|Year : 2023 | Volume
| Issue : 1 | Page : 38-45
Awareness of the causes and management of endodontic mishaps among dental students at King Saud University and Riyadh Al-Elm: A cross-sectional study
Mazen Alkahtany1, Khalid Almadi1, Abdulaziz Ghassab Alotaibi2, Yazeed Alzahrani2, Bader Fatani2, Almaha Alabdullatif2, Haifa Alaiban3
1 Department of Endodontic, King Saud University, Riyadh, Saudi Arabia
2 Dental Student at King Saud University, Saudi Arabia
3 Dental Students at Riyadh al Elm University, Saudi Arabia
|Date of Submission||21-Jun-2022|
|Date of Decision||13-Sep-2022|
|Date of Acceptance||10-Oct-2022|
|Date of Web Publication||3-Jan-2023|
Abdulaziz Ghassab Alotaibi
King Saud University, College of Dentistry, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Nonsurgical root canal treatment is an inseparable and essential element of thorough dental health care. Any errors that occur through any phase of endodontic treatment can affect the success of treatment. Objective: The aim of this study is to evaluate and assess dental Student's knowledge, awareness, and practice regarding the endodontic mishap. Materials and Methods: This study was carried out in Saudi Arabia, Riyadh, King Saud University, Dental hospital, and Riyadh Al-elm dental hospital. A well-structured questionnaire consisting of 24 questions were sent to 465 dental students from both colleges male and female from 3rd, 4th, and 5th academic year using Google form. Results: In general, 260 students (55.9%) reported at least one endodontic procedural error. Access cavity errors were reported by 158 students (34%). The total number of instrumentation errors was 243, which were performed by 187 students (40.2%). A total of 284 obturation errors were reported by 220 students (47.3%), and among the whole sample, the average knowledge of the student regarding endodontic mishaps was only 34%, which mean that 66% of the student does not know the causes and management of the endodontic procedural errors. Conclusion: As health-care providers, it is our responsibility to treat our patient with highest quality, and update our knowledge constantly, and according to our results, the average knowledge of the student regarding endodontic mishaps was only 34%, this shows that dental students have inferior knowledge about the causes and management of the endodontic errors, thus measures should be taken by the educational program and the student them self to improve their knowledge regarding endodontic mishaps.
Keywords: Awareness, dental student, endodontic mishaps, endodontic procedural errors
|How to cite this article:|
Alkahtany M, Almadi K, Alotaibi AG, Alzahrani Y, Fatani B, Alabdullatif A, Alaiban H. Awareness of the causes and management of endodontic mishaps among dental students at King Saud University and Riyadh Al-Elm: A cross-sectional study. J Nat Sci Med 2023;6:38-45
|How to cite this URL:|
Alkahtany M, Almadi K, Alotaibi AG, Alzahrani Y, Fatani B, Alabdullatif A, Alaiban H. Awareness of the causes and management of endodontic mishaps among dental students at King Saud University and Riyadh Al-Elm: A cross-sectional study. J Nat Sci Med [serial online] 2023 [cited 2023 Feb 9];6:38-45. Available from: https://www.jnsmonline.org/text.asp?2023/6/1/38/367000
| Introduction|| |
Nonsurgical root canal treatment (RCT) is an inseparable and essential element of thorough dental healthcare. Moreover, the purpose of it is to completely seal a thoroughly cleaned and disinfected root canal system. Root canal therapy is usually performed in three stages. First, the neurovascular tissues are removed from the root canal system. The root canal system is then shaped, and finally, the root canal system is obturated. The purpose of the root canal filling is to prevent subsequent ingress of bacteria, and re-infection of the root-canal system.
These several stages are interdependent and possess a high capacity to influence the final result. Any errors that occur through any phase of endodontic treatment, such as diagnosis, access cavity, root canal preparation, and obturation, can affect the success rate of treatment.,
Several endodontic mishaps are considered one of the causes of endodontic treatment failure. For instance, missed canals, ledge formation, zipping, separated instrument, void in the root canal filling, and perforations (which are related to the infection of the periodontal ligament and the alveolar bone, therefore, jeopardizing the healing process).
If these mishaps occur in any stage of RCT (access cavity preparation, instrumentation, and obturation), it may lead eventually to treatment failure.
A success rate of approximately 94% is associated with RCT and the result of such treatment depends mainly on the applied technique.
Nevertheless, when RCT is carried out by a general dentist, it has been stated that the high rate of success is decreased to 40%–65%.
The recent studies that have evaluated the quality and outcome of endodontic treatments have suggested the high prevalence of poorly executed endodontic procedures performed by students.
