Innovation in endodontic teaching at the Melbourne Dental School
Instrumentation using rotary nickel-titanium (NiTi) vs traditional stainless steel (SS) files
Teeth are composed of three hard tissues, enamel, dentine and cementum. Housed within the tooth is a loose innervated connective tissue, called the dental pulp, which occupies the root canal system of the tooth. |
The pulp may become exposed to a variety of noxious stimuli in the form of either constant irritants or specific events, which may lead to inflammation of the pulp or interfere with its blood supply. Should the pulp not cope with these noxious stimuli, it will become necrotic (degenerate due to the lack of a blood supply) and eventually the root canal system will also become infected. |
It has been well established that bacteria in the infected root canal system can then cause an inflammatory response around the apex of the tooth, referred to as apical periodontitis. Endodontic (root canal) treatment aims at curing such disease.
The objective of root canal treatment is to completely seal a thoroughly cleaned and disinfected root canal system. A thorough debridement of the root canal system is an essential step toward this goal. The process of debridement includes mechanical instrumentation in conjunction with chemical irrigation. This combined technique will usually eliminate most of the bacterial contaminants of the canal, as well as the necrotic debris and contaminated dentine.
The process of cleaning and shaping the canal is not an easy goal to achieve, especially in curved canals which most of the root canals are. Historically, SS files have been used to instrument the canals. These files are naturally stiff. They tend to straighten curved canals, in addition, more serious complications, such as the development of ledges, apical zipping, and perforations have been reported in publications. To negotiate around the curves with these instruments, operators need certain skills which only come with a long period of training and practice. Inexperienced operators usually find it very difficult to achieve a good result with these instruments.
One of the most significant advances that has alleviated these shortfalls is the NiTi file. These files are ideally suited for root canal treatment as they are “super-elastic”.
With motor-driven rotary NiTi files, the canal preparation results are more consistent and less time consuming. Operator and patient fatigue are reduced as a result. Furthermore, it has been reported that even inexperienced operators, such as undergraduate dental students with minimal or no training are able to instrument canals effectively when rotary NiTi files have been utilised. In other words rotary NiTi canal preparation is technically less sensitive than the stainless steel counterpart.
With generous support from VDW, Dentsply and Gunz, A/Prof Parashos and Dr Sathorn have adopted rotary Ni-Ti technology as a major instrumentation technique in undergraduate and postgraduate Endodontic programme.
All preclinical exercises are performed on a manikin in clinically simulated environments.
The following are examples of “My first root canal treatment” by fourth year dental students.
