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ENDODONTIC PRACTICES AMONG ENDODONTISTS IN CENTRAL INDIA
Article · June 2019
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Pratima R Shenoi Rajiv T Khode

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ORIGINAL RESEARCH PAPER Volume-8 | Issue-1 | January-2019 | ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
TO ASSESS THE PREDOMINANT PROTOCOL FOR CONTEMPORARY

ENDODONTIC PRACTICES AMONG ENDODONTISTS IN CENTRAL INDIA
Dental Science
Dr. Kushal Fuladi VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur- 440019
Dr. Pratima Shenoi VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur- 440019
Dr. Gautam Badole VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur- 440019
Dr. Rajiv Khode VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur- 440019
VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur- 440019
Dr. Purabi Edbor* *Corresponding Author
ABSTRACT
Introduction: Endodontics is always striving for predictable treatment outcomes with newer materials and endless innovations. Thus, we
conducted a study among the endodontists of Central India to assess the current protocols in their clinical practice.
Methods: A questionnaire was mailed to 120 endodontists with open and close ended questions. Results: 77% of them used cotton roll for isolation
whereas only 43% used rubber dam. 25% used microscopes for every case whereas 32% used it for special cases only. The common irritants
preferred by the respondents was sodium hypochlorite followed by normal saline. They also reported that 81% referrals were for retrieval of the
fractured instrument, 70% for calcified canals and 54% for resolution of large periapical lesions. Conclusions: Traditional protocol is followed and
contemporary endodontic practices are still not popular. Training workshops should be carried out for endodontists to get accustomed to newer
protocols.
KEYWORDS
Endodontist , Rubber dam , Microscope , Ultrasonics.
INTRODUCTION: endodontists towards endodontic treatment in Central India.

Endodontic treatment procedure is considered one of the essential The other objectives are to evaluate current trends, newer technique &
elements in dental practice. The contemporary endodontics involves materials preferred by endodontists and to determine primary reasons
the introduction of many new instruments, materials, and techniques for endodontic referrals by the general dental practitioners in Central
for predictable outcomes [1] .Technologies available for use in dental India.
clinics today include battery or electric motors with gear-reduction
handpieces using nickel titanium rotary file systems, new-generation METHODOLOGY:
electronic apex locators (EALs), improved digital radiographic The research protocol designed was ethically approved by the
sensors, operating microscopes, and ultrasonic units with a variety of Institutional Ethics Committee. The study was carried out in
tips designed specifically for use when performing both nonsurgical September 2017 in Central India. A total 120 Endodontists, working in
and surgical endodontic procedures. [2] government and private sector were sent a questionnaire via email and
responses were collected. Reminders were sent at regular intervals to
There are also new materials and methods for obturating the prepared all the participants to ensure maximum participation.
root canal system.The most important innovation is the use of
magnification to enhance visualization and use of contemporary Data were collected through a structured and validated questionnaire
techniques for root canal preparation using ultrasonic, rotary with close-ended and open-ended questions. The questionnaire did not
instruments and Irrigation protocol. Each of these innovations has disclose the identity of any participant.
dramatically impacted endodontics and significantly contributed to
more predictable success. The technical demands and level of The prepared questionnaires were personally mailed to each dentist via
precision required for an endodontist to perform successful endodontic Google Docs. An explanation was attached about the importance of
procedures is achieved by careful manipulation of instruments and by their participation and the study purposes. Loss of participants was
strict adherence to biological and mechanical principles[3]. considered when professionals did not respond within month duration.
The questionnaire was consisting of the questions regarding various
Current postgraduate endodontic training programs include the aspects of endodontic treatment: - choice of instruments, use of
implementation of these new technologies and materials. New magnification, isolation methods, techniques for root canal
ultrasonic units and specially designed endodontic tips provide the preparation , use of ultrasonics , intracanal medicaments, choice of
clinician with the options of performing nonsurgical retreatments and obturating techniques .
surgical root-end preparations that conserve more tooth structure. The
location and instrumentation of calcified root canal systems are also The responses of the questionnaires were entered in the Google Docs
enhanced using the ultrasonic technology. The improved database.
magnification and illumination systems allow the operator to better
visualize the working field during the nonsurgical and surgical RESULTS:
procedures they perform. Out of the 120 Endodontic practitioners, contacted by e-mail, 100
(83%) responded, and completed the survey. The percentages
Each of these innovations has dramatically impacted endodontics and calculated for each section of the questionnaire are shown in
significantly contributed to more predictable success. The technical subsequent pie charts.
demands and level of precision required for an endodontist to perform
successful endodontic procedures is achieved by careful manipulation Endodontic treatment begins with diagnosis , and we found in our
of instruments and by strict adherence to biological and mechanical study that 83% of respondents use digital radiograph while 45% of the
principles. Thus, purpose of the study is to assess the attitude of practitioner uses cold test for diagnostic of tooth . When asked about
endodontists towards use of newer materials & methods in root canal the mode of sterilisation of endodontic files , 75.4% endodontic
treatment. practitioners used Glass bead sterilizer and 52.3% used autoclave .
Aim of the study is to determine the current perspective of Isolation plays an important role in the dental treatment and it was seen
26 International Journal of Scientific Research

