Clinical Evaluation Of EIE, Obturation Quality And Outcomes Of Root Canal Treatment

The quality of the root canal obturation is judged to be one of the important factors for prognosis of the root canal treatment. A well performed root-canal treatment could seal the canal system and prevent the insult of bacterial and their by-products. A number of studies attempted to assess the technique quality and outcome of endodontic treatment. The reported outcomes have been diverse, reflecting considerable differences among the studies in material composition, treatment and methodology. Understanding outcomes of root canal treatment are an important aspect of the specialty, not only does it permit evaluation of clinical techniques, but it also allows for the development of criteria to further improve diagnostic treatment and post treatment recommendations. Technical and scientific advances in endodontics have made root canal therapy a widely accepted procedure with a predictably high success rate. Despite this success, however, there are many treated teeth had apical lesions, endodontic interappointment emergencies (EIE), Such as pain or swelling which require nonscheduled office visits and palliative treatment remain a major concern both for dentists and patients.Majority of the studies reported in the endodontics literature was conducted in European populations, few studies assessed endodontics treatment outcomes in Chinese populations. Therefore, the purpose of this study was : 1 )to determine the prevalence of EIE during root canal treatment and to evaluate its association with various clinical factors, 2) to evaluate the quality of root canal filling performed by dentists and advanced dental trainees and the current level of continuing education in a dental teaching hospital, and 3) to assess the healed rate of root canal treatment performed in a dental teaching hospital and to identify demographic and clinical factors that might affect the outcome.Part I Incidence and factors associated with endodonticinter-appointment emergency in a dentalteaching hospitalObjective: To assess the incidence of endodontic inter-appointment emergency (EIE) in a dental teaching hospital in China, and to correlate its occurrence with preoperative and treatment parameters. Methods: 3696 cases were collected at root canal treatment appointments on demographics, presenting symptoms, treatment procedures and periradicular status. The operators consisted of faculty, undergraduate students and advanced trainees. Root canals were conventional instrumented and then medicated. No systemic medication was prescribed. In cases EIE developed during the appointment, an emergency visit was arranged and active treatment was carried out. The data of EIE cases were statistically analyzed using the Chi-square test and a multiple logistic regression model. Results: The overall incidence of EIE was 5%; EIE occurred in 5.5% of the females and 4.3% of the males. Analyses of all potential factors revealed that patient age, tooth location, pre-operative percussion pain and pulp status were the most important independent variables. Conclusion: EIE was significantly associated with some host factors (patient age, tooth location) and presenting factors (preoperative percussion pain, pulp status).Part II Quality of obturation performed by the advanced dentist trainees and the endodontic care dentistsObjective To audit the quality of root canal treatment (RCT) performed by dentists and advanced dental trainees(ADTs) as well as to evaluate the current level of continuing education in our hospital. Methods 2043 cases randomly completed by dentists and ADTs over half a yea, were divided into two groups. The quality of root canal filling was analyzed radiographically. Results The percentage of the adequate root filling canals and teeth in dentists cases (63.9%,59.9%) was significantly greater than that inADTs cases (47.4%,40.1%) during the six months. In addition, the frequency of the adequate root filling canals for ADTs in the last 2 months (57.8%) was significantly higher than that in the first 2 months (40%). Conclusion The quality of root canal filling performed by dentists was adequate. There was a substantial improvement for ADTs in RCT after six months training, and continuing education has played important role in improving quality of RCT.Part III Factors influencing the outcome of conventionalroot canal therapy—A retrospective clinicalradiographic studyObjective: To determine retrospectively the clinical and radiographic outcome of root canal treatment performed in a dental hospital between 2001 and 2002. The influence of various factors that might affect the outcome of root canal therapy was also evaluated. Method: The population of this study comprised a total of 695 teeth from 357 patients. Pre- and intra-operative information was abstracted from the original patient records. The post-operative sign or symptom, periapical status and coronal restoration integrity were examined 3 years after obturation. The criterion used for evaluation of the outcome was from Friedman. Data were subjected to bivariate and multivariate analysis. Results: The overall healed rate was 75.1%. The tooth group, pre-operative pulp and periapical status, quality of root filling and integrity of coronal restoration were revealed by means of bivariate analysis, to exert a significant influence on treatment outcome. The logistic analysis indicated the pre-operative periapical status, quality of root filling and the integrity of coronal restoration had important effect on healed rate. Conclusion: Three clinical factors such as pre-operative periapical status, quality of root filling and the integrity of coronal restoration exert a significant influence on healed rate.