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.

Comparison of students' perception of problem-based learning and traditional teaching method in a Nigerian dental school.

OBJECTIVES: To evaluate the perceptions of dental students on problem-based learning, PBL, in comparison with the traditional lecture (TL) method. METHODS: This comparative study was conducted amongst 72 dental undergraduates. PBL was introduced to the students before the commencement of course. PBL method was used by the student to learn about cariology, whilst other lecture topics were taught by the TL. Students were not informed at the beginning of the course about end of course assessment of learning and teaching methods to limit their bias. The study was approved by the institution's ethics committee, and informed consent was obtained from participants at the end of the course to recruit them into the study. The students worked in small groups to solve tasks on clinical case scenarios. Four class sessions were held for presentations and discussions. The students' perceptions concerning the two teaching methods were sought by the use of an anonymously completed questionnaire. Six perceived factors that influenced the teaching and learning process were extracted from the twenty-two-perception-item questionnaire using factor analysis. Paired sample t test was used for comparison of means. RESULTS: The highest mean scores for all six perceived factors were observed in the PBL method. There were statistically significant differences (P < .05) between PBL and TL teaching methods for all the perceived factors; ("Challenge critical thinking," "Communication with peers," "Usefulness as pedagogical method," "Organization" and "Interaction between students and tutors") except for the perceived factor "Adequacy of teaching." The mean for most of the perception items was highest in the PBL method compared to TL. The perception item "Able to provide intellectual stimulation" had the highest mean score (4.21 ± 0.76) for the PBL method, whilst it was "Laboratory exercise" (4.14 ± 0.68) for TL. CONCLUSIONS: Students' perception of the two educational methods investigated showed a preference for the PBL method. The students felt that PBL provided a higher ability for intellectual stimulation.

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.

The Efficacy of Calcium Hydroxide Powder mixed with 0.2% Chlorhexidine Digluconate or mixed with Normal Saline as Intracanal Medicament in the Treatment of Apical Periodontitis.

AIM: To compare the efficacy of calcium hydroxide powder mixed with 0.2% chlorhexidine digluconate or mixed with normal saline as intracanal medicament in the treatment of apical periodontitis. MATERIALS AND METHODS: Subjects were 55 in number aged 17 to 60 years. Two-visit conventional root canal treatment was performed on 70 teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with 35 teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. All treated teeth were evaluated clinically and radiographically for signs and symptom of periapical infection at specified periods postoperatively. Overall efficacy of medicament was rated based on quality guidelines for endodontic treatment by the European Society of Endodontology 2006. RESULTS: A postoperative favorable outcome of 97.1% in the control group and 94.3% in the experimental group was observed at 6-month review. This difference was not statistically significant (p > 0.05). CONCLUSION: The use of normal saline or 0.2% chlorhexidine digluconate to mix calcium hydroxide used as intracanal medicament during endodontic treatment resulted in high postoperative favorable outcomes. CLINICAL SIGNIFICANCE: Efficacy of 0.2% chlorhexidine digluconate as a vehicle for mixing calcium hydroxide as an intracanal medicament in the treatment of apical periodontitis is comparable to the efficacy of calcium hydroxide mixed with normal saline.

Distal cervical caries in second molars associated with impacted mandibular third molars: a case-control study.

OBJECTIVE: This study compares the incidence of cervical caries in the mandibular second molar associated with impacted third molar with that of fully erupted third molar. STUDY DESIGN: The participants consisted of subjects with second molar adjacent to an impacted third molar (study group), and subject with second molar adjacent to a fully erupted third molar (control group). Incidence of cervical caries on the second molar and other variables were recorded and analyzed for both groups. RESULTS: The incidence of distal cervical caries in the study group was 15.7% and no case of distal cervical caries was seen in the control (P = .000). DMF score in study group was significantly lower than in control (P = .000). The incidence of distal cervical caries increased with age of subjects and DMF scores (P ≤ .05). CONCLUSIONS: Distal cervical caries in second molars is a phenomenon limited only to impacted mandibular third molars.

