An audit of root canal treatments completed by students and dentists at an academic hospital

Abstract

The University of Pretoria Oral Health Centre (UPOHC) houses the School of Dentistry where dental, oral hygiene and post graduate students are trained. Dentists employed at the School of Dentistry generally do not complete root canal treatments (RCTs) due to their academic and research commitments but mainly perform emergency dental procedures such as pulpectomies for the relief of acute pain. The pulpectomy procedure includes the extirpation of the necrotic or inflamed pulp, minimal shaping of the canal and irrigating with sodium hypochlorite. This is followed by placing a medicament with an anti-inflammatory action such as Ledermix® or calcium hydroxide and sealing the tooth with a temporary restoration. The patient is then placed on a waiting list (approximately 18 months) for completion of the RCT by students in their fourth and fifth year of study. Dentists complete RCTs mainly in cases where previous attempts made to locate the canals were not successful orwhere files have fractured in the canals or when retreatment is indicated. The students complete a limited number of RCTs due to the time-consuming nature of the procedure and their relative lack of skill and experience. During the fourth year of study the students are required to complete five RCTs on teeth with one and two canals. The clinical quota for the students in the fifth year of study is five RCTs on teeth that have three or four canals. Several studies have been conducted on the acceptability of root canal obturations with regard to the technical quality as viewed on post-operative radiographs. The studies in question reported an acceptable technical quality of 47.4%, 84.1%, 61.35%, 57% and 44% respectively. In four of these, the RCTs assessed were completed by undergraduate students. Root fillings between 0.5mm to 2mm from the radiographic apex, consistent density and uniform taper were the criteria used to categorize the RCT as acceptable. Peak et al. also included the absence of apical pathology in the criteria. To date no research has been conducted on the technical quality of root canal fillings at tertiary institutions in South Africa