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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 26-30

An endodontic practice profile among general practitioners in Chennai: A questionnaire survey


1 Department of Public Health Dentistry, Asan Memorial Dental College and Hospital, Chengalpet, Tamil Nadu, India
2 Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Thiruvallur, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance06-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
R Ganesh
Reader, Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Thiruvallur, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_22_21

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  Abstract 


Introduction: The practice of dentistry shows a vast difference owing to the place of practice, that is, between private practice and institutional one as well as between the general practitioner and the specialists. Endodontic treatment itself offers a wide gamut of options to a clinician in the way a simple root canal can be carried out. Use of rubber dam, irrigants, prescription of antibiotics, choice in single- and multiple-visit treatment, and interappointment dressings are the aspects of one most commonly carried out procedure, that is, root canal treatment in dentistry. Materials and Methods: This study was a questionnaire-based survey of samples of dentists in Chennai. The self-administered questionnaire contained 15 close-ended questions with multiple-choice options. The data collected included demographic details of respondents, root canal preparation techniques, irrigants and intracanal medicaments used, the number of appointments, method of working length determination, root filling techniques, cements used, and the scope of treatment performed. Results: The usage of rubber dam is very low among general practitioners. Most of the dentists follow radiographs with instruments in the canal as the best option for working length determination. Out of three root canal instrumentation techniques such as crown down, push and pull, and step back, the third one (56%) is the most followed technique. Hero shaper (51%) is the choice of Ni-Ti rotary instrument used by the dentists of Chennai followed by Mtwo. Stainless steel hand files (69%) are mostly used to prepare canals followed by nickel–titanium hand files (21%) and rotary nickel–titanium files (10%). Lateral compaction (91%) is the commonly used obturation technique. Autoclave sterilization (20%) is mostly followed by the dentists followed by glass bead and chemical sterilization (12%). The most commonly used sealer is ZOE sealer (72%). Conclusion: During the past decade, many innovative concepts, techniques, and instruments have been introduced in practice, and standard of care for endodontics can be improved by increasing general dental practitioner interest. This study concludes that standard guidelines and new technologies are to be implemented by the practitioners in Chennai.

Keywords: Apex locator, endodontic practice, general practitioners, medicaments, root canal


How to cite this article:
Banu S T, Ganesh R. An endodontic practice profile among general practitioners in Chennai: A questionnaire survey. Int J Soc Rehabil 2020;5:26-30

How to cite this URL:
Banu S T, Ganesh R. An endodontic practice profile among general practitioners in Chennai: A questionnaire survey. Int J Soc Rehabil [serial online] 2020 [cited 2024 Feb 25];5:26-30. Available from: https://www.ijsocialrehab.com/text.asp?2020/5/2/26/331469




  Introduction Top


The practice of dentistry shows a vast difference owing to the place of practice, that is., between private practice and institutional one as well as between the general practitioner and the specialists. Endodontic treatment itself offers a wide gamut of options to a clinician in the way a simple root canal can be carried out. Use of rubber dam, irrigants, prescription of antibiotics, choice in single- and multiple-visit treatment, and interappointment dressings are the aspects of one most commonly carried out procedure, that is, root canal treatment (RCT) in dentistry. With the introduction of new materials, devices, and techniques, the quality of endodontic treatment has increased leading to higher endodontic success rate.[1],[2] With the development of these technologies, many teeth with guarded prognosis that used to be extracted in the past can be salvaged by surgical or nonsurgical endodontic treatment. Endodontic treatment includes all clinical procedures designed to maintain the teeth in a functional state in the dental arch. The challenges of preserving the dental arch free of pulp and periapical diseases have contributed to numerous innovations in contemporary endodontic practice. Research data on attitude of general dental practitioners (GDPs) toward endodontic therapy are rare.[3] Several studies have investigated the attitudes of GDPs toward various aspects of endodontic treatment in England, UK, Belgium, Nigeria, Sudan, Australia, Denmark, USA, Sweden, Turkey, Jordan, and Iran. However, there has been no survey of the current status of endodontic practice in India. Hence, the primary purpose of this survey was to determine the attitude of GDPs toward endodontic treatment and current use of new endodontic technology and materials by them.[4],[5] Changes in the field of endodontics have been so rapid in recent years that current instruction in RCT bears little resemblance to that of 10 years ago. The consequence is that dentists are faced with numerous materials and techniques, while dental schools try to tailor their curriculum accordingly. To ensure acceptable treatment outcomes, quality guidelines for endodontic practice have been published. The aim of the study is to investigate and compare the status of endodontic practice among Indian endodontists that will help suggest a standardized treatment guideline.


