 5). However, statistical comparisons using Fisher's exact test did not reveal any significant differences between the groups (P > 0.05). ...Similar publications
AIM: This study was conducted to investigate the effect of applying Gates-Glidden (GG) drill by pre-clinical dental students on root canal treatment quality.
METHOD: A total of 56 first molars consisting of 168 canals were selected in this study. For this purpose, 56 students who had been formerly trained by two methods of root canal preparation w...
Citations
... Accordingly, to the tooth type, procedural errors were high in molar teeth (25.6%) compared to anterior teeth (15.8%). This can be attributed to various factors, including the complex form and shape of molar roots, the challenges associated with accessing the treated tooth, difficulty in achieving sufficient coronal access during the procedure and skill level of the students 24,29 . The highest incidence of procedural error was observed amongst third year students (26.5%). ...
To evaluate the radiographic quality of endodontically treated cases performed by undergraduate dental students at Thumbay dental hospital, Gulf Medical University (GMU) from 2020 to 2022. The sample consisted of 510 randomly selected postoperative periapical radiographs from patient records at the Thumbay dental hospital Gulf Medical University (GMU). Radiographs were from patients who underwent root canal treatment (RCT) performed by 3rd, 4th and 5th year clinical undergraduate dental students. Evaluation criteria included root canal filling (RCF) length, density, taper and the presence of iatrogenic errors. Inter-examiner agreement was measured using a Cohen's kappa test. A comparison of frequency was calculated using the Chi-square test. P-values ≤ 0.05 were considered significant. Adequate length, density, and taper of the root canal fillings was observed in 77.2%, 34%, and 78.6% of cases, respectively. The rate of acceptable quality was higher for teeth treated by 5th-year students (33.3%) compared to those treated by 3rd-year students (20.5%). Density and taper were more adequate in patients treated by 5th-year students (38.6% and 82.1% respectively) compared to 3rd-year student (p≤ 0.05). Significant differences were observed in procedural errors based on tooth location, with higher percentages in the mandible (23.7%) compared to maxilla. Anterior teeth showed high rates of acceptable quality (36.6%) compared to molars (22.5%). Iatrogenic errors were observed in 19.1% of cases. This study highlights the importance of training dental students to detect and correct procedural errors in root canal procedures at early clinical stage. A notable 29.3% quality improvement achieved with stainless steel K-files, underlines the imperative for enhancing future education approaches to ensure superior results and improved patient care. Clinical article (J Int Dent Med Res 2024; 17(1): 310-318)
... The greatest significant impact on treatment outcomes was caused by the length or apical extension of the obturation parameter [17]. [42], acceptable cases (88.1%) were found in this study for the length parameter. Other authors (86.2%, 89.6%) who conducted an audit at Qassim University in Saudi Arabia observed similar findings [43,44]. ...
... This could have an effect on how frequently voids are found on radiographs. In the current report, an acceptable taper (89.6%) was the metric that was most commonly accomplished among the several parameters used to evaluate the quality of obturation, which is in agreement with Javed et al. (89%) [43] and Fong et al. (90%) [42] but not with Balto et al. (34.9%) [34]. ...
... In the current report, an adequate taper was found in 86.4% of the studied sample. Fong et al. [42] found findings that were similar; however, Al-Anesi et al. [10] and Alhablain et al. [44] reported substantially lower frequencies with an acceptable taper (14.2% and 54.1%, respectively). When individual canals were examined for taper adequacy, the placement of the canal had a substantial impact on the results. ...
Background
The educational process in the field of endodontics commences with preclinical exercises to enhance students’ proficiency in cleaning, shaping, and performing root canal fillings. Therefore, this study aimed to radiographically evaluate the technical quality of root canal fillings performed by preclinical students on extracted teeth at the College of Dentistry, University of Ha’il, Saudi Arabia.
Methods
A total of 788 extracted human teeth received root canal treatment by undergraduate students. The samples were then gathered and radiographically assessed using the three quality criteria of length, density, and taper. The category of root canal fillings was classified as either acceptable or unacceptable. The criteria for evaluating the acceptability of filling quality were defined based on the presence of adequate length, density, and taper. The effectiveness of root canal fillings was also evaluated in relation to the tooth type, sex, and treatment year. The agreement between the examiners was evaluated using Cohen’s kappa test, and the relationship between the research variables was determined using the chi-squared test. The significance threshold was set at 0. 05.
