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Journal home page: http://www.journalijiar.com INTERNATIONAL JOURNAL OF INNOVATIVE AND APPLIED RESEARCH

RESEARCH ARTICLE

Current trends in endodontic treatment: cleaning and shaping protocol followed by Dental

surgeons in Mumbai

Dr KhushbooMehra and Dr Lalitagauri Mandke Professor and Head of Department, Department of Conservative Dentistry & Endodontics

D Y Patil University School of Dentistry Nerul, Navi Mumbai, Maharashtra INDIA.

……………………………………………………………………………………………………… Abstract:

………………………………………………………………………………………………………

Introduction Root canal treatment is considered an essential element in the dental services provided to the population in

developed countries. Numerous studies have been published evaluating the success and failure of root-canal

treatment. Indeed, many innovative concepts, techniques and instruments have been introduced for the most

acceptable cleaning, shaping and obturation. In the past decade, guidelines have been formulated reflecting an

increased interest in quality assurance in endodontic procedures.

Although the viewpoint of academic teaching and endodontic societies is clear, little information is available

regarding the attitude of dental practitioners towards these standards, and on how far the changes in endodontic

technique have been incorporated into daily practice[1].

Aims and objectives AIM of the study was to investigate the attitudes of general practitioners, endodontists and dental specialists of

other branches towards the cleaning and shaping protocol followed during root canal treatment and to

compare them to academic standards of treatment and established quality assurance guidelines.

OBJECTIVE of the study was

- to find an association of education (BDS , MDS) with cleaning and shaping protocol.

- Association of profession (private practice or academics)with cleaning and shaping protocol.

Materials and method

A questionnaire was prepared and distributed to 200 dental surgeons including post graduate students, academicians

and private practitioners (Table 1).

These subjects were studied under 2 groups:

1) based on education - BDS or MDS

2) based on profession - PRIVATE PRACTICE , ACADEMICS or BOTH. (Table 2)

The survey form included questions pertaining to materials ,armamentarium and techniques used during cleaning

and shaping of root canals

The collected data were transferred into a personal computer and analyzed . Simple descriptive statistics were used

together with Chi – square test.

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Table 1- Survey Form

Table 2- Response Rate Details

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Results The survey was completed with no missing questions from the questionnaire. The following results were obtained:

1. Use Of Specialized Equipment (graphs 1and 2) - MDS used more specialized equipments than BDS.

Amongst MDS, Rubber Dam was most popular (26%) whereas BDS preferred Loupes (14%). Academicians mostly

used Rubber dam(38.1%). Loupes (30.8%) and surgical microscope (3.8%) were more commonly used by private

practitioners.

2.Coronal Flaring(graphs 3and 4)-The concept of Coronal flaring was accepted in all categories, albeit slightly more

by BDS (84.6%) than MDS (81.2%). 72% academicians and 79.1% private practitioners practiced coronal flaring.

3.Method Of Working Length Determination(graphs 5and 6) - Radiographs was the most commonly used method

by all i.e. BDS (48.5%), MDS (34%), private practitioners (36.4%), academicians (36%) and 50% of dentists doing

both academics and private practice

22% MDS used apex locators .

4.Files For Cleaning and Shaping (graphs 7and 8): BDS use more hand files (42.4%) and MDS use more rotary files

(31.3%) for cleaning and shaping. Hand files used more commonly by academicians (32%)and rotary files more

commonly used by private practitioners (27.3%)

5.Technique Of Cleaning And Shaping : (graphs 9and 10)Crown down and step back techniques were most common

methods used. BDS use more Step back (29.2%). MDS use more Crown down technique (31.7%)

Step back technique most common method used by academicians(44%), whereas private practitioners preferred

Crown down method (27.3%)

6.Irrigant used: (graphs 11and12).A combination of Saline and Sodium Hypochlorite were most popular irrigants

amongst all dental surgeons except academicians, who preferred only Sodium Hypochlorite (40%). 45.5% BDS,

39.6%MDS, 47% private practitioners and 43.8% of academicians and practitionersused Saline and sodium

hypochlorite together.

7.Intracanal Medicament (graphs 13 and14) Calcium hydroxide was the most common intracanal medicament used.

71.3%MDS,60% BDS,75% academicians, 63% private practitioners and 62% both preferred Calcium Hydroxide.

