Introduction - Materials and methods.
G. Slaus & P. BottenbergDepartment of Endodontics, and Department of Restorative Dentistry, Free University of Brussels, Brussels, Belgium.Introduction.
Numerous studies have been published evaluating the success and failure of root-canal treatment (Sjogren et al. 1990, Weiger et al. 1998). However, there are many opinions on how to best accomplish the goals of canal debridement, cleaning and shaping and obturation. Indeed, many innovative concepts, techniques and instruments have been introduced. In the past decade, guidelines have been formulated (ESE 1994) 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 general dental practitioners (GDPs) towards these standards, and on how far the changes in endodontic technique have been incorporated into daily practice.
Epidemiological studies suggest that the failure rate is distinctly higher for teeth treated by dentists who are not endodontic specialists (Eriksen 1991, Weiger et al. 1998). However, very few data are available about the GDPs approach to endodontic therapy (Gatewood et al. 1990, Whitten et al.1996, Jenkins et al. 2001). These studies mention that a majority of GDPs do not conform to established guidelines. The purpose of this study was to investigate the current opinions of the GDPs in Flanders (Dutch-speaking part of Belgium) regarding fundamental aspects of routine endodontic treatment and to compare them to academic standards of treatment and established quality assurance guidelines. Materials and methods.
A survey of dental practitioners in Flanders was carried out between December 1996 and January 1997 on their methods of treating endodontically involved teeth. A questionnaire (Becker et al. 1974) was distributed to all (4545) the Flemish (Belgian Dutch-speaking) practitioners registered by the Flemish Society of Dental Practitioners (VVT). The questionnaire was made up of 38 questions with multiple-choice answers and mailed with an explanatory covering letter and a stamped return envelope. Local ethical approval was granted, and the questionnaire was fully piloted and refined for clarity and scope before being issued. A selection of 32 of the 38 questions, grouped according to five main topics, was selected for this article. The questions concerned:
- The main professional activity, gender, the years of professional activity and details of working environment (see Table 1).
- Root-canal preparation technique and choice of instruments, use of rubber dam, number of appointments, choice of the working length and frequency of treatment of a fourth root canal in the maxillary molar (see Table 2a-e).
- Emergency treatment in cases of acute pain and acute apical periodontitis, the occurrence of complications after treatment of teeth with acute pulpitis, acute apical periodontitis and chronic apical periodontitis, and the occurrence of complication in mandibular and maxillary teeth, the choice of treatment with a tooth presenting a radiographic lesion of 10 mm (see Table 3a-d).
- The choice of root-canal irrigant, the concentration of sodium hypochlorite, and the use of intracanal medication (see Table 4).
- The choice of obturation technique, sealer and temporary filling material (see Table 5).
- The attitude towards endodontic treatment in general, satisfaction with preparation and obturation techniques and whether they performed re-treatments (see Table 6 a, b).
The data were checked and entered twice in a personal computer and analysed using the statistical software SPSS. Blank or multiple answers were all treated as missing values; only single unequivocal replies were included in calculating frequencies and percentages.
Table 1. Demographic and professional data of the responding dentists.
Table 2a. Data related to preparation and instrumentation: use of rubber dam.
Table 2b. Data related to preparation and instrumentation: use of nickel-titanium instruments.
Table 2c. Data related to preparation and instrumentation: number of appointments to complete root-canal treatment by number of root canals.
Table 2d. Data related to preparation and instrumentation: working length and choice of instruments.
Table 2e. Data related to preparation and instrumentation: preparation and obturation of a fourth canal in maxillary first molars.
Table 3a. Management of emergencies.
Table 3b. Occurrence of complication in general and in function of diagnosis.
Table 3c. Occurrence of complications by tooth type.
Table 3d. Management of a tooth presenting a periapical lesion with diameter of 10 mm.
Table 4. Choice of root-canal irrigants and disinfectant intracanal-medication.
Table 5. Choice of obturation technique and temporary filling material.
Table 6a. Attitude towards endodontic treatment and satisfaction of the practitioner.
Table 6b. Attitude towards endodontic treatment and satisfaction of the practitioner: performing of re-treatments.