The use of radiography and the apex locator in endodontic treatment within the UK: a comparison between endodontic specialists and general dental practitioners.

AIM: To investigate the attitudes of general dental practitioners (GDPs) and specialist endodontists working in the UK in the use of radiography and apex locators during root canal treatment and to see if use was related to respondent's age and the year of graduation. METHODOLOGY: A postal questionnaire was sent to 857 randomly selected GDPs and all endodontic specialists working in the UK (170). Non-responders were sent a further two mailings. Chi-squared tests were used to compare both groups at the P < 0.05 level of significance. For nonparametric data, the Mann-Whitney U test was employed. RESULTS: The overall response rate was 73%. There were significant differences between endodontic specialists and GDPs in the prescription of the preoperative, the cone-fit and the postoperative radiograph. A total of 114 (86.4%) endodontic specialists and 321 (53.2%) GDPs reported using an apex locator (P < 0.001). Eighty-eight (66.7%) endodontists and 217 (36%) GDPs used an apex locator and a radiograph to determine the working length for a single-rooted tooth (P < 0.001). For multi-rooted teeth, 91 (68.9%) endodontists and 229 (38%) GDPs used a combined approach of an electronic apex locator and a working-length radiograph (P < 0.001). One-millimetre short of the radiographic apex was employed by 56.2% of respondents as the apical limit. There were significant differences (P < 0.001) between the two groups with regard to routine radiographic follow-up. CONCLUSIONS: Both endodontists and GDPs were found to be observing national guidelines when performing root canal treatment. Greater use of apex locators was found amongst endodontists who tended to use a combined approach of an apex locator and periapical radiography.

A questionnaire study to derive information on the working environment, clinical training, use of ancillary staff and optimization of patient radiation dose within UK dental practice.

AIM: To evaluate the working environment of GDPs and Endodontists and the methods used to optimize patient radiation dose. METHODOLOGY: A total of 857 GDPs and 170 specialist Endodontists were contacted. The responders, 603 of the former and 132 of the latter, completed a questionnaire covering practitioner demographics, pattern of practice, the use of radiographic techniques and the optimization of dose. Chi-squared tests were used to compare groups at the P=0.05 level of significance. For nonparametric data, the Mann-Whitney U-test was employed. RESULTS: A response rate of 73% was achieved. Overall, 79.5% of endodontic specialists used film holders compared with 65.9% of GDPs (P=0.001). One hundred and thirty (98.5%) endodontists and 581 (96.3%) GDPs reported that they were well prepared or adequately prepared in radiographically assessing the presence of apical pathosis. The study found significant differences (P<0.001) between the use of digital radiography by specialist endodontists 93 (70.5%) compared with general dental practitioners 167 (27.7%). Significant differences (P=0.004) were also observed in the use of rectangular collimation between endodontic specialists 55 (42%) and GDPs 223 (37%). With regard to the use of film holders in diagnostic radiography, 105 (79.5%) of endodontic specialists employed these devices compared with 396 (65.7%) GDPs; this finding was significant (P=0.005). For working length estimation, significant differences (P=0.001) were noted in the use of a film holder between endodontic specialists 105 (79.5%) and GDPs 386 (64%). CONCLUSIONS: Both Endodontists and GDPs demonstrated compliance with guidelines relating to radiation protection being more significant amongst those clinicians working within specialist clinical practice.

The impact of different viewing conditions on radiological file and working length measurement.

AIM: To determine the effect of different viewing conditions and observer experience upon the accuracy of file and working length measurements using analogue intra-oral radiographs. METHODOLOGY: Twenty-five observers from a range of clinical backgrounds examined working length analogue periapical radiographs of 30 extracted teeth. Each participant measured both file (FL) and working length (WL) on each of the radiographs using three different viewing conditions consisting of a viewing box, a viewing box with film masking and a viewing box with film masking and x2 magnification. Statistical analysis was conducted to derive interobserver reliability by intraclass correlation coefficients, and multiple linear regression models were fitted to compare the mean differences between the joint consensus between specialists and estimated values for file length and working length for each of the three viewing conditions. RESULTS: Multiple regressions models were fitted and found significant differences between the use of the viewing box alone and a viewing box with masking (FL P = 0.001; WL P < 0.001) and the use of the viewing box alone and with a viewing box employing masking and magnification (FL P < 0.001; WL P = 0.002). Intraclass correlation coefficient showed a high level of agreement between all observers; however, no statistically significant differences were found between the five observers groups for either mean file length or working length values. CONCLUSIONS: The results of this study are in agreement with National and European guidelines, which recommend the use of a viewing box, magnification and masking for radiographic interpretation.