Results
The overall quality of root filling was determined to be satisfactory in 532 (67.5%) of 788 endodontically treated extracted teeth. The majority of the research sample (88.1%) had enough length, 89.6% had adequate density, and 86.4% had acceptable taper. The quality of anterior teeth was substantially better than that of posterior teeth (p < 0.001). Our findings showed that the quality of root canals was better in 2022 than it had been in earlier years (p = 0.001). The three RCT quality criteria differed significantly when compared between sexes (p = 0.002).
Conclusions
The quality of the root canal fillings completed by undergraduate students was rated as acceptable. The findings of the research suggest that the implementation of routine assessments to evaluate the technical competence of undergraduate dental students performing root canal treatments could provide significant insights into the efficacy of the curriculum requirements.
... Sonntag et al. [15] observed that undergraduate dental students could achieve better canal preparations with Ni-Ti, although file separations may still be the main concern for beginners that avoid using Ni-Ti rotary systems. Results from an audit at Queen's University Belfast on technical quality of root fillings performed by undergraduate students [16] concluded that in most of the teeth the technical quality of the root filling was acceptable, and students were exposed to an appropriate case mix for endodontic training. The use of machine-driven systems for instrumentation, the selection of primary ET, as well as the exclusion of ET with post-root filling or where only manual instrumentation was used, might have influenced the results. ...
... The European Society of Endodontology (ESE) and the Association for Dental Education in Europe (ADEE) have published curricular guidelines to define and harmonize the skills of students by the end of graduation, emphasizing the requirement of a minimum pre-clinical and clinical training that allows future professionals to achieve the necessary quality in ET performance [20][21][22]. Several studies on the effect of operator experience using mechanized systems concluded that, despite the good performance obtained by inexperienced operators, the associated learning curve should be highlighted; they considered it a crucial factor for establishing the minimum amount of work required for students to obtain the necessary competence for independent professional practice [16,[23][24][25][26]. Regarding the use of reciprocating systems, characterized by a simple and safer protocol [4,11], there are still few studies that evaluate the quality of the treatments performed by inexperienced operators, such as, undergraduate students, and the extension of its learning curve. ...
... This will allow the acquisition of the necessary skills to adequately perform simple procedures. It is also essential that every agent know their limits and be aware of the need for continued learning throughout their lifetime [16,31]. Thus, introducing new materials and techniques in undergraduate teaching, as well as monitoring the results obtained, is imperative for a better outcome for future professionals, to provide the best and safest clinical practice for patients [14,29]. ...
Rotary instrumentation has been proposed in undergraduate teaching. The aim of this study was to evaluate student’s performance, through the obturation quality and treatment time, in a sequential range of L-simulated root canals. A senior undergraduate dental student sequentially prepared randomly numbered canals from 1 to 40, with the WaveOne Gold glider and primary file, according to the manufacturer instructions. A gutta-percha cone matched with the finishing instrument and epoxy resin-based sealer (AH Plus) was selected for the obturation. Three independent observers evaluated the obturation quality according to both density and length. Active, total instrumentation and obturation times were also measured. Statistical analysis was obtained by Mann–Whitney and Kruskal–Wallis tests with a significance level of p < 0.05. The quality of the obturation was independent of the number of prepared canals with adequate length and density in 87.5% of the prepared canals. Both active and total instrumentation, as well as obturation times, reduced significantly as the number of the prepared canals by the student increased (p ˂ 0.05). The use of WaveOne Gold instrumentation and matched cone obturation by an inexperienced operator provided an adequate obturation quality in most of the curved simulated canals. The working time was significantly reduced through a short learning curve.
... Numerous studies have used radiographs to assess the technical quality of RCTs done by undergraduate dental students with these studies producing mixed results. [4,5] Apart from root canal filling, the quality of a coronal restoration is another outcome predictor of a RCT. The significance of the coronal seal over the apical seal on the periapical health has been emphasized by Ray and Trope [6] and Kirkevang. ...
