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Guidelines were developed by the Australian Society of Endodontology Inc. with the intent to describe relevant aspects of contemporary evidence-based root canal treatment. The document aims to support clinicians by describing a Standard of Practice in the Australian context. The presented guidelines refer to Competence criteria and Quality standards for the main steps in root canal treatment. While the intent is not to replace individual clinical decision-making, it is envisaged that these periodically reviewable guidelines may help to improve clinical outcomes., (© 2024 The Author(s). Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

Objective: The aim of this cross-sectional study was to assess the prevalence of apical periodontitis in root canal treated teeth in Turkish subpopulation and to evaluate the effects of both coronal restoration quality and root canal treatment (RCT) quality on apical periodontitis., Materials and Methods: Panoramic images of individuals who applied to our department for different diagnostic reasons were randomly and retrospectively scanned. Total RCT number, RCT quality, type of coronal restoration, restoration quality, periapical status, and total number of teeth were recorded. The criteria used for coronal restorations quality and RCT quality were defined by De Moor et al. and slightly modified by Gunduz et al. Periapical status was assessed by the periapical index developed by Orstavik et al. Pearson's Chi-square test was used for statistical analysis, and the intraobserver agreements were assessed by Kappa coefficients. Values of P < 0.05 were accepted to be meaningful., Results: The total examined teeth number was 6064, of which had 541 (8.9%) RCT. The prevelance of apical periodontitis was 40.5%. The number of adequate RCT was 178 (32.9%), and 138 (77.5%) of them were healthy. The number of adequate coronal restoration was 334, and 62.3% of them were healthy. For the cases that have adequate coronal restorations, there was statistically significant relationship between adequate RCT and periapical status (P < 0.001)., Conclusion: The prevelance of apical periodontitis was 40.5% and there was statistically significant relationship between adequate RCT and periapical status., Competing Interests: None

Aim: To evaluate the effectiveness of clinical audit-feedback cycle as an educational tool in improving the technical quality of root canal therapy (RCT) and compliance with record keeping performed by dental undergraduates., Methods: Clinical audit learning was introduced in Year 3 of a 5-year curriculum for dental undergraduates. During classroom activities, students were briefed on clinical audit, selected their audit topics in groups of 5 or 6 students, and prepared and presented their audit protocols. One chosen topic was RCT, in which 3 different cohorts of Year 3 students conducted retrospective audits of patients' records in 2012, 2014 and 2015 for their compliance with recommended record keeping criteria and their performance in RCT. Students were trained by and calibrated against an endodontist (κ ≥ 0.8). After each audit, the findings were reported in class, and recommendations were made for improvement in performance of RCT and record keeping. Students' compliance with published guidelines was presented and their RCT performances in each year were compared using the chi-square test., Results: Overall compliance with of record keeping guidelines was 44.1% in 2012, 79.6% in 2014 and 94.6% in 2015 (P = .001). In the 2012 audit, acceptable extension, condensation and the absence of mishap were observed in 72.4, 75.7% and 91.5%; in the 2014 audit, 95.1%, 64.8% and 51.4%; and in 2015 audit, 96.4%, 82.1% and 92.8% of cases, respectively. In 2015, 76.8% of root canal fillings met all 3 technical quality criteria when compared to 48.6% in 2014 and 44.7% in 2012 (P = .001)., Conclusion: Clinical audit-feedback cycle is an effective educational tool for improving dental undergraduates' compliance with record keeping and performance in the technical quality of RCT., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Root canal therapy is generally considered to be the most effective way to remove inflammation and infection in the root canal. However, the presence of persistent infection in the root canal may lead to a failure of the treatment. Therefore, the complete removal of root canal infection is essential for the success of root canal therapy. The purpose of root canal therapy is to clear up the intra-canal infection and thoroughly sterilize the root canal, and then fill up the root canal system with dimensionally, so as to prevent reinfection. This article focuses on the main methods and problems of the current root canal infection and the strategy of eradicating the infection in the root canal.

Introduction: The aim of this study was to measure the time consumed preparing retrograde cavities in root canals of maxillary molars filled using the GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) technique and the cold lateral condensation technique (CLC) and to examine the quality of the root-end cavity preparation by ultrasonic tips using micro-computed tomographic (micro-CT) scanning., Methods: A total of 24 maxillary molars were included; distobuccal and palatal canals were instrumented to size #40 and size #50, respectively. Teeth were randomly distributed into 2 experimental groups; half of the samples were filled with CLC, and half were filled with the GuttaCore technique. After 2 months, the apical 3 mm of each root apex was resected. A retrograde cavity was then prepared 3 mm deep into the root-end-filled canals using ultrasonic tips. The quality of the preparation was first confirmed by a surgical stereomicroscope, and the time required for the root-end preparation was recorded. After root-end cavity preparation, all samples were scanned by micro-CT scanning., Results: There was no significant difference between the palatal and distobuccal canals in the time required to prepare a retrograde cavity. Less time was required in the GuttaCore group to remove all root filling material and finish the cavity preparation than in the CLC group (P < .05), especially in the palatal canals. Micro-CT results confirmed that all material was removed from the root-end cavities and the absence of microcracks., Conclusions: GuttaCore was removed in less time from root-end cavities than root filling performed with the CLC technique. No damage to the surrounding dentin was detected by micro-CT scanning in the 2 groups., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

