|Year : 2017 | Volume
| Issue : 2 | Page : 45-48
Knowledge and practice of rotary instrumentation in primary teeth among indian dentists: A questionnaire survey
Lavanya Govindaraju, Ganesh Jeevanandan, EMG Subramanian
Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
|Date of Web Publication||13-Apr-2017|
Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Use of rotary instrumentation for pulpectomy is a recent emerging concept in the field of pedodontics. The objective of this study was to evaluate the knowledge and practice of NiTi rotary instruments' usage in primary teeth by the Indian dentists. Materials and Methods: A self-administrated questionnaire was prepared and pretested and was given to the private practitioners. A total of 100 completed questionnaires were obtained. The data were entered and analyzed for frequency and percentages using Statistical Package for the Social Sciences (SPSS) software version 17. Results: In the present study, about 50% of the practitioners used rotary instrumentation of root canals in primary teeth, of which majority were postgraduates. ProTaper was the commonly used rotary system in primary teeth. The practitioners felt both taper and length of the existing rotary file to be the limitation for its use in primary teeth. Conclusion: From the present study, it is concluded that there is a need for comprehensive education programs to be conducted to increase the awareness and use of rotary files for pulpectomy in primary teeth. In addition, there is a need for an exclusive pediatric rotary system for convenience in using it in children.
Keywords: Primary teeth, pulpectomy, rotary instrumentation
|How to cite this article:|
Govindaraju L, Jeevanandan G, Subramanian E. Knowledge and practice of rotary instrumentation in primary teeth among indian dentists: A questionnaire survey. J Int Oral Health 2017;9:45-8
|How to cite this URL:|
Govindaraju L, Jeevanandan G, Subramanian E. Knowledge and practice of rotary instrumentation in primary teeth among indian dentists: A questionnaire survey. J Int Oral Health [serial online] 2017 [cited 2017 Dec 13];9:45-8. Available from: http://www.jioh.org/text.asp?2017/9/2/45/203048
| Introduction|| |
Pulpectomy procedure is performed in primary teeth to avoid extraction and to maintain its form and function. The primary goal of cleaning and shaping the root canals in primary teeth is to remove the organic debris in shorter time.
Conventionally, pulpectomy in primary teeth was performed using hand files, which is considered to be time consuming. With the use of rotary instruments, the procedural time has decreased which in turn has increased the cooperation of the children.
A survey that was conducted among the endodontists and the general dentists in Tehran regarding the use of NiTi rotary instrumentation in permanent teeth concluded that there is a lack of knowledge in using rotary NiTi instruments and hence more training and comprehensive education is needed for the dentists. In another survey that was conducted in Turkey among the dental practitioners, it has been shown that although majority of the dentists used NiTi instrumentation techniques in permanent teeth, they still emphasized on the need of endodontic training after graduation. Despite being aware of the limitations, the dentists incorporated the use of rotary NiTi instruments and techniques into root canal treatment.
Although rotary instruments have been widely used for root canal treatment of permanent teeth, their use in pediatric dentistry is an emerging practice. There is no evidence in literature evaluating the knowledge of pedodontists and other general practitioners in using rotary NiTi instruments for pulpectomy in primary teeth. Hence, the aim of this study was to assess the level of knowledge and practice of the Indian dentists in the use of rotary instruments in primary teeth.
| Materials and Methods|| |
This questionnaire survey was conducted from August to November 2016 in Chennai, India. The study design and the protocol were approved by the Institutional Review Board [STP/SDMDS2015PED42]. Informed consent was obtained from the participated dentists.
A sample of 100 dentists which included both the bachelors and the masters in dental surgery, practicing in Chennai, was involved in the study. Students pursuing their bachelors in dental surgery, students in their internship, and doctors who are not practicing dentistry were excluded from the study. A self-administrated 10-item questionnaire was prepared in English to assess the knowledge and practice about the use of rotary instruments in primary teeth [Figure 1].
The validation of the questionnaire was done in a group of ten dentists who were asked to respond to the same questions twice, once on the 1st day and the other after a week. The coefficient of reliability was assessed using Cronbach's alpha (0.85), which indicated good reliability.
