A national wide survey of opinions and attitude of endodontists towards the intra canal seperation of endodontic instruments

Aim: The purpose of current survey is to investigate the opinions and attitudes of endodontists towards the intracanal separation of endodontic instruments, attending a national conference in India. Materials and Methods: 1000 copies of the questionnaire were circulated at the 28 IACDE and 21 IES National Conference, held at Hyderabad, amongst the Endodontists and students pursuing postgraduation in conservative dentistry and endodontics at various colleges across the country, on the issue of instrument separation. The survey participants were asked about experience of instrument separation, management of fractured instruments, techniques used for removal of fractured instruments. Results: This survey elicited a response rate of 68.5%. The respondents of our survey comprised of 73.4% being post graduate students and 26.6% being staff delegates. Of the respondents, 51.4% would use an endodontic file for 2-5 times before discarding. Files manufactured by Nickel-Titanium alloy were most commonly separated in root canal (64.4%). Step back technique is more prone for separation of instrument (60.4%). The majority of respondents reported that they would try to retrieve fractured instruments located in the coronal one-third (71.7%), bypass when located in middle third (69.1%), leave and review when located in apical third (76.8%) of root canal. The most frequently used technique for the retrieval of fractured instrument was ultrasonic (39.7%). Overall, 35.2% of the respondents reported experience of root perforation as a complication during retrieval of fractured instruments. Most respondents have reported a poor success rate in retrieving the fractured instrument when in apical third (91.2%). A total of 66.7% of respondents noticed highest incidence of fracture in mesial root of mandibular molar. 45% preferred using microscope for removal of separated instrument. Conclusion: General awareness, knowledge and understanding of most aspects related to fracture of endodontic instruments was apparent among majority of the participants. INTRODUCTION The primary goal of endodontic treatment is to eradicate microorganisms from the root canal system; to prevent further reinfection, by the procedure of cleaning and shaping of root canal system with copious irrigation. Procedural errors can occur during root canal instrumentation. The most problematic being, separation of endodontic instruments within the root canal. Such an error prevents the achievement of efficient cleaning and shaping, which in turn can result in under filling of root canal (1) Review of the literature shows that the incidence of separated stainless steel hand instruments ranges between 2% and 6% (2). Therefore, in the year 1988, root canal instruments manufactured from NickelTitanium (Ni-Ti) alloy were introduced to overcome rigidity of stainless steel files and are known to show superior resistance to torsional fracture than stainless steel files (3). Even after the advent of rotary NiTi files, unfortunate increase in the separation of these instruments has been reported (4). According to the survey studies, operators recognize file fracture as one of the most prominent issues with Ni-Ti rotary instruments (5). Although, factors for occurrence and different techniques for successful removal of separated instruments have been studied, little research has been conducted to determine the widespread practice and acceptance of such methods among endodontists. The current survey was carried out to evaluate the opinions and attitudes towards the intracanal separation of endodontic instruments among endodontists, attending a national conference in India. MATERIALS & METHODS After approval from the organizing committee, 1000 copies of the questionnaire were circulated at the 28 Indian Association of Conservative Dentistry & Endodontics (IACDE) and 21 Indian Endodontic Society (IES) National Conference, held at Hyderabad, India, amongst the Endodontists and students pursuing postgraduation in conservative dentistry and endodontics at various colleges across the country, on the issue of instrument separation. A questionnaire was prepared which was modified form of that employed by Madarati et al, among dentists in UK, published in International Endodontic Journal (2008). Among student delegates, 1 year post graduates were excluded, due to lack of awareness and experience. Ineligible forms were not taken into consideration when final response was calculated. A total number A National Wide Survey of Opinions and Attitude of Endodontists towards the Intra Canal Seperation of Endodontic Instruments Endodontology, December 2015;27(2):101-106 102 of 685 completely filled forms were received back by us. The survey participants were asked about pattern of practice and experience of instrument separation, management of fractured instruments, techniques used for removal of fractured instruments, and about the approach they take when management of fractured instrument does not succeed. A sample of survey questionnaire given to participants is given in table 1. The data were collected and analyzed using SPSS software version 18. RESULTS Out of 1000 copies of the questionnaire which were circulated, 685 completed surveys were received yielding an overall response rate of 68.5%. The questionnaire results are shown in Table/Fig-1. [Table/Fig-1]: Questionnaire and response received for each question S. No Question Number % Student Delegates 503 73.4% Staff Delegates 182 26.6% STUDENT DELEGATE: 2 Year Post Graduate 232 46.1% 3 Year Post Graduate 271 53.8% STAFF DELEGATE: Teaching 22 12.1%