A cross-sectional study was done in 2013 on 600 undergraduate dental students from the Riyadh Colleges of Dentistry and Pharmacy and the College of Dentistry at King Saud University (KSU) in Riyadh, Saudi Arabia. This cross-sectional study showed from a total of 560 undergraduate dental students, the percentage of endodontic mishaps was 68%.
According to another study that has been carried out in 2013 on dental students from two universities in Saudi Arabia, Riyadh, to assess the endodontic mishaps and it reported that this may be Due to the complex anatomy of the root canal system which will be challenging to the dental student to do RCT with the desired outcome without any mistakes.
Dental students mostly had been taught the knowledge about treatment and prognosis of endodontic mishaps; however, they appear to have lower knowledge about causes and prevention.
Er, et al. (2006) performed a study in turkey, to assess the quality of the RCT, a random sample of 2000 records of patients that received dental treatment by students was reviewed and found that the percentage of adequate root fillings was only 34.76% in maxillary teeth and 30.36% in mandibular teeth.
Eleftheriadis, et al. (2005) conducted a study to assess the technical quality of RCT, 388 root-filled teeth from the records of the Department of Endodontology at the Aristotle University of Thessaloniki were assessed. And found that only (55.3%) had a root filling that was classified as "acceptable."
Even with close clinical observation and watching of the instructors, unavoidably, undergrad dental students will still make mistakes. Hence, it is crucial to try to keep procedural error to a minimum since it is directly related to the failure of the treatment. And to do that the dentists and undergrad student must try their best to improve their knowledge and skills and know how to prevent complication and manage it if they happened to ensure the best treatment outcome for the patients. Various studies have demonstrated that undergraduate dental students implement poor-quality treatments due to a lack of experience.
Investigation of endodontic mishaps committed by students has not yet been fully assessed. It is vital that students provide feedback that could help evaluate and improve students' work quality and correct their mishaps.
Moreover, their feedback will lead to an Improvement in educational programs, by studying the quality of RCT and frequency of endodontic procedural errors, which will lead to an overall improvement in oral health-related quality and success of treatment.
Dental undergrad students are the future clinicians, thus their awareness and knowledge regarding endodontic mishaps must be continuously assessed and upgraded as well as their clinical skills which could be improve by the further practice of RCT.,
The aim of this study is to evaluate and assess dental student's knowledge, awareness, and practice regarding the endodontic mishap. We hypothesize that dental students have inferior knowledge regarding endodontic mishaps.
| Materials and Methods|| |
We used a well-structured questionnaire consisting of 24 questions and it was sent to dental student to both dental colleges (KSU, Riyadh Al-elm) male and female from 3rd, 4th, and 5th academic years using Google forms, and we received a response from 465 students.
The students were asked first about the schools they attend, their academic level, gender, age, and if they had endodontic error, and the student who answered with yes were asked about the type of the error they had in the access cavity, instrumentation, and obturation on virgin or previously initiated tooth, and if they know the cause and the management of the error that they had to assess their knowledge.
The study was carried out between December 2021 and April 2022 in Saudi Arabia, Riyadh, KSU, Dental hospital, and Riyadh Al-elm dental hospital. Dental students who attended Dental University Hospital (DUH) at KSU and Riyadh Al-Elm, aged between 21 and 25 years were included in this study. Dental students from other colleges other than DUH at KSU, and Riyadh Al-elm DUH and age above 25 and below 21 years were excluded from this study.
All information regarding the research questionnaire was explained and informed consent was obtained from each participant. Moreover, the research procedures are adhered to the ethical guidelines of the Declaration of Helsinki.
Permission from the Research Ethics Committee of King Khalid University Hospital (KKUH), and the date of approval: (January 20, 2022) (Ref. No. 22/0074/IRB, Research Project No. E-21-6539).
Statistical analysis was carried out using the Statistical Package for the Social Sciences (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY, USA: IBM Corp). Data were expressed as frequencies and percentages. Students' knowledge was primarily focused on the causes and management of access cavity errors, instrumentation errors, and obturation errors. The differences in students' knowledge were analyzed using a Chi-squared test or Fisher's exact test, whenever applicable. A multiple-response analysis was applied for selected outcomes which had more than one available response, including the type of teeth on which the student had worked, the types of errors (access cavity, instrumentation, and obturation errors), and the most common procedural errors. Statistical significance was considered at P < 0.05.
| Results|| |
The responses of 465 students were analyzed in the current study. Approximately half of them were males (50.5%) and aged 21–22 years. Almost one-third of the participants were studying in the third academic year (32.7%), 4th year (33.1%) and 5th year (34.2%). In addition, 242 students (52.0%) were studying at KSU, whereas 223 students (48.0%) were studying at Riyadh Al-Elm University [Table 1].
