Development of a basic root canal treatment (BRT) for primary oral health care--evaluation after one year.
OBJECTIVE
Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under-served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow-up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care.


METHODS
25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step-back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single-cone technique with gutta-percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively.


RESULTS
None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work.


CONCLUSIONS
Preliminary clinical follow-ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.
Jordan
Rainer A
RA
Department of Operative and Preventive Dentistry, Faculty of Dental Medicine, University of Witten/Herdecke, Witten, Germany. andreas.jordan@uni-wh.de
Markovic
Ljubisa
L
Holzner
Anna L
AL
Richter
Benjamin
B
Gaengler
Peter
P
D000293:Adolescent; D000328:Adult; D002710:Chlorhexidine; D003793:Dental Restoration, Permanent / Q000379:methods; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia; D006171:Gutta-Percha; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care; D011671:Pulpitis / Q000628:therapy*; D011788:Quality of Life; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D012390:Root Canal Therapy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult; D015035:Zinc Oxide-Eugenol Cement
D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D015035:Zinc Oxide-Eugenol Cement; C045432:Grossman's sealer; D006171:Gutta-Percha; D002710:Chlorhexidine