  Materials and Methods Top


The target population of this investigation was the GDPs in Chennai. A sample of 100 questionnaires with 15 closed-ended questions were distributed to them in their working place [Table 1]. Convenience sampling was used and samples were chosen to be 100 arbitrarily. Question categories included different aspects of endodontic treatment, including root canal therapy stages, materials, choice of instruments, isolation methods, use of canal irrigants, use of intracanal medicaments, and choice of obturation technique. Percentages were then calculated, based on the number of respondents to each question. The data were analyzed using descriptive statistics.[6],[7],[8]
Table 1: Questionnaire

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  Results Top


This study investigated the endodontic practice profile. Out of 100 dentists here, only very few use rubber dam [Figure 1]. The mostly used intracanal medicament is CaOH (74%) followed by formocresol and iodoform. Most of the dentists follow radiographs with instruments in the canal as the best option for working length determination. Out of three root canal instrumentation techniques such as crown down, push and pull, and step back, the third one (56%) is the mostly followed technique. Hero shaper (51%) is the choice of Ni-Ti rotary instrument used by the dentists of Chennai followed by Mtwo. Stainless steel hand files (69%) are mostly used to prepare canals followed by nickel–titanium hand files (21%) and rotary nickel–titanium files (10%). Most of the dentists bypass the fractured instrument (46%). Ultrasonic method (17%) and apical surgery (22%) are followed by very few dentists. [Figure 2] denotes that Lateral compaction (91%) is the commonly used obturation technique, then comes warm compaction (6%) and single cone (3%). Obturating beyond apex (42%) is the common root canal complication. [Figure 3] shows that Autoclave sterilization (68%) is mostly followed by the dentists followed by glass bead and chemical sterilization (12%). The mode of management of endodontic emergency was 74% for pulpectomy and medication followed by analgesics and antibioics [Figure 4].
Figure 1: Frequency of rubber dam usage in clinical practice

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Figure 2: Type of obturating technique used

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Figure 3: Sterilization of endodontic files

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Figure 4: Mode management of endodontic emergency

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  Discussion Top


A dentists' attitude, knowledge, and practice can be determined in an effective manner by conducting a questionnaire survey. Face-to-face surveys have response rates higher than electronic or mailed questionnaires. The respondents in the current study were dentists who were able to provide valid and valuable information on the current status of endodontic practice. The major limitations and weaknesses of this study include the inflexible nature of the study design. As opposed to direct observations, it is difficult to deal with specific contexts in the current questionnaire-based study. Moreover, some questions that may be more appropriate to respondents may have been missed in an attempt to standardize the questions.[9],[10],[11]

This study investigated the endodontic practice profile. Out of 100 dentists here, only very few use rubber dams. Because its time consuming and patient discomfort rate is very high. All endodontic procedures should be performed with a rubber dam, which should be considered standard care. The purpose of rubber dam protection in dentistry on whole cannot be overempasized. Although rubber dam isolation is taught as mandatory during training, its importance appears to be ignored by most of the endodontists in India. The mostly used intracanal medicament is CaOH (74%) followed by formocresol and iodoform. For intracanal medicament, calcium hydroxide usage was the most popular followed by formocresol, which was similar to that practiced by dentists in HK and endodontists of India. Calcium hydroxide has been determined as suitable for use as an intracanal medicament as it is stable for long periods, harmless to the body, and bactericidal in a limited area. It also induces hard tissue formation and is effective for stopping inflammatory exudates. Besides, intracanal dressing is also for a blockade against coronal leakage from the gap between filling materials and cavity wall. On the other hand, formocresol has a tissue fixative property and also is distributed to the whole body from the root apex and so might induce various harmful effects including allergies. Furthermore, as these medicaments are potent carcinogenic agents, there is no indication for these chemicals in modern endodontic. Most of the dentists follow radiographs with instruments in the canal as the best option for working length determination. With the use of either electronic apex locator or radiographs, the respondents preferred to be short of the apex, while Lee et al. in their survey showed that 30%–40% of respondents instrumented to the level of apex reading on the electronic apex locator regardless of the clinical situation.[12],[13],[14]

