|Year : 2017 | Volume
| Issue : 1 | Page : 23-26
Knowledge, attitude, and practice among pediatric dentists regarding the use of rotary endodontic instruments for endodontic treatment in India
Devanshi Nareshkumar Mehta, Bhavna Haresh Dave, Seema S Bargale, KS Poonacha, Vinay Mulchandani, Princy S Thomas
Department of Paedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Vadodara, Gujarat, India
|Date of Web Publication||17-Jul-2017|
Devanshi Nareshkumar Mehta
10/56, Ellora Park, Nr. Race Course Circle, Subhanpura, Vadodara - 390 023, Gujarat
Source of Support: None, Conflict of Interest: None
Background: In pediatric dentistry, loss of deciduous molars due to carious involvement is a major concern. Hence, endodontic therapy for primary teeth should be considered as a treatment of choice wherever required. Traditionally, used hand instruments were replaced by nickel–titanium alloy instruments to overcome disadvantages. Students' perceptions of these instruments and techniques used for endodontic treatment must be collected for knowledge, quality of endodontic education, and the level of practice among the students in the branch of pediatric dentistry. Aim: To evaluate the view of pediatric dentists on the use of rotary endodontic instruments for cleaning and shaping of canal in primary teeth in India. Materials and Methods: A total of 596 pediatric dentists registered with the Indian Society of Paedodontics and Preventive Dentistry were included in the study using an online questionnaire sent to the student members through the source of e-mail twice. Results: According to this study, from 365 participants, 85% of the participants were in favor of using rotary instruments for cleaning and shaping during endodontic treatment in pediatric practice and 38.1% of the participants were using rotary endodontic instruments in pediatric practice. Nearly 86.6% of the participants were in favor of the absolute need for an exclusive pediatric rotary endodontic system. Conclusion: The response of the study was as much as 60.83%. The results of the study reflect that the postgraduate students are keen on the usage of rotary instruments for cleaning and shaping of canal in endodontic treatment in primary teeth in pediatric practice.
Keywords: Cleaning and shaping, endodontic instruments, primary teeth, rotary instruments
|How to cite this article:|
Mehta DN, Dave BH, Bargale SS, Poonacha K S, Mulchandani V, Thomas PS. Knowledge, attitude, and practice among pediatric dentists regarding the use of rotary endodontic instruments for endodontic treatment in India. Indian J Oral Health Res 2017;3:23-6
|How to cite this URL:|
Mehta DN, Dave BH, Bargale SS, Poonacha K S, Mulchandani V, Thomas PS. Knowledge, attitude, and practice among pediatric dentists regarding the use of rotary endodontic instruments for endodontic treatment in India. Indian J Oral Health Res [serial online] 2017 [cited 2020 Jul 14];3:23-6. Available from: http://www.ijohr.org/text.asp?2017/3/1/23/210925
| Introduction|| |
In pediatric dentistry, the premature loss of deciduous posterior teeth can lead to difficulty in mastication and space loss. Hence, preservation of the carious deciduous teeth with pulpal involvement by endodontic therapy is a wise option compared to extraction. Endodontics has evolved with the introduction of many new instruments, materials, and techniques. Hence, upgradation of knowledge of the clinicians is essential to provide patients with most recent and predictable treatment planning. Traditionally, hand instruments made up of stainless steel were used for cleaning and shaping of the root canal in primary teeth. However, the concerns of its use in primary teeth were a lack of flexibility and increased preparation time. Especially, in young children with limited cooperation, procedural errors and inconsistency of quality tapered preparation compromised the clinical prognosis. To overcome some of these issues, nickel–titanium alloy was introduced in endodontics by Walia et al. (1988) which fulfilled the objectives of simplicity, speed, safety, and stress reduction for both the clinician and the patient. The use of rotary systems demands a thorough knowledge and previous training regarding their use. Moreover, root canals of primary teeth are complex, flattened, narrow, curved, and ribbon-shaped with a lot of variability which makes it difficult to prepare them. Research data on knowledge, attitude, and practice regarding the use of rotary instruments in cleaning and shaping by pediatric dentists are rare, and hence this study will help to generate data for the same.
