Operator-related aspects in endodontic malpractice claims in Finland

Objective: We analyzed operator-related differences in endodontic malpractice claims in Finland.

Materials and methods: Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002–2006 and 2011–2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n?=?1271). The case-related information included patient’s age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist’s age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses.

Results: Patients’ mean age was 44.7 (range 8–85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients’ gender, dentists’ age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n?=?970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator’s age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists.

Conclusions: Operator-related factors had no impact on endodontic malpractice claims.     

Recognition of patient‐reported impairment in oral aesthetics

The objectives of this study were to investigate the degree of effective recognition by professionals of patient‐estimated oral aesthetic impairment and the most reliable aspects in such recognition. Participants consisted of 95 patients with partial dentition in need of prosthodontic replacements. The oral aesthetics was professionally evaluated using the Prosthetic Esthetic Index (PEI), compiling 13 aesthetic aspects and an overall evaluation. The patient‐reported impairment was evaluated using the Oral Health Impact Profile Aesthetic (OHIP‐Aes) and the Oral Esthetic Scale (OES). Background variables were as follows: gender, age, work situation, education level, marital status, number and location of teeth, wearing a removable dental prosthesis (RDP) and smile line. A significant correlation was found between the overall professional evaluation and the OHIP‐Aes score (R = 0·43, P < 0·05), the OES score (R = 0·46, P < 0·05) and the overall patient evaluation (0·35, P < 0·05). Correlations of the 13 specific aspects of the PEI with the patient‐reported evaluations were generally small to moderate: the aspect ‘discoloration of the teeth’ showed the highest correlation. The multivariate analyses showed that up to 57% of the patient‐reported impairment could be explained by the professionally evaluated oral aesthetic in combination with background variables. Discoloration of the teeth was the greatest explanatory variable, but also dental arch symmetry, and position and colour of the teeth were significant aspects. A high percentage of the patient‐reported aesthetic impairment can be recognised by the professionals. The most reliable aspect is discoloration of the teeth, but also dental arch symmetry, and the position and colour of the teeth are important for recognising the aesthetic impairment.     

Endodontic malpractice claims in Denmark 1995-2004

Aim To study the reasons for and outcome of malpractice claims handled by the regional and national Danish Dental Complaint Boards (DCB) from 1995 to 2004. Specific attention was paid to endodontic claims. Three hypotheses were explored: endodontic malpractice claims are frequent, they are mostly due to technical shortcomings and male dentists are overrepresented. Methodology The reasons for the claims were classified and assigned to at least one of 14 categories. Cases assigned to the ‘endodontic treatment’ category were further sub‐categorized, and reasons for malpractice were examined. An age and gender analysis of dentists and complaining patients was performed only on data obtained from the endodontic cases. Results Overall, 3611 malpractice claims were registered. In 43% of the cases the dentist was judged to be guilty of malpractice. In the majority of the appealed cases the original verdict was affirmed (62.2%) by the national DCB. After crown & bridge treatment (23%) endodontic treatment was the next frequent malpractice claim (13.7%), in which ‘technical complications or incorrect treatment’ was the most frequent sub‐categorization (28.4%). Reasons for endodontic malpractice verdicts were related to root filling quality, the use of a paraformaldehyde product and instrument fracture. Male dentists were most often involved in an endodontic claim, and the majority of complainants were females. Conclusions Endodontic malpractice claims were relatively common in Denmark. Perceived technical shortcomings dominated the patients′ complaints concerning root canal treatment. Male dentists and female patients were overrepresented indicating a gender influence on aspects of the doctor‐patient communication important for liability claims.     

New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems

Conventional radiographs used for the management of endodontic problems yield limited information because of the two-dimensional nature of images produced, geometric distortion and anatomical noise. These factors often act in combination. This review paper assesses the limitations of periapical radiographs and seeks to clarify three-dimensional imaging techniques that have been suggested as adjuncts to conventional radiographs. These include tuned aperture computed tomography, magnetic resonance imaging, ultrasound, computed tomography and cone beam computed tomography (CBCT). Of these techniques, CBCT appears to be an effective and safe way to overcome some of the problems associated with conventional radiographs.     