Oral health-related quality of life following non-surgical (routine) tooth extraction: A pilot study.

AIM: The study was designed to explore the changes in oral health-related quality of life (QoL) in the immediate postoperative period following routine (non-surgical) dental extraction. SETTING AND DESIGN: A prospective study carried out at the Oral and Maxillofacial Surgery clinic of the Lagos University Teaching Hospital, Nigeria. MATERIALS AND METHODS: Subjects attending who required non-surgical removal of one or two teeth under local anesthesia were included in the study. A baseline QoL questionnaire (oral health impact profile-14 [OHIP-14]) was filled by each patient just before surgery, and only those who were considered to have their QoL "not affected" (total score 14 or less) were included in the study. After the extraction, each subject was given a modified form of "health related QoL" [OHIP-14]-instrument to be completed by the 3(rd) day-after surgery, and were given the opportunity to review the questionnaire on the 7(th) day postoperative review. RESULTS: Total OHIP-14 scores ranged between 14 and 48 (mean ± SD, 26.2 ± 8.3). Majority of the subjects (60%) reported, "a little affected." Only few subjects (5.8%) reported, "not at all affected," and about 32% reported, "quite a lot." Summation of OHIP-14 scores revealed that QoL was "affected" in 41 subjects (34.2%) and "not affected" in 79 subjects (65.8%). More than 30% of subjects reported that their ability to chew, ability to open the mouth and enjoyment of food were affected following tooth extraction. Few subjects (14-34%) reported deterioration in their speech and less than 20% of subjects reported that change in their appearance was "affected." Only few subjects (12.5-15.1%) reported sleep and duty impairment. Thirty-percent of subjects reported their inability to keep social activities, and 41% were not able to continue with their favorite sports and hobbies. Multiple regression analysis revealed no significant association between age, sex, indications for extraction, duration of extraction, intra-operative complications, and deterioration in QoL (P < 0.05). Consumption of analgesics beyond postoperative day 1 (POD1) was more common in subjects with socket healing complications than those without (P = 0.000). About 33% of subjects reported, "inability to work" (1-3 days). CONCLUSION: About a third of subjects experienced significant deterioration in QoL. The most affected domains were eating/diet variation and speech variation. Therefore, patients should be informed of possible deterioration in their QoL following non-surgical tooth extraction.

Experience of wrong-site tooth extraction among Nigerian dentists.

OBJECTIVE: To report the experience of wrong-site tooth extraction among Nigerian dentists. STUDY DESIGN: A self-administered questionnaire was distributed among a cross-section of Nigerian dentists. Information requested included personal experience on wrong-site tooth/teeth extraction and its after-effect, possible reasons for wrong-site tooth extraction and documentation of the event in patients' case. Respondents were also asked if they were aware of any colleagues who had previously experienced wrong-site tooth extraction and possible legal implication of the event, and if they aware of the universal protocol for preventing wrong site, wrong procedure, and wrong person surgery. RESULTS: Twenty-two (13%) of the respondents reported having extracted a wrong tooth. The event occurred within 5 years after graduation in most cases. Most respondents (53.6%) informed the patient immediately after the event. Only 68% of the respondents documented the event in patient's case record. Most common reasons for wrong-site tooth extraction were heavy workload, presence of multiple condemned teeth and miscommunication between dentists. Fifty-five percent of respondents were aware of a colleague who had extracted a wrong tooth. The most probable legal implication of wrong-site tooth extraction according to the respondents was litigation by the patient. Only 25% of dentists were aware of a universal protocol for preventing wrong-site surgery. CONCLUSIONS: Wrong tooth/teeth extraction is not an uncommon event in the studied environment. The need to be familiar with universal protocol on wrong-site surgery and its legal implications are highlighted.