Usefulness of an Endodontic Case Difficulty Assessment Form of Root Canal Treatments in Dental Education in Finland

According to current care guidelines, it would be beneficial to evaluate the difficulty of a root canal treatment (RCT) after the decision of an indicated RCT. For this matter, several difficulty assessment forms have been developed. In this pilot study, fifth-year dental students evaluated the usefulness of the Endodontic Case Difficulty Assessment Form (ECAF) presented in the Finnish Current Care Guidelines for Endodontic Treatment (2014). Another aim was to postoperatively investigate how well the evaluation by dental students using the ECAF associated with the outcome of RCT evaluated by a specialist in endodontics. The dental students’ (n = 33) and the supervisor’s assessments of the RCTs were compared postoperatively at the Dental Educational Unit, Oulu, Finland. After completing the ECAF, the students’ experiences of its use were explored with a structured form. In ECAF, patient-derived factors, such as gagging, deviant crown morphology, and complications in previous endodontic treatment, were all significantly associated with complications in RCTs by the dental students (p < 0.05). The assessments by students and the supervisor differed in 55% of cases, especially in moderately difficult cases. In the majority of these cases (71%), the students evaluated the case to be easier than the teacher. Students found the ECAF user-friendly, even if it did not demonstrate their competence in accomplishing RCTs. The ECAF appears useful for junior dentists, specifically in terms of distinguishing the least and most difficult cases. A simpler form could be useful for students and clinicians.

Get Smart – technological innovations in endodontics part 2: case-difficulty assessment and future perspectives

Given the importance of risk management to avoid mishaps, to achieve a quality result and to ensure a favourable outcome, challenging endodontic cases are best treated by clinicians with the appropriate level of training and experience. Digital and technological innovations in endodontics have led to the development of web-based and smartphone-compatible case-difficulty assessment tools that can help less-experienced dentists identify endodontic management complexities. These interactive tools may also be used for other applications, including primary and secondary care triage, research and dental education. Similarly, advances such as artificial intelligence and mixed reality technologies, are predicted to also benefit endodontics and help support dentists in the management of complex endodontic cases. CPD/Clinical Relevance: Digital and technological developments may help improve the management and treatment of endodontic cases.

Impact of endodontic case difficulty on operating time of single visit nonsurgical endodontic treatment under general anesthesia

Background A Case Difficulty Assessment Form was designed for use in endodontic curricula, and to assist practitioners with treatment planning, referral and recording. The aim of this study was to determine how endodontic case difficulty factors influence the operating time of single-visit nonsurgical endodontic treatments under general anesthesia. Methods Data on 198 single-visit endodontic treatments (80 anterior teeth, 43 premolars, and 75 molars) performed under general anesthesia by a specialized practitioner were obtained from 119 special needs patients (mean [SD] age = 30.7 [14.7] years). Total duration of operation was analyzed with relation to demographic and dental factors and American Association of Endodontists (AAE) Case Difficulty Assessment factors. Mann–Whitney U test, t-test, and Kruskal–Wallis test were used to assess relationships between operating time and confounding factors (p < 0.05). Results High difficulty cases required significantly longer time to complete operations than treatments of minimal-to-moderate difficulty regardless of tooth type (p < 0.05). Demographic factors of the patients rarely influenced operating time length. Among variables included in the AAE Case Difficulty Assessment Form, tooth position, crown morphology, root morphology, canal appearance, and periodontal condition were significantly associated with increased operating time (p < 0.05). Conclusions A higher level of case difficulty contributed to increased duration of endodontic treatment under general anesthesia indicating that Endodontic Case Difficulty Assessment Form is useful for predicting the duration of nonsurgical endodontic treatment. Among many factors, complicated anatomic features of the treated teeth increased case complexity and extended operating time.

