Lisans Öğrencileri Tarafından Manuel Aletlere Karşı Döner Aletler Kullanılarak Gerçekleştirilen Kök Kanal Tedavisinin Teknik Kalitesi: Bir Retrospektif Çalışma

Year 2023, , 468 - 473, 21.08.2023

Alperen Tekin , Yelda Erdem Hepşenoğlu , Seyda Ersahan , Nur Sena Arıkan

https://doi.org/10.15311/selcukdentj.1183747

Abstract

Giriş: Kök kanal tedavisinin (KKT) teknik kalitesi sonucu etkileyebilir. Lisans eğitimi sırasında alınan eğitimin kalitesi, genel dişhekimliği pratiğinde sağlanan tedavinin kalitesi ile bağlantılı olabilir.
Amaç: Türkiye'deki bir lisans eğitimi veren diş kliniğinde döner veya manuel step-back kanal preparasyon tekniğinin kullanıldığı KKT teknik kalitesini karşılaştırmaktır. İlave olarak, bu çalışma, her iki şekillendirme sisteminde radyografik olarak sık görülen komplikasyonları karşılaştırmayı amaçlamıştır.
Gereç ve yöntemler: Dişhekimliği öğrencileri tarafından KKT uygulanan 270 hastanın diş kayıtları geriye dönük çizelge ile incelendi. 270 diş 565 kök rastgele iki gruba [(Rotasyon, n=280&Manuel, n=285)] ayrıldı. Kök kanal dolumu, dolum uzunluğunun radyografik apeksten >2 mm olması, radyodensite ve kök kanal duvarlarına adaptasyon açısından değerlendirildi. Yetersiz kök kanal dolgusu, perforasyon, basamak, transportasyon, alet kırığı gibi işlemsel hataları içeriyordu. Kategorik değişkenleri (n, %) tanımlamak için tanımlayıcı istatistikler kullanıldı ve anlamlılık düzeyi 0.05 olarak belirlendi. Bulgular: Lisans diş hekimliği öğrencileri tarafından gerçekleştirilen KKT'nin teknik kalitesi, rotasyon ve manuel grupları için sırasıyla vakaların %75'inde ve %53.7’sinde 'yeterli' olarak sınıflandırıldı (p<0.05). En yüksek işlem hataları büyük azı dişlerinde görüldü. Genel olarak prosedürel hataların oluşumu gruplar arasında anlamlı farklılık bulundu, rotasyon grubunda %6.4 ve manuel grupta %12.3 idi (p = 0.017). Bununla birlikte, manuel grupta basamak oluşumunun meydana gelmesi, rotasyon grubuna göre daha yüksekti (p = 0.007).
Sonuç: Bulgularımıza göre, lisans dişhekimliği öğrencileri tarafından döner enstrümantasyon sistemleri kullanılarak gerçekleştirilen KKT, daha yüksek teknik kaliteye sahiptir ve ayrıca manuel enstrümantasyondan daha az prosedür hatasına sahiptir.

Keywords

DÖNER ENSTÜRMANTASYON, MANUEL STEP BACK YÖNTEMİ İLE ŞEKİLLENDİRME, KÖK KANAL TEDAVİSİ, LİSANS DİŞ HEKİMLİĞİ ÖĞRENCİSİ

Technical quality of root canal treatment performed by undergraduate students using rotary instruments versus hand instruments: A Retrospective Study

Abstract

Background: 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.
Objective: To compare the technical quality of RCT where rotary or manual step-back canal preparatory technique was employed in an undergraduate dental clinic in Turkey. Additionally, the present study aimed to compare radiographically commonly seen complications in both instrumentation systems.
Materials and Methods: Dental records of 270 patients who received RCT undertaken by dental students were investigated by retrospective chart review. 565 root canals belonging to 270 patients were randomized into two groups [(rotary, n=280, and manual hand instruments, n=285)]. Root canal obturation was evaluated on the basis of the length of obturation being >2mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as perforation, ledge, transportation, instrument separation. Descriptive statistics were used to define categorical variables (n, %) and the level of significance was set at 0.05.
Results: The technical quality of RCT performed by undergraduate dental students was classified as 'adequate' in 75% and 53.7% of the cases, respectively for rotary and manual groups, respectively (p < 0.05). The highest procedural errors were seen in molars. Occurrence of procedural errors differed significantly between the groups, being 6.4% in rotary group and 12.3% in manual group (p = 0.017). However, occurrence of ledge formation was higher in manual group than that of rotary group (p = 0.007).
Conclusion: In view of our findings, RCT performed by undergraduate dental students using rotary instrumentation systems is of higher technical quality and also has fewer procedural errors than manual instrumentation.

Keywords

Rotary instrumentation, manual step-back instrumentation, root canal treatment, undergraduate dental students

