A Panoramic Survey of Air Force Basic Trainees: How Research Translates into Clinical Practice
In an In-Press article from the Journal of Endodontics and published on-line in July 2014 Winward, Yaccino and Kirkpatrick have reinforced our knowledge that “Years of endodontic research have found a variety of treatment practices that correlate with improved treatment outcomes.”
As all basic trainees in the United States Air Force undergo a dental screening the authors were able to study 35,811 panoramic radiographs of inductees between January 1, 2011 and December 31, 2011.
As the authors state: “A young adult population, like those evaluated in this study, should have the best chance of receiving ideal endodontic treatment. Younger patients tend to have larger pulp chambers and canals, which improve ease of access. Ease of access can reduce the risk of procedural errors and allows for instrumentation and obturation to an ideal level.” But did they find this to be the case? No! “Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present.”
Even taking into consideration that panoramic radiographs alone do not take into consideration any clinical difficulties the clinicians may have had during treatment, the number of cases that did not utilize the knowledge that years of published research has given us is not only disheartening but is a disservice to patients who expect to, and have a right to, receive treatment based on best treatment practices.
The authors’ published abstract appears below:
The purposes of this study were to examine the following in young adults residing in the United States: (1) the prevalence of teeth with root canal therapy (RCT) and teeth in need of RCT, (2) how frequently treatment practices associated with success as cited in the literature are found in posterior teeth with RCT, and (3) which treatment practices are associated with periradicular pathology.
Panoramic radiographs taken of all basic trainees entering the US Air Force in 2011 were evaluated in a 2-part review. A general survey of all radiographs was performed to determine the prevalence of teeth with and teeth in need of RCT. All panoramic radiographs that showed a posterior tooth with RCT were evaluated in detail to consider the presence and quality of cuspal coverage restorations, the quality of RCT, and the presence of periradicular pathology.
A total of 35,811 panoramic images were evaluated. Ten percent of basic trainees had existing RCT, whereas 5% showed a need for RCT. The total number of posterior teeth with RCT was 3,455. Nearly half of these teeth had either no cuspal coverage or an unacceptable cuspal coverage restoration. Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present.
Factors cited in the literature as being associated with success are lacking in the dental treatment of young adults residing in the United States.