A. S. Al-Yahya, BDS, MS
Department of Restorative Dental Sciences, King Saud University College of Dentistry, P.O. Box 60169, Riyadh 11545

Endodontics training or undergraduate students differs from one school to another. The training quality reflects on the skill of the trainees. This study evaluates the performance of the undergraduate students of King Saud University College of Dentistry. Analysis of the treatment of 276 patients revealed that there is no relationship between the gender of students and the successful performance of endodontic procedures (P = .73). The most common treatment complications encountered by the students were underfilled can also, ledging, and voids.

Dental education may differ from one place to another according to its cultural, social, and economic conditions. The Kingdom of Saudi Arabia has conceptually utilized its vast resources to practically modernize its developmental thrust, including dental education. In 1975, King Saud University College of Dentistry (KSUCD) was officially established by a Royal Decree.

Although the KSUCD curriculum was initially derived from both American and European experiences, the result has often been described as analogous to one of the American dental schools. Evolutionary changes, internal and external factors, have, however, created a curriculum unique to this College.

The study, leading to the degree of Bachelor of Dental Surgery, is a twelve-semester course. Each academic year consists of two sixteenweek semesters with an optional eightweek summer session for remedial classes. The first three semesters con-tain thirtyfive hours of required predental courses. Since the English language is the medium of teaching, intensive courses in English are included in the predental requirements. At the end of the third semester, students fulfilling the predental requirements in good standing are enrolled in the Dental Program proper for the remaining nine semesters.

During the next nine semesters, an additional one hundred and sixty-four credit hours are required for graduation. In the Dental Program, the curriculum is "diagonal" where basic sciences and preclinical instruction are given in the earlier semesters. However, some preclinical courses are delayed as late as the sixth and seventh semesters. The two final semesters are spent primarily for clin­ ical practice.

The clinical content of the curriculum is based upon a departmental approach within the framework of a College semester credit hour sys­ tem. Individual courses are offered in each department with increasing depth and requirements. Accordingly, specific course requirements are generally directed to procedures which can be completed within one semester. The continuity of treating patients requiring complicated and timconsuming procedures is frequently not possible. Additionally, patients must be prescreened in order to equate the requirements of each course.1

The School has four academic departments, namely, the Biomedical Dental Sciences (BDS), Preventive Dental Sciences (PDS), Removable Prosthetic Dental Sciences (SDS), and Restorative Dental Sciences (RDS). Courses are assigned to different departments according to their specialty. The Endodontic courses are given in the Restorative Dental Sciences Department.2

In a teaching institution, the emphasis should be given to the quality of its graduates, rather than its quantity. Provision of needed facilities, proper selection of students and faculty, and a strong objective curriculum shouid be considered care­
fully. Such concern is necessary for graduating a dentist with high professional standards capable of undertaking dental health problems with confidence and genuine motivation to serve.3

KSUCD students are taught that the degree of endodontic success is determined by quantitative pulpal remnants after endodontics, as well as the body's ability to accommodate the treatment. The bacteriologic basis of endodontic treatment is as valid today as it ever was.4 Proper diagnosis, total isolation, adequate access, total caries removal, thorough debridement and irrigation, and complete obturation of the root canals, are emphasized.4,s

Despite the seemingly logical and contemporary endodontics curriculum at KSUCD, its success has never been evaluated on the basis of its students' performance. The purpose of this study was to evaluate the performance and the frequency of complications of the endodontic treatment performed by the undergraduate dental students at KSUCD.

Since KSUCD is housed in two separate buildings, one for male students and one for female students, the relationship between the gender of the students and their performance of endodontic procedures was also studied.

The dental clinics of KSUCD consist of two hundred and fiftytwo dental units. The clinics are staffed by third and fourth year dental students, in addition to interns, general practitioners, and specialists.

The clinic schedule of the students occurs as two daily sessions of three hours each, morning and afternoon. The endodontic clinic is scheduled for two sessions per week on each campus. The College applies the fourhanded dentistry approach where students are provided dental assistants to assist them during their clinical practice. These assistants deliver the needed instruments and/or materials from the Sterilization Center, in addition to chairside assisting. Consequently, the students spend more time in patient contact than in other endodontic programs.6

Endodontics Training:

There are three endodontic courses given to the students in the undergraduate level. The first course, 321 RDS, is both didactic and practical. The students have to attend two lectures and a threehour laboratory session for preclinical train
ing per week. In this course, the student is trained to work on extracted teeth. The student is expected to complete root canal treatment of at least one anterior, one bicuspid, and one molar teeth.

