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1 Journal home page: 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. 7

2 Table 1- Survey Form Table 2- Response Rate Details 8

3 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 9

4 Graph 2 Use of Equipment: Profession Graph 3- Coronal Flaring : Education 10

5 GRAPH 4: Coronal Flaring : Profession GRAPH 5: Method of Working Length Determination :Education 11

6 GRAPH 6: Method of Working Length Determination : Profession Graph 7 Files for cleaning and shaping : Education 12

7 Graph 8- Files for cleaning and shaping : Profession Graph 9 - Technique for cleaning and shaping Education 13

8 Graph 10- Technique for cleaning and shaping - Profession Graph 11- Irrigant : Education 14

9 Graph 12 Irrigant : Profession Graph 13 - Intracanal Medicament : Education 15

10 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 16

11 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 1. Shohreh Ravanshad, Saied Sahraei and Akbar Khayat.Survey of Endodontic Practice amongst Iranian Dentists Participating Restorative Dentistry Congress in Shiraz, November 2007Iran Endod J. 2008;2(4): Azhar Iqbal, Iftikhar Akbar, Beenish Qureshi, Mohd G. Sghaireen, and Mahmoud K. AL-Omiri A Survey of Standard Protocols for Endodontic Treatment in North of KSA ISRN Dent ; Article ID :4 pages. 3.Palmer NO, Ahmed M, Grieveson B.An investigation of current primary care in the north west of England.Br Dent J 2009 ;206(11):E22 endodontic practice and training needs in 4.Attitudes of general dental practitioners towards endodontic standards and adoption of new technology: literature review. Stomatologija, Baltic Dental and Maxillofacial Journal,2009;11(1): Slaus G, Bottenberg P.A survey of endodontic practice amongst Flemish dentists. Int Endod J2002 ;35(9): Ahmed MF, Elseed AI, Ibrahim YE.Root canal treatment in general practice in Sudan.Int Endod J ;33(4): Wael M, Al-Omari Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan. BMC Oral Health. 2004; 4: 1. 8.Peciuliene V, Rimkuviene J, Aleksejuniene J, Haapasalo M, Drukteinis S, Maneliene R.Technical aspects of endodontic treatment procedures among Lithuanian general dental practitioners.stomatologija, Baltic Dental and Maxillofacial Journal,2010;12(2):

12 9. Whitworth JM, Seccombe GV, Shoker K, and Steele JG. Use of rubber dam and irrigant selection in UK general dental practice. International Endodontic Journal 2000; 33(5): Christensen GJ. Using rubber dams to boost quality, quantity of restorative services. The Journal of the American Dental Association 1994; 125(1): Michaelides PL. Use of the operating microscope in dentistryj Calif Dent Assoc Jun;24(6): R. Dean Davis, J. Gordon Marshall, J. Robert Baumgartner,Effect of Early Coronal Flaring on Working Length Change in Curved Canals Using Rotary Nickel-Titanium Versus Stainless Steel Instruments 2002 Jun ;28(6), Bystrom A and Sundqvist G. Bacteriologic evaluation of the effect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral Surgery Oral Medicine and Oral Pathology 1983; 55(3): Wadachi R, Araki K, and Suda H. Effect of calcium hydroxide on the dissolution of soft tissue on the root canal wall. Journal of Endodontics 1998; 24(5):

Research Article A Survey of Standard Protocols for Endodontic Treatment in North of KSA

ISRN Dentistry, Article ID 865780, 4 pages http://dx.doi.org/10.1155/2014/865780 Research Article A Survey of Standard Protocols for Endodontic Treatment in North of KSA Azhar Iqbal, 1 Iftikhar Akbar,