Introduction: Root canal treatment (RCT) and its coronal restoration should be regularly assessed to ensure a successful treatment outcome. The aim of the current study is to evaluate the relationship between the obturation technical quality and coronal restoration in the clinical and radiographic outcome of RCT provided by Malaysian undergraduate students. Materials and Methods: A total of 143 root-treated teeth from 136 patients were evaluated through clinical examinations and periapical radiographs with a mean follow-up period of 2.4 (standard deviation = 1.59) years. The quality of the coronal restoration was classified according to modified United States Public Health Service criteria and the technical quality of the obturation was assessed based on two variables: length and density. Periapical status was evaluated according to periapical index scores. Results: About 64% of the teeth were classified as healthy with a significant reduction of apical periodontitis from 70.3% preoperatively to 36% at reassessment (P < 0.001). About 92.1% of obturation was of acceptable length, whereas 5% underfilled and 2.9% overfilled. Teeth with acceptable obturation length were five times less likely associated with apical periodontitis than the inadequately filled ones. 90% of canals had adequate obturation density with no significant association to apical periodontitis. Teeth restored with intracoronal restorations had 50% more chance of developing apical periodontitis. Inadequately restored teeth and teeth with poor obturation quality were associated with three times more likely apical periodontitis occurrence. The quality of endodontic treatment and the coronal restoration significantly influenced the periapical status (P < 0.001). Conclusion: The radiographic obturation quality and coronal restorations of the RCTs performed by the undergraduate students in a Malaysian public dental school were acceptable in 63.8% of cases with a 64% favorable outcome. Abstract Access this article online Quick Response Code: Website: www.saudiendodj.com
... The homogeneity of obturation in maxillary and mandibular premolars was adequate in 34% of root canal-treated teeth, while the highest quality of tapering was noted in premolars [5]. A study was done at Queen's University, Belfast, United Kingdom, reported that 39% of anterior teeth had inadequate obturation [8]. The radiographic evaluation of RCT was conducted by the University of Espírito Santo (UFES), Brazil [9], and a study conducted at Suleyman Demirel University, Turkey showed that the quality of obturation performed by first and second-clinical-year students was almost similar [6]. ...
Aim
To assess the radiographic quality of root canal treatment (RCT) performed on single-rooted anterior teeth by undergraduate dental students of Imam Abdulrahman Bin Faisal University (IAU). Moreover, the study also aimed to assess the types of procedural errors encountered during root canal treatment and to compare the results between male and female students.
Methodology
The record of patients who visited the endodontic clinics at IAU between the years 2018 and 2021 was obtained from the medical records department. The inclusion criteria for the study involved: i) RCT performed on anterior teeth with a single root; ii) RCT performed by fourth, fifth, and sixth-year undergraduate dental students; and iii) availability of pre-operative and post-operative peri-apical radiographs. After the inclusion criteria, a total of 278 records were selected. The radiographs were accessed by two calibrated examiners for the length of the obturation, homogeneity, and taper. In addition, procedural errors such as the presence of a ledge, perforation, or fractured instruments were also observed. Analysis was done using the Chi-square test.
Results
A total of 139 teeth (50%) were found to have an adequate quality root canal treatment. Regarding the length of the obturation, 85.6% were considered acceptable, while 65.1% of the obturations had acceptable radiographic homogeneity. The acceptable taper was found in 71.9% of the obturations. Dental students who participated in this study demonstrated a low rate of procedural errors, with 4.7% ledge formation and 1% perforation. A statistically significant difference was found in the quality of root canal obturation (P = <0.001) performed by fourth, fifth, and sixth-year students. Moreover, a significant difference was also observed between maxillary and mandibular teeth (P= 0.032).
Conclusion
The quality of RCT performed by undergraduate dental students demonstrated that improvements are required. The teaching methods used in the endodontic courses need to be developed and improved to ensure the best possible learning and treatment outcomes.
... One of the goals of the endodontic treatment is the elimination or reduction of microorganisms from the root canal and periapical tissues. For this, the chemical mechanical preparation needs to be effective and the filling of the canal systems promotes adequate sealing in root canals [1][2][3][4][5] . ...
Aim: To demonstrate the effectiveness of disinfecting substances with 2% and 5% Sodium Hypochlorite and 2% Chlorhexidine Gluconate at each of the pre-established times of 0:15 and 0:30 seconds, and 1, 2, 5, and 10 minutes. Methods: This study selected 96 gutta-percha cones that were contaminated with Enterococcus Faecalis, dried and treated with the aforementioned substances and applied at pre-established times. Subsequently, these were transferred to sterile Brain Heart Infusion broth and placed in a bacteriological incubator at 37°C for 24 hours to evaluate microbial growth, as well as in a nutrient agar medium in Petri dishes. Half of the cone was transferred to individual filter paper packages and exposed to the environment in a dental clinic at Universidade José do Rosário Velano, for 7 days, with subsequent evaluation for microbial growth. The bacterial phenotype test was performed using Gram stain and growth in 6.5% saline solution. The results were submitted to statistical analysis using the Kruskal Wallis H test, with a significance level of 5%. Results: The substances were effective at all times tested and individual storage supported disinfection. In the statistics test, the p-value was greater than 0.05, as there was no variability in the data configurations. Conclusion: The disinfection of gutta-percha cones and individual storage was an effective protocol to be adopted with 2% and 5% Sodium Hypochlorite and 2% Chlorhexidine.
