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Physical dimensions, torsional performance, bending properties, and metallurgical characteristics of rotary endodontic instruments. VI. Canal Master drills.

A laboratory study was performed on machine-driven Canal Master drills to determine their physical dimensions, torsional performance, bending properties, and metallurgical characteristics in fracture. Physical dimensions were determined for each of the available sizes (#50 to #100) of Canal Master drills from the manufacturer that distributes these instruments in the United States. Samples were also tested in clockwise torsion using a Maillefer memocouple. Bending properties of cantilever specimens were measured with a Tinius Olsen stiffness tester. Bending fatigue testing was performed on a unique laboratory apparatus. Scanning electron microscope examination confirmed visual observations that the stainless steel Canal Master drills exhibited ductile torsional fracture. This study is part of a continuing investigation to establish standards for all machine-driven rotary endodontic instruments.

Dental High-Speed Equipment↗

Endodontics: Part 9. Calcium hydroxide, root resorption, endo-perio lesions.

For more than 70 years calcium hydroxide has played a major role in endodontic therapy, although many of its functions are now being taken over by the recently introduced material MTA. Calcium hydroxide may be used to preserve the vital pulp if infection and bleeding are controlled; to repair root fractures, perforations, open apices and root resorptions. Endo-perio lesions are complex and the correct diagnosis is essential if treatment is to be successful. However, root canal treatment will always be the first phase in treating such lesions.

Alveolar Bone Loss↗

Custom-fabricated endodontic implants: report of two cases.

Teeth that have lost a good portion of alveolar support can be stabilized and maintained by the use of endodontic endosseous implants. Two hopeless cases were restored to function with ceramic-coated, custom-fabricated chrome-cobalt implants. The technique for fabrication is described.

Adolescent↗

A survey of participation in managed care programs by endodontic specialists.

A survey was published in the Quarterly Survey of Dental Practice (QSDP) Special Topics that dealt with contractual agreements in dentistry. This survey evaluated general dental practitioner participation apart from that of dental specialists in general. The Quarterly Survey of Dental Practice survey was modified and used in the present study to specifically determine the participation by endodontists in various contractual insurance agreements, including Preferred Provider Organization and Health Maintenance Organization programs. A 10% sample of practicing endodontists was randomly selected to participate in this survey. Questionnaires (331) were sent out, and 229 or 69% were returned. Total participation by endodontists responding to this survey in any Health Maintenance Organization and/or Preferred Provider Organization insurance plans was 31.3%; however the total percentage of patients treated under these insurance plans was only 6.6%. These results were similar to those in the 1994 survey in which it was shown that 27% of the general dental practitioners and 41% of the dental specialists participated in one or more of these insurance programs and treated respectively, 5% and 9%, of their patients under these plans. Although participation in various managed care programs by endodontists in this survey was close to one-third, the total number of patients treated under these plans was low. Overall patients treated under fee-for-service arrangements by endodontists responding to this survey formed 85.3% of their patient pool. It does not appear from the results of this survey that managed care insurance has a significant impact on the practice of endodontics. It can be postulated that endodontists are unwilling to accept more than a small reduction in fees to join managed care plans, and they also desire to retain full control of their dental practice.

Analysis of Variance↗

A survey of endodontic residents' attitudes about a career in dental education.

There is an increasing demand for qualified educators throughout American dental schools. A survey designed to identify reasons for interest or lack of interest in education as a career was sent to all first and second year endodontic residents enrolled in the United States in 1999. Seventy-four percent of the 392 students responded (224 men and 65 women). The survey results were analyzed using descriptive statistics and Chi-square tests. Ninety-three percent of the respondents reported an interest in teaching on a part time basis, and of those, 51% were willing to teach 1.5 days/week, but only 16% were willing to teach more than 1.5 days/week. The survey included a list of eight potential reasons for not being interested in a career in education and respondents were asked to mark their top three. Low salaries for teachers was the most frequently chosen reason (70%), 51% listed educational debt, and 31% listed desire to be their own boss or lack of interest in research. Students were also asked to choose the top three reasons for interest in dental education from a list of seven reasons. Enjoyment of clinical teaching was the most frequently selected reason (41%): 32% included enjoying working with others in the field and 24% listed enjoyment of the university atmosphere.