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., (© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Aim: To revaluate through re-audit the technical quality of undergraduate nonsurgical root canal treatment (RCTx) in a dental teaching hospital as a result of recommended changes to teaching practices., Methodology: The technical quality of undergraduate RCTx was evaluated radiographically after educational changes and the mandatory introduction of new technologies (nickel-titanium files, apex locators, greater taper gutta-percha points) in 182 root canals. Evaluation was based on four criteria: presence of voids, root canal filling termination (0-2 mm of radiographic apex), all roots filled and the prepared canal contained the original anatomy. Chi-squared analysis was used to determine statistically significant improvements in quality between the respective audits (P < 0.05)., Results: Twenty-three of the 40 canals in single-rooted teeth (57.5%) and 68 of the 129 (52.7%) canals in multirooted teeth analysed had an acceptable root filling. This compared with 48% of canals in single-rooted teeth and 38% of canals in multirooted teeth in the original audit. Specifically, the frequency of root canal voids and unsatisfactory apical root filling termination were reduced in multirooted teeth by 23% and 14% and in single-rooted teeth by 11% and 12%, respectively, compared with the original audit. When multirooted teeth were taken as one unit, 45.2% were considered to be acceptable, significantly better than the 18.8% multirooted teeth in the original audit (P = 0.042). Deviations from the canal anatomy on radiographic examination were rare findings in both audits., Conclusions: Changes to endodontic teaching practices significantly improved the technical standards of undergraduate root filling in multirooted teeth. The regular auditing of undergraduate teaching practice is necessary to inform current teaching, instigate change and improve standards., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Aim: To devise measurement instruments for 'quality' of root canal treatment to assess training and outcome of general dental practitioners working within primary care settings., Method: Scoring systems relating to quality of root canal treatment were developed using expert consensus and published literature. Domains scored included the Treatment Process, Quality of the Obturation, Clinical Healing, Radiographic Healing and Tooth Complexity. Scoring systems were applied to 10 clinical cases treated by each dentist at the beginning and 10 cases treated at the end of their clinical training and 135 cases treated after completion of training. The dentists recorded the treatment process and clinical healing in clinical logs. Two examiners independently scored the radiographs after undertaking calibration and training. Inter- and intra-examiner reliability of scoring radiographic outcomes was tested using Cohen's Kappa statistics., Results: An instrument was created with four domains to assess quality (two for process and two for outcome of root canal treatment), and a measure of case complexity. Domains of treatment process (n = 240 teeth), outcome (n = 32 teeth) and complexity (n = 215 teeth) were scored using radiographs. The Kappa scores for intra-examiner reliability between 0.22 and 1, whilst inter-examiner reliability ranged between 0.18 and 0.99., Conclusion: Evidence-based scores for assessment of the quality (process and outcome) and complexity (structure) of root canal treatment were devised. They were reliable, provided that clinicians were trained in record keeping and examiners have in depth training and calibration in the use of the instruments., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Aim: To explore elements of reasoning and understanding that might obstruct the performance of good-quality root canal treatment (RCT) and make general dental practitioners (GDPs) produce and accept root fillings of inferior quality., Methodology: The study was designed as a qualitative and explorative study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Nine predetermined questions were followed. Thirty-three GDPs (4-6 dentists/interview), employed in the Public Dental Health Service in Gothenburg, Sweden, participated., Results: Feelings such as anxiety, frustration, stress or exhaustion were associated with RCT. In general, RCT was regarded as complex, mysterious and embedded in uncertainty. A feeling of loss of control was frequently described in relation to all procedural steps from negotiating the canal to prognostic deliberations. Reasons could include challenging canals, complicated instruments and the fact that treatment had to be performed in a concealed space without visible insight. Several dentists questioned the requirements for correctly performing RCT, and some indicated that striving towards optimal technical root filling quality should not be expected in each case in general practice. Most of the GDPs were unable to complete a case within the remuneration system, and they therefore either spent more time than the set fee allowed for or accepted a suboptimal root filling when the time limit was reached., Conclusions: High levels of stress and frustration in relation to RCT were reported by the GDPs. RCT was regarded as complex and was often performed with an overall sense of lack of control., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Aim: This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development., Methods: Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation., Results: Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors., Conclusions: Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.

Objectives: To determine the health status of periradicular tissue and the quality of root canal fillings in an adult Saudi population attending dental clinics for the first time. Methods: This cross sectional study was conducted  in the dental clinics at King Saud University, Riyadh and other dental centers (Jeddah, Najran, and Albaha City), Kingdom of Saudi Arabia between year 2010   and 2012. Good-quality panoramic radiographs of 926 Saudi subjects (540 males and 386 females)were analyzed based on the gender, age, health status, smoking habits, periapical status of the endodontically treated teeth, technical quality of the root canal fillings, and the presence or absence of coronal restoration. Data were calibrated and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 17.  Results: Of the 25,028 teeth examined, 1,556 teeth (6.2%) had apical periodontitis (AP). Male subjects aged over 55 years and females between 36 and 45 years had higher AP. A total of 36 diabetic and 87 smokers subjects had AP. The AP was more common in male diabetics than female (p=0.383), and in female smokers more than male (p=0.44). Only 42.2% of male and 57.7% of female teeth had adequate root canal treatment.  Conclusions: Apical periodontitis was significantly related to diabetes, smoking, and inadequate endodontic treatment.

Aim: To assess the prevalence of apical periodontitis in the Finnish population aged 30 years and older and relate it to the technical quality of root filling by the type of tooth., Methodology: As part of the Finnish nationwide Health 2000 study, panoramic radiographs were used of the dentate subjects (n = 5335) aged 30-95 years (mean 50.2 years) to assess the apical and endodontic status of their teeth (n = 120635). Apical periodontitis (AP) was recorded when the periodontal ligament space was more than double in width, or loss of lamina dura or a periapical radiolucent lesion was seen. Technically, adequate root fillings had a gap of 0-3 mm from the apex; all others were defined as inadequate. Statistical methods included chi-square tests and anova. Risk of AP was estimated as cross-product odds ratio and its 95% confidence interval., Results: Teeth with AP occurred in 27% of the dentate subjects being more prevalent in subjects with root filled teeth than in those without (39% vs. 9%; P < 0.001; OR = 6.3; 95% CI 5.3, 7.4). AP was more prevalent in men than in women (31% vs. 23%). At a tooth level, AP was most frequent in mandibular molars with inadequate root fillings. For all root filled teeth, an inadequate root filling doubled the risk of AP for both women (OR = 2.0; 95% CI 1.7, 2.4) and men (OR = 2.5; 95% CI 2.1, 2.9)., Conclusions: AP occurred principally in subjects and teeth with root fillings. Inadequate root fillings doubled the risk of AP. An improvement in the technical quality of root canal treatment is essential., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

The Finnish guideline on endodontics emphasizes good quality of endodontic treatment and coronal seal of the restoration. For prevention of endodontic treatment need caries control is essential. For deep carious lesions stepwise excavation or partial caries removal are recommended. Partial pulpotomy can be used if bleeding can be controlled. The decision for root canal treatment is based on prognosis, occlusion and general health of the patient. The use of kofferdam is essential in aseptic working. Chemomechanical preparation with NaOCI and root canal filling within 0-2 mm from the apex improve prognosis. Healing should be controlled annually up to four years.