... In this investigation, not only the extrusion of gutta-percha cones but also any amount of sealer beyond apex was considered as overfilling. Various studies have investigated the radiographic quality of root canal fillings performed by clinical dental students [17,[37][38][39][40][41]. In this research, the adequate length and density of RCT performed by 4thyear students were found in 81.71% and 92.86%, respectively. ...
... A very similar distribution was presented by other scientists [24,36,81]. According to other studies, two-thirds of treated teeth by 4th and 5th year students were premolars and molars [23,37], while one study presented a uniform distribution of teeth treated by students [38]. According to the ESE undergraduate curriculum guidelines for endodontology [10], students should gain adequate experience in the treatment of anterior, premolar, and uncomplicated molar teeth. ...
... The most common diagnosis prior to primary RCT in the current study was pulpitis (55.78%), less often was periapical tissue disease (43.67%) and the least frequent was endoperio lesion (0.56%). These data coincided with the available literature [29,38,39]. Various studies reported that primary RCT was performed by postgraduate students of the program in endodontics, and additionally, pulpitis was diagnosed more often than non-vital pulp [16,80]. ...
The main goal of root canal treatment (RCT) is to eradicate or essentially diminish the microbial population within the root canal system and to prevent reinfection by a proper chemo-mechanical preparation and hermetic final obturation of the root canal space. The aim of this study was to assess the quality of the root canal filling and the number of visits needed for completing RCT by operators with different experience, including dentistry students (4th and 5th year), general dental practitioners (GDPs), and endodontists. Data from medical records of 798 patients were analyzed , obtaining 900 teeth and 1773 obturated canals according to the inclusion and exclusion criteria. A similar number of teeth was assessed in each group in terms of density and length of root canal filling and number of visits. The larger number of visits and the lower quality of treatment was observed for 4th year students than for other groups (p < 0.05); in contrast, the endodontists needed the lowest number of visits to complete RCT and more often overfilled teeth than other operator groups (p < 0.05). Interestingly, no statistical difference in quality of root canal filling was noted between 5th year students, GPDs and endodontists. The treatment of lower teeth demanded statistically more visits than that of upper teeth (p < 0.05). The results of the study emphasize that most of the root canal filling performed by operators was considered adequate, regardless of tooth type, files used and number of visits.
... Before, during, and after RCT, using periapical radiographs is crucial for the detection of periapical lesions, canal/s anatomy and dimensions, the quality of obturation, and records [2,3]. An appropriate RCT is characterized by a ity of RCT with respect to tooth type and location [1,14,16,22,26,33,34,36,37,40], extracting the frequency of technical errors [17,18,23,[27][28][29][30]41], identifying the academic grade of students who perform the treatment [24,35,38,39], and exploring the complications happening as a result of errors [20]. Although the studies showed significant variation in their outcomes, the overall quality of RCT performed by undergraduates was significantly high when comparing inadequate RCT (61.4% SD ± 20.2 and 38.6% SD ± 20.3, respectively). ...
... While the study for Fritz et al. showed the highest adequate RCT among dental students, 93.8% [21], the study performed by Ehsani et al. showed the lowest percentage of adequate RCT, 17.5% [38]. The maxillary anterior teeth, followed by premolar, showed higher RC quality compared to posterior teeth in most of the studies [15,16,20,22,25,26,35,37], while fewer of them showed no significant differences between anterior and premolars or anterior and posteriors [17,21]. The deficiency in the length of RCT was the highest error that happens during RCT as reported by some of the studies [16,18,21,30,34,39]. ...
... The current study showed that deficiency in the length of RCT (short length) was the highest among studied groups (29.6%). This result was highly comparable to other studies that showed the deficiency in the length of RCT was the highest among other errors, ranging from 25% to 30% [17,27]. However, these percentages were very high compared to different studies that showed 5-20% deficiency [14,26,32,45]. ...
This study aimed to assess the errors that happened during root canal treatment (RCT) and compare the quality of root canal fillings (RCFs) performed by different academic grades of dental students at Jouf University. Materials and Methods: a retrospective audit study was conducted to check the errors that occurred during RCT performed by seniors and undergraduates. The quality of the RCFs were evaluated, using digital periapical radiographs depending on previously validated criteria. Data analyses were performed using Statistical Package for the Social Sciences. Descriptive statistics were used for expressing the frequencies of variables and the Chi-square test was used for comparing different variables with a 0.05 level of significance. Results: overall, 332 endodontically treated teeth (566 root canals) were finally chosen for the study. Out of these treated cases, 156 teeth (47%) had a total of 287 recorded errors, mainly in posterior teeth. From the total number of errors, short obturation was the highest error occurred (29%), followed by lack of apical seal (25.1%). Root perforation was the least reported error (2.8%), proceeded by broken instruments (5.6%). A total of 13.2% of the errors were teeth left with unfilled canals, while 7.7% were for an overextended filling. There were no significant differences between the quality of RCF performed by different academic grades. Conclusion: depending on the current study, the quality of RCTs performed by seniors and undergraduate students was 53% acceptable. A clear plan should be applied to improve the quality of treatment outcomes of undergraduate students by implementing more effective preclinical training courses, increasing the ration of supervisor-to-students, and using more advanced modalities during treatment.
