Technical quality of root canal fillings performed in a dental school and the associated retention of root-filled teeth: a clinical follow-up study over a 5-year period

Summary  The aim of this study was to examine the technical quality of root canal fillings performed in a dental school and to investigate the associated effect on the survival/retention of root-filled teeth. A review of case notes of patients who had root canal treatment performed in the department of Restorative Dentistry, University Dental School and Hospital, Cork, Ireland was carried out. The technical quality of the root canal filling was described according to its relationship with the radiographic apex on a post-treatment radiograph. Tooth status at review was defined as 'tooth present' or 'tooth absent' based on the presence or absence of the root-filled tooth recorded in the treatment records at a review appointment following placement of the root canal filling. One hundred and forty-eight teeth (129 patients) were considered. Of these, 69·6% ( n  = 103) were of acceptable technical quality, 23·6% ( n  = 35) were under-extended, and 6·8% ( n  = 10) were overextended. An increased number of intra-treatment radiographs to confirm the relationship of the canal preparation to the radiographic apex and operator experience were significant predictors of adequate root canal fillings ( P  < 0·05). Eighty-three per cent ( n  = 123) of teeth were present at a review appointment held an average of 40 months following completion of treatment (12–60 months). The technical quality of the root canal filling was the only significant factor in predicting tooth survival ( P  < 0·05), while the presence of pre-treatment periapical pathology had no significant effect on survival of the root-filled tooth. Determination and maintenance of the working length of the canal system is an important feature in producing good quality root canal fillings, which in turn, is associated with increased likelihood of survival/retention of root-filled teeth.     

A multicentre investigation into the role of structured histories for patients with tooth avulsion at their initial visit to a dental hospital

Abstract  – A paper structured history (SH) is a sheet, which prompts or reminds the clinician to ask various important questions. The aim of this study was to examine avulsion cases with respect to the quality of clinical records. Hospitals studied used either a paper SH or had no specific structure in their recording of avulsion details, e.g. unstructured histories (USH). The most important prognostic items that should be recorded for avulsion cases at their first visit were identified by reviewing the literature. Clinical case records meeting strict inclusion criteria were retrospectively analyzed against 10 important prognostic items. Forty-seven patient records were identified in the SH group compared to 43 patient records in the USH group. Using chi-square and Fisher's exact tests, the SH group were significantly better at recording the following: accident details ( P  < 0.001), loss of consciousness ( P  < 0.001), other teeth or tooth injuries ( P  < 0.05), extra-alveolar mediums ( P  < 0.01), total extra-alveolar time ( P  < 0.001), antibiotics given at time of injury ( P  < 0.05) and apical maturity ( P  < 0.001). In all the dental hospitals selected, two-thirds of the case records were completed by junior dentists not in specialist training and the improvement in history when using an SH form was most pronounced in these groups. It is concluded, therefore, that an SH should be taken for cases of avulsion as it was significantly better at collecting essential prognostic information.     

The role for 'reminders' in dental traumatology: 1. Current practices in the UK and Ireland

Abstract –  The aim of this study was to investigate the current method for recording trauma in UK dental hospitals. A standard questionnaire was sent out to all 19 UK and Irish dental hospitals to investigate how trauma was recorded both at initial presentation and at review appointments. Where a standard form was used, a copy was requested. Each form was analysed to assess what information was being recorded and whether prompts were used. For the initial presentation of trauma, nine institutions had a standard trauma form, one used a standard form for avulsions only, seven had no form and two did not respond. For subsequent follow-up visits of trauma cases, six hospitals had a standard form, one used a standard from for avulsions only, 10 had no form and two did not respond. There was considerable variation in the questions that were asked at initial presentation of trauma cases and follow-up reviews in dento-alveolar trauma. Without consistent recording, there is little chance that multi-centred prospective clinical trials can take place in the field of dental trauma.     

The role for 'reminders' in dental traumatology: 3. The minimum data set that should be recorded for each type of dento-alveolar trauma – a review of existing evidence

Abstract –  The aim of this study was to establish the prognostic factors recorded at the time of diagnosis or initial treatment that affect pulp and periodontal healing and tooth survival. A search strategy and quality assessment method was established to review the literature. The significant factors identified are listed for each type of dento-alveolar injury. These factors identified are the gold standard against which quality assessments of dento-alveolar trauma records can be compared and all new computer or paper-based methods for recording any type of dento-alveolar trauma should aim to record this minimum information.     