Root canal curvature as a prognostic factor influencing the diagnostic accuracy of radiographic working length determination and postoperative canal axis modification: an in vitro comparative study

Background Radiographic analysis of tooth morphology is mandatory for accurate calibration of the degree of canal curvature angle and radiographic working length to its real dimensions in case difficulty assessment protocols. This study aimed to determine the impact of the degree of root canal curvature angle on maintaining the real working length and the original canal axis of prepared root canals using a reciprocating rotary instrumentation technique. Methods Radiographic image analysis was performed on 60 extracted single-rooted human premolar teeth with a moderate canal curvature (10°–25°) and severe canal curvature (26°–70°). Working length and longitudinal canal axis were determined using cone-beam computed tomography (CBCT) and digital periapical radiography. The real canal length was determined by subtracting 0.5 mm from the actual canal length. Root canals were prepared using the WaveOne Gold reciprocating file (Dentsply Maillefer, Ballaigues, Switzerland). Results There was no significant relation of the degree of canal curvature angle to the accuracy of radiographic working length estimated on CBCT and digital periapical radiographic techniques (P > 0.05). Postinstrumentation changes in the original canal axis between moderate and severe canal curvature angles, assessed on CBCT and periapical digital radiographic images were statistically non-significant (P > 0.05). Conclusions A standardized digital periapical radiographic method performed similarly to the CBCT technique near to its true working length. No significant interaction exists between the diagnostic working length estimation, postoperative root canal axis modification, and the degree of canal curvature angle, using reciprocating rotary instrumentation technique.

Estimation Accuracy of Root Canal Curvatures from Different Dental Diagnostic Imaging Techniques: An In Vitro Experimental Study

In clinical endodontics, preoperative estimation of root canal curvature is crucial regarding the prevention of iatrogenic errors. Reproduction of the two-dimensional radiographic images causes certain proximal view curvatures not seen. Therefore, the present study is aimed at investigating the degree of root canal curvature identified in different radiographic views. A total of 60 human permanent single-rooted teeth with varying degrees of curvature were selected. The root canal curvature for each tooth was measured on cone-beam computed tomography (CBCT) images (clinical view), standard digital periapical view (0° angle), digital periapical horizontal parallax view (30° angle), and digital periapical proximal view (0° angle), by using the Schneider method. No statistically significant difference was found in the degree of curvatures estimated on CBCT images and standard digital periapical view (0° angle) in the same tooth. The results revealed a significant difference between the proximal view and the other three groups ( p < 0.05 ). There was no significant difference in this respect between the horizontal parallax view (30° angle), clinical view (CBCT images), and standard digital periapical view ( p > 0.05 ). Proximal view curvatures cannot be predicted or estimated only from examining a clinical view radiograph. A horizontal parallax view (30° angle) is highly recommended as specific guidelines on how to estimate root canal curvature in case difficulty assessment protocols.

Root canal curvature as a prognostic factor influencing the diagnostic accuracy of radiographic working length determination and postoperative canal axis modification: An in vitro comparative study.

Background: Radiographic analysis of tooth morphology is mandatory for accurate calibration of the degree of canal curvature angle and radiographic working length to its real dimensions in case difficulty assessment protocols. This study aimed to determine the impact of the degree of root canal curvature angle on maintaining the real working length and the original canal axis of prepared root canals using a reciprocating rotary instrumentation technique. Methods: Radiographic image analysis were performed on 60 extracted single-rooted human premolar teeth with a moderate canal curvature (10-25o) and severe canal curvature (26-70o). Working length and longitudinal canal axis were determined using cone-beam computed tomography (CBCT) and digital periapical radiography. The real working length was established by subtracting 0.5 mm from the actual canal length. Root canals were prepared using the WaveOne Gold reciprocating file (Dentsply Maillefer, Ballaigues, Switzerland). Results: There was no significant relation of the degree of canal curvature angle to the accuracy of radiographic working length estimated on CBCT and digital periapical radiographic techniques (P > 0.05). Postinstrumentation changes in the original canal axis between moderate and severe canal curvature angles, assessed on CBCT and periapical digital radiographic images were statistically non-significant (P >0.05). Conclusion: A standardized digital periapical radiographic method performed similarly to the CBCT technique closest to its real canal length. No significant interaction exists between the diagnostic working length estimation, postoperative root canal axis modification, and the degree of canal curvature angle, using reciprocating rotary instrumentation technique.