Endodontic Output in Public Healthcare under Different Instrumentation Techniques: A Quantitative and Qualitative Study
Keywords:Endodontics, Secondary Care, Health Services Research, Dental Health Services
Objective: To evaluate output of endodontic in oral public healthcare by analyzing differences in instrumentation techniques, quantitative and qualitatively. Material and Methods: Endodontic services were differentiated by instrumentation techniques: hand techniques with stainless steel instruments (SS) or rotary using NiTi rotary instruments. Secondary data on the productivity of 2011 were obtained from the information system. Student’s t and Mann-Whitney tests were used. Qualitative data were based on semi-structured interviews, direct observation and field diary. Results: Service I employed SS hand techniques, service II used both techniques, while NiTi rotary system was used in service III. Statistically significant differences were observed in total endodontic productivity, with I presenting more productive results than II (p=0.001) and III (p=0.009); III presenting more productive results than II (p<0.001). Comparisons of endodontic treatment types revealed that I performed more multiradicular tooth treatments than did II and III (p=0.005), and III performed more treatments on biradicular teeth than did I and II (p=0.002). Qualitative analyses were divided into themes: “perceptions of the service” and “perceptions of the employed instrument”. Conclusion: Professional experience and high productivity per hour can be a differential; the use of rotary instrumentation can be useful in solving unmet demands. Perception of endodontists showed that chosen endodontic technique influenced job satisfaction and lack of integrality of the treatment is a problem in secondary care.
Koch M. On implementation of an endodontic program. Swed Dent J Suppl 2013; (230):9-97.
Schafer E, Burklein S. Impact of nickel-titanium instrumentation of the root canal on clinical outcomes: a focused review. Odontology 2012; 100(2):130-6. https://doi.org/10.1007/s10266-012-0066-1
Martins RC, Seijo MOS, Ferreira EF, Paiva SM, Ribeiro Sobrinho AP. Dental students’ perceptions about the endodontic treatment performed using NiTi rotary instruments and hand SS files. Braz Dent J 2012; 23(6):729-36. https://doi.org/10.1590/s0103-64402012000600018
Pedrazzi V, Dias KRHC, Rode SM. Oral health in Brazil – Part II: dental specialty centers (CEOs). Braz Oral Res 2008; 22(Suppl1):18-23. https://doi.org/10.1590/s1806-83242008000500004
República Federativa do Brasil. Decree 7508 of 28 June 2011, Which Regulates Law 8080 of 19 September 1990, to Provide for the Organization of the Universal Health System (SUS), Health Planning, Health Care, the Structure among the Federation and Other Measures; Republica Federativa do Brasil: Brasilia, Brazil, 2011.
Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet 2011; 377(9779):1778-97. https://doi.org/10.1016/S0140-6736(11)60054-8
Cortellazi KL, Balbino EC, Guerra LM, Vazquez FL, Bulgareli JV, Ambrosano GM, et al. Variables associated with the performance of Centers for Dental Specialties in Brazil. Rev Bras Epidemiol 2014; 17(4):978-88. https://doi.org/10.1590/1809-4503201400040015
Instituto Brasileiro de Geografia e Estatística (IBGE) [homepage]. Brasília (DF): Censo demográfico; 2010. Available from: http://www.ibge.gov.br/estadosat/perfil.php?sigla=mg. [Accessed on June 10, 2012]. [In Portuguese].
Bauer MW, Gaskell G. Qualitative Research with Text, Image and Sound. Vozes: Petrópolis, Brazil, 2002; p. 374.
Alcalde-Rabanal JE, Nigenda G, Bärnighausen T, Velasco-Mondragón HE, Darney BG. The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. Hum Resour Health 2017; 15(1):49. https://doi.org/10.1186/s12960-017-0220-5.
Morisaki M, Shozi H. Work study on endodontic treatments by means of practice administration. Dent Jpn 1990; 27(1):147-53.
Gonçalves CR, Cruz MT, Oliveira MP, Morais AJD, Moreira KS, Rodrigues CAQ, et al. Human resources: critical factor for primary health networks. Saúde Debate 2014; 38(100):26-34. https://doi.org/10.5935/0103-104.20140012.
Beazoglou T, Heffley D, Brown LJ, Bailit H. The importance of productivity in estimating need for dentists. J Am Dent Assoc 2002; 133(10):1399-1404. https://doi.org/10.14219/jada.archive.2002.0056.
