Treatment Outcome and Root Canal Preparation Techniques: 5-Year Follow-Up.

OBJECTIVE: This study aims at comparing treatment outcome and tooth survival of root canal-filled teeth following manual vs rotary instrumentation techniques over a 5-year period. METHODS: This was a single-centre study conducted as a follow-up to a short-term parallel-arm randomised controlled noninferiority trial in which root canal treatment was performed on teeth using either rotary or manual instrumentation. Patients were monitored at post 6-month, 1-year, 4-year, and 5-year review periods by blinded evaluators. Treatment outcome was categorised as favourable, uncertain, and unfavourable (employing European Society of Endodontology categorisation based on strict clinical and radiographic criteria), and 5-year tooth survival was determined by assessing whether tooth was in situ in the oral cavity or extracted. The Kaplan-Meier method and log rank test evaluated tooth survival. P value <.05 was considered statistically significant. RESULTS: Ninety of 120 treated teeth were assessed in 37 men and 40 women with mean age of 30.6 ± 10.99 years. Treatment outcome was significantly more favourable in the rotary group compared to the manual group at post 6-month (P = .021) and 1-year (P = .043) review periods. The differences in favourable outcome (P = .498) and tooth survival (P = .296) between the 2 groups were, however, not significant at the 5-year review period. CONCLUSIONS: The rotary instrumentation technique was shown to be more effective in resolving clinical symptoms and promoting periapical healing after the post 6-month and 1-year review compared to the manual instrumentation technique; however, both groups had similar favourable outcomes and survival rates after an extended 5-year review period.

Managing the phase-down of amalgam amongst Nigerian dental professionals and students: A national survey.

BACKGROUND: Amalgam is one of the most reliable dental restorative materials. Health and environmental concerns associated with the mercury content of amalgam have necessitated an amalgam phase-down in clinical practice. OBJECTIVES: This study investigated the level of awareness and preparedness for the planned amalgam phase-down recommended by the Minamata Convention amongst Nigerian dental students and dentists. METHODS: This cross-sectional national survey was performed across all geopolitical zones of Nigeria. Data regarding awareness, practice and level of preparedness for amalgam phase-down were obtained using a questionnaire that was distributed amongst clinical dental students and dentists of different cadres, who routinely place dental restorations, in public and private practice. The questionnaires were administered online or were hand delivered. Data were analysed using the chi-square test and Spearman's rank correlation coefficient. A p value ≤ 0.05 was considered statistically significant. RESULTS: Notably, 845 dental students and dentists participated in the survey. Mean age (±standard deviation) of participants was 30.15 ± 7.67 years, 33.8% were students, and 66.2% were dentists (most dentists [77.1%] were employed at public hospitals). A significant percentage of respondents had poor knowledge of the Minamata Convention (87.7%) and lacked training in the use of alternatives to amalgam (72.0%). Amalgam continues to be commonly used by 39.1% and 31.3% of dental students and dentists, respectively. Only 4.7% of the respondents admitted to following good amalgam phase-down practices. Awareness (P = 0.013) and amalgam phase-down practices (P = 0.011) were significantly higher amongst dentists than amongst dental students. CONCLUSION: We observed low levels of awareness regarding the Minamata Convention, amalgam phase-down, mercury hygiene practices and training in alternatives to amalgam use amongst Nigerian dental professionals and students.

Amalgam phase down: baseline data preceding implementation in Nigeria.

OBJECTIVE: The Minimata Convention on mercury includes amalgam phase-down and eventual phase-out from dentistry. To aid its subsequent evaluation it is important to have baseline data of amalgam use in a locality prior to implementing a phase-down. METHODOLOGY: Records of patients spanning 5 years from January 2011 to January 2016 were analysed to determine and the compare frequency of amalgam usage with other dental materials for carious teeth restorations in a Nigerian university teaching hospital. Classes of cavities restored and cadres of operators who employed the different materials were included. Institutional ethics committee approval was obtained prior to commencing the study. RESULTS: 2,058 patients' records were retrieved, 59% females and 41% males. Their ages ranged 19-80 years, mean 33.5 ± 12.7 years, young adults 20-39 years old were the majority (62.9%). Filling materials included 57.5% amalgam, 17.6% glass ionomer cement (GIC) and 24.9% resin composite. Class I restorations constituted 70.5% of amalgam restorations, while Class II restorations made up 29.4% and Class V restorations accounted for 0.1%. Undergraduate dental students placed most of the amalgam restorations (60.5%), and 78.9% of all their restorations were amalgam. Less experienced dentists used all materials equally; the more experienced dentists placed more composite resin and GIC (43.3%). CONCLUSION: Amalgam fillings constituted nearly 60% of the restorations of carious teeth. Training of dental students in placement of non-mercury alternatives to amalgam and Minimum Intervention Dentistry needs to be emphasized in dental schools. Phase-down of amalgam should be intensified in Nigeria with the ultimate aim of a phase-out in line with the Minamata Convention.

Comparison of the incidence of flare-up and time efficiency in single visit root canal treatment employing either rotary or manual step-back canal preparatory technique.

AIM: This study aims to compare the incidence of flare-up and operating time in root canal treatments where rotary or manual step-back canal preparatory technique was employed. MATERIALS AND METHODS: A randomised study was conducted in a Nigerian Teaching Hospital. One hundred and twenty teeth belonging to 95 patients were randomised into two (Rotary and Manual) groups. Root canal treatment was performed using either rotary or manual step-back canal preparatory technique. Canal preparation time and total operating time were measured. Patients were monitored for severe pain and/or swelling over 1-week. Data were analysed using SPSS version 20.0, at alpha-level of P ≤ 0.05. Chi-square and independent Student's t-test were employed for comparison where categorical and numeric variables were involved, respectively. RESULTS: There was neither associated pain/swelling before treatment in 28 (46.7%) of the teeth in rotary group nor in 27 (45.0%) of the teeth in manual group. Pain incidence was 11.7% and 16.7% in rotary and manual groups, respectively, at 1-week review. Severe pain was experienced by 3.3% patients in both groups at 1-week review. Only 1.7% and 6.7% in rotary and manual groups, respectively, presented with swelling over 1-week. Flare-up incidence at 1-week review was 3.3% in rotary and 8.3% in manual groups, the difference was not significant (P = 0.243). Canal preparation and total operating times were significantly shorter (P < 0.05) in the rotary group in all tooth categories. CONCLUSION: No significant difference was noted in flare-up incidence between rotary and manual groups. Canal preparation time and total operating time were significantly shorter for rotary technique. Time efficiency is clinically invaluable, especially for multi-rooted teeth.