The participants were asked to mark the most appropriate answer which they felt to be significant. The participants were encouraged to approach the investigator in case of any clarification. The filled questionnaires were collected back by the investigator on the same day.
The data were entered and analyzed for frequency and percentages using Statistical Package for the Social Sciences (SPSS) software version 17.0 (SPSS Inc., Chicago III., USA).
| Results|| |
A total of 100 practitioners participated in the study, of which 61% were males and 39% were females. In addition, 31% had completed only undergraduation and 69% had completed their postgraduation.
In the present study, it was found that about 50% of them use rotary instrumentation for pulpectomy in primary teeth, of which 32% were masters in dental surgery and only 11% of the practitioners have attended Continuing Dental Education (CDE) Programs regarding rotary instrumentation. Nearly 34% of the practitioners used ProTaper system for the canal preparation in primary teeth. The detailed description of the same is depicted in [Figure 2]. About 17% of them use it for 3–5 cases, 12% of them use it for 6–10 cases, and 10% of them use it for all the ten cases.
Nearly 26% of the practitioners felt that decreased working time was the greatest advantage of using rotary files in primary teeth while 13% of them felt that the removal of pulp tissue was better and 12% of them found there was an uniform canal preparation with the help of rotary files [Figure 3]. The greatest disadvantage experienced by the practitioners in using rotary instrumentation in primary teeth was the instrument separation (26%) followed by the cost (25%) [Figure 4].
|Figure 4: Disadvantage of using rotary instrumentation in primary molars|
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About 47% of the practitioners felt that it was easy to access both maxillary and mandibular arches with rotary files, while 24% found mandibular arch to be easily accessible, and for 28%, accessing maxillary arch with rotary files was easier. Length of the existing rotary file was considered to be the limitation in the existing system for 15% of the practitioners while 27% of them found both length as well as taper as the limitation in the design of the existing system for primary teeth [Figure 5]. Nearly 76% of the practitioners were not aware of minimally invasive files and its use in primary teeth. Nearly 66% of them thought that there was a need for an exclusive rotary file for canal preparation in primary teeth.
|Figure 5: Limitation in the design of the existing rotary file in primary teeth|
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| Discussion|| |
Endodontics in the field of pediatric dentistry is undergoing a constant evolution. The most important innovation is the use of NiTi rotary instruments for canal preparation in primary teeth. Numerous surveys have been done to determine the usage of NiTi rotary instruments in permanent teeth. Use of rotary instrumentation for pulpectomy in primary teeth being a newer concept, its usage, advantages, and disadvantages among the practitioners are not been studied. Hence, this study was done to assess the level of knowledge and practice of the dentists in the use of rotary instruments in primary teeth.
In the present study, it was found that about 50% of them use rotary instrumentation for pulpectomy in primary teeth in their practice. Out of the ten cases, 10% of them used rotary files for all the ten cases; 12% of used it for about 6–10 cases; 17% used it for 3–5 cases; and about 5% used it for 1–2 cases. In the study done by Kathariya et al. in 2013, they concluded that 67.3% of the 3rd year postgraduates used NiTi rotary files for canal preparation in primary teeth. In the present study also, larger number of master degree holders (32%) practiced pulpectomy in primary teeth with rotary files than the practitioners with degree in Bachelor of Dental Surgery (18%).
In the current study, only 11% of the participants had attended CDE or workshop regarding rotary instrumentation in primary teeth. This result has emphasized the need of conducting workshops. It also leads to a conclusion that, with increase in the knowledge and training, there would be an increase in the number of dentists using rotary instrumentation for root canal instrumentation in primary teeth as well. This result was in accordance with the previous study done by Mozayeni et al., 2011. Use of different rotary file systems in primary teeth has been widely studied in numerous in vitro studies and has been proved to be equally effective.,,, In the present study, majority of the practitioners used ProTaper (34%) followed by K3 (6%) and Mtwo (4%).
