Table 1.
Summary of In Vivo Studies Evaluating the Quality of Root Canal Treatment Conducted Worldwide (n=13) and in Saudi Arabia (n=9)
| Study Characteristics | Quality of Obturation | Procedural Errors | Assessed Outcome Parameters | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Length (%) | Density (%) | Taper (%) | ||||||||||
| Author(s), Year, Country | Number of Canals | Study Design and Type | Tooth Type (%) | Dental Setting; Operators | Acceptable | Unacceptable | Acceptable | Unacceptable | Acceptable | Unacceptable | ||
| Worldwide Studies | ||||||||||||
| Gavini et al,8 2022, Brazil | 2213 | Cross-sectional retrospective |
Anterior 25.8% Premolar 32.2% Molar 42.0% |
Dental school; FYSs | 72.9% | 27.1% | 87.3% | 22.7% | 91.6% | 8.4% | Instrument fractures 0.81%. In last 5 mm of apical tip 77.8% | Better results in maxillary teeth |
| Silnovic et al,9 2023, Sweden |
60 | Retrospective | Anterior 27.1% Premolar 31.8% Molar 41.8% |
Polyclinics, governmental; GDP |
28.7% | 71.3% | NM | NM | NM | NM | NM | Poor quality in anterior and molars |
| Ameen et al,14 2024, United Arab Emirates | 601 | Cross-sectional retrospective |
Anterior 48.4% Premolar 51.6% |
Dental school, private; FYSs |
93.5% | 6.5% | 96.5% | 3.5% | 98.2% | 1.8% | NM | SD ↔ anterior and premolars regarding taper, density, and overall quality |
| Al Shehadat et al,10 2023, United Arab Emirates | 124 | Cross-sectional retrospective |
Anterior 32.9% Premolar 45.6% Molar 21.5% |
Private dental school; FYSs | 73.5% | 26.5% | 57.5% | 42.3% | 66.2% | 33.8% | Ledge 5.4%, apical transportation 3.5%, fractured instrument 1% |
SD ↔ quality parameters SD ↔ ledge formation and apical transportation |
| Laukkanen et al,11 2021, Finland |
426 | Cross-sectional retrospective |
Anterior 34.2% | Governmental; GDP | 71.0% | 29.0% | NM | NM | NM | NM | NM | SD ↔ teeth, poorer in molars |
| Premolar 40.7% | 57.0% | 43.0% | NM | NM | NM | NM | ||||||
| Molar 25.1% | 43.0% | 57.0% | NM | NM | NM | NM | ||||||
| Ribeiro et al,15 2019, Brazil | 274 | Retrospective | Anterior 39% | Governmental; FYSs | 71.7% | 28.9% | 99.7% | 0.3% | 96.6% | 3.7% | NM | 80% unsatisfactory quality |
| Premolar 61% | 67.3% | 32.7% | 98.1% | 1.9% | 96.0% | 4.0% | ||||||
| Saatchi et al,16 2018, Iran | 1674 | Cross-sectional | Anterior 9.7% | Governmental; FYSs | 57.7% | 42.3% | NM | NM | 67.5% | 32.5% | Ledge 12.8%, foramen perforation 2%, root perforation 2.4% |
SD ↔ procedural errors, higher molars |
| Premolar 21.9% | 61.3% | 38.7% | NM | NM | 69.5% | 30.5% | ||||||
| Molar 68.4% | 51.3% | 48.7% | NM | NM | 63.7% | 36.3% | ||||||
| Fritz et al,17 2021, Brazil | 442 | Prospective | Anterior 38.2% | FYSs | 94.5% | 5.5% | NM | NM | 96.8% | 3.2% | NM | SD ↔ anterior and premolars |
| Premolar 45.0% | 96.5% | 3.5% | NM | NM | 96.5% | 3.5% | ||||||
| Molar 16.8% | 92.1% | 7.9% | NM | NM | 92.4% | 7.6% | ||||||
| Pietrzycka et al,30 2022, Poland | 219 | Retrospective randomized double-blind comparison | Anterior 43.7% Premolar 42.2% Molar 14.1% |
GDP | 85.8% | 14.2% | 99.5% | 0.5% | NM | NM | NM | NSD ↔ GDP and specialist |
| 257 | Anterior 26.5% Premolar 18.4% Molar 45.1% |
Specialist | 74.5% | 25.5% | 99.3% | 0.7% | NM | NM | ||||
| Wong et al,23 2016, Malaysia |
75 | Retrospective clinical audit | Anterior 26.7% | FYSs | 75.8% | 24.2% | 75.8% | 24.2% | NM | NM | Ledge 9.3%, perforation 11.4%, instrument separation 0.7% | SD ↔ misshape |
| Premolar 29.3% | 78.3% | 21.7% | 65.3% | 34.85 | NM | NM | ||||||
| Molar 44.0% | 61.5% | 38.5% | 57.7% | 42.3% | NM | NM | ||||||
