Assessment Of Knowledge, Attitude And Practice Survey On Endodontic Failure Among Endodontists, Post Graduates And General Practitioners In South Indian Population - A Survey
Kalyani Behera .A1, S.Delphine Priscilla Antony2*, Haripriya .S2
1 Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Science,
Saveetha University, India.
2 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute Of Medical and Technical Science, Saveetha University, India.
*Corresponding Author
S. Delphine Priscilla Antony,
Senior Lecturer, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamallee High Road, Chennai – 600077, India.
E-mail: delphine.sdc@saveetha.com
Received: November 06, 2020 Accepted: November 21, 2020; Published: November 30, 2020
Citation:Kalyani Behera .A, S.Delphine Priscilla Antony, Haripriya .S. Assessment Of Knowledge, Attitude And Practice Survey On Endodontic Failure Among Endodontists, Post Graduates And General Practitioners In South Indian Population - A Survey. Int J Dentistry Oral Sci. 2019;S10:02:0020:106-112. doi: dx.doi.org/10.19070/2377-8075-SI02-0100020
Copyright: S. Delphine Priscilla Antony© 2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
The causes of endodontic failures are due to the variations in the anatomy of the teeth, the presence of additional root canals,
lateral canals, depend on technical, biological and iatrogenic factors so the correct diagnosis, optimal mechanical and chemical
preparation with three- dimensional obturation of the root canal will be the main goal of endodontic treatment. Having knowledge
about the relation between these factors may help in increasing the chances of preventing the possible endodontic treatment
failures. The questionnaire was closed- ended type consisting 15 questions, of which 5 were knowledge- baked, 5 were attitude
based, and 5 were practice -based questions. The questionnaire contained multiple responses. The answers to each question were
numerically coded, and the data were entered in the SPSS software. The results were analyzed by descriptive statistics including
frequencies and percentages.In the study, it was seen that the overall mean and standard deviation of knowledge score (53.4%),
attitude (44%) and practice (61%). Dentists, being members of the healthcare profession, should know about endodontic mishaps
and its management which may occur during procedure. Only 56.4% areaware of endodontic mishaps and its management according
to the study.
2.Introduction
3.Materials and Methods
4.Results and Discussion
5.Conclusion
6.Author Contribution
7.Acknowledgements
8.References
Keywords
Root Canal Treatment; Endodontic Failures; Retreatment.
Introduction
Endodontic failure is a recurrence of a clinical symptom with well
definedperiapical radiolucency, the success rate was upto 86-98%.
The factors which causes endodontic failure are the persistence
of bacteria (Intra- canal and Extra- canal), Inadequate filling of
the canal (canals that are poorly cleaned and obturated), overextension
of Root filling materials, Improper coronal seal (Leakage),
Untreated canals (both Major and accessory), Iatrogenic procedural
errors such as poor access cavity design, complications of
instrumentation (ledges, perforations (or) separated instruments.
All endodonticallytreated should be evaluated clinically as well as
radiographically [7]. To ensure the success of the treatment patients
should be given appointments for follow up.
The important role of an endodontic treatment is to retain the
tooth in the oral cavity. The purpose of root canal treatment is
to block all the passages for causing infections in the root canal
lumen and to form a fluid tight seal on apical foramen of tooth,
thereby leakage in the root canal system can be avoided and occurrence
of secondary infection is prevented [5]. Endodontic failures
can also be related for treating wrong tooth, missed canals,
damage to existing restorations, access cavity perforations, crown
fractures, instrumentation with ledge formation, cervical canal
perforations, mid root perforations, apical perforations, separated
instruments, foreign objects, canal blockage and obturation related
due to over extended, under- extended root canal fillings and
vertical root fractures [19, 3, 10]. Endodontic treatment is fairly
predictable in nature with reported success rate up to 86-98%
[18, 4, 6](“Impact of case difficulty on endodontic mishaps in an
undergraduate student clinic”, 2019).
The aim of Endodontic treatment should be thorough cleaning
and debridement of the root canal of an infected pulp, and filled
with an inert material, thus preventing (or) minimizing any chances of reinfection.
Materials And Methods
A total of 220 questionnaires were distributed with the guidance
of previous studies, the questionnaires were developed. A web
based survey tool was used to create the survey. The survey was
sent by email to Endodontists, post - graduates, General dental
practitioners in the South Indian population. The participants
were asked to answer 15 Multiple choice questions. The questions
were based on general approach towards Knowledge, attitude and
practice towards Endodontic failures.