The questionnaire-based study aimed at identifying issues that influence treatment decisions from the operator point of view, by exploring pedodontists' perspectives on treatment approaches.
| Materials and Methods|| |
The present cross-sectional study was carried out among the students in pediatric dentists in different parts of India. A list of student members registered with the Indian Society of Paedodontics and Preventive Dentistry was obtained from the Office of Indian Society of Paedodontics and Preventive Dentistry. A total sample of 596 was hence taken. The survey was conducted online using a questionnaire.
The questionnaire was self-prepared, validated, and reliable using Chi-square test. The questionnaire comprised a set of 12 validated questions. The validation of the questionnaire was done by the principal investigator himself/herself along with the professors, readers, and senior lecturers of the Department of Paedodontics and Preventive Dentistry of the same institute. Ethical clearance was obtained from the Institutional Ethical Committee Review Board.
A questionnaire was sent to the student members through the source of e-mail. Each student was sent the questionnaire twice. A response was awaited for a period of 3 months. Sixty percent of response rate was considered in the study as stated as a requirement by the American Association for Public Opinion Research.,
| Results|| |
According to this study, the observations were obtained from 365 participants from the total 600 participants who were sent the questionnaire through e-mail. That makes up to 60.83% response rate.
The question-wise result was obtained which is as under.
Out of the total participants, 85% of the participants favored the use of rotary instruments for cleaning and shaping during endodontic treatment in pediatric practice [Graph 1].
Nearly 55% of the total participants had attended a Continuing Dental Education (CDE) or Workshop regarding rotary instruments while 45% had not. Almost 67.2% of the participants were aware of the different generations and types of rotary endodontic instruments in pediatric practice from various sources. Only 43.2% were aware of minimally invasive files and its use in rotary endodontics in pediatric practice [Graph 2].
Only 38.1% of the participants were using rotary endodontic instruments for cleaning and shaping of canal during endodontic treatment in pediatric practice. Out of ten cases, 49.3% never used, 11.9% used in half of the cases, and 7.5% used in two cases out of ten for cleaning and shaping [Graph 3].
Almost 59.3% of the participants used rotary endodontic instruments in permanent teeth only, 9% participants used for primary teeth, and 41.8% used for both primary and permanent teeth. For 38.8% of the participants, use of both hand and rotary instruments was feasible [Graph 4].
From the results obtained from the study, 59.7% of the participants had the ease of working using rotary endodontic instruments in mandibular arch, 5.7% in maxillary arch; for 26.9% participants; it was same in both the arch while 7.7% participants found no difference. Nearly 79.1% of the participants found the use of hand instruments more time consuming and only 4.9% found rotary instruments time consuming. When asked about the reasons for not using rotary endodontic instruments in some cases, the participants were found to be concerned regarding the cost-effectiveness of the rotary instruments (36.4%), 33.2% had the fear of the curved canals while 14.9% had a concern regarding the patient cooperation [Graph 5].
In addition, 86.6% of the participants were in favor of the absolute need for an exclusive pediatric rotary endodontic system for cleaning and shaping during endodontic procedure.
| Discussion|| |
The introduction of these new technologies made endodontic treatment easier, faster, and better. In a postgraduate program, acquiring the knowledge of new instruments and techniques is very essential.
Various aspects regarding the knowledge, attitude, and practice of the postgraduate students were evaluated. According to this study, the maximum participants were in favor of rotary instruments for cleaning and shaping during endodontic treatment in pediatric practice [Graph 1]. The reason being cleaning and shaping could be done more effectively and efficiently using rotary instruments. The use of rotary files in primary teeth has several advantages when compared with manual files including the efficiency in both, preparation time and root canal shape as a decreased working time, increased patient cooperation by diminishing the potential for tiredness, favoring a higher quality of the root canal filling, and increasing clinical success.,
The adequate and quality knowledge regarding any instruments before its use is of utmost importance. The knowledge of the use of rotary instruments is mandatory to avoid the procedural errors and patient discomfort. Even the general practitioners and the endodontists are not well versed with the actual use of the rotary instruments to an extent. Therefore, it becomes more of concern about the knowledge among the pedodontists because of the age group they deal with. The awareness was found to be quite high in the participants of this but still was deficit. The modes of creating the awareness can be through lectures, CDE programs, web, etc. Reaching to the postgraduate students is the best way to spread the awareness as they are budding practitioners.