Aim: To compare digital images of conventional radiographs with the original radiographs for perceived clarity of periapical lesions and the quality of root canal treatment., Materials and Methods: One hundred and four intraoral periapical radiographs of patients with endodontically treated teeth were randomly selected. The radiographs were digitized using an MD300 USB X-ray Reader. The digital images were transferred to an HP laptop. Three evaluators compared each conventional radiograph with the matching digital image. The images were ranked for clarity and assessed for diagnostic quality; data were analyzed using the Reliability Calculation "ReCal." Results . Both the digital images and conventional films had comparable clarity and diagnostic quality. Results indicated a moderate agreement between the evaluators., Conclusions: Conventional radiographs digitized using an MD300 USB X-ray Reader have similar clarity and diagnostic quality in comparison to the original radiographs.

The success rate of root canal therapy(RCT)have been improved continuously along with the advancement in RCT techniques in the past several decades. If standard procedures of modern RCT techniques are strictly followed, the success rate of RCT may exceed 90%. The success of RCT is mainly affected by such factors as clear concept of the anatomy of root canals, proper mechanical and chemical preparation and perfect filling of root canal system. If these factors are sufficiently noted, a success is easy to achieve. Even though the primary RCT fails, retreatment can further be conducted to save the diseased teeth.

Although the principles of endodontics have remained unchanged for many decades, root canal treatment has been subject to major changes in the past few years. This paper outlines the cutting-edge advances including the materials and techniques used. CPD/Clinical Relevance: This article provides an overview of bioactive materials and insight into regenerative endodontics, vital pulp therapy and intentional replantation.

Aim: To gather information on aspects of endodontic practice and referral behaviour by Flemish (Dutch-speaking Belgian) dentists and to compare the results with an earlier investigation., Methodology: A postal questionnaire was distributed to 4468 active Flemish dentists. It consisted of multiple-choice questions on endodontic practice and endodontic referral need. Basic information on age, gender, year of qualification and clinical specialty was also obtained. The questionnaire was free of charge to return. Data were imported in a database, subjected to descriptive and analytical statistics and compared to those of an earlier, comparable survey., Results: The response rate was 18.5%. Of all respondents, 95% were general practitioners. More than half (56%) of the respondents never or seldom used rubber dam during endodontic treatment. The use of sodium hypochlorite as an irrigant was well established (80% of respondents using it), whereas the use of EDTA was limited. Female respondents were more likely to refer to an endodontist than male (70 versus 49%). Referrals for treatment of root canal obstruction (48%), perforations and root resorption (42%) and retreatment (39%) were rated 'very important'. Younger respondents more frequently made use of magnification, rotary instruments and rubber dam. Activation of irrigants was incorporated by a small number of respondents (50% never, 12.6% seldom). Cold lateral condensation was used by most GDPs (35.3% always, 19.5% frequently)., Conclusions: Endodontic practice of general dentists in Flanders did not always comply with quality guidelines. However, when comparing the present data with those of a previous study, an obvious trend towards a more present-day treatment protocol is noticeable, as well as an increased appeal for endodontic referral., (© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

This article will discuss why a root filling that appears satisfactory on a radiograph may fail, and why one which appears unsatisfactory on a radiograph may succeed. In doing so, this article will also discuss the criteria of endodontic success and failure and its implications on the decision to retreat.

Aim: This article aims to gain understanding into the perception of undergraduate dental students in terms of their confidence and competence at performing root canal treatment and their perception of the quality of endodontic education., Methods: An online questionnaire was distributed to all 3rd, 4th and 5th year dental students at Cardiff University via their academic e-mail addresses. The questionnaire utilised both scaled response and open questions to gain an insight into undergraduate opinion., Results: Out of a possible 208 students, 98 responses were obtained (response rate = 47%). Perception of competence and confidence were significantly greater amongst the more senior year groups (P < 0.01). However, 49% (n = 38) of participants did not feel competent performing root canal treatment on anterior, single-rooted teeth, whilst 74% (n = 70) did not feel competent performing root canal treatment on posterior, multirooted teeth. Free comments from participants indicated that this was due to a lack of clinical experience. Approximately, 80% of participants ranked education in endodontics at Cardiff University as ≤5 on a Likert scale (1 = inadequate to 10 = good), indicating that improvement was required. Improvements that were suggested by the students included the provision of further information within lectures, a broader range of lecturers, an increased number of shorter, more organised practical sessions, additional training equipment, greater supervision and online reference guides to root canal treatment., Conclusion: Enhancing undergraduate education in endodontics is necessary to increase students' perception of their confidence and competence when performing root canal treatment., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Traditionally, poor obturation has been considered the primary cause of root canal treatment failures. The purpose of this study was to assess the success rate of overfilled root canal treatment cases in order to decide whether a definitive restoration can be placed immediately following treatment in an overfilled case or whether the patient needs to be kept on a follow up prior to the placement of a definitive restoration., Methods: A total of 1242 patient's periapical radiographs (1748 teeth) were assessed, out of which 397 teeth (in 285 patients) were found to be overfilled. Out of these 285 patients, 111 (128 cases) agreed to participate in this cross sectional study and were recalled for clinical and radiographic examination. Success was evaluated clinically by absence of symptoms (pain, swelling, tenderness to percussion and sinus tract) and radiograhically by the decrease in size of periapical lesion or no change in size. Increase in size of periapical lesion was deemed to be a failure., Results: Our findings revealed that despite overfill, the treatment was successful in 115 cases and failure was noted in 13 cases showing an overall success rate of 89.8% and failure rate of 10.2%. Out of 13 cases of failure, all 13 showed an increase in periapical lesion size, out of which 10 were accompanied with pain., Conclusion: We have determined that there is no need to delay placement of a permanent restoration on overfilled teeth (ruling out the presence of other procedural errors) nor is there any need to pursue any further surgical or non-surgical endodontic treatment. However we would suggest that patients should be kept on follow-up after placement of permanent restoration.