Graph 1- Use of Equipment: Education

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Graph 2 – Use of Equipment: Profession

Graph 3- Coronal Flaring : Education

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GRAPH 4: Coronal Flaring : Profession

GRAPH 5: Method of Working Length Determination :Education

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GRAPH 6: Method of Working Length Determination : Profession

Graph 7 – Files for cleaning and shaping : Education

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Graph 8- Files for cleaning and shaping : Profession

Graph 9 - Technique for cleaning and shaping – Education

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Graph 10- Technique for cleaning and shaping - Profession

Graph 11- Irrigant : Education

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Graph 12 – Irrigant : Profession

Graph 13 - Intracanal Medicament : Education

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Graph 14 - Intracanal Medicament: Profession

Discussion Endodontics is a continuously evolving branch of dentistry, with new materials and techniques being introduced

at frequent intervals. Because of the huge range of armamentarium available, dentists have a wide range of choice in

selection of instruments and techniques. This has led to varied treatment protocols in endodontics.

Cleaning and shaping is one of the most critical phases in endodontic treatment. Success of endodontic therapy

depends on thorough cleaning and shaping of the root canal system. This is also a step where a dental clinician has

an array of armamentarium at his disposal.

Hence we undertook this survey to assess the cleaning and shaping protocol followed by dental surgeons. The

subjects were categorised according to education (BDS, MDS) and profession ( Academicians, private practitioners

and both)

Similar studies have investigated the perception of dentists towards endodontic treatment in countries such as

Germany , Belgium, the USA , UK as well as developing countries like Sudan , Iran and Jordan[2-8] .These studies

offer an insight into the materials and techniques employed by the dental clinicians, as well as their exposure to the

latest advancements in the subject

Our survey indicated that Rubberdam was the most commonly used specialized equipment. Rubber dam gives a dry

aseptic field, good access and visibility. It also protects soft tissues from NaOCl and other caustic medication and

prevents aspiration of instruments. [9,10]

Dental operating microscopes and Loupes provide magnification and enhance the quality and precision of routine

non surgical endodontics [ 11]

MDS used more specialized equipment than BDS. This could probably be because MDS are more trained to handle

specialized equipments, and have more exposure to latest techniques. Since academicians included post graduate

students use of rubber dam was more among academicians.

Coronal flaring of the root canal was accepted and followed unanimously through all categories. The advantages of

coronal flaring include obtaining a straight-line access, ease of instrumentation, lesser chance of instrument

separation and superior cleaning and shaping[ 12 ]

Radiographs were the most common method used for working length determination, irrespective of education and

profession. Advantages of radiographs being easy use, ease of availability48.5% BDS and 34% MDS used

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radiographs.22% MDS used apex locators, again emphasizing that MDS use more specialized equipment

.Academicians and private practitioners together used radiographs popularly

Crown down and Step back were most commonly used cleaning and shaping methods. Step back technique allows

small apical preparation with larger instruments used at successively decreasing lengths to create taper. Whereas

crown down allows straight access to apical region by removing coronal interferences with less chances of zipping

near apical preparation. BDS and academicians use more step back technique. MDS and private practitioners use

more crown down technique. The reason for this is probably because the former ( BDS and academicians) preferred

hand files, whereas MDS and private practitioners used more rotary files. Step back is usually done with hand files,

Crown Down with rotary files.

Saline and sodium hypochlorite are the most popular irrigants irrespective of education and profession. Saline is

biocompatible and creates no adverse reaction if extruded periapically. Whereas sodium hypochlorite when used

cautiously acts as a lubricant , pulp solvent , antimicrobial . Both are economical to list a few advantages. Nowadays

sodium hypochlorite is the gold standard irrigant used in cleaning and shaping and used unanimously by all [13]

Calcium hydroxide is the most preferred medicament irrespective of education and profession since it is bactericidal

and can repair and stimulate hard tissue formulation. Advantages of calcium hydroxide being its antiseptic action

because of its high ph values. It is also extremely beneficial in treatment of weeping canals, phoenix abscess,

resorption cases, non surgical endodontic treatment and endodontic retreatment [14].Most of the other intracanal

medicaments are being discontinued due to their caustic action.

Conclusion Considerable advances have been made in materials and techniques over the last decade in the endodontics, which

has made it a highly dynamic and evolving discipline of dentistry.

It was heartening to note that most of the latest advancements are being endorsed by dental surgeons in Mumbai,

bringing them at par with global endodontic standards.

Such surveys provide a useful insight into the dentists’ perceptions and emphasize the fact that continuing dental

education and knowledge upgradation is of paramount importance for success in this field.

References

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