The greatest advantage as felt by the practitioners in using NiTi files in primary teeth was decreased working time (26%). A significant decrease in the instrumentation time with the use of rotary files was reported in previous studies., Nearly 13% of them felt that the removal of pulp tissue was much easier with rotary files while 12% of them felt that there was uniform canal preparation. Barr et al. also stated that the canal preparation with rotary NiTi files in primary teeth resulted in funnel-shaped canals leading to superior obturation quality. Fracture of the instrument (26%) was the disadvantage faced by the practitioners. Nearly 25% of them felt NiTi instruments to be costlier while 2% of them have complained that rotary files do not remove the pulp tissue completely. Nagaratna et al. in 2006 have pointed out that higher fracture rate is the greatest disadvantage of using rotary instrumentation in primary teeth.
Both length and taper were considered to be the limitation in the design of existing rotary file systems in primary teeth by 27% of the practitioners. Around 15% of them felt only length as the limitation in the existing rotary system. In addition, 66% of them felt that there is a need for an exclusive pediatric rotary file for better accessibility and faster preparation. Kuo et al. in 2006 also stated that a new NiTi rotary file, exclusively for primary teeth with modified taper, length, and tip size, would be more advantageous. These findings indicate that an exclusive pediatric file with altered taper and length would further help the practitioners in doing pulpectomy in children.
Various studies are being conducted to evaluate the efficacy of existing rotary system in relation to dentine and smear layer removal in primary teeth.,, Further methodological studies should be conducted with various existing rotary systems as well as with the exclusive pediatric file systems to make shaping of the root canals in primary teeth easy and less time consuming.
Smaller sample size is the limitation of the present study. Furthermore, the questionnaire was directed toward all the general practitioners rather than the specialists. If it had been directed toward only the pedodontists and endodontists, more reliable results would have been obtained.
| Conclusion|| |
The results of the present study conclude that:
- There is a need for more training and comprehensive education programs regarding the technique of using rotary file system in primary teeth
- Reduction in the instrumentation time was the advantage observed by most of the practitioners. Likewise, instrument fracture was the greatest disadvantage faced by them
- Both length and taper were the limitation in using existing rotary system in primary teeth and there is a necessity for developing an exclusive pediatric rotary file.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pinkham JR, Casamassimo PS. Pediatric Dentistry. Infancy through Adolescence. 4th
ed. Philadelphia, PA: WB Saunders Co.; 2005. p. 390.
Kuo C, Wang Y, Chang H, Huang G, Lin C, Li U, et al
. Application of Ni-Ti rotary files for pulpectomy in primary molars. J Dent Sci 2006;1:10-5.
Silva LA, Leonardo MR, Nelson-Filho P, Tanomaru JM. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time in deciduous molars. J Dent Child (Chic) 2004;71:45-7.
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.
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.
Kucukkaya S, Gorduysus M, Gorduysus MO, Anil D. A questionnaire survey on current endodontic practice of dental practitioners in Turkey. J Clin Dent Res 2015;39:101-9.
Parashos P, Messer HH. Questionnaire survey on the use of rotary nickel-titanium endodontic instruments by Australian dentists. Int Endod J 2004;37:249-59.
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.
Rosa FM, Modesto A, Faraco-Junior IM. Manual and rotary instrumentation techniques for root canal preparation in primary molar. Dentistry 2014;2:1-5.
Ramezanali F, Afkhami F, Soleimani A, Kharrazifard MJ, Rafiee F. Comparison of cleaning efficacy and instrumentation time in primary molars: Mtwo rotary instruments vs. hand K-files. Iran Endod J 2015;10:240-3.
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.
Nagaratna PJ, Shashikiran ND, Subbareddy VV.In vitro
comparison of NiTi rotary instruments and stainless steel hand instruments in root canal preparations of primary and permanent molar. J Indian Soc Pedod Prev Dent 2006;24:186-91.
] [Full text]
Subramaniam P, Girish Babu KL, Tabrez TA. Effectiveness of rotary endodontic instruments on smear layer removal in root canals of primary teeth: A Scanning Electron Microscopy Study. J Clin Pediatr Dent 2016;40:141-6.
Selvakumar H, Kavitha S, Thomas E, Anadhan V, Vijayakumar R. Computed tomographic evaluation of K3 rotary and stainless steel K file instrumentation in primary teeth. J Clin Diagn Res 2016;10:ZC05-8.
George S, Anandaraj S, Issac JS, John SA, Harris A. Rotary endodontics in primary teeth – A review. Saudi Dent J 2016;28:12-7.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]