Difficulty Assessment Of Root Canal Therapy System Improvement And Its Application In The Intermediate Grade Doctors

Background:The core of medical work is medical quality and medicalsafety.Since,the government,insurance and hospital managers are veryconcerned about how to control the quality of a particular disease.In ourcurrent health care system,the hospitals is classified into Grade A,B and nograde.While the doctor is divided into primary,intermediate andadvanced.By the influence of historical,geographical,medical resources andcontinuing medical education opportunities and other factors,the objectivegap is existent between different grade hospital doctors,different titles oftechnical level of doctors.In order to better controlling of medical quality,theadministrative department of Health issued a variety of approaches,such asoperation grading management approach,three doctor guidance system,andso on.Therefore,in medical quality control and grading management,toestablish an objective,effective,effective,practical method of evaluation isvery necessary.With respect to Oral Medicine,root canal therapy is the basictechnology in physician’s daily work,which is an important index in disease quality control. Although the root canal therapy has a history of over100years,in our country,root canal therapy began in a considerable part of thecity region below the county level hospital popularity in recent years.Infact,in the part of highest grade in general hospital,root canal treatment wasdeveloped in recent years,which quality was not ideal.Clinical and experimental studies have indicated that,the quality of rootcanal obturation is the main factor that effect long-term efficacy of root canaltherapy.As a result of the root canal system of complex diversity and soon,difficulties in root canal therapy vary greatly.For the low difficulty of rootcanal treatment,doctors at all levels have a higher qualified rate,while thehigh difficulty of root canal treatment even if the hospital doctor completedhigh title qualified rate is limited.So in the root canal therapy quality controland grading management,the first thing is to assess the root canal treatmentdifficulty.At present both at home and abroad to a variety of difficultyassessment of root canal therapy,because of its design purpose,the use of arange is different.It is lack of compliance with the current medicalsystem,used in medical quality control and operation managementevaluation system.The United States of America endodontic associationdeveloped the difficulty assessment of root canal therapy table and describedof various subjective and objective factors,to facilitate the doctor treated bythe difficulty of a tooth evaluated qualitatively.Gao Xiaojie analyzed variousfactors which led to root canal treatment failure and established preliminarily the difficulty assessment system of the root canal therapy.Thesystem was divided into3levels of difficulty,for the need to use specialequipment case difficulty level division still lacks rigor.In this experiment,as a reference to the difficulty assessment of rootcanal therapy system established by the scholars at home and abroad,byimproving the difficulty assessment of root canal therapy system,the rootcanal treatment difficulty level is divided into4levels,in order tocorresponding the hospital level and the doctor,s grade.By analying theactual level of root canal treatment of the oral surgeon in differenthospitals,it is laid the foundation for the difficulty assessment of root canaltherapy in disease classification,technical quality control,improving medicalquality and reducing the medical risk.The division standard is:In1,2levelsof difficulty,it can be well done with the basic skills in root canaltherapy.Respectively corresponding to level two and the followinghospital(the hospital usually lack oral senior physicians),intermediate doctorin level three hospital,hospital attached to a medical university hospital andgrade of junior doctors,graduate students;The three level of difficultyrequiring a skilled professional skills and equipment tocomplete,corresponding to the three grade senior hospital doctors andMedical University Affiliated Hospital and the hospital doctor classintermediate;And the four level of difficulty in addition to very skilledprofessional skills,but also the need of high-end complete equipment,corresponding to the senior doctor in medical university hospitaland grade hospital; The one,two and three levels difficulty is for inspectionat all levels of hospital and doctors at all levels of technical level,the fourlevel is mainly used for inspection specialist hospital in senior doctor oftechnical level and on the special equipment to master.Objective:The purpose of this study is to improve the difficulty assessment of rootcanal therapy system,and analyzes oral specialized subject hospitalintermediate title doctor of root canal therapy qualified rate.Methods:In a continuous period (four mouths), The x-ray films of teeth werecollected according to the following criterion: the patients were treated bydoctors with junior and intermediate grade in a dental clinic of colloge ofStomatology, Chongqing Medical University. The risk factors of root canaltherapy was assessed in teeth with System history,tooth position,the pulpchamber,the number of root canal,root curvature,calcification,endodontictreatment history,working length, the gag reflex and other indicators.Chi-square test and multiple logistic regression analysis were used toanalyze the correlation between the risk factors and the failures,. Screeningindicators which were statistically significant,re-establishing the logisticregression analysis model,and brought the filtered indicators into improveddifficulty assessment system of the root canal therapy; State on each difficulty level of root canal filling of the intermediate title doctor.Results：A total of630cases were collected at root canal treatment appointments,518of which were qualified, indicating the achievement ratio was82.22%..The results of signal factor analysis indicated that tooth position, the pulpchamber，the number of root canal, root curvature, calcification, endodontictreatment history had significantly influenced the treatment outcome（P＜0.05）. According to the multiple logistic regression analysis, pulp chamberwere rejected（P>0.05）, while the number of tooth position，root canal, rootcurvature, calcification, the previous endodontic treatment were brought tothe improved assessment system.Based on the improved difficulty assessment system of the root canaltherapy, the concordance rate of evaluation between Preoperative andIntraoperative（Kappa＞0.80）.By giving the indicators of different levels ofdifficulty scores,statistics of the root canal filling qualified rate.The resultsshowed that class Ⅰ,Ⅱ,Ⅲ and Ⅳof the root canal filling pass rates were96.7%、89.3%、83.0%and52.2%.There was no apparent different betweenclass Ⅰand Ⅱ,class Ⅱand Ⅲ levels of difficulty for quality of root canalfilling.The quality of root canal filling between Ⅲ level and Ⅳ level wasstatistically significant(P<0.05).For Ⅳ level of difficulty,intermediatedoctor could consider to take into consideration the turn in superior doctorsto make a diagnosis and give treatment,in order to improvement the quality of medical treatment.Conclusion:The qualified rate of root canal preparation was associated with toothposition,pulp chamber,the number of root canals,root curvature, calcificationand endodontic treatment history closely. So they were brought to theimproved assessment system,given different scores,obtaining the finaldifficulty level and the different level of root canal filling qualified rate.