Follow-up study of endodontic status in an adult Swedish population

Abstract The purpose of this study was to examine changes in the endodontic status of selected teeth in a population over time, in order to get a long-term perspective of endodontically treated teeth. A random sample of the adult Swedish population was selected in 1974 and offered a clinical and radiographic examination. Eleven years later 351 of the selected persons attended a follow-up examination (1985). In radiographs, covering the mandibular premolar and molar regions, the status of 1974 was directly compared, tooth by tooth, with the status of 1985. The results showed that a number of endodontically treated teeth with an apical periodontitis healed during the observation period. During the same period, approximately the same number of endodontically treated teeth presented with a new apical periodontitis. This finding suggested that cross-sectional studies could provide reliable information on the long-term success rate of endodontic treatment at the population level. The periapical lesions that persisted or developed during the observation period were strongly related to incomplete root canal obturation, which is in agreement with observations in follow-up studies from teaching and specialist clinics.     

An overview of the endodontic curriculum in Fiji from 2009 to 2013

This paper seeks to provide the reader with an overview of the endodontic curriculum in Fiji from 2009 to 2013. It also intends to inform readers of the changes in endodontic teaching, the learning methods utilised, curriculum development, the transition from block teaching to partial block teaching combined with longitudinal teaching, and the future plans for the endodontic module.     

A longitudinal study of changes in frequency and technical standard of endodontic treatment in a Swedish population

Abstract Longitudinal studies of endodontic treatment are rare. The purpose of this investigation was to study changes in frequency, technical standard and treatment need in a Swedish population with an interval of 5–7 years. The number of endodontically treated teeth in the population increased while the number of periradicular radiolucencies was at about the same level at the second examination. The number of radiolucencies found in endodontically treated teeth was reduced while it was increased in untreated teeth. The number of root fillings ending ≤2 mm from the apex of the tooth as well as fillings with a proper seal had increased at the second examination, but still only 40.2% ended ≤2 mm from the apex of the tooth and 59.1% of the root fillings were judged to have a proper seal. It was concluded that a great need for endodontic treatment existed in the population examined. A slight improvement in the quality of the treatment was evident at the second examination. However, the technical standard was still poor and obviously affected the outcome of the treatment. It is the opinion of the authors that endodontic treatment methods should be simplified as much as possible in an effort to improve the technical quality of the treatment. The prognosis of endodontic treatment would then improve as well.     

54例持续性根尖周炎的显微根尖外科手术1年疗效观察

目的评价显微根尖手术治疗54例持续性根尖周炎病例的短期临床疗效。方法对54例持续性根尖周炎病例进行显微根尖手术,包括翻瓣、去骨、根尖周刮治、根尖切除,使用超声器械倒预备,三氧化矿物凝聚体（MTA）作为倒充填材料,术后定期复查,通过临床和X线片检查和测量,评价术后疗效。结果54例持续性根尖周炎病例术后1年随访,治愈者31例（57.41％）,改善者19例（35.19％）,失败者4例（7.41%）。根据患者性别、年龄、牙位分布、根尖周暗影的最大直径和根尖周病变组织病理分类分别统计显微根尖手术的疗效,组间差异均无统计学意义（P>0.05）。结论显微根尖手术明显提高持续性根尖周病变的治疗成功率。     

Frequency and technical standard of endodontic treatment in a Swedish population

Abstract The purpose of this investigation was to study the frequency and technical standard of endodontic treatment in a Swedish population. The material consisted of full-mouth radio-graphic surveys from 200 patients treated by general practice dentists, and the radiographs were analyzed by two observers. Thirteen percent of the teeth had been endodontically treated. Periradicular radiolucencies were found in 5.2% of the teeth and 26.4% of the endodontically treated teeth had such periradicular radiolucencies. In nearly half of the root-filled teeth, the root filling ended more than 2 mm from the apex, and only 56.3% were judged to have a proper seal. It is concluded that the need for endodontic treatment is great and the technical standard of the root fillings is poor. This strongly indicates that there is a need for standardized endodontic treatment methods and for more specialists in endodontics in Sweden.     

An assessment of endodontic treatment completion rate in a University‐based student clinic and the factors associated with incomplete treatment

Incomplete endodontic treatment is potentially a public health issue. The aim of this retrospective study was to evaluate the endodontic treatment completion rate at a University student clinic and to identify the factors associated with completion rates. The records of all patients who commenced an endodontic treatment (code 415) from January 2015 to December 2015 were extracted. A total of 783 records were available for analysis of which 86% received complete endodontic treatment. Maxillary first molars were significantly associated with incomplete endodontic treatment (IET). Patients requiring an additional visit (code 455) were 1.5 times more likely to have an IET. The endodontic treatment completion rate at the School of Dentistry at the University of Queensland is higher than those reported in other international university‐based student clinics. Focus group surveys of students and supervisors are required to identify the reasons for higher IET with maxillary first molars and code 455.     

Study on bending behaviour of nickel–titanium rotary endodontic instruments by analytical and numerical analyses

Aim

To develop analytical models and analyse the stress distribution and flexibility of nickel–titanium (NiTi) instruments subject to bending forces.

