Knowledge Attitude And Perception Of Regenerative Endodontic Procedure Among Specialist And Dental Practitioners
Nandita R1, Dr J Mahalakshmi2*
1 Undergraduate Student, Department of Conservative Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical
Sciences (SIMATS), Saveetha University, Chennai- 77, India.
2 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai- 77, India.
*Corresponding Author
Dr. J Mahalakshmi,
Senior Lecturer, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS],
Saveetha University, Chennai- 77, India.
Tel: 9003080462
E-mail: mahalakshmij.sdc@saveetha.com
Received: September 13, 2021; Accepted: September 23, 2021; Published: September 24, 2021
Citation:Nandita R, Dr. J. Mahalakshmi. Knowledge, Attitude, Perception On Irrigant Activation Devices Among Specialists And Dental Practitioners. Int J Dentistry Oral Sci. 2021;8(9):4689-4693. doi: dx.doi.org/10.19070/2377-8075-21000954
Copyright: Dr. J Mahalakshmi©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: Irrigation of the root canal space is an essential part of root canal treatment. Procedures for acoustic and
hydrodynamic enactment of the irrigant have been created because syringe irrigation isn't powerful in the apical piece of the
root canal. It has been shown that acoustic streaming and cavitation add to the cleaning effectiveness of root canal irrigation.
Acoustic streaming can be characterized as a quick development of liquid in a vortex-like movement around a vibrating record.
Aim: The aim of the present study is to analyse the knowledge, attitude, perception on irrigant activation devices among
specialists and dental practitioners.
Materials and Methods: Self administered questionnaire of close ended questions was prepared and it was distributed
among dental students from February to March 2021 through the online survey “google forms”. Data was analysed with SPSS
version (22.0). Descriptive statistics as percent were calculated to summarise qualitative data.
Results: The questionnaire was distributed among 200 participants. 13.9% of the participants were PG students, 11.4% of
the participants were dental practitioners, 73.8% of the participants were Endodontists. 94.1% of the participants were aware
of the terminology irrigant activation devices. Pearson chi square test showed P value= 0.239 (<0.05) statistically significant.
80.2% of the participants used sodium hypochlorite as an irrigant, 3.5% of the participants used chlorhexidine as an irrigant,
7.9% of the participants used saline as an irrigant, 7.4% of the participants used sterile water as an irrigant. Pearson chi square
test showed P value= 0.834 (>0.05) not statistically significant.
Conclusion: Dental practitioners had overall good knowledge and awareness on the irrigant activation devices. On comparing
different education levels, Endodontists had good knowledge and awareness regarding the irrigant activation devices.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
Awareness; Endodontists; Irrigation; Knowledge; Innovative Technique.
Introduction
Irrigation of the root canal space is an essential part of root canal
treatment. Procedures for acoustic and hydrodynamic enactment
of the irrigant have been created because syringe irrigation
isn't powerful in the apical piece of the root canal. It has been
shown that acoustic streaming and cavitation add to the cleaning
effectiveness of root canal irrigation. Acoustic streaming can be
characterized as a quick development of liquid in a vortex-like
movement around a vibrating record [1]. A definitive goal of endodontic
treatment is to control the microbial factor in complex
root canal systems, particularly in the apical one third. This goal is
accomplished by consolidating instrument-based readiness (manual
or mechanical) with sterile watering arrangements followed by
three-dimensional obturation of the root canal system [2]. This
blend counterbalances the disadvantages of the instrument-based
readiness, especially the making of debris and the smear layer [3].
One of the benefits of syringe irrigation is that it permits similarly
simple control of the profundity of needle penetration inside
the canal and the volume of irrigant that is flushed through
the canal. Ideal root canal irrigants should meet all the conditions portrayed above for endodontic achievement. In any case, there
is nobody interesting irrigant that can meet every one of these
necessities, even with the utilization of strategies, for example,
bringing down the pH, expanding the temperature, just as expansion
of surfactants to build the wetting viability of the irrigants
[4]. Root canal irrigation plays an essential part in Endodontics,
to encourage instrumentation by lubrication, remove debris, microorganisms,
smear layer and prevent apical debris pressing.
