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 Table of Contents  
ORIGINAL RESEARCH
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 32-35

Assessment of staff perspective toward restored endodontically treated teeth at selected dental clinics, in Saudi Arabia


1 Department of Dentistry, Al Kharj Military Industries Corporation Hospital, Kingdom of Saudi Arabia
2 Dental Section, Ministry of Health, Kingdom of Saudi Arabia

Date of Web Publication26-Feb-2018

Correspondence Address:
Dr. Naseer Ahmed
Buiding No. 213, Flat No. 201, Assulemania Al Kharj City
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_220_17

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  Abstract 

Aims: The aim of this study was to assess the staff perspective toward endodontically treated teeth (ETT) restoration at selected dental clinic to promote prevention strategies for improving the management outcome. Materials and Methods: A descriptive research design was utilized in the current research. A total of 150 dental staff at selected dental clinics were given a structured questionnaire on April 2017. Their reply reflects that there was a high level of the studied dental staff perspective about the restoration of ETT in relation at selected dental clinics. Data were collected based on selected cases to investigate the success and survival of restored ETT in a general practice environment related to restorative parameters. Success was analyzed using Kaplan–Meier statistics and a multivariate cox regression analysis was performed to assess variables influencing success and survival. The inclusion criteria for the selected cases were had 19 teeth were extracted and 27 restorations needed repair or replacement. According to the Cox regression, increasing maximum pocket depth of the tooth resulted in a higher risk for failure (P = 0.012). Descriptive statistics like percentage was used to describe the findings using SPSS software version 20. Results: The current research focus was to assess the staff perspective toward the restoration of ETT at selected dental clinics which was found to be (73.1%). Cox regression analysis was performed to assess variables influencing success and survival. Based on the inclusion criteria for the selected cases which were selected from the patients' records, for treated cases that were had 19 teeth were extracted, and 27 restorations needed repair or replacement. According to the Cox regression, increasing maximum pocket depth of the tooth resulted in a higher risk for failure; the collected findings showed significant differences (P = 0.012). Conclusion: Concerning the dental staff perspective toward ETT restorations at selected dental clinics, the data findings showed that; there was an approximately high level of perspective for dental Staff about the management of such cases within the selected setting.

Keywords: Dental clinic, endodontic treated teeth, periodontal status, restored teeth


How to cite this article:
Sheehan SA, Alqahtani HM, Ahmed N. Assessment of staff perspective toward restored endodontically treated teeth at selected dental clinics, in Saudi Arabia. J Int Oral Health 2018;10:32-5

How to cite this URL:
Sheehan SA, Alqahtani HM, Ahmed N. Assessment of staff perspective toward restored endodontically treated teeth at selected dental clinics, in Saudi Arabia. J Int Oral Health [serial online] 2018 [cited 2022 Jan 18];10:32-5. Available from: https://www.jioh.org/text.asp?2018/10/1/32/226179


  Introduction Top


Endodontic treatment has been assessed at numerous different levels, starting at the accomplishment of the management itself in curing periapical lesions,[1] all the way through the level of achievement of restoring to utility endodontically treated teeth (ETT), and in conclusion, at the level of long-term continued existence of ETT.[2] gradually but surely, it is appropriate clear that factors further than the quality of endodontic management definitely relatively significant in decisive long-term outcomes. For illustration, the quality of the coronal restoration was shown to be more imperative in endodontic treatment achievement than the quality of the endodontic filling. When exploration the variables further than the extraction of ETT, endodontic failure represents frequently only a small division of total malfunction, with nonrestorable breakdown; caries, root fracture, or periodontal disease reported as the main failure reasons.[3]

The preservation or reproduction of optimal muco-gingival esthetics can be difficult to achieve from both a surgical and prosthetic perspective.[4] An increasing patient and clinician awareness of the importance of gingival and smile esthetics has resulted in the development of both surgical and prosthetic techniques aimed at improving or maintaining these esthetic characteristics.[4]