Results And Discussion
200 respondents were received from the respondents. Among
200 responses received from the participants, 58.9% consisted of
males and 41% females of the participants [Figure 1] were of
mean group age (43%) age- (25- 30 yrs) followed by mean age
group (52%) age- (31- 40 yrs)of the 200 respondents [Figure 2 ]
and it was seen that the overall mean and standard deviation of
knowledge score (53.4%), attitude (44%) and practice (61%). Survey
results are explained in the figures given below (Figures 2- 16).
In the present study of era, emerging new advent methods and
tools, therapeutic and controlling measures applicable to the pulp
and periradicular diseases have been developed significantly to an extent that most of the teeth pulled out because of root damages
and dental caries in the past, which are now maintained by undergoing
Endodontic treatment with a relatively good prognosis [13].
Many teeth require RCT due to caries, trauma, (or) other reasons.
Considering millions of people needing RCT, patients should be
aware of the success rate and soundness of this method. Investigations
have revealed that the majority of root canal failures
are due to procedural accidents [14]. Moreover, based on these
findings, the level of students' knowledge about treatment and
prognosis is higher than their knowledge about the causes and
prevention Methods.
Some of the most common procedural accidents include perforation
of the pulp chambers during preparation of access cavity,
creating ledges, broken instruments, root perforation, and a
vertical root breakage [2]; such accidents can happen in various
stages of Endodontic treatment such as developing access chamber,
canal formation and cleaning, canal filling or preparation of post chambers. Being unaware of the causes (Teja KV 2018)
[15], prevention and method of treating procedural accidents
cause different complications such as canal blockage, Incomplete
canal cleaning (or) various physical , chemical and thermal
stresses. Furthermore , being aware of the procedural accidents
can be useful to prevent them. The therapists should also know
how to diagnose and treat such procedural accidents, reviewed
the outcome of Endodontic procedural errors [8, 9]. They indicated
that Endodontic procedural errors are not the direct cause
of treatment failure [16]. Many authors reported that one of the
stresses of reasons for furcation perforations, Missed canals, over
perforations ,strip perforations, kedge , zipping , broken Files,
and apical perforation (R et al., 2019). There has not been any
research to compare the level of knowledge of Male and female
respondents about Endodontic procedural accidents, However ,
increasing hours of practical teaching and workshops can be helpful
in increasing students' awareness in this area. Furthermore, it is
essential to have knowledge about the procedural accidents [12].
Moreover, therapeutic and diagnostic methods and the impacts
of such accidents on prognosis should be learned [8]. Most of
the pertinent problems can be prevented by observing the fundamental
principles of diagnosis, tooth selection, treatment plan, preparation by observing the fundamentals. Principles of diagnosis,
tooth selection, treatment plan, preparation of access cavity,
canal formation and cleaning, canal filling and preparation of
post chamber [20].
Figure 1. Bar chart showing comparison of responses based on gender to the field of practice in the survey, where X axis represents the field of practice and Y axis represents the number of respondents. Higher number of males reported (119) when compared to females ( 81) and there is no significant difference in responses between males and females ( Chi square test;(p value >0.05)- Not Significant [ Blue- Female; Green- Male]
Figure 2. Bar chart showing the age distribution of the respondents to the field of practice involved in the survey, where X axis represents the field of practice and Y axis represents the number of respondents. Higher number among (19-25 years) of age groups was 2.5 times higher when compared to other age groups and this was found to be statistically significant. ( Chi square test;(p value < 0.05)- Significant [ Blue- 19-25yrs, Green-25-30 yrs, Grey- 31-40 yrs and Violet- 41-50 yrs].
Figure 3. Bar chart showing the correlation between the field of practice and their response regarding common missed canals, where X axis represents the field of practice and Y axis represents the number of respondents and there was significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality.( Chi square test;(p value < 0.05)- Significant [Blue- Mesiobuccal canal of maxillary first molars, Green- Mesiobuccal canal of maxillary second molars, Grey- Mesiolingual canal of mandibular second molars, Violet- Medial mesial canal of mandibular second molars].
