Quality of Root Canal Treatment Performed By Undergraduate Dental Students ofBangladesh Dental

Background: Root canal treatment are most commonly in Dental clinic, college and hospitals by dentist. It is inevitable for graduated to be qualified to perform root canal treatment efficiently. Objective: Evaluation of quality of root canal treatment by undergraduates of Bangladesh Dental College. Materials and Methods: A retrospective study was performed using a total of 600 intra periapical radiographs. Total 200 patient underwent root canal treatment by undergraduates of Bangladesh Dental college were used for assessment. Three qualified investigators assessed the quality of treatment. Descriptive statistics used to present the results. Results: 64% of root canal treatment performed by phase IV undergraduates’ student. Mostly anterior/single canal root canal treatment were done. As per pulp status, pulpitis, necrosis, periapical lesion and failure of previous root canal treatment were high. Among cmplications, instrument breakage and under filling were 14% and 12 % respectively. Percentage of acceptable to perfect quality of root canal treatment was 55% Conclusion: Based on results only 4% root canal treatment was perfectly performed which is very low. Acceptable quality of root canal treatment percentage was 51%.


Introduction
Root canal treatment is an important part of comprehensive oral health care.Root canal treatment (RCT) has high success rates 1 .That depends on many variables one of which is the technical quality of the root canal treatment.Smith et al. 2 reported that the canal preparation technique and the root canal filling length, relative to the radiographic apex, significantly affect the success of conventional RCT.
According to the association for Dental Education in Europe, all dental students should be qualified to perform root canal treatment efficiently after graduation 3 .The teaching of endodontics is considered a major challenge for those academics responsible for this task more than any other subject in the undergraduate curriculum.Contemporary endodontic curricula focus on optimizing the technical quality of root canal procedures.Although practical exercises by Evaluation:The radiographs were independently evaluated using X-ray viewer by twoEndodontist.
In case of disagreement, the third investigator was assigned to make the final decision.
The RCT was assessed for filling at the end of the root with radiographic apex, the density of the filling material, and taper from the orifice to apex (Table I).After assessing, the quality of RCT was recorded as totally unacceptable, slightly unacceptable, acceptable and perfect based on the treatment score (Table II).The following procedural errors were assessed as clinical endpoints of treatment: furcal perforation, cavity wall perforation, transportation, root perforation, instrument breakage, and ledge formation, under filling, voids and missed canal.Analysis:The analyses of the data were performed using MS Excel 2013 and the descriptive results were presented.Calibration:Before thestudy, 20 periapical radiographs not included in the study wereused to calibrate the examiners and came to an agreementfor the criteria for evaluation.

Table I: Parameters used to evaluate root canal obturation
Parameter Definition Score

Length of root canal obturation
Root filling ending >2 mm short of the radiographic apex (under-filling) Root filling limited to the pulp chamber 0 (unacceptable) Root filling ending beyond the radiographic apex (over-filling) Root filling ending at the radiographic apex (tiptotip) or 1-2 mm shorter than the radiographic apex  Perfect

Results
Table 3 show the number of RCT done by the students.Table 4 detailed the RCT perfomed teeth type.

Discussion
Recent years have seen a marked increase in the demand of patients for root canal treatment due to the increased age of the population, so dental students should possess the knowledge and skills in this discipline before the need increases even more.The assessment of dental student performance in endodontics will help to improve dental education [4].Therefore, undergraduate training should promote the comprehension of root canal treatment outcome and related factors.Quality of root canal treatment may affect the outcome of the procedure and the long-term retention of teeth.Development of apical lesion or endo-perio lesion are related with the quality of the root treatment.The standard of root canal treatment carried out in teaching hospitals by learners is poor.That quality of treatment might be due to lack of expertise and a poor understanding of the principals involved [5].Although some studies show that the technical quality of root canal treatments performed by undergraduates demonstrates a good quality of endodontic work in a very wide range, between 13% and 70% [6].Procedural errors compromise root canal cleaning and shaping, and result in incomplete root filling and jeopardize the outcome of the treatment.An association between root-canal-specific training as an undergraduate and improved quality of root canal obturation by dental graduates has been reported [7].Evaluation of root canal treatment quality has been shown to assist in planning future endodontic educational programs [8].The quality of root canal filling is an important component of endodontic treatment.To improve clinical performance, knowledge, training, ability, and utilization of technology are necessary.
Studies of the quality of root canal treatments (RCTs) and prevalence of endodontic procedural accidents can improve educational programs, leading to improvement in the oral-health-related quality of life.Evaluation of the technical quality of root canal obturation is based on the limit and density of the obturation material [9].The length of root canal obturation from the radiographic apex and its density and taper have also been used to evaluate RCT.Canals with a 0-to 1-mm distance between the radiographic apex and the end of the obturation material were more successful than were canals in which the obturation material ended more than 1-3 mm from the radiographic apex.However, both are preferable obturation materials that extrude through the apex [10].

Conclusion
Based on results acceptable to perfect quality RCT performed by student of Bangladesh Dental college was 55%.Totally unacceptable and slightly unacceptable quality of RCT percentages were 12 and 33 respectively.
canal obturation Not consistently tapered from the apex to the coronal part (over-or under-shaped) 0 (unacceptable) Not enough taper 1 (acceptable) Consistently tapered from the apex to the coronal part (adequate) 2 Perfect