Volume-8 | Issue-1 | January-2019 ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98
in the current study that the use of cotton roll was 77% , similar to the
use of suction tip i.e. 75% .
In Central India, it was interesting to see the use of rubber dam by

endodontic practitioners. It was seen that 28% used rubber dam for
every case whereas 52% of the respondents used rubber dam for only
special cases. See figure no.1
Figure 3: Reasons For Endodontic Referrals By General

Practitioners Of Central India.
DISCUSSION:
This survey involved a range of respondents in terms of their clinical
experience and practice setup. In this survey , the vast majority of
respondents preferred to use digital radiographic technique for
diagnostic methods which was similar to the study undertaken by Lee
Figure 1: Use Of Rubber Dam By Endodontic Practitioners Of et al [2]. Anabtawi et al in 2014 concluded in his study that 74%
Central India. endodontics used rubber dam in every case and 44% of respondents
used it for special cases, whereas in our study 52% endodontics used
The introduction of microscopes in dentistry has shown great impact rubber dam for special cases and 30% used it for every case[4].
on the outcome of root canal treatment. The use of magnification by the
respondents reported in our study was 25% for every case whereas According to Kersten et al. the use of magnification was 52% in 1999
32% of respondents used microscope for special cases only. See table in America which increased to 90% in 2007 whereas in contrast in
no.2 India , the use of magnification was found to be lesser which was
probably because of lesser training of the operator on the microscope
[5] . In our study, the use of magnification was 35% in special cases and
28% for every case. In the present survey, it was observed that the
choice of irrigants was mainly sodium hypochlorite followed by
normal saline that is similar to the study conducted by Clarkson et al. in
Australia in 2003[6].
The majority of respondents in our study used Calcium hydroxide

paste (93%) for intracanal medicament followed by triple antibiotic
paste (57%) and this same scenario was found in the survey conducted
by Ruchi Gupta et al in India[1]. Madarati et al in his study found that
the use of Ultrasonics for removal of fracture instrument was more that
is 98% and the present survey is in accordance as the use of ultrasonics
for removal of fracture instrument was 75% [7].
Ree MH. et al. stated that patient's referral to endodontist by general