The role for 'reminders' in dental traumatology: 4. The use of a computer database for recording dento-alveolar trauma in comparison to unstructured and structured paper-based methods

Abstract –  The aims of this study were to investigate the effectiveness of a computer database (CD) developed for this study, a plain paper unstructured history (USH) and structured histories (SH) for the recording of important prognostic factors for simulated dento-alveolar trauma. Twelve vocational trainees, seven postgraduates in paediatric dentistry and 24 general dental practioners were randomly assigned to using USH, SH or CD. Each dentist visited a series of simulated trauma cases (with models, photos, radiographs and actors) and was asked to record important prognostic factors for each injury and make a diagnosis. There were a total of 243 dentist contacts with the trauma stations. The average percentage of important prognostic factors recorded per station was: USH 53%, SH 75.3% and CD 58.6%. SH was significantly better than the other two methods ( P  < 0.001, anova ). Interestingly, those general dental practitioners (GDPs) who qualified prior to 1990 were significantly poorer at recording important prognostic information using CD. This effect was not obvious when using USH and SH. It was also seen that USH and SH were significantly better at helping clinicians reach a correct diagnosis as compared with CD ( P  < 0.001, chi-squared). A paper-based SH was the most effective method for collecting essential prognostic information for simulated trauma cases used in this study. At present, the introduction of our CD for recording of trauma is not justified without significant modification.     

Neosono Co-pilot根尖定位仪准确性的临床评价

目的：研究Neosono Co-pilot根尖定位仪在根管工作长度测定方面的准确性。方法：将需行根管治疗的137个牙、共389个根管随机分为两组。电测组采用Neosono Co-pilot根尖定位仪测量根管工作长度,对照组采用手感法结合插针定位X线片测量。根据根管充填后X线片评价其准确性。结果：Neosono Co-pilot的适充率为95.63%,手感法结合插针定位X线片法的适充率为91.26%,两种方法无显著性差异（p〉0.05）。结论：Neosono Co-pilot根尖定位仪临床操作简便、准确性较高,同时能减少X线的辐射量。     

A comparative study of three periapical radiographic techniques for endodontic working length estimation

AIM: To compare the diagnostic quality of endodontic working length estimation films produced using film holders with those taken using the bisecting angle technique and to assess the level of acceptance of film holders by operator and patient. METHODOLOGY: Five post-graduate and 20 final year undergraduate students attending a UK Dental School produced working length radiographs using either the paralleling or the bisecting angle technique. The paralleling group used one of two film holders, the Endoray II or the XCP Endodontic Instrument, on alternate patients. An assessment of the ease of use of the device and the patients' views on the comfort of the examination were recorded. Each radiograph was examined simultaneously by two assessors, scored for film faults and diagnostic acceptability. Statistical data was derived using the Mann-Whitney U test and Cohen's kappa. RESULTS: The rates of unacceptable radiographs for the XCP Endodontic Instrument, Endoray II and the bisecting angle techniques were 12.2%, 21.4% and 48.6%, respectively. The combined percentage of unacceptable paralleling technique films (16.7%) was highly significantly different (P < 0.001) when compared with the bisecting angle technique (48.6%). The paralleling technique produced a significant reduction in incorrect vertical angulation (P < 0.001), cone cutting (P < 0.001) and incorrect film placement (P < 0.001). Film holders were rated either excellent or good in 90% of examinations by operators and 47.5% of patients reported no discomfort. CONCLUSIONS: These results support the use of the film holders for endodontic working length estimation.     

