An audit of root canal treatment performed by undergraduate students

AIM: The objective of this study was to audit the quality of root canal treatment performed by undergraduate students on adult patients. METHODOLOGY: All root canal treatment completed by first and second clinical year undergraduates over a 12-month period were included in the study. The availability and readability of pretreatment, diagnostic length, try-in point and postoperative radiographs were noted for each case. All readable postoperative radiographs of primary treatments were examined for quality of the root filling, categorized as complete, incomplete apical, incomplete apical and lateral or not assessable. The distance from the radiographic apex of the root to the apical extent of each root filling was measured to 0.1 mm precision. RESULTS: Undergraduates performed primary treatment on 157 teeth. A postoperative radiograph was available in 97% of cases. A try-in point radiograph was unavailable in one-fifth of cases. Twenty-seven teeth (13%) were categorized as satisfactory in terms of both radiographic quality and distance of the root filling from the radiographic apex. CONCLUSIONS: Overall, the technical quality of root canal treatment completed by undergraduate students was poor.     

An audit of the quality of root canal treatments performed by undergraduate dental students on single-rooted teeth in Glasgow dental hospital and school

The aim of this investigation was to assess the technical quality of root canal treatments performed by undergraduate dental students on single rooted teeth at the Glasgow Dental Hospital and School. One hundred radiographs of single rooted teeth that had root canal treatment were randomly selected and examined under even illumination in a darkened room using x2 magnification. Of 100 teeth, 20 had voids, and one was perforated. The remaining 79 teeth were assessed using predetermined criteria, and 80% (n=63) were judged to be 'acceptable' 5% (n=4) were 'under-filled, and 15% (n=12) were 'over-filled'. The quality of root canal fillings performed in single rooted teeth by undergraduate dental students at the Glasgow Dental Hospital and School was found to comparable to, or better than, that reported from other international institutions.     

Radiographic evaluation of the technical quality of root canal fillings performed by dental students

The objective of this study was to evaluate radiographically the technical quality of root canal fillings performed by dental students at the School of Dentistry, University of the West Indies. The school's database between 2000 and 2004 was investigated for patients with completed root canal treatment. The final sample consisted of 198 patients with 288 root‐filled teeth and 460 canals. The length, presence of voids, taper, curvature of canal and fractured instruments were recorded and scored. Chi‐squared analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type. Sixty‐three per cent, 27.6% and 72.2% of root‐filled canals had adequate length, density and taper respectively. The overall acceptability of root fillings having adequate length and taper, absence of voids and no fractured instruments was found in 10.9% of canals. Changes in teaching methods may be required to improve the technical quality of root canal treatment done by dental students.     

Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan

OBJECTIVES: The objective of this study was to evaluate radiographically the technical standard of root canal treatment performed by undergraduate dental students at the Dental Teaching Center in Jordan. METHODS: A random sample of 8500 records of dental patients was examined. A total of 542 endodontically treated teeth with 912 roots were evaluated. Periapical radiographs were used to assess the technical quality of the root canal filling. The length of each root canal filling was categorized as acceptable, short and overfilled based on their relationship with the radiographic apex. Density and taper of filling was evaluated based on the presence of voids and the uniform tapering of the filling, respectively. Chi-square analysis was used to determine statistically significant differences between adequacy of root canal filling in each group of teeth according to its location, position and curvature. RESULTS: Sixty-one percent of roots had fillings of acceptable length, while 34.5% were short and 4.2% were overfilled. The root canal fillings of 47.4% were found to be adequate. Adequate fillings were found more in maxillary than mandibular teeth (P < 0.005), anterior compared to posterior teeth (P < 0.05) and in straight canals compared to curved canals (P < 0.001). CONCLUSION: The technical quality of root canal treatment performed by undergraduate dental students using step-back preparation and lateral condensation was found to be less than 50%. Review of the endodontic curriculum requirements, specialized clinical supervision and increasing the time of training at the preclinical and clinical levels should improve this quality.     

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.     

Quality of root canal fillings performed by undergraduate dental students on single-rooted teeth.

