The relationship between endodontic case complexity and treatment outcomes.

OBJECTIVE: The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. METHODS: Three hundred and forty nine radiographs of patients who had received endodontic treatment at a postgraduate dental institute in Dubai were retrieved from the Institute's data base. The majority of the cases were referred by in house general dental practitioners (GDPs). Unreadable radiographs were all excluded. From the original sample of 349,in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic postgraduate students. All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Based on this, the technical quality of the root filling was evaluated for each individual case. RESULTS: The sample consisted of 53% high,35% moderate and 12% minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. There were statistically significant differences between the length of root canal filling and level of difficulty (p = 0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p = 0.794). CONCLUSION: Eighty four percent (0.93 × 0.90 = 0.84) of the cases treated proved to be adequate in terms of length and homogeneity which is in line with published work of Endodontic treatment carried out by specialists. CLINICAL SIGNIFICANCE: GDPs require robust guidelines to help with appropriate referral of patients to Endodontic specialists.

Preparation Prerequisites for Effective Irrigation of Apical Root Canal: A Critical Review.

BACKGROUND: It is well recognized that disinfection of the complex root canal system at the apical root canal remains the most critical therapeutic measure to treat apical periodontitis. MATERIAL AND METHODS: Observational and experimental data in relation to the anatomy of the apical root canal in different tooth types and the cross sectional diameters of the apical part of the most commonly used hand and rotary files are critically reviewed. RESULTS: The present data analysis confirm that the challenging issue of antibacterial efficacy of modern preparation protocols in non-surgical endodontics requires more attention to apical root canal irrigation as a balance between safety and effectiveness. Ex vivo investigations clearly indicate that a specific design of the chemo-mechanical preparation is needed at the onset of RCT, more particularly in infected teeth. Design should be based on specific anatomical parameters, and must determine the appropriate size and taper of preparation as pre-requirements for effective and safe apical irrigation. CONCLUSIONS: The optimal irrigation protocols might be designed on the basis of technical specifications of the preparations procedures, such as the penetration depth, the type of the needle, the required time for continuous irrigant flow, the concentration of NaOCl, and the activation parameters. Key words:Endodontics, root canal treatment, instrumentation, irrigation, apical root canal.