Attitude of Health Personnel↗

Virtual endodontics: three-dimensional tooth volume representations and their pulp cavity access.

The purpose of this study was the application of both digital three-dimensional image processing and virtual reality techniques in endodontics. Three-dimensional volume representations of 2 teeth from each tooth category, 16 teeth in total, have been reconstructed. All teeth were embedded in polyester resin, and serial cross-sections 0.75-mm thick were taken from each tooth by using a special microtome. Each section was studied under a stereoscopic microscope, and its microscopic image was directly digitized using a video-camera. The surfaces of hard dental tissues were segmented from each section. Semiautomatic alignment and frame interpolation were performed on the sequence of tooth sections by using appropriate digital image processing techniques. Three-dimensional volume representations from each tooth were achieved in this project to produce the final three-dimensional teeth models, on which virtual accesses of pulp cavities have been performed. Three-dimensional teeth volume representations and virtual tooth "drilling" could serve as perfect educational tools under certain circumstances.

Anatomy, Cross-Sectional↗

Root canal treatment in a population-based adult sample: status of teeth after endodontic treatment.

The purpose of this study was to quantify treatment outcomes of endodontically treated teeth, in a representative, population-based adult sample. The "Florida Dental Care Study" was a prospective, longitudinal, cohort study of 873 subjects who had at least one tooth at baseline and who were 45 yr or older. An in-person interview and clinical examination were conducted at baseline, 24 months, and 48 months after baseline, with 6-monthly telephone interviews between those times. Dental record information was abstracted afterward. Seventy-five teeth had conventional root-canal therapy (RCT) performed and met the inclusion criteria of 1-yr of follow-up or extraction. The mean duration of follow-up after RCT was 24.8 months. The mean (SD) attachment loss (AL) on teeth receiving RCT was only 3.3 (1.4) mm. Permanent restorations were placed in 79% of teeth a mean of 4.4 months after the RCT. However, 12% of teeth did not have any restorative treatment after RCT. After RCT had been completed, 81% of teeth were retained and 19% were ultimately extracted. Taken as a whole, this community-based study of a representative sample of adults suggests a higher failure rate than reported from studies in highly controlled environments or insured populations. It also suggests that the length of time to initial restoration of RCT-treated teeth is less than optimal. RCT was almost never performed on teeth with advanced periodontal attachment loss.

Adult↗

Optimal positioning for a dental operating microscope during nonsurgical endodontics.

The most comfortable positioning for a dental operating microscope (DOM) during nonsurgical endodontics for operators was investigated. Operators were categorized into 3 groups according to height. We recorded the time taken to obtain magnified images, and the angles of binoculars, microscope body, and the mirror to floor surfaces. For the group of shorter operators, observations were also made with an angled optics or a short objective lens (200 mm). It took longer to observe the mandibular molars than maxillary in every group. Although the differences in angles among each group were not remarkable for maxillary observation, we confirmed significant differences for the mandibular. Shorter operators had to adopt a strained position for mandibular observation in a standard setup but were more comfortable using angled optics or a short objective lens. By understanding the proper position, operators could learn to perform microendodontics more efficiently.

Body Height↗

Essential elements of evidenced-based endodontics: steps involved in conducting clinical research.

Endodontists have the opportunity to apply relevant research findings to the care of their patients using the principles and methods of evidence-based treatment. Finding evidence begins with a specific, well-built clinical question. Once a specific question is framed, the validity and relevance of the evidence need to be appraised. The best levels of evidence can then be used to inform decisions regarding care. The purpose of this paper is to discuss the history of evidence-based treatment and to clarify the process of conducting a systematic review. The various types of research designs appropriate for answering clinical questions most commonly encountered in dental practice, including a description of the strengths and weaknesses of each, are also presented. Finally, the implications of evidence-based research on endodontics and future research are outlined.

Dental Research↗

Undergraduate endodontic teaching at the London Hospital Dental Institute.

Integration, whole patient care and small group teaching are concepts which set the pattern for undergraduate teaching at 'The London'. This system promotes co-operation between disciplines, enables students to see the basic teaching in a wider clinical context, activates the learning process and gives students an opportunity to learn responsibility by running their own 'mini-practices'. Unfortunately, the system also has some undesirable effects, which are discussed with special reference to the teaching of endodontics.