INTRODUCTION: Root canal therapy is an accepted and successful form of tooth conservation. Educational guidelines require dental schools to ensure that their graduates are competent on graduation at performing root canal therapy. The aim of this investigation was to assess the technical quality of root canal fillings placed by undergraduate students in single-rooted teeth. MATERIALS AND METHODS: A total of 100 radiographs of root canal fillings placed by undergraduate students in single-rooted teeth were examined under even illumination in a darkened room using x2 magnification. These were graded as 'adequate', where the root canal filling was within 2 mm of the radiographic apex, 'under-filled', where the root canal filling was >2 mm from the radiographic apex, and 'over-filled', where the root canal filling was extruded beyond the radiographic apex. The presence of voids, fractured instruments, and root perforations were also noted. RESULTS: All teeth were obturated with gutta-percha and sealer (Roth Cement), using a cold lateral condensation technique. Of 100 teeth, 10% (n = 10) had voids. Of the remainder, 70% (n = 63) were judged to be 'acceptable', 21% (n = 19) were 'under-filled', and 9% (n = 8) were 'over-filled'. There was no evidence of fractured instruments or root perforations in any root filling examined. CONCLUSIONS: The quality of root canal fillings placed in single-rooted teeth by undergraduate dental students at the University Dental School and Hospital, Cork was acceptable (63% of root fillings placed in single rooted teeth were graded as 'adequate'). The probable reasons for this are multi-factorial, but may be linked to the amount of pre-clinical and clinical teaching in endodontics at the University Dental School and Hospital, Cork. It should be remembered that factors other than radiographic quality/evidence must be considered when determining the outcome of root canal therapy.     

Radiographic technical quality of root fillings performed by dental students in Turkey

AIM: To evaluate the radiographic technical quality of root fillings performed by undergraduate students at a dentistry faculty in Turkey. METHODOLOGY: A random sample of 2000 records of patients who received dental treatment at the Faculty of Dentistry, University of Gazi between 2000 and 2003 was investigated. The final sample consisted of 1,893 root-filled teeth with 3,692 root canals in 1,654 dental patients. For each root-filled tooth, at least three periapical radiographs were examined: preoperative, working length determination and postoperative. The length, density and taper of root fillings were recorded. The length of root fillings was recorded as adequate, short or overfilled. Density of root fillings was recorded as adequate or inadequate. Taper of root fillings was recorded as adequate or inadequate. Results were evaluated statistically using one-way analysis of variance (anova) and chi-square analysis. RESULTS: Sixty-nine per cent, 53.2% and 68.3% of root fillings had adequate length, density and taper, respectively; only 33% of teeth fulfilled these three criteria at the same time. The relationship between the length, density and taper of the root filling and the presence of canal curvature was statistically significant (P < 0.001). There was no significant difference between maxillary and mandibular teeth according to the adequacy of the root fillings. The highest percentage of adequate root fillings was found in maxillary canines (51.5%). CONCLUSIONS: The percentage of adequate root fillings performed by undergraduate students was only 33%.     

Radiographic technical quality of root canal treatment performed ex vivo by dental students at Valencia University Medical and Dental School,Spain

Objectives: To evaluate radiographically the quality of root canal fillings and compare manual and rotary preparation performed on extracted teeth by undergraduate dental students.Study Design: A total of 561 premolars and molars extracted teeth were prepared using nickel-titanium rotary files or manual instrumentation and filled with gutta-percha using a cold lateral condensation technique, by 4th grade undergraduate students.Periapical radiographs were used to assess the technical quality of the root canal filling, evaluating three variables: length, density and taper. These data were recorded, scored and used to study the “technical success rate” and the “overall score”. The length of each root canal filling was classified as acceptable, short and overfilled, based on their relationship with the radiographic apex. Density and taper of filling were evaluated based on the presence of voids and the uniform tapering of the filling, respectively.Statistical analysis was used to evaluate the quality of root canal treatment, considering p < 0.05 as a statistical significant level.Results: The percentage of technical success was 44% and the overall score was 7.8 out of 10. Technical success and overall score were greater with rotary instruments (52% against 28% with a manual one, p < 0.001; 8.3 against 6.7 respectively, p < 0.001).Conclusions: It appears that inexperienced operators perform better root canal treatment (RCT) with the use of rotary instrumentation. Key words:Dental education, endodontics, rotary instrumentation, radiographs, root canal treatment, undergraduate students.     

Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta‐analysis

The technical quality of root canal treatment (RCT) may impact on the outcome. The quality of education received during undergraduate school may be linked to the quality of treatment provided in general dental practice. In this context, the aim of this systematic review was to answer the following focused questions: (i) What is the frequency of acceptable technical quality of root fillings, assessed radiographically, performed by undergraduate students? (ii) What are the most common errors assessed radiographically and reported in these treatments? For this purpose, articles that evaluated the quality of root fillings performed by undergraduate students were selected. Data were collected based on predetermined criteria. The key features from the included studies were extracted. GRADE‐tool assessed the quality of the evidence. MAStARI evaluated the methodological quality, and a meta‐analysis on all studies was conducted. At the end of the screening, 24 articles were identified. Overall frequency of acceptable technical quality of root fillings was 48%. From this total, 52% related to anterior teeth, 49% to premolars and 26% to molars. The main procedural errors reported were ledge formation, furcation perforation, apical transportation and apical perforation. The heterogeneity amongst the studies was high (84–99%). Five studies had a high risk of bias, eight had a moderate risk, and 11 had low risk. The overall quality of evidence identified was very low. The conclusion was that technical quality of root fillings performed by undergraduate students is low, which may reveal that endodontic education has limited achievement at undergraduate level. A plan to improve the quality of root fillings, and by extrapolation the overall quality of root canal treatment, should be discussed by the staff responsible for endodontic education and training.     

The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontists

Aim  To investigate the technical quality of nonsurgical root canal treatment performed by endodontists in Melbourne, Australia.
Methodology  Clinical and radiographic records of 100 sequential nonsurgical patients were obtained from each of six endodontists working in private practice. The following variables were analysed: proximity of root filling to radiographic apex; homogeneity and radiodensity of root filling; lateral adaptation of the root filling to the canal walls; taper; extrusion of material; small, appropriate or excessive apical enlargement; presence of lateral canals; transportation; procedural errors. The radiographs were assessed by three independent evaluators. Exploratory data analysis was undertaken using simple frequencies and cross-tabulations. A generalised linear mixed model (GLMM) was used for the formal statistical modelling.
Results  Of the 1351 canals that were examined, 91.7% were filled within 2 mm of the radiographic apex and 74% were within 1 mm. Homogeneity and adequate density were found along the entire length of the canal in 86.1% and 88.6% of cases respectively. Lateral adaptation was adequate in 95.6% of cases and the taper was 'smooth and continuous' in 83.8% of roots. No and/or small extrusion of sealer was noted in 98.3% of cases. Apical enlargement was 'appropriate' in 85% of roots. Both transportation (1.1%) and procedural errors (1.3%) were rare occurrences.
Conclusions  The technical quality of root fillings performed by endodontists in Melbourne, Australia complied with current guidelines in 77.4%–91.0% of roots. All variables examined confirmed high levels of technical proficiency. There were very few instances of canal transportation and/or procedural errors.     

Hand and nickel-titanium root canal instrumentation performed by dental students: a micro-computed tomographic study

The aim of this study was to evaluate root canals instrumented by dental students using the modified double-flared technique, nickel-titanium (NiTi) rotary System GT files and NiTi rotary ProTaper files by micro-computed tomography (MCT). A total of 36 root canals from 18 mesial roots of mandibular molar teeth were prepared; 12 canals were prepared with the modified double-flared technique, using K-flexofiles and Gates-Glidden burs; 12 canals were prepared using System GT and 12 using ProTaper rotary files. Each root was scanned using MCT preoperatively and postoperatively. At the coronal and mid-root sections, System GT and ProTaper files produced significantly less enlarged canal cross-sectional area, volume and perimeter than the modified double-flared technique (P < 0.05). In the mid-root sections there was significantly less thinning of the root structure towards the furcation with System GT and ProTaper (P < 0.05). The rotary techniques were both three times faster than the modified double-flared technique (P < 0.05). Qualitative evaluation of the preparations showed that both ProTaper and System GT were able to prepare root canals with little or no procedural error compared with the modified double-flared technique. Under the conditions of this study, inexperienced dental students were able to prepare curved root canals with rotary files with greater preservation of tooth structure, low risk of procedural errors and much quicker than with hand instruments.     