Aim: The aim was to assess the technical quality of root canal treatment conducted in paediatric patients. No specific data is available assessing endodontic treatment quality in children. General adult populations report satisfactory technical quality between 12.8 and 55.7 %, with higher rates by endodontists (77.4-91.0 %)., Methods: Radiographs of 100 chronological cases, conducted by staff (categorised as; junior staff, middle grades or consultants) in a UK teaching hospital, were evaluated retrospectively. Technical outcomes were compared to the European Society of Endodontology quality guideline consensus. A satisfactory root filling was defined as having: root filling material <2 mm from the radiographical apex; no canal space seen beyond the end of the obturation and an obturation of homogeneous density with no voids. In addition where MTA was used a plug of ≥3 mm was required. Any variation was considered unsatisfactory treatment., Results: 61 % [95 % CI 51-70 %] of cases were deemed satisfactory. Of the remaining obturations 20.5 % were short of the apex, 28.2 % had extruded material and 56.4 % contained voids. Patients with co-operation issues, particularly anxiety, had lower technical outcomes (p = 0.001) and the use of thermoplastic obturation greatly reduced the chance of void inclusion (p = 0.004; OR 0.20 [95 % CI 0.06-0.65]). Although 'staff grade' did not show a statistically significant difference, a trend between experience and quality was suspected., Conclusion: Overall technical quality of treatment was comparable to the higher rates found in the general adult population. Additionally thermal obturation may be superior to cold lateral condensation in improving obturation quality, and anxiety negatively impacts on treatment provision.

Overbearing regulators with their various labyrinthine regulations have had adverse impacts on dentists and their teams' behaviours. This has produced the perverse outcomes of demoralizing dental teams as well as reducing their capacity and/or desire to deliver compassionate oral healthcare. These adverse outcomes do not seem to have benefited patients, or dentists, or their teams, in any sensible or measurable way. CPD/CLINICAL RELEVANCE: The vastly increased burdens on the UK dental profession of intrusive, bullying regulations, emanating from the various UK agencies, such as the supposedly fair and independent GDC, but including the increasingly politically controlled NHS and the CQC, have had unfortunate, perverse, effects on many dentists' clinical practices and affected dental teams' desires, or willingness, to be as compassionate as they used to be about helping to solve some patients' dental or oral problems.

Introduction: The purpose of this study was to evaluate the relationship between periapical status and the quality of coronal restoration and of root canal filling, assessed both clinically and radiographically, in a cohort of Brazilian patients., Methods: A total of 523 teeth from 337 patients submitted to endodontic treatment were clinically and radiographically reexamined 2-10 years postoperatively. Restoration and root canal filling quality were classified according to modified criteria from Tronstad et al. Periapical status was evaluated according to periapical index scores. Mann-Whitney and Friedman tests were used to conduct the descriptive analysis. Correlations were analyzed by using simple and multivariate logistic regression analysis., Results: No significant difference was observed between the rates of apical periodontitis for adequate or inadequate coronal restorations assessed clinically (12.8% versus 19.4%), whereas these rates were significantly different when the restoration quality was assessed radiographically (11.6% versus 28.7%, P < .001). The rates of apical periodontitis in teeth with inadequate root canal filling, with or without adequate restoration, were significantly higher than in teeth with adequate canal filling, with or without adequate restoration (38.6% and 48.4% versus 6.5% and 14.6%, respectively; P < .0001)., Conclusions: Using either a radiographic or clinical assessment alone was not a reliable method to ascertain whether restoration quality could be correlated with postoperative periapical status. Poor root canal filling quality was a prognostic determinant of endodontic treatment failure, whereas coronal restoration quality had a lesser impact on the outcome of the endodontic treatment., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To study the association between type of restoration and apical periodontitis (AP) in root filled teeth., Materials and Methods: The present study used data from surveys conducted in 1983, 1993 and 2003. In 1983, 130 randomly selected subjects aged 3-80 years in the city of Jönköping, Sweden, were invited for a clinical and radiological examination. The study was repeated in 1993 and 2003. New participants were, thus, recruited with the same sampling criteria and sample size in the same geographical area in 1993 and 2003, respectively. In the present study, only dentate individuals aged 20-70 years with ≥1 root filled tooth were included, yielding a sample of 788 subjects with 2634 root filled teeth. Apical periodontitis on the tooth level was the dependent variable. Periapical status was assessed according to Periapical Index (PAI). Independent variables were root filling quality, recurrent caries, type of restoration, number of teeth with apical periodontitis, age and gender. Root fillings appearing homogenous and ending within 2 mm from radiographic apex were regarded as adequate, otherwise inadequate. All radiographs were re-studied by one observer regarding periapical status and root filling quality. Risk was analyzed by means of a GEE model., Results: Type of restoration, root filling quality, number of teeth with apical periodontitis within the individual and age were found to be predictors of AP in root filled teeth. Presence of recurrent caries and gender were not found to be associated with AP., Conclusions: According to the present study, root filling quality and type of restoration may be predictive of AP in root filled teeth.