The unsightly recession defects may present with concomitant buccal cervical cavities which may require restoration to protect from further tooth surface loss, reduce plaque retention, or decrease dentinal sensitivity. Where recession is more generalized and especially in those patients who have undergone successful periodontal therapy, the loss of papillae may also be unsightly and the term “black triangle syndrome” has been coined. The maintenance of papillae after extraction can be difficult, especially where heavily restored teeth, trauma, or congenital conditions present with both compromised quality and quantity of bone and soft tissues. Surgical techniques advocated for recreating gingival architecture around recession or alveolar defects are technique-sensitive and may require a graft from an additional surgical site with consequent additional morbidity.[5]

Where edentulous spaces present with marked vertical and horizontal defects bone grafting may be required to support implant rehabilitation, especially in the esthetic zone. If patients are keen to improve these aspects, the surgical option may be presented without much alternative.[5]

According to Ray and Trope[6] (1995), progressively more, variables at the level of total dentition or complete patient are being integrated into studies of success and survival of ETT. Based on the results of evidence-based practice one of the currently conducted study report by this group on a retrospective study on 795 teeth in 458 patients in a private practice, it was shown that dentition related factors, as number of teeth in the dentition and being the last tooth in the arch, might play an important role, (Landys Borén et al., 2015).[7]

In addition, it was found that there is a frequently accepted standard in dentistry that tooth prediction is taken into account before demonstrating widespread and possibly expensive treatments, resembling an endodontic treatment. A characteristic often included in shaping prognosis is the periodontal conditions of the tooth, by and large, the attachment loss. The impact of endodontic treatment on the success of consequent periodontal management has been investigated.[8] Conversely, Touré et al.,[9] mentioned that there is extremely restricted scientific evidence for the impact of various dental factors on the outcome of restored ETT, The pivotal etiology for teeth romoval recorded were endodontic failure, periodontal disease followed by carious tooth substance loss. McGuire and Nunn[10] in 2016 stated that clinical parameters should be weighed more heavily than others when predicting teeth survival.

Furthermore, there is a limited evidence available about the impact of restorative status on the survival of ETT. The aim of present research is to assess the staff perspective toward restoring ETT at selected dental clinic.


  Materials and Methods Top


Ethical approval number for this study was received as IRB Log Number: 17-486E. The current research utilizes a descriptive research design comprises 150 dental staff from selected dental clinics in Saudi Arabia utilizing a structured questionnaire from April to September 2017. This number constitutes, more than two-third of the dental clinic staff at the time of data collection. All wards representing units concerning all the subspecialties' were considered as a setting for the current research. The dental staff at each unit was contacted to discuss the importance of the research and the study protocol. A structured questionnaire was adopted in the current research including valid and reliable variables in line of research. All questions had fixed answer categories [Annexure I] [Additional file 1].

The questionnaire was used to assess the staff perspective toward ETT restorative techniques at selected dental clinics in this practice-based survival study. A total of 150 staffs were had a questionnaire including the items of restored ETT which are included but not limited to preferred technique for restoring ETT, type of prefabricated post used, shape of prefabricated post used pocket depth of tooth, number of teeth in dentition, Molars (Reference-Incisors) and premolars (Reference- Incisors), decayed teeth andr of survival the response were recorded using Likert scale.

Further data were collected based on selected cases to investigate the success and survival of restored ETT in a general practice environment related to types of restorative parameters used. Data from 360 restored ETT treated were collected from the patient's records. In which dates of interventions such as restorations, repairs, replacements, and extractions were recorded. In addition, general information about patients, dentition status, pocket depth of tooth, number of teeth in dentition, molars (Reference-Incisors) and premolars (Reference-Incisors), decayed teeth and rate of survival was recorded [Table 1]. Success was analyzed using Kaplan–Meier statistics and a multivariate cox regression analysis was performed to assess variables influencing success and survival.
Table 1: Cox regression model extension of starting model with “pocket depth of tooth treated”: Source of data is patients records

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The inclusion criteria for the selected cases were had 19 teeth were extracted, and 27 restorations needed repair or replacement. According to the Cox regression, increasing maximum pocket depth of the tooth resulted in a higher risk for failure (P = 0.012).

Furthermore, from the patient records, dates of endodontic and restorative procedures, date and type of intervention (repairs/replacement/extractions) and dates of periodontal treatments or periodontal checkup were collected. The last visit was considered as the censoring date for restorations and tooth still in situ. The following periodontal characteristics were collected from the patient files – maximum pocket depth of tooth: pockets were measured before endodontic treatment at six sites, and the highest value of the six measurements was recorded as maximum pocket depth of the tooth. Average of the maximum pocket depth of dentition: an average of maximum pocket depths of all teeth (as described above) was calculated.