Irrigants apply their belongings, by mechanical, compound and
natural activities. On the mechanical front, streaming powers are
conveyed to the canal walls. On the compound front, the dynamic
parts apply explicit actions on the natural and inorganic debris [5].
The gold standard irrigant is still sodium hypochlorite, which
can be related with EDTA to offer bactericidal, dissolvable, and
chelating activities across the board. This combination balances
the downsides of the instrument-based arrangement, especially
the production of debris and the smear layer. The smear layer
is conceivably contaminated, and its evacuation permits more
proficient entrance of intracanal drugs into the dentinal tubules
and a superior interface between the filling material and the root
canal walls [6]. In root canal treatment, irrigant solutions are vital
for aid debridement and sterilization, yet their spread and activity
is frequently confined by canal systems. Subsequently, initiation
of irrigants is recommended to improve their dissemination in
the canal system, expanding irrigation adequacy. Enactment can
be done with lasers, named laser-activated water irrigation (LAI)
[7]. Ultrasonic agitation and pulsed lasers are the two major techniques
for activating endodontic irrigation fluids. Ultrasonic agitation
enhances performance of irrigants, extrusion of fluids from
the root canal during activation. Ultrasonic agitation with piezoelectric
devices were used as a moving tip, while laser agitation
was used as a stationary tip [8].
Root canal irrigation plays a vital role which facilitates instrumentation
by lubrication, removing debris, bacteria and preventing
apical debris packing. Irrigant activation is used as a method to
agitate and improve flow of irrigants to the intricacies of the root
canal system by mechanical forms. Just 1mm beyond the needle
tip is the best delivered irrigant in conventional irrigation methods
[9]. Surface quality of the tip and cleaning efficiency of the
canal are not provided by any existing irrigation activation system
[10]. Our team has extensive knowledge and research experience
that has translate into high quality publications [11-30].
The aim of the present study is to create knowledge, attitude and
perception on irrigant activation devices among specialists and
dental practitioners.
Materials and Methods
Study design:
A cross sectional study was conducted through an online survey
from February to April 2021 among dental practitioners and specialists.
Study subjects:
A simple random sampling was used to select the study participants.
Inclusion criteria:
All the dental practitioners and specialists who were willing to
participate were included.
Ethical considerations:
Returning the filled questionnaire was considered as implicit consent
as a part of the survey. Ethical approval for the study was
obtained from the Institutional Review Board (IRB), Saveetha
Dental College.
Study methods:
Self administered questionnaire of close ended questions was
prepared and it was distributed among dental practitioners and
specialists from February to April 2021 through the online survey
“google forms”. The collected data were checked regularly
for clarity, competence, consistency, accuracy and validity. Demographic
details were also included in the questionnaire.
Statistical analysis:
Data was analysed with SPSS version (22.0). Descriptive statistics
as percent were calculated to summarise qualitative data. Chi
square test was used to analyze.
The confidence level was 95% and of statistical significance P
< 0.05. Finally, the result was presented by using bar charts, pie
charts and percentage tables.