Figure 4. Bar chart showing the correlation between the field of practice and their response regarding common cause of endodontic failure, where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality ( Chi square test;(p value >0.05)- Not Significant [ Blue- Instrument separation, Green- Canal blockage, Grey- Ledge formation and Violet- Perforations]
Figure 5. Bar chart showing the correlation between the field of practice and their response regarding Factors affecting failure of endodontic therapy, where X axis represents the field of practice and Y axis represents the number of respondents and there was significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality.( Chi square test;(p value < 0.05)- Significant [Blue- Diagnosis and a treatment planning, Green- Radiographic interpretation , Grey- Anatomy of the tooth and root canal system, Violet- Debridement of root canal system and Yellow- All of the above].
Figure 6. Bar chart showing the correlation between the field of practice and their response regarding ledge formation, where X axis represents the field of practice and Y axis represents the number of respondents and there was significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality.( Chi square test;(p value < 0.05)- Significant [Blue- Over enlargement of small curved canals,Green- Calcification, Grey- Multiple canals and Violet- straight - Straight canals].
Figure 7. Bar chart showing the correlation between the field of practice and their response regarding cause of perforation during access cavity, where X axis represents the field of practice and Y axis represents the number of respondents and there was significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality. ( Chi square test;(p value < 0.05)- Significant [Blue-Improper size of the bur, Green- Lack of proper degree of axial inclination, Grey- Additional canals and Violet- Debris accumulation].
Figure 8. Bar chart showing the correlation between the field of practice and their response regarding ,errors that happen during instrument separation, where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality ( Chi square test;(p value >0.05)- Not Significant Green-Inadequate lubrication, Grey- increased speed of instrumentation and violet- improper radiographic examination].
Figure 9. Bar chart showing the correlation between the field of practice and their response regarding ,errors that happen during instrument separation, where X axis represents the field of practice and Y axis represents the number of respondents and there was significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduat es and other speciality.( Chi square test;(p value < 0.05)- Significant [Blue- Accurate working length measurement, Greenproper cleaning and shaping, Grey- proper radiographic examination, Violet- All of the above]
Figure 10. Bar chart showing the correlation between the field of practice and their response regarding Is age is successful for endodontic treatment , where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality ( Chi square test;(p value >0.05)- Not Significant [ Blue- yes, Green- no and Grey- may be]
Figure 11. Bar chart showing the correlation between the field of practice and their response regardingIsendodontically treated tooth is always successful , where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgr aduates and other speciality ( Chi square test;(p value >0.05)- Not Significant[ Blue- yes, Green- no, Grey- sometimes and Violet- not always]
Figure 12. Bar chart showing the correlation between the field of practice and their response regarding In which file is not retrievable easily, where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality. (Chi square test;(p value >0.05)- Not Significant[ Blue- apical third, Green- middle third and grey- coronal third].
Figure 13. Bar chart showing the correlation between the field of practice and their response regarding Ledging bypassed by , where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality ( Chi square test;(p value >0.05)- Not Significant [Blue- using teardrop shaped file, Green- using air rotor with long bur, Grey- using EDTA and violet- Extraction of tooth].
Figure 14. Bar chart showing the correlation between the field of practice and their response regarding materials used in management of perforations, where X axis represents the field of practice and Y axis represents the number of respondents and there was significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality.( Chi square test;(p value < 0.05)- Significant [ Blue- Zinc oxide eugenol, Green- MTA, Grey- Dycal and Violet- composites]
Figure 15. Bar chart showing the correlation between the field of practice and their response regarding best method to treat endodontic failure , where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality ( Chi square test;(p value >0.05)- Not Significant [Blue- non surgical root canal treatment, Green- surgical method, Grey- leave as it is and Violet- Extraction]
Figure 16. Bar chart showing the correlation between the field of practice and their response regarding missed canal during access cavity preparation, where X axis represents the field of practice and Y axis represents the number of respondents and there is no significant difference in the responses obtained from Endodontists,generalpractitioners,postgraduates and other speciality ( Chi square test;(p value >0.05)- Not Significant [ Blue-ultrasonics, Green- methylene blue, Grey- champagne bubble test and violet- magnification loupes]
Conclusion
The clinician must practice careful treatment strategies for working
length, precautions against over instrumentation. The direct
cause of treatment failures are the endodontic procedural errors,
with high enhanced magnification by operating microscope, almost
all procedural errors during endodontic therapy can be minimised.
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