The frequency and characteristics of endodontic errors
In general, 260 students (55.9%) reported at least one endodontic procedural error. Among these, about half of the errors (49.6%) were performed in the maxillary arch and 24.6% of the errors were in the mandible. Errors in the straight roots represented 50.0% of the total errors, while errors due to curved roots and abnormal root anatomy were reported among 42.7% and 3.5%, respectively [Table 2].
|Table 2: The frequency and characteristics of endodontic errors as reported by dental students|
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Based on the multiple response analysis, the 260 students reported a total of 425 errors. The most frequent endodontic errors were reported in the upper premolar teeth (25.9%) followed by the upper anterior teeth (20.2%) and lower premolars [17.2%, [Figure 1]].
The distribution and types of endodontic errors
Access cavity errors were reported by 158 students (34.0%). Students reported a total of 173 errors, with gouging being the most common error (74.6%). The total number of instrumentation errors was 243, which were performed by 187 students 40.2)%). Ledge errors were the most frequently reported instrumentation errors (38.3%). A total of 284 obturation errors were reported by 220 students (47.3%), and voids were the most common obturation errors (47.5%) [Table 3].
Knowledge about causes and management of endodontic errors
Among the whole sample, about one-third of the participating students had adequate knowledge about the causes (28.8%) and management of access cavity errors (30.8%). Similarly, 38.1% and 33.1% of students knew about the causes and management of instrumentation errors. Knowledge about the causes of obturation errors was prevalent among 43.7%, whereas the knowledge about obturation error management was apparent among 29.7% of the students [Figure 2].
|Figure 2: This figure shows the knowledge of the dental student regarding different endodontic errors|
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University-based differences in the reported endodontic errors
The proportion of reported access cavity errors was significantly higher among the students of KSU (40.5%) compared to those of Riyadh Al-Elm University (26.9%, P = 0.002). Furthermore, self-reported knowledge about the management of access cavity errors was significantly higher among Riyadh Al-Elm University students (86.7%) than KSU students (60.2%, P = 0.002). The reported instrumentation errors were also significantly higher among the students of KSU compared to those of Riyadh Al-Elm University (46.3% vs. 33.6%, P = 0.005). There were no additional significant differences in the obturation errors as well as the management and causes of other errors [Table 4].
|Table 4: Differences in the reported endodontic errors and their causes and management based on the University|
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Gender-based differences in the reported endodontic errors
At KSU, male dental students reported significantly higher proportions of access cavity errors (47.1% vs. 34.1% among males vs. females, respectively, P = 0.041) and obturation errors (62.2% vs. 41.5% among males vs. females, respectively, P = 0.001); yet, however, they reported a significantly lower proportion of instrumentation errors [37.8% vs. 54.5% among males vs. females, respectively, P = 0.009, [Table 5]].
|Table 5: Differences in the reported endodontic errors and their causes and management based on the students' gender at King Saud University|
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Concerning Riyadh Al-Elm University, although there was no gender-based difference in the reported access cavity errors, a higher proportion of males was significantly knowledgeable than females (94.4% vs. 45.8%, respectively, P < 0.0001). Interestingly, males had reported a significantly higher proportion of instrumentation errors than females (39.7% vs. 27.1%, respectively, P = 0.047), and knowledge levels about the causes of these errors were significantly higher among males compared to females (91.3% vs. 72.4%, respectively, P = 0.030). On the other hand, females reported a higher proportion of obturation errors than males (49.5% vs. 36.2%, respectively, P = 0.044), and females had higher self-reported knowledge regarding obturation error management [73.6% vs. 35.7%, respectively, P < 0.0001, [Table 6]].
|Table 6: Differences in the reported endodontic errors and their causes and management based on the students' gender at Riyadh Al-Elm University|
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Differences in the reported endodontic errors based on the academic year Compared to the higher academic years, students of the 3rd year reported significantly higher rates of access cavity errors (60.5% vs. 25.3% for 4th year and 17.0% for the 5th year, P < 0.0001) and instrumentation errors (52.0% vs. 29.9% for 4th year and 39.0% for the 5th year, P < 0.0001). Nevertheless, there were no significant differences among students of different academic years regarding their knowledge about the causes and management of access cavity errors and instrumentation errors. However, students of the 3rd academic year had significantly lower self-reported knowledge regarding the management of obturation errors (46.4%) compared to the students of the 4th and 5th academic years [63.1% and 67.6%, respectively, P = 0.005, [Table 7]].
|Table 7: Students' knowledge regarding the causes and management of endodontic errors and the difference in knowledge based on the academic year|
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Self-perceived common errors performed by dental students The majority of students (60.9%) reported that underfilling (root filling >2 mm from the radiographic apex) was the most common error performed by dental students. More than half of the students in the sample (54.0%) thought that inadequate filling (voids present in the root filling or between root filling and root canal walls) was the most common criteria associated with the students, while 62.8% of them indicated that tapering (consistent taper from the orifice to the apex) is adequately performed by dental students [Table 8].