Results
The questionnaire was distributed among 200 participants. Of the
200 participants, 40% of the participants were male while 60% of
the participants were female. 37.5% of the participants belong to
the 15-18 years of age group, 24% of the participants belong to
the 18-25 years of age group, 38.5% of the participants belong to
the above 25 years of age group. 33% of the participants have experience
of 0-5 years, 36.5% of the participants have experience
of 5-10 years, 30.5% of the participants have experience above
10 years. 14% of the participants were PG students, 11.5% of
the participants were dental practitioners, 74.5% of the participants
were Endodontists. 95% of the participants were aware of
the terminology irrigant activation devices (Figure:1). 81% of the
participants used sodium hypochlorite as an irrigant, 3.5% of the
participants used chlorhexidine as an irrigant, 8% of the participants
used saline as an irrigant, 7.5% of the participants used sterile
water as an irrigant (Figure:2). 84.5% of the participants were
aware of irrigant which differ based on the pulpal or peri apical
diagnosis (Figure:3). 14.5% of the participants were aware that <
30sec as the duration of irrigation, 79% of the participants were
aware that 30 sec- 1 min as the duration of irrigation, 6.5% of the
participants were aware that 1-2 min as the duration of irrigation
(Figure:4). 87% of the participants were aware when to remove
the smear layer. 19.5% of the participants were aware that 1mm
from the apical foramen is the depth of penetration of needles
for irrigation while 58% of the participants were aware that 2mm
from the apical foramen is the depth of penetration of needle for
irrigation. 61.5% of the participants were aware that 5-10 ml is the volume of irrigant to be employed per canal while 26.5% of
the participants were aware that 0.5ml is the volume of irrigant
to be employed per canal. 67% of the participants used ultrasonic
activation as the adjuncts to irrigation, 14.5% of the participants
used sonic activation , 11.5% of the participants used manual agitation
and 7% of the participants used LASER (Figure:5). 62.5%
of the participants were aware that antimicrobial action is the advantage
of using irrigant activation devices, while 22.5% of the
participants were aware that lubricant is the advantage of using irrigant
activation devices. 19% of the participants use irrigant for
every case, 69.5% of the participants use irrigant for tooth with
infection while 11.5% of the participants will not use irrigant at
all. 21.5% of the participants would not use irrigant because they
think it is not necessary. 72% of the participants would not use
irrigant because they don’t have knowledge on it.
Figure 1. Bar graph showing comparison of responses between different educational levels of undergraduate dental students and awareness of the term irrigant activation devices. X axis represents the irrigant activation devices and Y axis represents the No. of responses. Most of the Endodontists were more aware of term irrigant activation devices (34.52%) and the difference was statistically significant. Chi square test showed p value= 0.852 (>0.05) not statistically significant.
Figure 2. Bar graph showing comparison of responses between different educational levels of undergraduate dental students and awareness of the irrigant used. X axis represents the uses of irrigant and Y axis represents the No. of responses. Most of the Endodontists were more aware of irrigant use (26.19%) and the difference was statistically significant. Chi square test showed p value= 0.834 (>0.05) not statistically significant.
Figure 3. Bar graph showing comparison of responses between different educational levels of undergraduate dental students and awareness of irrigant that differ based on the pulpal or peri apical diagnosis. X axis represents the choice of irrigants and Y axis represents the No. of responses. Most of the Endodontists were more aware of irrigant that differ based on the pulpal or peri apical diagnosis (28.57%) and the difference was statistically significant. Chi square test showed p value= 0.677 (>0.05) not statistically significant.
Figure 4. Bar graph showing comparison of responses between different educational levels of undergraduate dental students and awareness of duration of irrigation that is preferred per canal. X axis represents the duration of irrigants and Y axis represents the No. of responses. Most of the Endodontists were more aware of the duration of irrigation that is preferred per canal (19.05%) and the difference was statistically significant. Chi square test showed p value= 0.030 (<0.05) statistically significant.
Figure 5. Bar graph showing comparison of responses between different educational levels of undergraduate dental students and awareness of adjuncts utilised for irrigation. X axis represents the adjuncts to irrigation and Y axis represents the No. of responses. Most of the Endodontists were more aware of adjuncts utilised for irrigation (26.19%) and the difference was statistically significant. Chi square test showed p value= 0.000 (<0.05) statistically significant.
Discussion
From the present study it was evident that 95% of the participants
were aware of the irrigant activation devices. The similar
study was done by Madhusudhana Koppolu in which 80.6% of
the participants were aware of the irrigant activation devices [31].
In the present study, 33% of the participants have experience
of 0-5 years, 36.5% of the participants have experience of 5-10
years, 30.5% of the participants have experience above 10 years.
The similar study which was conducted by Madhusudhana Koppolu
in which 43.3% of the participants have experience of 5-10
years and 33.3% of the participants have experience of <5 years
[31].