A comparison of computer‐ and hand‐generated clinical dental notes with statutory regulations in record keeping

Introduction: Dental patient records should be of high quality, contain information to allow for good continuity of care and clinical defence (should the need ever arise) and, ideally, facilitate clinical audit. Handwritten dental records have been assessed for their compliance to statutory regulations, but the same cannot be levelled at computer‐generated notes. This study aimed to compare and analyse the compliance of both methods of data recording with statutory regulations. Method: Fifty consecutive sets of handwritten notes and 50 sets of computer‐generated notes were audited for compliance with a number of legal requirements and desirable characteristics for dental records and the results compared. The standard set for compliance with all characteristics was 100%. Results: The computer‐generated notes satisfied the set standard for 8 of the 11 legal requirements and three of six desirable characteristics. The handwritten notes satisfied the set standard for 1 of 11 legal requirements and none of the desirable characteristics. A statistical difference (using a 95% confidence interval) between the two methods was observed in 5 of 11 legal characteristics and three of six desirable characteristics, all of which were in favour of computer‐generated notes. Conclusions: Within the limitations of this study, computer‐generated notes achieved a much higher compliance rate with the set parameters, making defence in cases of litigation, continuity of care and clinical audit easier and more efficient.     

Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy

The vascularized iliac crest graft with internal oblique muscle as a method of reconstruction after maxillectomy has been used routinely at the Regional Maxillofacial Unit in Liverpool since 1993. Twenty-four consecutive operations have now been done and this paper reports an audit of our experience. An analysis of case-notes was made retrospectively after checking theatre diaries and records. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the complications and the outcome in terms of recurrence and disease survival. The type of defect was recorded, as was whether it had been possible to rehabilitate the patient both dentally and facially. At the time of this study 9 patients (38%) had died of their disease leaving 15 surviving. In 13 cases full dental and facial rehabilitation had been achieved or patients were waiting for an implant-retained prosthesis. Donor site problems important enough to be recorded in the notes were minimal, one case of abdominal wall weakness was noted, which required no intervention. The vascularized iliac crest graft with internal oblique muscle offers a complete solution for reconstruction after maxillectomy, providing there has been no sacrifice of the overlying facial skin and oral sphincter. There is sufficient height and depth of bone to maintain a facial profile and the muscle epithelializes to provide an ideal oral and nasal lining. This flap provides a base to enable full dental and facial prosthetic rehabilitation with either implant-retained or conventional prostheses.     

Blank paper or printed set task forms for retrievable patient notes?

Patients' clinical notes made at review appointments following removal of third molars under a general anaesthetic at five Mersey Hospitals have been compared with those formed from the recording of the findings of preselected tasks. Consistent high quality retrievable records were achieved using the preselected task forms, superior to those formed on blank paper.     

Accuracy of an electronic apex locator in primary teeth with root resorption

Aim  To evaluate whether root resorption of primary molar teeth affects the accuracy of the Root ZX apex locator and to compare the Root ZX at different meter readings with direct canal measurement.
Methodology  Sixty extracted primary molar teeth with root resorption affecting one sixth to one third of root length were used. The teeth were embedded in an alginate model. A K-type file was used in association with a Root ZX apex locator to measure canal length. Measurements were recorded using the Root ZX meter reading 'Apex' and '0.5 bar'. Actual tooth length was measured with a K-file to the major foramen. All measurements were read under a stereomicroscope at 15× magnification. The deviation of the Root ZX measurement from the actual canal length was determined.
Results  Mean differences between Root ZX length meter reading 'Apex' and actual length were 0.01 ± 0.23 mm whereas mean differences between Root ZX length meter reading '0.5 bar' and actual length were −0.33 ± 0.30 mm. The Root ZX was 96.7% accurate to within ± 0.5 mm of the apical foramen when compared with the actual canal length of primary molars with root resorption.
Conclusions  Using a criterion of ± 0.5 mm, the accuracy of the Root ZX was high and not affected by root resorption. When compared with direct canal measurement, the error in locating the apical foramen was smaller with measurement at meter reading 'Apex' than meter reading '0.5 bar'.     

Dentists' selection of measures for assessment of oral health risk factors for Finnish young adults.