Methodology

The analytical method was used to analyse the behaviours of NiTi instruments under bending forces. Two NiTi instruments (RaCe and Mani NRT) with different cross‐sections and geometries were considered. Analytical results were derived using Euler–Bernoulli nonlinear differential equations that took into account the screw pitch variation of these NiTi instruments. In addition, the nonlinear deformation analysis based on the analytical model and the finite element nonlinear analysis was carried out. Numerical results are obtained by carrying out a finite element method.

Results

According to analytical results, the maximum curvature of the instrument occurs near the instrument tip. Results of the finite element analysis revealed that the position of maximum von Mises stress was near the instrument tip. Therefore, the proposed analytical model can be used to predict the position of maximum curvature in the instrument where fracture may occur. Finally, results of analytical and numerical models were compatible.

Conclusion

The proposed analytical model was validated by numerical results in analysing bending deformation of NiTi instruments. The analytical model is useful in the design and analysis of instruments. The proposed theoretical model is effective in studying the flexibility of NiTi instruments. Compared with the finite element method, the analytical model can deal conveniently and effectively with the subject of bending behaviour of rotary NiTi endodontic instruments.     

Evaluation of the Dental Hygienist Beliefs Survey; test-retest assessment in a group of general dental patients

To cite this article: Int J Dent Hygiene 10 , 2012; 30–35
DOI: 10.1111/j.1601‐5037.2011.00521.x
Abrahamsson KH, Andersson P, Krok L, Hakeberg M. Evaluation of the Dental Hygienist Beliefs Survey; test–retest assessment in a group of general dental patients. Abstract: Objective: To evaluate the Dental Hygienist Beliefs Survey (DHBS) and the test–retest reliability of DHBS in a group of general dental patients. Material and methods: The DHBS, which is a questionnaire constructed to assess patients’ specific attitudes towards dental hygienists (DHs), was distributed together with the Dental Anxiety Scale adapted to specifically assess fear of DH treatment (DHAS). It was hypothesized that DHBS would correlate with DHAS and gender. The questionnaires were consecutively distributed to 80 patients at their first visit and after a clinical examination performed by a DH student. Retest assessments of DHBS were conducted approximately two weeks later in conjunction with the next visit at the DH student and before treatment (scaling session). The final study sample included 77 adult general dental patients in treatment at an education clinic for DH students. Results: The results verified a statistically significant correlation between DHBS and DHAS. The DHBS sum of scores showed high internal consistency with Cronbach’s a coefficient of 0.88 and 0.91 at the first and second assessments, respectively, and the test–retest reliability of the DHBS was acceptable with intraclass correlation coefficient of 0.76. No statistically significant association was found between DHBS and gender. Conclusion: The results suggest that the DHBS is a reliable and stable scale to use to assess patients’ specific attitudes towards DHs. Moreover, DH beliefs are associated with fear of DH treatment.     

Micro-XRD and temperature-modulated DSC investigation of nickel–titanium rotary endodontic instruments

ObjectivesEmploy Micro-X-ray diffraction and temperature-modulated differential scanning calorimetry to investigate microstructural phases, phase transformations, and effects of heat treatment for rotary nickel–titanium instruments.MethodsRepresentative as-received and clinically used ProFile GT and ProTaper instruments were principally studied. Micro-XRD analyses (Cu Kα X-rays) were performed at 25 °C on areas of approximately 50 μm diameter near the tip and up to 9 mm from the tip. TMDSC analyses were performed from ?80 to 100 °C and back to ?80 °C on segments cut from instruments, using a linear heating and cooling rate of 2 °C/min, sinusoidal oscillation of 0.318 °C, and period of 60 s. Instruments were also heat treated 15 min in a nitrogen atmosphere at 400, 500, 600 and 850 °C, and analyzed.ResultsAt all Micro-XRD analysis regions the strongest peak occurred near 42°, indicating that instruments were mostly austenite, with perhaps some R-phase and martensite. Tip and adjacent regions had smallest peak intensities, indicative of greater work hardening, and the intensity at other sites depended on the instrument. TMDSC heating and cooling curves had single peaks for transformations between martensite and austenite. Austenite-finish (A_f) temperatures and enthalpy changes were similar for as-received and used instruments. Heat treatments at 400, 500 and 600 °C raised the A_f temperature to 45–50 °C, and heat treatment at 850 °C caused drastic changes in transformation behavior.SignificanceMicro-XRD provides novel information about NiTi phases at different positions on instruments. TMDSC indicates that heat treatment might yield instruments with substantial martensite and improved clinical performance.