Purpose: To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis., Materials and Methods: The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'under-filled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2., Results: Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of root-filled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were under-filled teeth (P < 0.001 and P < 0.05, respectively)., Conclusions: The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment.

The aim of this study was to investigate the technical quality of root canal treatment provided by the undergraduate students as their first experience in molar endodontics using nickel-titanium (NiTi) files in a crown-down approach compared with stainless steel standard technique. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training programme, using two different questionnaires to assess the overall technical quality and potential problems regarding endodontic complications after root canal preparation with these two techniques. The overall results indicated a statistically significant difference in the performance of the two instrument techniques in difficult cases showing better performance of the NiTi system and mean rotary preparation time (P < 0.001). Under the conditions of this study, novice dental students, using NiTi ProTaper rotary files, were able to prepare root canals faster with more preparation accuracy compared with canals of same teeth prepared with hand instruments., (© 2014 Australian Society of Endodontology.)

Objective: To study the periapical status of root-filled permanent teeth of 9-17-year-olds in Møre & Romsdal county, Norway., Materials and Methods: All permanent teeth with endodontic treatment in patients born in 1994-2001 were identified in the dental records of the Public Dental Service. The data collected consisted of chart entries and radiographs. Of 1182 teeth, 174 teeth in 155 patients met further inclusion criteria, i.e. completed endodontic treatment and a follow-up with a readable radiograph of at least 1 year. Periapical status was assessed with the Periapical Index (PAI) and the technical quality of the root fillings was also quantified on a 4-grade visual scale., Results: Apical periodontitis was found on follow-up radiographs in 25% of all teeth and in 48% of the teeth with pre-operative apical periodontitis. Forty-two per cent of root fillings were of adequate technical quality. Adequate technical quality of the root filling was significantly correlated with radiographic success., Conclusions: About one fourth of all root-filled teeth and almost half of the teeth with pre-operative apical periodontitis showed clear signs of the disease at recall.

Introduction: The purposes of this study were to examine the following in young adults residing in the United States: (1) the prevalence of teeth with root canal therapy (RCT) and teeth in need of RCT, (2) how frequently treatment practices associated with success as cited in the literature are found in posterior teeth with RCT, and (3) which treatment practices are associated with periradicular pathology., Methods: Panoramic radiographs taken of all basic trainees entering the US Air Force in 2011 were evaluated in a 2-part review. A general survey of all radiographs was performed to determine the prevalence of teeth with and teeth in need of RCT. All panoramic radiographs that showed a posterior tooth with RCT were evaluated in detail to consider the presence and quality of cuspal coverage restorations, the quality of RCT, and the presence of periradicular pathology., Results: A total of 35,811 panoramic images were evaluated. Ten percent of basic trainees had existing RCT, whereas 5% showed a need for RCT. The total number of posterior teeth with RCT was 3,455. Nearly half of these teeth had either no cuspal coverage or an unacceptable cuspal coverage restoration. Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present., Conclusions: Factors cited in the literature as being associated with success are lacking in the dental treatment of young adults residing in the United States., (Published by Elsevier Inc.)

Introduction: The aim of this systematic review was to assign levels of evidence (LOEs) to existing clinical articles related to the outcome of regenerative endodontic therapy and to evaluate the clinical and radiographic outcomes of this treatment modality., Methods: Electronic search was executed in PubMed, Scopus, and Cochrane databases by using appropriate Medical Subject Headings terms covering the period from January 1993 to December 2013. Additional publications from hand-searching and reference section of each relevant article enriched the article list. The LOE of each article was assessed according to guidelines provided by the Oxford Centre of Evidence-Based Medicine. Quality assessment of the observational studies was executed by using the Newcastle-Ottawa scale., Results: Fifty-one relevant publications were included in this review. There were 2 high-level cohort studies (LOE 2), 8 case series (LOE 4), and 41 case reports (LOE 5). The vast majority of the treated teeth in those publications showed resolution of clinical signs, symptoms, and periapical radiolucencies at follow-up period. Furthermore, the majority of treated teeth presented further increase in root length and root wall thickness and apical closure at the follow-up period. However, because of lack of sufficient high-level evidence it was not possible to answer totally the review question and determine definitely the outcome of regenerative endodontic therapy., Conclusions: The lack of adequate high-level studies that could possibly strengthen the satisfactory current data and allow practicing more evidence-based dentistry constitutes a significant knowledge gap in the endodontic literature. However, the current best available evidence undeniably allows clinicians to provide this treatment modality safely to patients., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to investigate the effectiveness of basic root canal treatment (BRT) with tactile working length determination in terms of radiographic and clinical outcome parameters compared with endodontic treatment with standard radiographic working length control., Methods: This was a clinical, multicenter, controlled, open-label trial to evaluate BRT effectiveness after 24 months. The primary end point was the apical extension score of the radiographic quality parameter of root canal fillings. The secondary radiographic end point was the periapical index, and the secondary clinical end point was tooth tender to percussion. The safety end point was tooth loss as a consequence of endodontic failure. Statistical analyses of binary and categoric data were calculated using cross tables and the chi-square test., Results: BRT with tactile working length determination compared with standard radiographic working length control did not significantly differ in terms of radiographic and clinical outcomes after 24 months. The apical extension of the root canal fillings and the periapical anatomic structures showed no significant differences according to radiographic analyses (P = .5). Corresponding results were found in clinical aspects of tooth tender to percussion (P = .6) and tooth loss (P = .7)., Conclusions: Tactile working length determination in BRT resulted in comparable treatment outcomes compared with standard endodontic treatment with radiographic working length control and turned out to be an accurate method in BRT., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

To deliver the knowledge and skills required to equip undergraduate students for practice is a significant responsibility; graduates must be familiar with the diagnosis and treatment of pulpal and periradicular diseases and the preservation and restoration of pulpally compromised teeth. A greater understanding of the microbiological processes involved in endodontics and developments in instruments and materials have transformed our approaches to root canal treatment. Information technology has revolutionised certain aspects of education and has had an effect on endodontic teaching. Dental graduates will be expected to treat an increasingly elderly population and will enter a climate in which remuneration for root canal treatment could have a significant effect on the number of cases treated and the pattern of referral. Teachers of endodontics at the majority of dental schools are taxed by competing demands for time in packed curricula, a lack of availability of natural teeth for classroom exercise and a lack of suitable patients. The debate as to whether endodontics should be a specialist subject in its own right has rumbled on for three decades. Compared with the situation in the 1970s, there are now well defined curricula guidelines to which those involved in teaching can refer and map teaching in their schools against agreed norms. These create the potential for students to graduate with the knowledge and skills at a sound level of competence to carry out endodontic procedures and with a deeply engrained understanding of the need for continuing professional development.