Figure 2 : Use Of Microscope By Endodontic Practitioners Of dental practitioners was 54% for the instrument retrieval followed by
Central India. 43% for the calcified canals followed by 37% and 35% for curved
canal and large periapical lesion and very less (11%) for surgical
Patients were asked about the different methods for measuring the intervention[8]. In the present survey, respectable amount (81%) of
working length and in our study 83% of the respondents used apex patients were referred to endodontists for instrument retrieval and 70%
locator for measuring the working length whereas 75% of the for calcified canal. We also found that 44% and 35% were referred for
respondents used radiograph. The use of hand files (stainless-steel files curved canals and large periapical reasons respectively . In a study by
and hand protaper files) by the respondents was reported as 78% i.e. Ree MH. et al., only 11% were referred for surgical intervention but in
whereas among rotary files : the usage was reported 79% for protaper this survey, there were 64% respondents for the surgical referred cases.
file system followed by 37% for hyflex files by the practitioner. For
successful treatment of root canal, cleaning of the canal is paramount CONCLUSION:
important so, the common irrigants preferred by the respondents in our Analysis of survey shows that in Central India, still the traditional
study was sodium hypochlorite that is 83%, followed by normal saline protocol is followed and contemporary endodontic practice is still not
which was 71% . The most frequently used intracanal medicament popular.
seen was calcium hydroxide which in our study was reported as 94%.
Many of practitioners lack advance clinical skills and need to update
The technique commonly reported for biomechanical preparation was on newer technological advances.
crown down technique as 48% of practitioners used this technique. For
a hermetic seal and a predictable obturation , newer techniques have
So, there is urgent need for upgradation of technical knowledge
been introduced to ensure lateral canal fills. In the present study , it
amongst endodontists. More webinars, CDE programs and certified
was reported that the use of calamus was maximum (68%) followed by
courses should be targeted.
Obtura (48%) and Hot shot (38%) . When the mode of removal of
fractured instrument was considered , it was seen that 56% of
respondents used ultrasonic tips. In recent decades, it has been seen LIMITATIONS OF THIS STUDY: A larger sample size will be
that there has been an increase in speciality practice in every field , required to corroborate our findings.
there has been a parallel increase in the patient referral to endodontists
by the general dental practitioners . The present study reported that FINANCIAL SUPPORT AND SPONSORSHIP- Nil
81% of the referrals were for retrieval of the fractured instrument,70%
and 69% were referred for calcified and curved root canal anatomy, and CONFLICT OF INTEREST
64% and 54% were referred for surgical intervention and large
periapical lesions respectively. See figure no.3 The authors declare that they have no conflict of interest.
International Journal of Scientific Research 27

Volume-8 | Issue-1 | January-2019 ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98
REFERENCES
1. Gupta R, Rai R.( 2013). The Adoption of New Endodontic Technology by Indian Dental
Practitioners: A Questionnaire Survey . Journal of Clinical and Diagnostic Research.
Nov, Vol-7(11): 2610-2614 .
2. Lee M, Winkler J, Hartwell G, et al.(2009). Current trends in endodontic practice:
emergency treatments and technological armamentarium. J Endod ;35:35–9.
3. Revathi M, Rao CVN, Lakshminarayanan L.(2001). Revolution in endodontic
instruments-A review. Endodontology.43–50.
4. Anabtawi MF, Gilbert GH, Bauer MR, et al.(2013). Rubber dam use during root canal
treatment: findings from the Dental Practice-Based Research Network. J Am Dent
Assoc .144:179–86.
5. Kersten DD, Mines P, Sweet M.(2008). Use of the microscope in endodontics: results of
a questionnaire. J Endod 2008;34:804–7
6. Clarkson RM. Podlich HM, Savage NW. Moule AJ.(2003). A survey of sodium
hypochlorite use by general dental practitioners and endodontists in Australia. Aust Dent
J ; 48:20-6.
7. Madarati AA, Watts DC, Qualtrough AJ. (2008). Opinions and attitudes of endodontists
and general dental practitioners in the UK towards the intra-canal fracture of endodontic
instruments: part 2. Int Endod J;41:1079–87.
8. Ree MH, Timmerman MF, Wesselink PR.(2003). Factors influencing referral for
specialist endodontic treatment amongst a group of Dutch general practitioners. Int
Endod J;36:129–34.
28 International Journal of Scientific Research
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See discussions, stats, and author profiles for this publication at: https://www.researchgate.

TO ASSESS THE PREDOMINANT PROTOCOL FOR CONTEMPORARY

Article · June 2019

Pratima R Shenoi Rajiv T Khode

SEE PROFILE SEE PROFILE

Case reports View project

original study View project

The user has requested enhancement of the downloaded file.

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

TO ASSESS THE PREDOMINANT PROTOCOL FOR CONTEMPORARY

INTRODUCTION: endodontists towards endodontic treatment in Central India.

26 International Journal of Scientiﬁc Research

In Central India, it was interesting to see the use of rubber dam by

Figure 3: Reasons For Endodontic Referrals By General

The majority of respondents in our study used Calcium hydroxide

Ree MH. et al. stated that patient's referral to endodontist by general

International Journal of Scientiﬁc Research 27

28 International Journal of Scientiﬁc Research

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