Statistical analyses were performed using SPSS software version 20 (SPSS Inc., Chicago, IL, USA) and R (v. 3.0.2: R. Foundation for Statistical Computing, Vienna, Austria). For the outcome success, failure was defined as an ETT needing repair, a new restoration or extraction. For the outcome survival, failure was defined as an ETT being extracted. The influence of variables on success/survival was analyzed using Cox-regression with a Gamma-distributed frailty term to model for the clustering of multiple ETT in one patient. As a starting point for the Cox model, the final model from the parent dataset was used. For this model, the best extension with additional periodontal information was evaluated. For visualization of the effect of the periodontal variable, Kaplan-Meier curves were constructed for both success and survival. Moreover, the data were analyzed to reflect the total mean of the assessment of staff perspective toward restored ETT.


  Results Top


A descriptive research design was utilized in the current research. A total of 150 Dental Staff at selected clinics was given a structured questionnaire on April 2017. Their reply reflects that there was a high level of the studied dental staff perspective about the ETT at selected dental clinics. Descriptive statistics like percentage was used to describe the findings using SPSS 20.

The data of the current research study was reflect that there was a Concerning the Dental Staff perspective toward ETT in Relation to at Selected Dental Clinics, the data findings showed that; there was an approximately high level of perspective for dental staff about the management of such cases within the selected setting, total mean score was (73.1%) for treated cases that were had 19 teeth were extracted and 27 restorations needed repair or replacement. According to the Cox regression [Table 2], increasing maximum pocket depth of the tooth resulted in a higher risk for failure, the collected findings showed significant differences (P = 0.012).
Table 2: Mean of the assessment of staff perspective toward restored endodontically treated teeth in rtelation to various factors analyzed

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  Discussion Top


A descriptive research design was utilized in the current research. A total of 150 dental staff at selected dental clinics were given a structured questionnaire. The aim was to assess the staff perspective toward restored ETT which was found to be (73.1%). Furthermore, from treated cases, 19 teeth were extracted and 27 restorations needed repair or replacement. According to the Cox regression, worsening in periapical and periodontal territories in the restored tooth as the time progresses due to any reason would result in a risk of failure, the current research findings showed a significant difference of (P = 0.012) which is consistent with the research of Iqbal et al.[11] (2003) who built their point of view based of assessment of high quality root canal filling adequate crown margins and physiological occlusal contacts enhances ETT outcome in patients, where most of the patients were rehabilitated with fixed restoration and a primary focus on periapical changes, Cast posts and cores were most often used to restore ETT.

There are other cross-sectional studies where both periodontal status and endodontic status were evaluated in restored teeth saved by applying old and contemporary materials and techniques.[4],[5],[6],[8],[9] Timmerman, and Van der Weijden[12] (2006) investigation showed more periapical attachment loss (0.6 mm) in restored than in contra-lateral untreated controls no difference was found between mesial and distal, teeth without and with posts and different tooth types. In a more recent study evaluating 175 single rooted teeth restored and observed for 3 years the occurrence of negative events, like loss of proximal attachment and continous bone loss was found related to endodontic infections than periodontal lesions alone.[13]

Furthermore, the present study results was found to be congruent with the findings of the researches carried out by Onofre et al[14] and who conclude that the level of staff perspectives concerning the Restored ETT was reflecting a total mean score of (68%) upon investigation the dentists prefered cast metal and glass fiber posts cemented with resion containing luting cements to restore ETT. The findings of current reserch in relation to periodontal health is also in accordance with the study of Setzer et al.,[15] in which the need of retreatment or tooth removal were linked with pretreatment periodontal attachment loss of the teeth. The pocket depth records in current study showed significant values in terms of endodonticlly treated teeth survival.

In a recent report on 1175 ETT in 411 patients, where most of the patients were cases rehabilitated with fixed prostheses with a primary focus on endodontic therapy evaluation, the 10-year survival rate was high 93% with only 7% teeth extracted. and the most common reason for extraction was periapical changes.[16]

The current study recommends utilization of continuous educational measures to enhance the familiarity of dental practitioners about means of prevention and restoring endodontrically treated teeth keeping in mind the outcome.