Introduction: A 2009 American Association of Endodontists survey of dentists in general practice (GPs) to assess their perceptions and understand the factors associated with referrals to endodontists was the first of its kind. The American Association of Endodontists repeated the survey in 2012 to update our understanding of the referral behavior of GPs by reexamining the effects of endodontist characteristics and professional behavior and the role of GP demographics and perceptions in determining referrals to endodontists., Methods: Researchers conducted a cross-sectional study that included a quantitative online survey of 786 GPs in the United States (14% of 5737 initially opened invitations) from November 1-13, 2012., Results: Ninety-four percent of the GPs had positive perceptions of endodontists, but they referred only 43% of patients who required root canal treatment to endodontists. The perception that endodontists are partners in patient care and endodontic services are worth the cost was strongly related to the likelihood of referring (P < .05). GPs rated referring patients back for restorative treatment (95%, n = 734), timely follow-up of reports and images (94%, n = 726), and patient scheduling accommodation (91%, n = 707) as effective ways to build partnerships. Gender and years in practice moderated the relationships between several predictors (eg, communication, value of treatment, and expertise) and the likelihood of referring., Conclusions: There are concrete actions that endodontists can take and segments of the GP population that can be targeted to successfully address the issue of increasing referrals. However, examining the role of endodontist actions and GP perceptions and demographics is just the beginning in addressing the relationships involved in referral behavior., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to evaluate the radiographic technical quality of endodontic treatment performed by undergraduate students at the School of Dentistry, Faculty of Medicine, University of Novi Sad, Serbia., Materials and Methods: Electronic records of 220 patients treated by final-year undergraduate students during the school year 2011/2012 were examined, and the final sample consisted of 212 patients, 322 teeth, and 565 root canals. The criteria for overall radiographic adequacy of root canal fillings were defined as the presence of adequate length and density and absence of iatrogenic errors (ledge, fractured instrument, untreated canal, and apical transportation). Chi-square test was used to determine statistical significance between different parameters., Results: Adequate root canal fillings were found in 74.22% of the teeth. The percentage of root fillings with adequate length and density was 89.73% and 92.6%, respectively. Fractured instruments and ledges were present in 16 root canals (2.8%), while the presence of missed canal and apical transportation was observed in 2 cases, each (0.3%)., Conclusions: Overall, the technical quality of root canal fillings performed by undergraduate students was satisfactory.

Because there are several ways to cement glass-fiber posts (GFPs) into root canals, there is no consensus on the best strategy to achieve high bond strengths. A systematic review was conducted to determine if there is difference in bond strength to dentin between regular and self-adhesive resin cements and to verify the influence of several variables on the retention of GFPs. This report followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In vitro studies that investigated the bond strength of GFPs luted with self-adhesive and regular resin cements were selected. Searches were carried out in the PubMed and Scopus databases. No publication year or language limit was used, and the last search was done in October 2012. A global comparison was performed between self-adhesive and regular resin cements. Two subgroup analyses were performed: 1) Self-adhesive × Regular resin cement + Etch-and-rinse adhesive and 2) Self-adhesive × Regular resin cement + Self-etch adhesive. The analyses were carried out using fixed-effect and random-effects models. The results showed heterogeneity in all comparisons, and higher bond strength to dentin was identified for self-adhesive cements. Although the articles included in this meta-analysis showed high heterogeneity and high risk of bias, the in vitro literature seems to suggest that use of self-adhesive resin cement could improve the retention of GFPs into root canals.

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.

Introduction: Outcome studies of endodontic treatment of necrotic immature permanent teeth rely on radiographic measures as surrogates of whether the treatment achieved regeneration/revascularization/revitalization. An increase in radiographic root length and/or width is thought to result in a better long-term prognosis for the tooth. In this study, a method to measure radiographic outcomes of endodontic therapies on immature teeth was developed and validated., Methods: A standardized protocol was developed for measuring the entire area of the root of immature teeth. The radiographic root area (RRA) measurement accounts for the entire surface area of the root as observed on a periapical radiograph. Reviewers were given instructions on how to measure RRA, and they completed measurements on a set of standardized radiographs., Results: The intraclass correlation between the 4 reviewers was 0.9945, suggesting a high concordance among reviewers. There was no effect of the reviewer on the measured RRA values. High concordance was also observed when 1 rater repeated the measurements, with an intraclass correlation value of 0.9995. There was no significant difference in RRA values measured at the 2 sessions by the same rater. Furthermore, significant differences in RRA were detectable between clinical cases that showed obvious continued root development and cases that did not demonstrate discernible root development., Conclusions: These results suggest that RRA is a valid measure to assess radiographic outcomes in endodontically treated immature teeth, and RRA should be useful in future clinical studies of regenerative endodontic outcomes., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: The permanent maxillary central incisors are critical to dento-facial aesthetics in humans. Their restoration in the event of periapical infection or traumatic injury to the pulp requires an accurate determination of the root canal working length; an important outcome predictor in endodontic treatments., Aim: To determine the standard working length of permanent maxillary central incisor in a Nigerian population., Methods: This study was carried out between March 2008 and June 2010. The study involved Nigerian patients of both gender, receiving endodontic treatment of the permanent maxillary central incisor. The study participants were selected based on a predetermined exclusion and inclusion criteria. The working lengths of the patient's teeth were determined using the radiographic method and Electronic apex locator., Results: The average working length of the permanent maxillary central incisor of the patient's was 25.0 ± 1.7 mm while the values in males and females were 25.4 ± 1.2mm and 24.4 ± 2.2mm respectively. The male patients had longer working length than the females (P<0.05). The study also revealed that the most common indication for endodontic treatment in permanent maxillary central incisors in the studied population was trauma., Conclusion: The endodontic working length of permanent maxillary central incisors in adult Nigerian population was greater than that reported in Caucasians and Asians. This variation should serve as an important reference for endodontic procedures in the maxillary central incisors of adult Nigerians and perhaps others nationals from the West Africa sub region.