The other two courses are clinical courses where students have to spend one clinical session per week in each course. Course number 421 RDS is the first clinical course taken by the students after didactic and preclinical training in endodontics. The students at this stage are supposed to diagnose and perform non-surgical endodontic therapy. By the end of this course, the student should have completed endodontic treatment on a singlecanaled anterior tooth, a twocanaled bicuspid, and an upper or lower molar. In 426 RDS, which is an advanced clinical endodontics course, the student, is given the chance to perform some other procedures, such as apexification, simple apical surgery or bleaching in addition to the root canal treatment. Each student is required to complete root canal treatment procedures for a minimum of three molars.

The technique of preparation and obturation, being taught to students, is the conventional technique of serial, step back, and circumferential filling followed by lateral condensation of gutta percha.

The performance of the students in the entry level clinical endodontics course (421 RDS) was evaluated. The students examined and treated a total of 276 patients; 162 were treated by male students and 114 by female students. All steps of treatment were conducted by the students under direct supervision of clinical instructors, who are specialized in endodontics. Since this was the first clinical course in endodontics, criteria for selection of cases was made according to its simplicity with straight canals and without having previous conventional treatments or required surgical approach.7 The criteria for successful operative results were: the absence of pain or swelling, disappearance of fistulae, if present; retention of func tion, absence of tissue destruction, and roentgenographic evidence of an eliminated or arrested area of rarefaction after a posttreatment interval of six months to two years.8, 9 The collected data were analyzed statistically using the Chisquaretest.10

The results of this study are presented in Tables 1 and 2. The results of the four- way analysis indicates that there is no relationship between the gen­ der of students and the successful performance of endodontic procedures (P = .73, Chi-square =
11) as shown in Table 1. The odds ratio was 1.14. The independent results of the gender could be due to the fact that the curriculum, as well as the faculty staff, are the same for both male and female students in the two different campuses of KSUCD.

It appears that the most common problems encoutered by the students were underfilled canals, ledging and voids [Table 2]. This pattern was similar in both males and females performances. Complications, such as broken instruments, were limited to three cases.

Treatment of pulpitis and of the infected root canal occupies the major part of the endodontic practice. The radical treatment of pulpless teeth by extraction, which was so prevalent a few decades ago, has given way to conservative treatment and retention of such teeth. This change has been due to a gradual veering away from the focal infection theory. Simplification of treatment was probably another significant factor that lead to a more general practice of endodontics. A third factor could have been the prevalence of widespread clinical use of crown and bridge prostheses, which oftenly necessitates the utilization of pulpiess teeth as strategic abutments.

The most important factor, however, has been the realization that properly treated pulpless teeth are not injurious to health.11 The success rates of endodontic treatment techniques have enormously increased due to the large number of special­ ists and welltrained general dentists performing endodontics in their daily practice with a high success rate.5 However, this success is related to our more recent understanding of the biological basis of endodontics in the light of bacteriologic and immunologic developments. These developments lead to proper diagnosis, total tooth isolation, adequate access, total caries removal, thorough debridement, irrigation, and complete obturation of root canal.4

The evaluation of the endodontic services to the public must be critically considered, in particular those services which are being given by inexperienced clinicians.12 This careful consideration will give some guidance for designing a proper program for the clinical training of undergraduate students.

Some practitioners rely on periapical X-rays at six-month intervals for follow-up of their patients. They also keep these cases under observation, as long as it is possible, in addition to asking the patients about any symptoms.13 Other studies pointed out some of the inadequacies of radiographic interpretation in assessing endodontic success. These studies stressed the need for careful examination of the patient as well.2

Some investigations found out that root fillings made by undergraduate students with fairly limited training and clinical experience, had higher technical standards than those made by the general practitioners.14 Other investigations showed that patients who received endodontic therapy in a teaching clinic had a high percentage of missing molars and a considerable need for retreatments.14 The difference in these findings reflects the differences in the teaching program, the quality of which is directly related to the performance of the trainees.

In this study, underfilling canals, ledging and voids were found to be the most common problems. In another study,14 overfilling seemed to be a common technical problem. This difference can be attributed to the different methods of measurement and calculation of the root canal length. Success of endodontic treatments by the undergraduate dental students at KSUCD had no correlation with the gender of the students.