Dentists' selection of measures for assessing oral health risk factors for young adults, in relation to their oral health status and to those dentists' characteristics, was studied in one administrative unit of the Finnish public oral health service. A random selection (n = 239) was made of all young adults born in the period 1966-71 and clinically examined during 1994. On the original oral health records of those selected, all notes were scrutinized concerning the most recent clinical examination and treatment course; in total 208 (87%) records. We found that assessment of risk factors to oral health was rare. The patient's diet had been recorded as assessed in 7% of all cases, use of fluoride in 8%, and oral hygiene habits in 14%. No salivary tests were performed; nor was patients' use of tobacco assessed. No correlation was detected between measures used by these dentists and their patients' oral health status (DMFT and DT scores, number of approximal incipient lesions, and number of healthy sextants by CPITN). The oral health status impelled only slightly assessments by bite-wing radiographs. Fewer than half (44%) of the dentists performed and recorded any kind of assessment measure; 4% assessed diet, hygiene, and use of fluoride for all their patients in our sample. A dentist's gender showed no correlation with number of measures used; younger dentists tended to perform and record assessments slightly more often than did older dentists, but in all age groups there were those who had not done this. The practice of risk-factor assessment should be more widespread and standardized, contributing to needs-based treatment and allocation of resources.     

Comparison between two methods of working length determination and its effect on radiographic extent of root canal filling: a clinical study [ISRCTN71486641]

Background  

Obtaining a correct working length is critical to the success of endodontic therapy. Different methods have been used to identify this crucial measurement. The Aim of this clinical study was to compare the effect of working length determination using apex locator alone or in combination with working length radiograph on the apical extent of root canal filling.     

The accuracy of electronic working length determination

AIM: To determine in vivo the accuracy of two impedance quotient apex locators under clinical conditions. METHODOLOGY: Electronic working length determination was carried out before extraction in 79 human teeth with 93 root canals. In 51 root canals, the determination was performed using the apex locator Justy II(R) (Hager & Werken, Duisburg, Germany); in 42 canals, the apex locator Endy 5000(R) (Loser, Leverkusen, Germany) was used. A root canal instrument was fixed at working length with composite material prior to extraction followed by the exposure of a radiograph. After histological preparation of the apical region, the teeth were examined under a light microscope. The distance of the file tips to the target intervals 'minor foramen - major foramen' and 'apical canal constriction' was determined. These values were compared with the calculated working lengths, determined by radiographic assessment. The data were statistically analysed by a paired t-test. RESULTS: For both apex locators and both target intervals, no significant differences between the electronic and radiographical assessments were recorded. The probability of determining the area between minor and major foramen was 82.4% for Justy II and 81% for Endy 5000. However, accurate determination of the apical constriction was only successful in 51% (Justy II) and 64.3% (Endy 5000) of canals. Variation of the inaccurate measurements was higher for Endy 5000 than for Justy II. CONCLUSIONS: Under clinical conditions, it is possible to determine the region between the minor and major apical foramen with electronic length measuring devices (ELD). However, use of these devices does not result in precise determination of the apical constriction.     

Technical quality of root fillings performed by dental students at the dental teaching centre in Reims, France

Aim  To evaluate the technical quality of root fillings performed by undergraduate students at a dental teaching centre in France.
Methodology  A random sample of 419 records of patients who received dental treatment at the dental service of the teaching Hospital, in Reims, France between 2005 and 2006 was investigated. Evaluation of root filled was based on radiographical criteria defined by the French National Health Service. The length of root fillings, the radiodensity and the presence of voids in the root filling or between root filling and root canal walls were recorded and scored. Chi-square analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type.
Results  Of the 304 teeth included in the study, 69% had an adequate length of root filling and 42.7% had a dense root filling without voids; only 30.3% of teeth fulfilled these criteria at the same time. The relationship between the technical quality of root fillings and tooth type was statistically significant ( P  < 0.001), the highest percentage of adequate root fillings occurred in single-rooted teeth (36.1%). The highest percentage of inadequate root fillings according to the criteria of root filling length and lateral adaptation was found in molar teeth (71.9%).
Conclusion  Overall, the technical quality of root fillings performed by undergraduate students was poor.     