... in most cases with acceptable quality and adequacy [1], the error rate increases with more complex root canal systems [2]. University education can only provide theoretical and practical skills to a limited extent, but the question arises as to how education can be improved; therefore, standards of university education in endodontics have been established [3][4][5]. ...
Background
E-learning has found its way into dental teaching in general and endodontic teaching in particular. The present study aimed to implement a newly developed multimedia learning application and assess its effect on students’ first root canal treatment on real patients. With the COVID-19 outbreak, the application’s performance was investigated during the pandemic.
Methods
A total of 138 students in the initial clinical endodontic course participated in this study. The control group ( n = 49) followed the traditional curriculum, including practice on artificial teeth and face-to-face teaching events. In addition to the traditional curriculum, test group 1 ( n = 54) had access to an endodontic e-learning application containing videos demonstrating artificial teeth and patient cases. With the COVID-19 outbreak, test group 2 ( n = 35) had no face-to-face teaching; however, endodontic patient treatments were included. The quality of students’ first root canal treatment on real patients was compared using performance and radiographic assessment items. Statistical analysis was done using Kruskal–Wallis and chi-squared tests. Test groups received a questionnaire to assess the learning application. Test group 2 also completed a COVID-19-specific survey to measure students’ perceptions of how the pandemic affected their endodontic education.
Results
The results of endodontic treatments were significantly better for test group 1 ( P < 0.001) and 2 ( P < 0.001) than for the control group. Likewise, there were significantly fewer treatment errors in test group 1 ( P < 0.001) and 2 ( P < 0.001). No significant differences were found between test groups 1 and 2. Students of the test groups positively evaluated the e-learning application. Students of test group 2 expressed their fear of negative impacts on their course performance.
Conclusion
The e-learning application was well-received and seemed to improve endodontic education. The results imply that the quality of education may be maintained by implementing e-learning to compensate for face-to-face teaching. As no difference was found between online and face-to-face teaching, students’ and lecturers’ concerns that endodontic education is suffering because of the pandemic may be eased.
... Root canal treatment is an essential part of general dental practice. 1,2 The retention of natural permanent teeth is important for patients. Therefore, clinicians are expected to provide high-quality treatment. ...
... Dental school graduates should be able to competently perform root canal treatments. 2 The success of root canal treatment is dependent on having proper access cavity preparation, appropriate cleaning, shaping and filling of the root canal system, and maintaining adequate coronal and apical seal. 3,4 The poor technical quality of root fillings evaluated by radiographic images was related to posttreatment disease, which compromises the treatment outcome. ...
Objectives The aim of this study was to determine the technical quality of root canal fillings and the presence of iatrogenic errors in the cases treated by undergraduate dental students using radiographic images.
Materials and Methods This study included 480 root-filled teeth, which were evaluated using intraoral periapical radiographic images. The technical quality of obturation was assessed by observing the length, density, and taperness of the root filling. Ledges, apical transportation, fractured instruments, zipping, and root perforation were recorded as iatrogenic errors. Teeth were classified as acceptable if the technical parameters were adequate and there were no iatrogenic errors.
Statistical Analysis Data were statistically analyzed using Pearson's chi-squared test.
Results The quality of root filling was acceptable in 183 of the 480 teeth. The rate of acceptable quality was higher for the teeth treated by 4th-year students (41.9%) than for those treated by 5th-year students (27.4%; p = 0.004). Length and taperness were adequate in more of the patients treated by the 4th-year students (p<0.05). There was a significant difference in the incidence of ledge formation and apical transportation in relation to the student's level (p<0.05).
Conclusions The technical quality of root fillings performed without iatrogenic errors by undergraduate dental students was declared acceptable in 38.1% of the assessed teeth. There was a noticeable difference in the quality of root canal treatment between the 4th- and 5th-year students.
Clinical Relevance The findings demonstrate that periodic assessment of the technical quality of root filling performed by undergraduate dental students provides feedback on curriculum standards.