Education, Dental↗

Comparison of undergraduate endodontic teaching programmes in the United Kingdom and in some dental schools in Europe and the United States.

The pattern of teaching root canal therapy within dental schools of the UK was determined and compared with that carried out within several dental schools in Europe and the USA. Although it appeared that 'teachers of endodontics' in the UK were advocating techniques adopted elsewhere, it was clear that, within the dental undergraduate curriculum as a whole, the teaching of root canal therapy was given a lower priority than that in some schools in Europe and the USA. Recommendations to remedy this unsatisfactory position are provided.

Education, Dental↗

Vocational trainees' views of their undergraduate endodontic training and their vocational training experience.

By means of a questionnaire, the views of recently qualified graduates, who were participating in vocational training schemes, on their undergraduate endodontic training and postqualification experience were examined. On the basis of these finding suggestions are made as to what changes are necessary in their undergraduate training and how their skills can be further improved after qualification.

Education, Dental↗

Specialization in endodontics.

The dental profession within the UK is currently reviewing the desirability of recognition of practice-based specialties and the establishment of specialist registers in various disciplines, including endodontics. In order to merit consideration for specialty status, in any discipline there must be an increase in the level of theoretical knowledge, and in the range and complexity of clinical procedures beyond the basic level of training. There must be an identified public need extending beyond the provisions of the general dental services for the particular skills of the practice-based specialist, who would also complement the consultant services, which have a limited capacity to provide the level of treatment demanded. Acceptance of the principle of specialist practice implies a belief that this will enhance the development of the profession, improve academic and clinical standards and provide a higher-quality and more widely available service to the public. The case for the specialist endodontist is argued, as is the importance of establishing appropriate academic and clinical training programmes to equip individuals with the requisite knowledge and skills. Academic institutions must develop imaginative and innovative courses to provide such education within the profession.

Education, Dental, Graduate↗

Establishing a postgraduate course in endodontics.

A proposal was first made to the University of London in 1985 to establish an MSc degree in Endodontics. It was finally approved in 1988. The first course started in 1988, and is now offered by two schools of the University, the United Medical and Dental Schools of Guy's and St Thomas's Hospitals and the Institute of Dental Surgery. The course has three main components: a taught part, clinical practice and a research project. The taught part is a course common to both the schools, while clinical practice and the research are carried out at the students' respective schools.

Education, Dental, Graduate↗

Digital radiographic images will benefit endodontic services.

Future assurances for endodontic services and assessments of traumatized teeth will depend in part on significant improvements to the quality of dental radiographs. Whereas digital images offer many potential sensor, display and archival advantages over film-based radiographs, the marginal image improvements from intraoral sensors primarily benefit patient education. Precisely digitized conventional radiographs are more likely to yield quantum image resolution improvements, although neither dentists nor patients will benefit until cost-effective digitizing systems have been developed for the dental office.

Alveolar Bone Loss↗

Is antibiotic prophylaxis required for endodontic treatment?

The stable prevalence of infective endocarditis since the advent of antibiotic prophylaxis for patients at-risk reflects the increasing polymicrobial etiology of such infections not associated with dental procedures. In addition to concerns for the growing crisis for antibiotic-resistant bacteria, the need for controlled clinical trials to determine the continued efficacy of prophylactic regimens for endodontic and other dental procedures cannot be overstated.

Antibiotic Prophylaxis↗

Tissue engineering in endodontics.

The key elements of the regeneration of dentine-pulp complex are stem cells, morphogens and a scaffold of extracellular matrix. The pulp stem cells have the potential to differentiate into odontoblasts in response to bone morphogenetic proteins (BMPs). However, the use of BMPs in vivo has been restrained by lack of a suitable scaffold. Therefore, two alternative approaches, in vivo and ex vivo gene therapy were performed. Bmp I I/Gdf I I gene was directly transferred into amputated pulp by sonoporation and the reparative dentine formation was stimulated in vivo. However, there should be enough responsive stem cells in the pulp. Therefore, the isolated progenitor stem cells from pulp were transfected with Bmp I I/Gdf I I by electroporation and implanted onto the amputated pulp. This ex vivo gene therapy stimulated reparative dentine formation more optimally and rapidly compared with the in vivo gene therapy. These results suggest the possible clinical use of gene therapy of BMPs for endodontics.

Animals↗