The minimally invasive dentistry is gaining popularity due to its advantages over the conventional. Minimal invasive dentistry in endodontic treatment is the use of the self-adjusting files. These files have an advantage of less cutting, safer use, and more flexibility. Its success with the curved canals in permanent teeth is well established., Hence, its knowledge which is limited among the pedodontists (43%) should be enhanced to gain out of the advantages in the permanent teeth and primary teeth.
The use of rotary instruments in primary teeth is less prevalent and practiced due to many possible reasons. Some of the known issues are the increased cost of the armamentarium involved, cyclic fatigue of endodontic instruments, proneness to fracture, and insufficient knowledge about the technique., The ratio of the participants using rotary instruments to the participants not using was very high in this study. The participants favored the use of rotary instruments in permanent teeth more compared to primary teeth. They had comfort in using both hand and rotary instruments in combination. The ease of working was more in the mandibular arch due to greater accessibility and higher visibility. This was similar to other studies.
The participants included in this study also voted for the introduction of an exclusive rotary system for primary teeth in pediatric practice. This will eliminate the fear from the practitioner's mind, encouraging more use, and thus demystify the suspense cloud.
| Conclusion|| |
The response of the study was as much as 60.83%. The results of the survey reflect that the postgraduate students are keen on the usage of rotary instruments for cleaning and shaping of canal in primary teeth in pediatric practice. The survey helps us to know that the participants have a positive attitude regarding the same. The advantages of the rotary instruments such as effectiveness for debridement of the uneven walls of primary teeth, time efficient, and cost-effectiveness have inclined the practitioners to use them. Moreover, preparation of root canal of primary teeth using rotary instruments gives a better fill  which increases the longevity. However, a proper training and knowledge regarding the use is mandatory to procure good results of the procedure. Hence, more training workshops should be held, and inclusion of the same in the curriculum should be done to the enhance the knowledge, ensure the proper use of rotary instruments, and to reduce errors as it is a technique-sensitive step in the procedure of pulpectomy.
Special thanks to my university, Sumandeep Vidyapeeth for the support and provision of the background and needful resources.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gupta R, Rai R. The adoption of new endodontic technology by Indian dental practitioners: A questionnaire survey. J Clin Diagn Res 2013;7:2610-4.
Fincham JE. Response rates and responsiveness for surveys, standards, and the Journal. Am J Pharm Educ 2008;72:43.
The American Association for Public Opinion Research. Standard definitions final dispositions of case codes and outcome rates for surveys revised. ESOMAR: The American Association for Public Opinion Research; 2008. p. 1-50.
Kathariya MD, Patil S, Patil A, Jadav RH, Mandlik J, Sharma AS. Evaluate the usage of different advanced endodontic instruments and techniques in pediatric dentistry. J Contemp Dent Pract 2013;14:61-4.
Crespo S, Cortes O, Garcia C, Perez L. Comparison between rotary and manual instrumentation in primary teeth. J Clin Pediatr Dent 2008;32:295-8.
Vieyra JP, Enriquez FJ. Instrumentation time efficiency of rotary and hand instrumentation performed on vital and necrotic human primary teeth: A randomized clinical trial. Dentistry 2014;4:1-5.
Mozayeni MA, Golshah A, Nik Kerdar N. A survey on NiTi rotary instruments usage by endodontists and general dentist in Tehran. Iran Endod J 2011;6:168-75.
Metzger Z. The self-adjusting file (SAF) system: An evidence-based update. J Conserv Dent 2014;17:401-19.
] [Full text]
Pawar AM, Pawar MG, Kokate SR. Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India. Indian J Dent Res 2014;25:509-12.
] [Full text]
Barr ES, Kleier DJ, Barr NV. Use of nickel-titanium rotary files for root canal preparation in primary teeth. Pediatr Dent 2000;22:77-8.
Katge F, Patil D, Pimpale J, Wakpanjar M, Shivsharan P, Dalvi S. Application of rotary instrumentation in paediatric endodontics – A review. Int J Prev Clin Dent Res 2014;1:48-52.
Poornima P, Disha P, Nagaveni NB, Roopa KB, Bharath KP, Neena IE. 'Volumetric analysi
s of hand and rotary root canal instrumentation and filling in primary teeth using Spiral Computed Tomography' – An in vitro
study. Int J Paediatr Dent 2016;26:193-8.