1. CHALLENGES OF ROOT
CANAL TREATMENT IN POOR
COUNTRIES
Rukoma A,M.
©2013

3. Introduction
RCT is changing in terms of
 Demand
 diagnosis techniques
 treatment techniques
 Equipment, instruments and materials used

4.  This necessitates a workforce which is well
equipped and able to cope with the current
situations- A global challenge

5. 1. Demand
Is increasing as a result of:
 Increased awareness
 population expansion and aging
 Combination of the two
 more people with increased awareness, the demand
is even higher

6. 2. Diagnostic techniques
 X-ray is still the reliable means of diagnosis
and assessment of the endodontium
 Can show
 Pulp status
 Canal morphology
 Periodontal and periradicular status
 Determine if RCT can be done or not

7. Conventional X-ray
 Most commonly used in poor countries
 The reliability is about 60%-overlapping hides
some details multiple pictures +associated cons.
 Time consuming in developing-several minutes
 Difficult to store for future references
Despite these, some clinics don’t even have them

8. 3D Digital X-rays
 Not new but uncommon in poor countriesexpensive vs. conventional
 Very accurate -adjustments can be made all
along
 Quick
 Easy to store
 Easy to share
 The recommended
Far from reach especially in public clinics

9. 3.Treatment techniques
 Relatively unchanged, mostly conventional.
However, advocates for surgical or
combined are increasing.
 Exploratory surgery to diagnose the problem
that cannot be diagnosed in any other way;
for example, when NS-RCT and retreatment
have failed and the reasons for failure have
not been established.

10. Other indications for S-RCT include:
 Repair of perforations, root resection, end
filling, apical curettage and biopsy
 These need a practitioner with adequate
knowledge of the root anatomy and
endodontium in general
Note: additional canals in molars currently is
almost normal

11. Single visit RCT
 Another area which is being promoted
 Inter-visit burden is eliminate from both
patient and practitioner
 The success rate is similar to multiple visits

12. Single visit cont.
 depending on the nature of the disease as well as:
 availability of instruments and materials
 availability of time
 skill and experience of the operator
 and accessibility of the treated tooth for
instrumentation
In poor countries it is still a story of the future

13. 4. Equipments, instruments and
materials
 Power demanding-electricity availability and
reliability
 Not adequate and not reliable
 Quantity and quality-national and health
facility level
 Not enough and uncertain quality
Unfourable for RCT

14. Dental chair and accessories
Generally,
 Not enough, rarely serviced and old fashion
 RCT is a demanding procedure
 needs a full functioning (obeying) Dental
Chair

15.  X-ray
 Not enough, rarely serviced and mainly
conventional-2D for 3D object -overlappingꜜ
accuracy
 Handpieces
 Quality and quantity
 Autoclave every after patient
 Light cure machine
 Composite era

16. BUT WHY?
 Inadequate funding
 Few technicians with or without adequate
knowledge
END RESULT
 Failure to perform as expected

17. Instruments
Some are
 Outdated
 Overused
 Not readily available
 Not even known

18. What instruments are we using for?
 Filing
 Compaction of GP
 Cutting GP
 Instruments to removing GP from the canals
NiTi flexo type are recommended

19. Visual aids
 The use of magnification and adequate
lighting assist in accurate location of the root
canals
 Rarely used in poor countries

20. 5. RCT irrigating and filling materials
Not a big challenge
 Irrigants Naocl
 Core filling material
 GP, Resin based e.g. Resilon points
 Sealers
 resin based sealers eg. AH series, endorez and
diaket

21. Crown filling material
 Poor obturation but adequate crown seal has
better prognosis than adequate obturation
but poor crown seal
 Ideally all root canal treated teeth must have
artificial crown fixed
 Situation on the ground- very rare

22. 6.Work force
 General practitioners
 The number is still low
 Taught under poor conditions
 No continued education
 Endodontists
 The number is very low even in rich
countries- mostly in Dental schools

23.  WHY?
 Funding
 expensive to train a dentist
 Endodontist even more
 Motivation

24. Complete dental chair

25. 19TH CENTURY DC

26. Handpieces with light source

27. Visual aids
Dental loop with light
Dental surgical micr.

28. GP Devices
Easy Cut
NiTi rotary flexo file

29. 7. Conclusion
 There is a lot of challenges in performing
RCT in poor countries

30. 8. Recommendation
 RCT should be included under 10 health care
procedures and be given priority it deserve

31. http://rukomadentalanswers.blogspot.com