Improvement Of The Difficulty Assessment System Of The Root Canal Treatment And The Preliminary Research Of The Applications Of Endodontics Primary Doctor

Background:In recent years, with the attention of the medical quality and the safetyof medical treatment in the medical work, it is necessary to establish theevaluation system line with the current health care system, used for medicalquality control and classification management.Pulpitis and periapical periodontitis are the most common disease onein oral medical treatment. In the ordinary department of stomatology clinic,about half of patients who suffer from dental pulpitis and periapicalperiodontitis, and in the Endodontics is accounted for almost two-thirds.Root Canal therapy (Root Canal Treatment, RCT) is the most effective wayto treatment pulpitis and periapical periodontitis and relieve pain and keepteeth. RCT is the most often used to treatment technology about oralcomprehensive and oral medicine specialized subject (Endodontics) doctors,and is one of the core contents of medical quality control. Although RCTfor hundreds of years of history, due to our country national condition, in recent years RCT began in some parts of the city and county the followinghospital popularization, even parts of higher level of comprehensivehospitals developed RCT, the treatment quality is grim.RCT is the most commonly used dental treatment technology, but thecomplex diversity of root canal system result in RCT difficulty veryenormously. Generally speaking, low difficult RCT doctors at all levelswere able to achieve the high yield and high difficult RCT even the seniordoctors of specialized hospital, that pass is limited. Difficult RCT whetherthe high quality is completed or not, which is not only by the influence oftechnical level, but also by the influence of instrument equipment.Therefore, we primarily assess difficulty of RCT, during the RCT qualitycontrol and classification management.At present, the world has been established some the difficultyevaluation systems, for different of the purpose and use range, in ourcountry, there is no the systems in line with the current medical system andused for medical quality control and the classification management ofoperation. This paper referenced to domestic and foreign scholars RCTassessment methods, improved assessment difficulty of RCT,characteristics are: assessment difficulty levels of RCT are divided intofour that corresponding with hospital and the doctor’s title levels; difficultRCT of1,2levels have the basic skills can be a good finish, correspondingto the secondary hospitals and doctors (the class hospitals usually lack of senior doctors), level3hospitals′intermediate doctors, the affiliatedhospitals of medical university and specialized hospitals′primary doctorsand graduate students; Level3should have professional skills and somespecial equipment to complete, corresponding to three level hospitals′senior doctors and the affiliated hospitals of medical university andspecialized hospitals′intermediate doctors; level4not only need veryprofessional skills, but also need to high-end complete equipments andinstruments, corresponding to the affiliated hospitals of medical universityand specialized hospitals′senior doctors. Below level3can be used toexamine the technical level of the hospital and the doctor at all levels; level4is mainly used for investigation technology level of specialized hospitals′senior doctors and mastery of special equipments.A set of method of complete assessment system,which applies to asingle individual, but for assessment the whole, and its evaluation index isvarious and unpractical. Therefore, we need through the statistical analysisof the clinical data, and find out index of enormous implication, closerelationship, high frequency of occurrence, thus make index simplified, andthe scope more widelyPurpose:This topic referenced on the basis of study abroad and use byreference the domestic scholars’ research method, improved a root canaldifficulty evaluation system, to form a assessment system which is the simplified and suitable for medical quality grading control. Wepreliminarily investigate the filling rate of different difficulty RCT ofprimary dentists. Setting up the difficulty assessment system of the RCT,which providing the baseline date for further setting up for medical gradingcontrol.Materials and methods:First of all, this study established4levels RCT difficulty assessmentsystem from the domestic and foreign experience. Second,522patientswere collected at RCT appointments in endodontic department, ChongqingMedical University Affiliated Stomatology Hospital. The patients with thewhole body health and630teeth (junior doctors have272teeth,intermediate doctors358) of the anatomy of the risk factors (teeth lengthand the teeth arrangement, pulp chamber anatomy, root canal anatomy,dental history), operation risk factors (open degree, swallow reflex, salivaquantity) and assessed difficult grades for preoperative and perioperativethe factors, and calculated coincidence rate of both. Under the high ratecase, influencing factors and other data were analyzed by Chi-square testand multiple logistic regression analysis. According to the result ofregression, and combined with practical experience and a root canaltreatment theory, setted up a root canal therapy difficulty assessmentmethod. We assessed the factors levels and preoperational difficultyglobalassessmet of272teeth by the assessment method. Then, according to evaluation root canal filling effect by the postoperative x-ray, finallyanalyzed tooth root canal filling success rate of different difficulty ofprimary dentists.Results:Coincidence rate of assessment preoperation and perioperation was ashigh as74.76%。 This study assesses influencing factors grades of630teeth with RCT filling, and found degree of the general condition, maximalmouth opening, saliva amount, and the gag reflex, the length of theteeth,that mostly concentrated in grade1, and2levels of samples are few,3,4class almost have no. the indexes were unable to perform a chi-squareanalysis. In addition, root canal surgery did not involve in this study,therefore, in the single factor analysis will be out. The outcome of theremaining factors of Chi-square test reveals that tooth position, pulpchamber, number of root canals, root canal curvature, root canalcalcification and RCT history were the real risk factors (P<0.05). Theresult of multiple logistic regression analysis shows that in the five factorsroot canal calcification has the most significantly influenced the treatmentoutcome(P<0.001). For primary dentists four grades of root canal fillingquality evaluation, the result reveals that the success rate of four gradesRCT have statistically significant (P <0.001). Among four equals4, thepercentage of filling cases of the group whose difficulty value equals Ⅳisthe lowest. Conclusion:This study improved difficulty assessment system of RCT that thequantity of assessment index is limited, the assessment simple and to beoperable. The assessment system applied in Endodontics, which can easilydistinguish difficult.