Periapical radiographs are important in endodontics for diagnosis, determine the number, location, shape, size, and direction of roots and root canals, estimate and confirm the length of root canals before instrumentation, localize hard-to-find, or disclose unsuspected, pulp canals by examining the position of an instrument within the root, aid in locating a pulp that is markedly calcified and/or receded, determine the relative position of structures in the facial–lingual dimension, confirm the position and adaptation of the primary filling point, and aid in the evaluation of the final root canal filling. This method can be useful in patients who need not to be exposed to repeated radiation because of mental, medical, or oral conditions. Moreover, electronic apex locators are particularly useful when the apical portion of the canal is obscured by anatomic structures, such as impacted teeth, tori, the zygomatic arch, excessive bone density, overlapping roots, or shallow palatal vaults. Irrigation has been performed in conjunction with endodontic therapy for many years. One of the primary reasons for irrigating the root canal system is to ensure cleanliness of the canals prior to obturation. This cleanliness involves both elimination of microorganisms and removal of organic matter. Out of three root canal instrumentation techniques such as crown down, push and pull, and step back, the third one (56%) is the mostly followed technique. A crown-down approach provides certain advantages including early organic debris removal, the creation of a large reservoir for irrigating solutions, a straighter access to the apical region of curved canals, and greater precision with regard to the exact working length and apical size. 20. Only 23% of the GDPs used crown-down technique, while 90% still followed step-back technique. Hero shaper (51%) is the choice of Ni-Ti rotary instrument used by the dentists of Chennai followed by Mtwo. Stainless steel hand files (69%) are mostly used to prepare canals followed by nickel–titanium hand files (21%) and rotary nickel–titanium files (10%). Nonrotary manual endodontic files were commonly used by the endodontists surveyed. Recently introduced rotary NiTi files are able to produce a uniformly tapered canal configuration without canal transportation.[13],[14],[15]

However, unpredictable instrument separation remains a deterrent to their popularity. Moreover, cost of rotary files also restrained their use in developing countries such as India. Majority of respondents only replaced their instruments when signs of distortion and bluntness were obvious, which is likely to result in a higher risk of instrument separation in the canal. Most of the dentists bypass the fractured instrument (46%). Ultrasonic methods (17%) and apical surgery (22%) are followed by very few dentists. Lateral compaction (91%) is the commonly used obturation technique, then comes warm compaction (6%) and single cone (3%). The preferred technique for filling the root canals in the current study was the lateral condensation technique and this has been reported as the most universally accepted technique.[5] It is also the preferred technique among undergraduate dental students.[16],[17],[18] Obturating beyond apex (42%) is the common root canal complication. Autoclave sterilization (20%) is mostly followed by the dentists followed by glass bead and chemical sterilization (12%). The most commonly used sealer is ZOE sealer (72%). Resin-based (10%), calcium hydroxide-based (9%), and bioceramic sealers (9%) are also used.

There are some limitations of the present study which are worth mentioning. Since the study used a face-to-face questionnaire, it was not possible to survey a large sample size. The survey did not attempt to differentiate the participants based on their specialty and training. Hence, it could be assumed that not all the dentists would perform all procedures listed in the questionnaire frequently. This could result in their response to be based on knowledge and not on routine practice.