Quality aspects of ex vivo root canal treatments done by undergraduate dental students using four different endodontic treatment systems

Objective: To evaluate factors associated with treatment quality of ex vivo root canal treatments performed by undergraduate dental students using different endodontic treatment systems.

Material and methods: Four students performed root canal treatment on 80 extracted human teeth using four endodontic treatment systems in designated treatment order following a Latin square design. Lateral seal and length of root canal fillings was radiographically assessed; for lateral seal, a graded visual scale was used. Treatment time was measured separately for access preparation, biomechanical root canal preparation, obturation and for the total procedure. Mishaps were registered. An ANOVA mirroring the Latin square design was performed.

Results: Use of machine-driven nickel-titanium systems resulted in overall better quality scores for lateral seal than use of the manual stainless-steel system. Among systems with machine-driven files, scores did not significantly differ. Use of machine-driven instruments resulted in shorter treatment time than manual instrumentation. Machine-driven systems with few files achieved shorter treatment times. With increasing number of treatments, root canal–filling quality increased, treatment time decreased; a learning curve was plotted. No root canal shaping file separated.

Conclusions: The use of endodontic treatment systems with machine-driven files led to higher quality lateral seal compared to the manual system. The three contemporary machine-driven systems delivered comparable results regarding quality of root canal fillings; they were safe to use and provided a more efficient workflow than the manual technique. Increasing experience had a positive impact on the quality of root canal fillings while treatment time decreased.     

Record keeping by undergraduate dental students: a clinical audit

AIMS AND OBJECTIVES: An audit was carried out to assess the standard of clinical record keeping by undergraduate dental students, with the object of improving the quality of care of patients treated by these students. METHODOLOGY: One hundred sets of undergraduate student clinical treatment records were evaluated against a modified CRABEL scoring system. The results of this initial part of the audit were presented in tutorial form to a group of 20 students, together with a teaching session on good record keeping, after which the audit was repeated, and another 100 records were examined over five consecutive Fridays, thus completing one complete audit cycle. RESULTS: The most commonly absent record related to the department where the patient was seen followed by illegible signatures of both the demonstrator and the student. Almost all elements of record keeping investigated had improved in the second audit, most reaching 100% compliance, except for two (the updated medical history and the patient's most recent complaint). CONCLUSION: Positive changes can be achieved by creating awareness among dental students on the importance of keeping records.     

Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic

AIM: To evaluate the technical quality of root canal treatment (RCT) and detect iatrogenic errors in an undergraduate dental clinic. METHODOLOGY: Three-hundred and eighty-eight root-filled teeth from the records of the Department of Endodontology at the Aristotle University of Thessaloniki, Greece were evaluated. Evaluation of root-filled teeth was based on two variables: length and presence of voids within the root filling. The technical standard of root fillings was categorized as: < or = 2 mm from the apex with no voids (acceptable); >2 mm from the apex with no voids; overfilling with no voids; < or = 2 mm from the apex with voids; >2 mm from the apex with voids and overfilling with voids. Iatrogenic errors that were detected included ledges, root perforations, furcation perforations, strip perforations and presence of fractured instruments. Chi-squared analysis was used to determine statistically significant differences between frequencies of root fillings between each tooth type. Significant differences were also determined between frequencies of ledges and root perforations according to tooth type and separately in molars according to tooth number, canal location and root canal curvature. Results Three-hundred and forty-three out of 620 root canals (55.3%) had a root filling that was classified as 'acceptable'. The frequency of root canals with an 'acceptable' filling was significantly greater in the anterior teeth (72.1%) than in pre-molars (55.2%) (P < 005) or in molars (46.7%) (P < 0.001). One-hundred and fifty-four (24.8%) root canals had ledges and 17 (2.7%) had a root perforation. The frequency of ledged root canals was significantly greater (P < 0.001) in molars than in anterior teeth. In molars, 105 out of 270 root canals (38.9%) had been ledged. Mesiobuccal, mesiolingual and distobuccal root canals were the most frequently ledged. Canal curvature was found to be the most important factor associated with ledges and root perforations. Conclusions Technical quality was found to be acceptable more often in anterior teeth. Ledges were identified more often in curved canals in molar teeth.