Development of Basic Endodontic Treatment (BET) – 6Month Clinical Results

Objectives: Atraumatic restorative treatment (ART) has been shown to be effective in stopping caries progression, and it is mainly used in underprivileged areas. There is a dilemma between successful early treatment and late diagnosis with pulp involvement. To avoid tooth extraction, it was the aim to develop a basic endodontic treatment concept, based on efficient ART manual instrumentation and root canal obturation according to Grossman s postulates.The study was approved by the ethical committee of UWH.

Methods: In Gambian Community Health Centers 232 patients were treated with 84% tooth extractions, 9% ART and 7% BET. These 15 patients with endodontic treatment could be followed up for 6 month. Inclusion criteria were single rooted teeth and deep caries with pulp exposure during ART and acute pulpitis without apical periodontitis. Pulpectomy, apex location and root canal shaping was performed with extirpation instruments and reamers under 0.2% chlorhexidine rinsing. The root canal was obturated with single guttapercha point in combination with Grossman s cement. Evaluation criteria at the day of treatment, one day postoperatively, 5 days p.o. and 6 month p.o. were any pain, periapical pain and/or related swelling. A modified Health-related Quality of Life index (HR-QOL in 5 scores) was assessed to evaluate the subjective oral and general health development.

Results: Slight periapical pain present in 12 of 25 cases disappeared after 5 days. No other pain history nor swellings were diagnosed. Mean HR-QOL dental health status index after 6 month was reduced from 2.3 to 1.9, whereas the overall health status index remained unchanged by 2.1. None of the root canal filled teeth had to be revised or extracted.

Conclusions: BET seems to be effective in short-term reevaluation. Longitudinal observations have to prove these first results. A further challenge will be the implementation in training programmes for Community Oral Health Workers.