  Conclusion Top


This study investigated and compared the status of endodontic practice among Indian endodontists. It showed that dentists are following the basic protocols and techniques in accordance with recognized international standards. But still, there are certain differences that suggest a need for standardization of treatment guidelines for the Indian specialist.[19],[20] These findings would help reach a consensus to set an Indian endodontic treatment protocol/guideline by the Indian Board of Endodontists similar to one done by the European Society of Endodontists, American Association of Endodontists, and the Canadian Academy of Endodontists. During the past decade, many innovative concepts, techniques, and instruments have been introduced in practice, and standard of care for endodontics can be improved by increasing general dental practitioner interest. This study concludes that standard guidelines and new technologies are to be implemented by the practitioners in Chennai.[21],[22]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Chan AW, Low D, Cheung GS, Ng RP. Questionnaires survey of endodontic practice profile among dentists in Hong Kong. Hong Kong Dent J 2006;3:80-7.  Back to cited text no. 2
    
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Udoye CI, Jafarzadeh H. Rubber dam use among a subpopulation of Nigerian dentists. J Oral Sci 2010;52:245-9.  Back to cited text no. 3
    
4.
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Jenkins SM, Hayes SJ, Dummer PM. A study of endodontic treatment carried out in dental practice within the UK. Int Endod J 2001;34:16-22.  Back to cited text no. 5
    
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Al-Omari WM. Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan. BMC Oral Health 2004;4:1.  Back to cited text no. 7
    
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9.
Vadhera N, Makkar S, Kumar R, Aggarwal A, Pasricha S. Practice profile among endodontists in India: A nationwide questionnaire survey. Indian Journal of Oral Sciences. 2012;3:90.  Back to cited text no. 9
    
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Ahmed MF, Elseed AI, Ibrahim YE. Root canal treatment in general practice in Sudan. Int Endod J 2000;33:316-9.  Back to cited text no. 10
    
11.
Ravanshad S, Sahraei S, Khayat A. Survey of endodontic practice amongst Iranian Dentists Participating Restorative Dentistry Congress in Shiraz, November 2007. Iran Endod J 2008;2:135-42.  Back to cited text no. 11
    
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Ravanshad S, Nabavizade MR. Endodontic treatment of a mandibular second molar with two mesial roots: Report of a case. Iran Endod J 2008;3:137-40.  Back to cited text no. 12
    
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Ahmed MF, Elseed AI, Ibrahim YE. Root canal treatment in general practice in Sudan. International endodontic journal. 2000;33:316-9.  Back to cited text no. 13
    
14.
Cartwright A. Professionals as responders: Variations in and effects of response rates to questionnaires, 1961-77. Br Med J 1978;2:1419-21.  Back to cited text no. 14
    
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Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ 1992;305:160-4.  Back to cited text no. 15
    
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Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol 1972;33:101-10.  Back to cited text no. 16
    
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Smadi L. Comparison between two methods of working length determination and its effect on radiographic extent of root canal filling: A clinical study [ISRCTN71486641]. BMC Oral Health 2006;6:4.  Back to cited text no. 17
    
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Sharma MC, Arora V. Determination of working length of root canal. Med J Armed Forces India 2010;66:231-4.  Back to cited text no. 18
    
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Pasqualini D, Bianchi CC, Paolino DS, Mancini L, Cemenasco A, Cantatore G, et al. Computed micro-tomographic evaluation of glide path with nickel-titanium rotary PathFile in maxillary first molars curved canals. J Endod 2012;38:389-93.  Back to cited text no. 19
    
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Tortini D, Colombo M, Gagliani M. Apical crown technique to model canal roots. A review of the literature. Minerva Stomatol 2007;56:445-59.  Back to cited text no. 20
    
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Mohan GM, Anand VS. Accuracy of different methods of working length determination in endodontics. IOSR J Dent Med Sci 2013;12:25-38.  Back to cited text no. 21
    
22.
Abraham S, Raj JD, Venugopal M. Endodontic irrigants: A comprehensive review. Journal of Pharmaceutical Sciences and Research 2015;7:5.  Back to cited text no. 22
    


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