根管长度电测仪在老年人根管治疗中的临床应用

目的初步探讨RootZX根管长度电测仪测定老年人根管工作长度的准确性及不同根髓状态对其测量准确性的影响。方法选择老年患者需作根管治疗的患牙204颗,根管373个,随机分为电测法组和手感法组,分别测定根管的工作长度后预备根管,X线片试尖测定牙齿的长度,比较电测法组和手感法组测定根管工作长度的准确率。以及不同根髓状态对电测法测定根管工作长度准确率的影响。结果电测法组、手感法组准确率分别为93.75%、67.96%。经χ2检验,两组间有显著性差异。电测法中活髓根管准确率为93.81%,死髓根管的准确率为93.68%。经χ2检验,两组准确率无显著性差异。结论RootZX测量老年人根管工作长度的准确率明显高于手感法,其准确性不受根髓状态的影响。     

Raypex 5根尖定位仪临床应用的准确性观察分析

目的：观察Raypex 5在临床应用中测量根管工作长度的准确性及影响因素。方法：共收集342例患者的903个根管,随机分为实验组和对照组。实验组458个根管采用Raypex 5测量根管工作长度。对照组445个根管,按手感法测量根管工作长度,拍摄X线片,分析比较,研究其准确性及影响因素。结果：在X线片上恰填范围内,实验组准确率达94.32%,对照组75.06%。电测法与手感法的准确率比较有显著性差异（P〈0.01）。牙髓活力,根尖骨质破坏状况,龋洞类型,牙位,牙齿形态,根管数目对Raypex 5测量根管工作长度的准确性无明显影响。结论：根尖定位仪Raypex 5能较为准确地测量根管工作长度,准确率比手感法高,值得临床推广使用。     

Comparison of measurements obtained with hand files or the Canal Leader attached to electronic apex locators: an in vitro study

AIM: The aim of the present in-vitro study was to combine directly the Canal Leader handpiece (SET, Olching, Germany) with the electronic apex locators ROOT ZX (Morita, Kyoto, Japan) and JUSTY (Yoshida, Tokyo, Japan) to find out whether the working length values thus obtained were identical to those resulting from the combination of the same electronic devices with hand files. METHODOLOGY: A total of 50 natural extracted teeth with single canals and mature apices were used. A radiograph was used as a control and the distance from the radiographic apex to the tip of the file was measured and compared with the results of the electronic length determination. RESULTS: For both electronic devices the differences amongst the distribution of the measurements were not statistically significant under the specified conditions (P > 0.05), indicating that the measurements with hand files and with the Canal Leader were identical for the majority of the cases. CONCLUSIONS: Under the conditions of this study the working length of canals obtained with electronically assisted hand files were similar to those obtained with the electronically assisted mechanical handpiece Canal Leader.     

ProPex 根尖定位仪准确性的临床研究

目的研究ProPex根尖定位仪在临床测量根管工作长度的准确性。方法选择60颗患牙98个根管,先以ProPex根尖定位仪确定根管工作长度,再插入初尖锉至根尖定位仪确定工作长度,拍摄X线片测量、计算根管工作长度,将测得数据进行配对t检验。结果 ProPex根尖定位仪测量结果为(18.5±2.1)mm,插针X线法测量结果为(18.4±2.0)mm,两者差异无统计学意义(t=-1.845,P=0.068)。结论 ProPex根尖定位仪与插针X线法的测量结果无明显差异,是一种较为可靠的确定根管工作长度的方法。     

Contributions of reformatted computed tomography and panoramic radiography in the localization of third molars relative to the maxillary sinus

OBJECTIVE: The aim of this clinical study was to seek an answer to the question of whether CT gives better qualitative and quantitative information as compared to panoramic radiograph when deciding on extraction of upper impacted third molars. STUDY: The study concerned 34 third molars appearing in direct relation with the sinus on the panoramic radiograph for which a CT scan had been recommended. For each case, the panoramic radiograph was compared with the CT scan for 5 evaluation criteria. RESULTS: The CT scan was more precise than the panoramic radiograph by 1.67 mm for measurement of the level of impaction of the third molar, by 12.44 degrees for measurement of the third molar displacement, by 0.74 mm for bone height separating the third molar roots and the sinus, and by 2.26 mm for the length of roots in the sinus. The CT scan was equally accurate for measurement of the distance separating the crowns of second and third molars in 34 cases. CONCLUSIONS: This study confirms the gain in precision for the CT scan as compared with conventional techniques. The CT scan therefore presents advantages when considering the extraction of upper third molars by providing both qualitative and quantitative information liable to bear on the diagnosis and therapeutic management.