Donabedian A. The quality of care. How can it be assessed? Arch Pathol Lab Med 1997; 121:1145-50.
Arboit J, Padoin SM, Vieira LB, Paula CC, Costa MC, Cortes LF. Health care for women in situations of violence: discoordination of network professionals. Rev Esc Enferm USP 2017; 51:e03207. https://doi.org/10.1590/S1980-220X2016113303207
Brazil. Ministry of Health. Department of Health Care. Department of Primary Care. Oral Health, Brasília, 2008. Technical Standards and Manuals - Basic Care Notebooks number 17. 92 p.
Scavo R, Lalis RM, Zmener O, Dipietro S, Grana D, Pameijer CH. Frequency and distribution of teeth requiring endodontic therapy in an Argentine population attending a specialty clinic in endodontics. Int Dent J 2011; 61(5):257-60. https://doi.org/10.1111/j.1875-595X.2011.00069.x
Bjørndal L, Laustsen MH, Reit C. Root canal treatment in Denmark is most often carried out in carious vital molar teeth and retreatments are rare. Int Endod J 2006; 39(10):785-90. https://doi.org/10.1111/j.1365-2591.2006.01149.x
Bjørndal L, Reit C. The annual frequency of root fillings, tooth extractions, and pulp related procedures in Danish adults 1977–2003. Int Endod J 2004; 37(11):782-8. https://doi.org/10.1111/j.1365-2591.2004.00879.x
Parashos P, Messer HH. Questionnaire survey on the use of rotary nickel-titanium endondontic instruments by Australian dentists. Int Endod J 2004; 37(4):249-59. https://doi.org/10.1111/j.0143-2885.2004.00784.x
Bjørndal L, Reit C. The adoption of new endodontic technology amongst Danish general dental practitioners. Int Endod J 2005; 38(1):52-8. https://doi.org/10.1111/j.1365-2591.2004.00904.x
Magalhães MBP, Oliveira DV, Lima RF, Ferreira EF, Martins RC. Evaluation of secondary care in endodontics at Dental Specialties Centers (DSC). Cien Saude Colet 2019; 24(12):4643-54. https://doi.org/10.1590/1413-812320182412.04112018
Martins RC, Reis CMR, Matta-Machado ATG, Amaral JHL, Werneck MAF, Abreu MHNG. Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil. PLoS ONE 2016; 11(10):e0164986. https://doi.org/10.1371/journal.pone.0164986
Chaves SCL, Barros SG, Cruz DN, Figueiredo ACL, Moura BLA, Cangussu MCT. Brazilian Oral Health Policy: factors associated with comprehensiveness in health care. Rev Saude Publica 2010; 44(6):1005-13. https://doi.org/10.1590/s0034-89102010005000041
Molander A, Caplan D, Bergenholtz G, Reit C. Improved quality of root fillings provided by general dental practitioners educated in nickel-titanium rotary instrumentation. Int Endod J 2007; 40(4):254-60. https://doi.org/10.1111/j.0143-2885.2007.01208.x
Koch M, Eriksson HG, Axelsson S, Tegelberg A. Effect of educational intervention on adoption of new endodontic technology by general dental practitioners: a questionnaire survey. Int Endod J 2009; 42(4):313-21. https://doi.org/10.1111/j.1365-2591.2008.01511.x
Fleming CH, Litaker MS, Alley LW, Eleazer PD. Comparison of classic endodontic techniques versus contemporary techniques on endodontic treatment success. J Endod 2010; 36(3):414-8. https://doi.org/10.1016/j.joen.2009.11.013
Coelho MS, Card SJ, Tawil PZ. Safety assessment of two hybrid instrumentation techniques in a dental student endodontic clinic: a retrospective study. J Dent Educ 2017; 81(3):333-9.
Barnett ML. Decisions, decisions: challenges to the introduction of new technologies to clinical practice. J Dent Res 2002; 81(1):5. https://doi.org/10.1177/002203450208100102
Koch M, Tegelberg A, Eckerlund I, Axelsson S. A cost-minimization analysis (CMA) of root canal treatment before and after education in nickel–titanium rotary technique in general practice. Int Endod J 2012; 45(7):633-41. https://doi.org/10.1111/j.1365-2591.2012.02019.x
How to Cite
Copyright (c) 2021 Pesquisa Brasileira em Odontopediatria e Clínica Integrada
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.