|Table 8: Students' perceptions regarding the common procedural errors performed by dental students|
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Based on the multiple selection of the most common procedural errors (n = 1135), students indicated that gouging was commonly performed (20.4%) followed by ledge (20.3%) and apical perforation (14.5%, [Figure 3].
|Figure 3: This figure shows the percentages of different endodontic mishaps made by dental students|
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| Discussion|| |
The clinician who performs RCT must have a fundamental knowledge of etiologic factors and methods of prevention as well as recognition, management, and prognosis, This knowledge reduces the rate of endodontic failures and increases our chances of saving more teeth.
A lot of studies reported high endodontic procedural errors among dental students. However, knowledge of the causes and management of these endodontic mishaps has not yet been illustrated and assessed intensely. A study was conducted at Abha and AlFarabi dental college showed that Female students (65%) had more errors than male students (49%). In addition, 54% of reported errors were in the posterior teeth with increasing in the percentage of errors with curved roots. The most common errors were gouging (68%), ledge formation (47%), and voids (41%). However, our study demonstrated that male dental students reported significantly higher proportions of access cavity errors (47.1% vs. 34.1%) and obturation errors (62.2% vs. 41.5%), yet, however, they reported a significantly lower proportion of instrumentation errors (37.8% vs. 54.5%) at KSU. Concerning Riyadh Al-Elm University, although there was no gender-based difference in the reported access cavity errors, a higher proportion of males were significantly more knowledgeable than females (94.4% vs. 45.8%) and knowledge levels about the causes of these errors were significantly higher among males compared to females (91.3% vs. 72.4%). On the other hand, females reported a higher proportion of obturation errors than males and females had higher self-reported knowledge regarding obturation error management (49.5% vs. 36.2%). According to a study done at Taibah University, there were no significant differences based on the academic year in the reported procedural errors. However, our study demonstrated higher differences in the reported endodontic errors based on the academic year. A previous study done at King Khalid University revealed that the upper left second molar showed a higher frequency of endodontic errors among dental students, and molars showed more access-related errors. In correlation, our study showed that the most frequent endodontic errors were reported in the upper premolar teeth (25.9%) followed by the upper anterior teeth (20.2%) and lower premolars (17.2%). Regarding knowledge, attitude, and awareness of Saudi dental students at KSU and Riyadh Al-Elm University, about one-third of the participating students had adequate knowledge about the causes (28.8%) and management of access cavity errors (30.8%). Similarly, 38.1% and 33.1% of students knew about the causes and management of instrumentation errors. Knowledge about the causes of obturation errors was prevalent among 43.7%, whereas the knowledge about obturation error management was apparent among 29.7% of the students.
This study was done in 2018 on undergraduate dental students at KSU to investigate their clinical experiences and perceptions of the current endodontic practice. Surveys' forms were distributed to the 125 4th year and 120 5th year dental students (males and females), and it found that half of the students found endodontics "difficult" or "more difficult" comparable with other branches. The percentage of students who would not consider specializing in endodontics was 25.3% among the 4th year students, and 50% among the 5th year students.
This study shows that measures have to be taken to improve the student experience regarding endodontic.
The evaluation of endodontic treatment during preclinical and clinical training programs is vital in determining the level of the provided education in endodontics.
As well as the valuable feedback and suggestions for revising the educational program which can be provided by undergraduate students for the improvement of learning.
The limitation in this study is that we only sent the questionnaire to two universities only.
Hence, we recommend for future research to have larger sample size for more precision.
| Conclusion|| |
As health-care providers, it is our responsibility to treat our patients with the highest quality based on the recent evidence, and to do that health-care provider should update their knowledge constantly.
And according to our result, the average knowledge of the student regarding endodontic mishaps was only 34%, which mean that 66% of the student does know the causes and management of different endodontic mishaps, this shows that dental students have inferior knowledge about the causes and management of the endodontic errors, thus measures should be taken by the educational program to improve the dental student knowledge, also the student has the responsibility as well to educate their self about the endodontic errors to prevent them and manage it if it happen.
This study was evaluated by The Research Ethics Committee of King Khalid University Hospital and the date of approval: (January 20, 2022) (Ref. No. 22/0074/IRB, Research Project No. (E-21-6539).
AA, YA, BF conducted and designed the study and started the initial review of articles and studies. And wrote the initial manuscript. AA2 and HA collecting of data. AA did the data analysis. AA, YA, and BF wrote the final drafts of the article. All authors have critically reviewed and approved the final draft.
We would like to thank our participants for their time and contribution in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]