In the present study, 81% of the participants used sodium hypochlorite
as an irrigant, 3.5% of the participants used chlorhexidine
as an irrigant, 8% of the participants used saline as an irrigant,
7.5% of the participants used sterile water as an irrigant.
7.4% of the participants used sterile water as an irrigant. A similar
study was performed by Clarkson in which 77.7% of the respondents
used sodium hypochlorite as the irrigant while 27.7%
of the respondents used chlorhexidine as the irrigant [32]. In
contrast, the study performed by Al-Ali in which 92% of the respondents
used sodium hypochlorite as the irrigant while 65.03%
of the respondents used saline as the irrigant [33]. In contrast, a
study which was performed by Shrestha in which 95.8% of the
respondents used sodium hypochlorite as the irrigant while 42%
of the respondents used chlorhexidine as the irrigant [34]. In contrast,
the author Erecan concluded that 94% of the participants
have used sodium hypochlorite as an irrigant [35].
In the present study, 14.4% of the participants were aware that <
30sec as the duration of irrigation, 78.2% of the participants were
aware that 30 sec- 1 min as the duration of irrigation, 6.4% of
the participants were aware that 1-2 min as the duration of irrigation.
A similar study was conducted by Madhusudhana Koppolu
in which 22.2% of the participants were aware that <30sec as the
duration of irrigation, 66.7% of the participants were aware that
30 sec- 1 min as the duration of irrigation, 11.1% of the participants
were aware that 1-2 min as the duration of irrigation [31].
In the present study, 19.3% of the participants were aware that
1mm from the apical foramen is the depth of penetration of
needles for irrigation while 57.4% of the participants were aware
that 2mm from the apical foramen is the depth of penetration of
needles for irrigation. A similar study was performed by Madhusudhana
Koppolu in which 11.1% of the participants were aware
that 1mm from the apical foramen is the depth of penetration of
needles for irrigation while 50% of the participants were aware
that 2mm from the apical foramen is the depth of penetration of
needles for irrigation [31].
In the present study, 14.5% of the participants were aware that <
30sec as the duration of irrigation, 79% of the participants were
aware that 30 sec- 1 min as the duration of irrigation, 6.5% of the
participants were aware that 1-2 min as the duration of irrigation.
A similar study was conducted by Miglani in which 25% of the
participants were aware that 30- 1 min as the duration of irrigation,
55.6% of the participants were aware that 1-2 min as the
duration of irrigation, 19.4% of the participants were aware that
> 2min as the duration of irrigation [36].
In the present study, 87% of the participants were aware when to
remove the smear layer. A similar study conducted by Garberoglio
in which 50% of the respondents remove the smear layer [37].
A similar study was performed by Al-Ali in which 68.7% of the
participants remove the smear layer [31]. A similar study was performed
by Shrestha in which 80.7% of the respondents remove
the smear layer [34].
In the present study, 84.5% of the participants were aware of
irrigant which differ based on the pulpal or peri apical diagnosis.
In contrast, the study conducted by Torabinejad in which 84% of
the participants were aware of irrigant which differs based on the
pulpal or peri apical diagnosis [38].
In the present study, 67% of the participants used ultrasonic activation
as the adjuncts to irrigation, 14.5% of the participants used
sonic activation, 11.5% of the participants used manual agitation
and 7% of the participants used LASER. In contrast, a study performed
by Shrestha in which 10.1% of the respondents used ultrasonic
activation as the adjuncts to irrigation [34].
Conclusion
Dental practitioners had overall good knowledge and awareness
on the irrigant activation devices. On comparing different education
levels, Endodontists had good knowledge and awareness
regarding the irrigant activation devices. It is recommended that
dental practitioners and specialists should be more exposed and
motivated about the principles of endodontics during their dental
education in order to be prepared for future practice of utilizing
irrigant activation devices.
Acknowledgement
This research was done under the supervision of the Department
of Research of Saveetha Dental College and Hospitals. We sincerely
show gratitude to the corresponding guides who provided
insight and expertise that greatly assisted the research.
Source of Funding
This study was supported by the following agencies.
• Saveetha Institute of Medical and Technical Sciences.
• Sarkav Health Services.
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