The current research focuses on techniques and measures available in dental world since quite long now therefore we recommend precisely planned and accomplished researches by experienced fellows, furthermore, contemporary clinical techniques and restorative materials are immensely needed to enhance longevity of ETT, nevertheless, variations in clinical conceptions and procedures should not be adopted until satisfactory time has passed to authorize the fallouts of the research by practical clinical reflection.


  Conclusion Top


In relation to the dentists opinion in the direction of ETT restoration at designated dental setups, the statistics verdict exhibited an approximately high level of perception about the management of such cases. Furthermore, prevention strategies regarding stabilizing periodontal tissues of endodontically teeth should be promoted to improve the management outcome within dental settings.

Acknowledgments

The authors would like to thank all the dental staff who were cooperating and actively participating on the current research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Weiger R, Rosendahl R, Löst C. Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions. Int Endod J 2000;33:219-26.  Back to cited text no. 1
    
2.
Scotti N, Eruli C, Comba A, Paolino DS, Alovisi M, Pasqualini D, et al. Longevity of class 2 direct restorations in root-filled teeth: A retrospective clinical study. J Dent 2015;43:499-505.  Back to cited text no. 2
    
3.
Skupien JA, Opdam N, Winnen R, Bronkhorst E, Kreulen C, Pereira-Cenci T, et al. Apractice-based study on the survival of restored endodontically treated teeth. J Endod 2013;39:1335-40.  Back to cited text no. 3
    
4.
Ahmad I. Protocols for predictable aesthetic dental restorations. John Wiley & Sons; 2008 Apr 15.  Back to cited text no. 4
    
5.
Alani A, Maglad A, Nohl F. The prosthetic management of gingival aesthetics. British dental journal. 2011 Jan 22;210(2):63.  Back to cited text no. 5
    
6.
Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J 1995;28:12-8.  Back to cited text no. 6
    
7.
Landys Borén D, Jonasson P, Kvist T. Long-term survival of endodontically treated teeth at a public dental specialist clinic. J Endod 2015;41:176-81.  Back to cited text no. 7
    
8.
Zadik Y, Sandler V, Bechor R, Salehrabi R. Analysis of factors related to extraction of endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e31-5.  Back to cited text no. 8
    
9.
Touré B, Faye B, Kane AW, Lo CM, Niang B, Boucher Y, et al. Analysis of reasons for extraction of endodontically treated teeth: A prospective study. J Endod 2011;37:1512-5.  Back to cited text no. 9
    
10.
McGuire MK, Nunn ME. Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. J Periodontol 1996;67:666-74.  Back to cited text no. 10
    
11.
Iqbal MK, Johansson AA, Akeel RF, Bergenholtz A, Omar R. A retrospective analysis of factors associated with the periapical status of restored, endodontically treated teeth. Int J Prosthodont 2003;16:31-8.  Back to cited text no. 11
    
12.
Timmerman MF, Van der Weijden GA. Bone level around endodontically treated teeth in periodontitis patients. J Clin Periodontol 2006;33:620-5.  Back to cited text no. 12
    
13.
Jansson L, Ehnevid H, Lindskog S, Blomlöf L. The influence of endodontic infection on progression of marginal bone loss in periodontitis. J Clin Periodontol 1995;22:729-34.  Back to cited text no. 13
    
14.
Sarkis-Onofre R, Pereira-Cenci T, Opdam NJ, Demarco FF. Preference for using posts to restore endodontically treated teeth: findings from a survey with dentists. Brazilian Oral Research 2015;29:1-6.  Back to cited text no. 14
    
15.
Setzer FC, Boyer KR, Jeppson JR, Karabucak B, Kim S. Long-term prognosis of endodontically treated teeth: A retrospective analysis of preoperative factors in molars. J Endod 2011;37:21-5.  Back to cited text no. 15
    
16.
Fonzar F, Fonzar A, Buttolo P, Worthington HV, Esposito M. The prognosis of root canal therapy: A 10-year retrospective cohort study on 411 patients with 1175 endodontically treated teeth. Eur J Oral Implantol 2009;2:201-8.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2]



 

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