Objectives: To help the dental practitioner solve a specific clinical problem, systematic reviews (SRs) are seen as the best guide. In addition to the unmanageable quantity of SRs, however, one should be aware of their variable quality. The present review describes the methodological quality of SRs on postendodontic restorations to work out the value of these reviews for the dental practitioner., Methodology: SRs were searched in April 2012, independently and in triplicate. Post survival was used as measure of outcome. The methodological quality of included SRs was assessed with the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Kappa statistics were used to assess reviewer agreement., Results: Three hundred sixty-three papers were retrieved from the initial search. Ten SRs were included. One SR achieved a high R-AMSTAR score, whereas the other nine SRs achieved scores that indicate a substantial lack of methodological quality. Especially the items "grey literature," "combination of findings," "likelihood of publication bias," and conflict of interest" showed low R-AMSTAR scores. The three reviews with the highest R-AMSTAR scores tended to conclude that fewer failures occurred when using nonmetal posts. The reviewer agreement was excellent (kappa ranged from 0.79 to 0.85) in the R-AMSTAR classification., Conclusion: The approach presented revealed a lack of SRs with high methodological quality. Thus, no decisive conclusion can be drawn with respect to this topic. It appears that there is a trend for the superiority of fiber-reinforced posts., Clinical Relevance: SRs must be of high methodological quality. This can be achieved by taking into consideration the results of this review. Improved methodological quality would make SRs more supportive for the general practitioner.

Clinical audit is part of the NHS clinical governance framework for dentistry and is recommended as a quality improvement process for patient care, yet there is very mixed evidence supporting audit's ability to produce change in practice. Findings show evidence of changes following audit which improved patient care and practice efficiency. However, there is a general lack of dissemination of audit results, little useful feedback provided to participants, limited use of formal re-auditing of a particular topic and little reported on whether audit improves outcomes for patients. As part of its clinical governance responsibility, the Community Dental Service (CDS) is committed to ensuring that its clinical audit is robust, strategic and measures patient outcomes in its evaluation. The aim of this paper is to present a complete endodontic audit cycle; its recommendations and effects on the process and on outcomes of clinical patient endodontic care; and to evaluate if audit was a useful tool in this case.

Introduction: This cross-sectional study determined the prevalence of apical periodontitis in 1086 root canal-treated teeth from an urban Colombian population and evaluated the association of several factors with the periradicular status., Methods: Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periradicular status. Other factors were also evaluated for their association with the periradicular conditions, including gender, quality of both endodontic treatment and coronal restoration, apical level of filling, and presence of post restoration., Results: Fifty-one percent of the treated teeth were classified as healthy. Only 33% of the teeth had endodontic treatment rated as adequate. The quality of both endodontic treatment and coronal restoration significantly influenced the periradicular conditions (P < .001). Combined data revealed that teeth with both adequate endodontic treatment and adequate restorations showed significantly better periradicular status than the other combinations (P < .01), except for teeth with adequate treatment and inadequate restoration (P = .08). Canals filled up to 0-2 mm short of the apex had a significantly higher number of teeth rated as healthy than overfilled or underfilled cases (P = .02). Regression analysis showed that the quality of endodontic treatment was the most significant factor influencing the periradicular status (P < .001). Gender and presence of post restoration had no association with the periradicular conditions., Conclusions: Data from this Colombian population showed a relatively high prevalence of apical periodontitis in root canal-treated teeth. This was largely due to an equally high prevalence of treatments performed under substandard technical quality. The quality of the endodontic treatment was the most determinant factor for healthy periradicular status., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Including students' perceptions in the educational process is considered a key component in monitoring the quality of academic programs. This study aimed to evaluate the concept of one's learning experience in endodontic teaching from the perspective of a group of Brazilian students. A total of 126 self-administered, structured questionnaires were distributed to undergraduate dental students enrolled in endodontics courses during the second semester of the 2009 academic year. The questionnaires were administered during final examinations and focused on students' opinions concerning learning during endodontic treatments, time spent during endodontic treatments, difficulties found during endodontic treatments, quality of endodontic treatments performed, characteristics of the technique employed, and suggestions to improve endodontic teaching. Ninety-one percent of the questionnaires were returned for evaluation. The obtained answers were discussed and analyzed, thereby generating quantitative and qualitative data showing students' perceptions of their experiences in endodontics courses. The main points that can affect the teaching of endodontics, according to the undergraduate students, included patients' absences and delays, selection of patients, preclinical and clinical training, difficulties found, type of technique employed, and teachers' orientation during endodontic treatment. The students' perceptions provided valuable information about the development of the course and the teacher-student relationship, together with the added intention of enhancing the teaching of endodontics as well as other courses.

The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p<0.01). Moreover, voids were detected in the root canal fillings of 52.7 percent of endodontically treated teeth. The PAI scores of root fillings with inadequate density were significantly higher than adequate ones (p<0.01). Although endodontic treatments performed by undergraduate students do not appear to be unqualified compared to those performed by general practitioners, more emphasis must be placed on the technical quality of endodontic treatment to obtain better results.