| Yusufoğlu et al,29 2021, Turkey | 3115 | Retrospective | Max & Mand Molars | GDP | 76.7% | 23.3% | 37.3% | 62.7% | NM | NM | Separated instrument 2.6%, ledges 0.4%, lateral perforation 0.1% | SD ↔ GP and endodontist in obturation quality NSD iatrogenic |
| Endodontist | 82.3% | 17.7% | 62.7% | 37.3% | NM | NM | Separated instrument 4.6%, ledges 0.5%, lateral perforation 0.1% | |||||
| Elemam et al,38 2015, Libya | 284 | Retrospective | Anterior 9.7% Premolar 15.5% Molar 73.3 |
Governmental; FYSs | 48.6% | 51.35% | 75.8% | 24.2% | 68.8% | 31.2% | NM | SD ↔ overall quality between tooth types |
| Awooda et al,39 2016, Sudan | 173 | Retrospective, cross-sectional | Anterior 35.3% Premolar 27.2% Molar 37.5% |
Private college; FYSs | 71.7% | 28.3% | 72.8% | 27.2% | 94.8% | 5.2% | Separated instrument 3.5% |
|
| Saudi Studies | ||||||||||||
| Alshehri et al,12 2023 | 278 | Retrospective | Anterior 100% | Governmental; FYSs | 85.6% | 14.4% | 65.1% | 34.9% | 71.9% | 28.1% | Ledge 4.7%, root perforation 0.4%, foramen perforation 0.7% |
SD ↔ 4th, 5th, 6th SD ↔ Max and Man teeth NSD ↔ Male and female |
| Al-Obaida et al,13 2020 | 200 | Cross-sectional prospective | Private hospital: Anterior 24.0% Premolar 33.0% Molar 43.0% |
Private; GDP | 48.0% | 52.0% | 60.5% | 39.5% | 56.5% | 43.5% | NM | Tooth type: SD ↔ length and tapering Hospital type: SD ↔ length, tapering, density |
| Governmental; GDP | 60.0% | 40.0% | 71.5% | 29.5% | 71.5% | 29.5% | ||||||
| 200 | Government hospital: Anterior 32.5% Premolar 28.5% Molar 39.0% |
Private; GDP | 41.7% | 58.8% | 46.0% | 58.1% | 42.8% | 62.0% | ||||
| Governmental; GDP | 58.3% | 41.2% | 54.0% | 41.9% | 57.0% | 38.0% | ||||||
| Habib et al,18 2018 | 390 | Cross-sectional retrospective | Anterior 27.4% Premolar 27.7% Molar 42.9% |
Private college; FYSs | 59.5% | 40.5% | 50.8% | 49.2% | 57.4% | 42.6% | NM | SD ↔ length and density NSD ↔ tapering |
| Kader et al,20 2016 | 352 | Retrospective observational | NM | Governmental; FYSs | 61.7% | 38.3% | 54.0% | 46.0% | 53.1% | 46.9% | Ledge formation and gauging | NM |
| Bajawi et al,19 2018 | 209 | Retrospective cross-sectional | Max 58.2% Mand 41.8% |
Governmental ; Dental center consultant |
69.6% | 30.4% | 100.0% | 00.0% | 100.0% | 00.0% | NM | SD ↔ arch, canal position, level of experience |
| Specialist | 62.5% | 37.5% | 81.3% | 18.8% | 87.5% | 12.5% | ||||||
| GDP | 46.4% | 53.6% | 75.8% | 24.2% | 77.7% | 22.3% | ||||||
| Abumostafa et al,24 2015 | 450 | Retrospective | Max 48.9% Mand 51.1% Anterior 14.9% Posterior 85.1% |
Private college; FYSs | 77.6% | 22.5% | 46.4% | 53.6% | 78.8% | 26.2% | Ledge 2.4%, transportation 3.1%, apical perforation 1.1%, root perforation 0.2%, stripping perforation and fractured instrument 1.1% | NM |
| Akbar,25 2015 | 130 | Cross-sectional | Anterior 12.3% Premolar 13.8% Molar 74.6% |
Governmental; FYSs | 76.5% | 23.3% | NM | NM | NM | NM | Separated instrument 3.1%, stripping perforation 2.3%, furcal perforation 0.8%, coronal leakage 0.8% |
SD ↔ under-filling and poor filling and apical radiolucency |
| Smadi et al,26 2015 | 66 | Prospective | Anterior 40.8% Premolar 40.4% Molar 18.8% |
Governmental; FYSs | 61.5% | 38.5% | 50.5% | 49.5% | 56.1% | 43.9% | Present in 85.3%. Man molars were highest | SD ↔ errors among teeth and obturation parameters |
| Mustafa,40 2022 | 400 | Retrospective clinical study | Anterior 36.0% Premolar 17.0% Molar 47.0% |
Governmental; FYSs | 67.3% | 32.7% | 51.7% | 48.3% | 74.9% | 25.1% | NM | SD ↔ length |
Abbreviations: NM, none mentioned; SD, significant difference; ↔, between; GDP, general dental practitioner; NSD, non-significant difference; FYS, final year student; Max, maxillary; Man, mandibular.