References

• 1. Ahmed MA, Dall AQ, Khoso NA, Jouhar R. Comparison of post-operative pain by using ProTaper rotary and manual step-back root canal preparation techniques in single visit endodontics. J Pak Dent Assoc. 2012;21:103–107.
• 2. Viana, F. L. P., Souza, T. A., Sampieri, M. B. S., & Vasconcelos, B. C. Endodontic treatment of hypertaurodontic teeth with anatomical variations. General dentistry. 2021.
• 3. Saunders EM. Hand instrumentation in root canal preparation. Endodontic Topics 2005;10:163-7.
• 4. Kapalas A, Lambrianidis T. Factors associated with root canal ledging during instrumentation. Endod Dent Traumatol 2000; 16: 229–231.
• 5. Krishna PP, Beena RG, Bharani DP. A comparison of root canal preparations using stainless steel, NiTi hand and NiTi engine-driven endodontic instruments – An in vitro study. Bangladesh J Med Sci. 2010;9:223–230.
• 6. Schäfer E, Lohmann D. Efficiency of rotary nickel-titanium FlexMaster instruments compared with stainless steel hand K-Flexofile--Part 1. Shaping ability in simulated curved canals. Int Endod J. 2002;35(6):505-513.
• 7. Song YL, Bian Z, Fan B, Fan MW, Gutmann JL, Peng B. A comparison of instrument centering ability within the root canal for three contemporary instrumentation techniques. Int Endod J. 2004;37:265–71.
• 8. Esposito PT, Cunningham CJ. A comparison of canal preparation with nickel titanium and stainlesssteel instruments. J Endod. 1995;21:173-76.
• 9. Hülsmann M, Herbst U, Schäfers F. Comparative study of root canal preparation using Lightspeed and Quantec SC rotary NiTi instruments. Int Endod J 2003;36:748-56.
• 10. Lambrianidis T. Risk Management in Root Canal Treatment. Thessaloniki, Greece: University Studio Press.;2001
• 11. Saunders WP, Saunders EM, Sadiq J, Cruickshank E. Technical standard of root canal treatment in an adult Scottish sub-population. Br Dent J. 1997;182(10):382-386.
• 12. De Alencar AH, Dummer PM, Oliveira HC, Pécora JD, Estrela C. Procedural errors during root canal preparation using rotary NiTi instruments detected by periapical radiography and cone beam computed tomography. Braz Dent J. 2010;21(6):543-9.
• 13. Bjorndal L, Reit C. The adoption of new endodontic technology amongst Danish general dental practitioners. Int Endod J 2005;38:52–8.
• 14. Alamoudi RA, Alharbi AH, Farie GA, Fahim O. The value of assessing case difficulty and its effect on endodontic iatrogenic errors: a retrospective cross-sectional study. Libyan J Med. 2020;15(1):1688916.
• 15. Khabbaz MG, Protogerou E, Douka E. Radiographic quality of root fillings performed by undergraduate students. Int Endod J. 2010;43(6):499-508.
• 16. Eleftheriadis GI, Lambrianidis TP. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J. 2005;38(10):725–734.
• 17. De Cleen MJ, Schuurs AH, Wesselink PR, Wu MK. Periapical status and prevalence of endodontic treatment in an adult Dutch population. Int Endod J. 1993;26(2):112-119.
• 18. Kirkevang LL, Hörsted-Bindslev P, Orstavik D, Wenzel A. A comparison of the quality of root canal treatment in two Danish subpopulations examined 1974-75 and 1997-98. Int Endod J. 2001;34(8):607-612.
• 19. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16(10):498-504
• 20. Chugal NM, Clive JM, Spångberg LS. Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(1):81-90.
• 21. Smith CS, Setchell DJ, Harty FJ. Factors influencing the success of conventional root canal therapy--a five-year retrospective study. Int Endod J. 1993;26(6):321-333.
• 22. Baumann, M.A. and A. Roth, Effect of experience on quality of canal preparation with rotary nickel-titanium files. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 1999.88(6): p. 714–718.
• 23. Sonntag D, Delschen S, Stachniss V. Root-canal shaping with manual and rotary Ni-Ti files performed by students. Int Endod J. 2003;36(11):715-723.
• 24. Alrahabi M. Comparative study of root-canal shaping with stainless steel and rotary NiTi files performed by preclinical dental students. Technol Health Care. 2015;23(3):257-265.
• 25. Kum KY, Spängberg L, Cha BY, et al. Shaping ability of three ProFile rotary instrumentation techniques in simulated resin root canals. J Endod. 2000;26(12):719-723.
• 26. Iqbal MK, Kohli MR, Kim JS. A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: a PennEndo database study. J Endod. 2006;32(11):1048-1052.
• 27. Yared GM, Bou Dagher FE, Machtou P. Failure of ProFile instruments used with high and low torque motors. Int Endod J. 2001;34(6):471-475.
• 28. Wu MK, Fan B, Wesselink PR. Leakage along apical root fillings in curved root canals. Part I: effects of apical transportation on seal of root fillings. J Endod. 2000;26(4):210-216.
• 29. Eriksen HM, Bjertness E. Prevalence of apical periodontitis and results of endodontic treatment in middle-aged adults in Norway. Endod Dent Traumatol. 1991;7(1):1-4.
• 30. Lin LM, Rosenberg PA, Lin J. Do procedural errors cause endodontic treatment failure?. J Am Dent Assoc. 2005;136(2):187-231.
• 31. Miserendino LJ, Moser JB, Heuer MA, Osetek EM. Cutting efficiency of endodontic instruments. Part 1: a quantitative comparison of the tip and fluted regions. J Endod. 1985;11(10):435-441.
• 32. Er O, Sagsen B, Maden M, et al. Radiographic technical quality of root fillings performed by dental students in Turkey. Int Endod J. 2006;39(11):867–872.
• 33. Vukadinov T, Blažić L, Kantardžić I, Lainović T. Technical quality of root fillings performed by undergraduate students: a radiographic study. ScientificWorldJournal. 2014;2014:751274.
• 34. Alves RAA, Souza JB, Alencar AHG, et al. Detection of procedural errors with stainless steel and NiTi instruments by undergraduate students using conventional radiograph and cone beam computed tomography. Iran Endod J. 2013;8(4):160.
• 35. Eriksen HM, Kirkevang L-L, Petersson K. Endodontic epidemiology and treatment outcome: general considerations. Endodontic Topics 2002;2: 1–9.