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On implementation of an endodontic program.

Margaretha Koch¹

¹Department of Endodontics, Faculty of Odontology, Malmö, Sweden.

Swedish Dental Journal. Supplement

|August 22, 2013

Summary

This summary is machine-generated.

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The adoption of nickel-titanium rotary (NiTiR) instrumentation improved root canal filling quality and cost-effectiveness but did not significantly enhance treatment success rates or reduce apical periodontitis. Further research is needed to identify factors improving endodontic care quality.

Area of Science:

Dental research
Endodontic treatment
Health services research

Background:

Advances in dental technology, such as nickel-titanium rotary (NiTiR) instrumentation, aim to improve root canal treatment outcomes.
Limited knowledge exists regarding the adoption processes and effectiveness of new techniques in general dental practice.
Previous studies indicate inadequate root-filling quality and associated periapical inflammation in general populations.

Purpose of the Study:

To investigate the adoption of clinical routines and the NiTiR technique in a Swedish Public Dental Service.
To analyze the process of change and identify factors facilitating successful implementation of new endodontic techniques.
To evaluate the clinical effects, including treatment outcome and cost-effectiveness, of root canal treatment before and after the adoption of NiTiR.

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Main Methods:

A two-year educational intervention program on endodontic routines and NiTiR technique for 400 dental professionals.
Post-education surveys and in-depth interviews (phenomenological analysis) to assess practice change and implementation factors.
Radiographic assessment of root-filling quality, periapical status, and tooth survival in 850 root canal treatments; micro-costing analysis for cost-effectiveness.

Main Results:

Significantly higher adoption of NiTiR technique (77% vs. 6%) and fewer instrumentation sessions in the intervention county.
Identified factors for successful change: disclosed motivation, individual learning processes, professional collaboration, and a facilitating educator.
Improved root-filling quality and higher tooth survival post-education, but no significant improvement in success rate (68% vs. 67%) or reduction in apical periodontitis (34% vs. 33%).
NiTiR technique led to lower treatment costs (SEK 264-564 per treatment) and was more cost-effective.

Conclusions:

A partial relationship exists between output (e.g., improved quality) and outcome (e.g., success rate), highlighting the efficacy-effectiveness gap.
While NiTiR improved efficiency and cost-effectiveness, it did not directly translate to better clinical success rates or reduced periapical inflammation.
Effective implementation requires clinically relevant interventions, skilled educators, and supportive learning environments that foster clinician motivation and collaboration.