Outcomes encompass multiple factors, not just success and failure. They include other considerations such as being workable and profitable to the dentist and safe and acceptable to the patient. The more biological outcomes are most frequently measured. These measurements are on a scale from least to most predictable outcomes of treatment by the dentist, as shown on the evidence pyramid. Impact trauma is an example of a general scarcity of high-level evidence with treatment because of the nature and individuality of the injuries and the difficulty (or impossibility) of designing controlled clinical trials in humans. Much of the evidence is cohort (retrospective or observational studies), case reports, animal studies, and "expert" opinion. Thus, guidelines are largely based on lower levels of evidence. Nonetheless, the current guidelines provide the clinician with the best evidence that is available. The best opportunity for randomized controlled trials is in prevention. Specifically, mouthguard design and usage can be subjected to higher levels of controlled research. Revitalization and regeneration are relatively new procedures. To date, there is a lack of high levels of evidence to be able to substantiate whether these are clinically feasible to become a routine in practice., (Copyright © 2013. Published by Elsevier Inc.)

It is widely accepted that the uptake of research findings by practitioners is unpredictable, yet until they are adopted, advances in technology and clinical research cannot improve health outcomes in patients. Despite extensive research there is limited knowledge of the processes by which changes occur and ways of measuring the effectiveness of change of practice. The overall aim of this thesis was to investigate aspects of an educational intervention in clinical endodontic routines and new instrumentation techniques in a Swedish County Public Dental Service. Special reference was made to the establishment of changed behaviour in practice, the process of change, and the clinical effects. Although a high level of competence in root canal treatment procedures is required in general dental practice, a number of Swedish studies have revealed inadequate root-fillings quality and associated periapical inflammation in general populations. It is suggested that the adoption of the nickel-titanium rotary instrumentation (NiTiR) technique would improve the cleaning and shaping of root canals and the quality of the root-filling. However, there is limited knowledge of the effectiveness of the technique when applied in general dental practice. In two of four consecutive studies, the subjects were employees of a county Public Dental Service. The aim was to investigate the rate of adoption of clinical routines and the NiTiR technique: the output, and the qualitative meaning of successful change in clinical practice. In the other two studies the aim was to investigate treatment effect and the cost-effectiveness of root canal treatment in a general population: the outcome. Four hundred employees (dentists, dental assistants, administrative assistants and clinical managers) of a Swedish County Public Dental Service were mandatorily enrolled in an educational and training program over two years. Change of practice was investigated in a post-education survey. The NiTiR technique was adopted by significantly more dentists in the intervention county compared to a control county (77% and 6% respectively). Dentists in the intervention county completed root canal instrumentation in significantly fewer sessions than the dentists in the control county. Eight in-depth interviews, two with each participant, (dentist, dental assistant, receptionist, clinical manager), were strategically selected for a phenomenological analysis. Four factors were identified as necessary for successful change: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. A random sample of 850 performed root canal treatments was used for a study of treatment outcome; 425 before and 425 after the education and adoption of the NiTiR technique. Root-filling quality, periapical status and tooth survival were assessed on radiographs taken at treatment and at follow-up, > or = 4 years later. Apical periodontitis was found in 34% of the teeth root-filled before the education compared to 33%, after. After the education, root-filling quality improved significantly, tooth survival was significantly higher, however, without a subsequent improvement in success rate post-education; 68% vs. 67%. A micro-costing model was used to calculate the costs of root canal instrumentation, pre- and post-education, in the same sample used in the study of treatment outcome. Costs were lower post-education: by SEK 264 for teeth with one canal and SEK 564 for teeth with three or more canals. A reason for lower costs was that the NiTiR technique dominated after the education and required significantly fewer instrumentation sessions. A cost-minimization analysis disclosed that root canal treatments undertaken post-education were more cost-effective. In conclusion, there was only a partial relationship between output and outcome. Although root-filling quality improved significantly, the study did not show any association between the more frequent use of NiTiR and an improvement in remaining teeth with normal periapical status or success rate. However, the use of NiTiR was more cost-effective. These results are in accordance with previous findings of the so called efficacy-effectiveness gap in clinical practice: a high output is not predictive of a high outcome. The overall conclusion to be drawn from these studies is that further research is warranted to identify factors associated with improvement of the quality of endodontic care. The general interpretation of the findings of these implementation studies is as important as the effects of the change in endodontic instrumentation: a clinically relevant and applicable intervention, introduced by experienced expertise under allowing learning and collaborating circumstances, disclosed clinicians' motivation and facilitated implementation. The finding of qualitative differences between the questionnaire responses and the in-depth interviews suggest that a critical approach is warranted when comparing surveys and qualitative methods aimed at investigating qualitative experiences of change, due to their different epistemological premises.

Objectives: The aim of this study was to assess the prevalence of periapical lesions in root canal-treated teeth in a Turkish Cypriote population and to investigate the influence of the quality of root canal fillings and coronal restorations on the prevalence of periapical lesions., Subjects and Methods: The sample for this cross-sectional study consisted of 1,006 adult patients seeking routine dental care. Patients who had received dental care in the last 2 years were excluded. Radiographs of 2,200 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. Periapical status was assessed using periapical index (PAI) scores., Results: Of the 2,200 root canal-treated teeth, 1,364 (62%) had apical periodontitis as compared with 1,364 (5.5%) of the total sample. Root-filled teeth classified as adequately treated had apical periodontitis in 223 (26.6%) cases compared with 1,192 (87.7%) in teeth classified as inadequately root filled. PAI 1 scores of adequate root canal treatment were significantly higher than in inadequate root canal treatment, regardless of the quality or presence of coronal restorations (p < 0.01)., Conclusion: Our findings showed a high prevalence of periapical pathology with or without endodontic treatment and poor technical standard of both root fillings and coronal restorations of root-treated teeth. Hence, we suggest the need for better education for dental health providers so that they can perform better root canal treatments and coronal restorations., (Copyright © 2012 S. Karger AG, Basel.)