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ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 88-94

Attitude and opinions of general dental practitioners, pedodontists, and endodontists toward regenerative endodontics in the Kingdom of Saudi Arabia


1 Department of Endodontics, North of Riyadh Dental Center, MOH, Riyadh, Saudi Arabia
2 Department of Dental, Khamis Mushayt General Hospital, MOH, Khamis Mushayt, Saudi Arabia
3 Department of Dental, King Saud Medical City, MOH, Riyadh, Saudi Arabia
4 Rabwa Primary Care, MOH, Riyadh, Saudi Arabia
5 Department of Restorative Dental Sciences, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia

Date of Submission02-Jun-2019
Date of Acceptance30-Jul-2019
Date of Web Publication23-Apr-2020

Correspondence Address:
Dr. Mashael Al-Shahrani
Department of Endodontics, Northern Riyadh Dental Complex, Ministry of Health, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sej.sej_88_19

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  Abstract 

Introduction: The aim of this survey study was to interpret the level of awareness, attitude, knowledge, and viewpoint toward regenerative endodontic treatments among general dental practitioners, pedodontists, and endodontists.
Materials and Methods: A self-administered short questionnaire comprising 20 questions was circulated through WhatsApp mobile application among general dental practitioners, pedodontists, and endodontists of all the regions of the Kingdom of Saudi Arabia. The questionnaire consisted of four parts: demographic information, professional status, ethical opinions/beliefs, and information regarding clinical practice. The answers were tabulated and statistically analyzed.
Results: A total of 311 duly filled-in questionnaires were received. The majority of the respondents were male (69.1%). Only one-third (38.3%) had received continued education in stem cells and/or regenerative dental treatments (P = 0.000). Two-thirds (75.6%) of the respondents were willing to save teeth/dental tissue and incorporate regenerative endodontic treatments in dental practice. The results suggested that one-third (33.8%) of the respondents were already using some kind of regenerative endodontic procedure in their clinical practices (P = 0.000).
Conclusions: The level of awareness regarding the stem cell and regenerative dental procedures was low among the respondents in general.

Keywords: Attitude, knowledge, regenerative endodontic, stem cell, survey


How to cite this article:
Al-Shahrani M, Al-Qahtani SA, Al-Nefaie M, Al-Enezi G, Al-Nazhan S. Attitude and opinions of general dental practitioners, pedodontists, and endodontists toward regenerative endodontics in the Kingdom of Saudi Arabia. Saudi Endod J 2020;10:88-94

How to cite this URL:
Al-Shahrani M, Al-Qahtani SA, Al-Nefaie M, Al-Enezi G, Al-Nazhan S. Attitude and opinions of general dental practitioners, pedodontists, and endodontists toward regenerative endodontics in the Kingdom of Saudi Arabia. Saudi Endod J [serial online] 2020 [cited 2020 May 28];10:88-94. Available from: http://www.saudiendodj.com/text.asp?2020/10/2/88/283144


  Introduction Top


In recent years, stem cell research has dramatically increased. The potential applications of stem cells have caught the attention of clinicians and researchers equally.[1] The recent advancement in tissue engineering and regenerative medicine has paved the way for regenerative endodontic research. With modern therapeutic modalities and regenerative capabilities of stem cells, it is deemed that regeneration of the dental tissues will not be a far future.[2],[3]

Stem cells are categorized into embryonic and adult (postnatal and somatic) stem cells.[4] Dental stem cells (DSCs) are like adult stem cells which have the capacity to generate into arrays of cell and tissue types in vitro.[4] They offer a very encouraging therapeutic method to reinstate structural defects, and this concept is considerably investigated by several researchers, which is evident by the rapidly growing literature in this field.[5] Moreover, DSCs are easily accessible sources of stem cells, and it is for sure that the current trend in regenerative endodontic research will soon offer unprecedented advances in regenerative endodontic therapies.[2]

The outcome results of recently reported cases and animal studies support and favor the regenerative endodontic therapies.[6],[7],[8],[9],[10] The evidence-based application of these regenerative procedures in clinical dentistry warrants serious thought to include this new therapeutic approach for fulfilling various patient needs.[11] However, the usefulness and applicability of reported cases depend on the teamwork between clinicians and researchers.[3] Therefore, the knowledge of clinicians about different products and their applications and following the latest advances in this field is very important.[12] Thus, it is essential to understand the attitude of dental practitioners toward regenerative endodontic procedures.

A survey to understand the attitude of the endodontics and dental practitioners toward regenerative endodontics has been conducted.[13],[14],[15],[16] However, a strong need to survey general practitioners, postgraduate students as well as dental specialists would help in evaluating the international awareness on the topic that enlightens us about the current perspectives, understanding, and expectations regarding the clinical applications of regenerative endodontic procedures. Therefore, the aim of this study was to investigate the attitude and opinions of general dental practitioners, pedodontists, and endodontists toward regenerative endodontics in the Kingdom of Saudi Arabia (KSA).


  Materials and Methods Top


Study setting

The targeted population comprised of all the general dentists, postgraduate students, pedodontists, and endodontists working in both private and public health sectors, in randomly selected major cities of KSA.

Ethical consideration

The study protocol was reviewed and approved by the Institutional Review Board of College Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia (RC/IRB/2018/1288). Written informed consent was obtained from the respondents. Participation in the study was totally voluntary, and no incentive was offered to any respondent.

Study design

This survey used the questionnaire proposed by Epelman et al.[13] with some modification done to meet the targeted population. A modified self-administered questionnaire was used as a data collection tool. The questionnaires were distributed in December 2018, and collection of the data was completed by the end of January 2019. A questionnaire was sent electronically to the targeted dental practitioners (n = 450) employed in both public and private dental health services across KSA, using a mobile-based software program, i.e., WhatsApp.

The first part of the questionnaire consisted of four closed-ended questions related to demographic information. The second part of the questionnaire consisted of four closed-ended questions related to the professional status of the respondents. The third part of the questionnaire mainly focused on the ethical opinions and beliefs of the respondents with four structured questions. The last part comprised of questions related to the implication of regenerative procedures in clinical practice. A total of eight questions (a combination of structured and closed-ended) were selected in this part.

Statistical analysis

The data were processed using SPSS version 18.0.3 (Statistical Package for the Social Sciences; SPSS Inc., Chicago, IL, USA), and statistical evaluation was carried out by means of descriptive statistics as frequencies (n) and percentages (%). Pearson's Chi-square test was employed to observe significant correlations. A two-sided P < 0.05 was considered statistically significant in 95% confidence interval.


  Results Top


The questionnaire of this cross-sectional study with descriptive statistics is presented in [Table 1], [Table 2], [Table 3].
Table 1: Demographic data and attitudes of dental practitioners toward regenerative endodontics in the Kingdom of Saudi Arabia

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Table 2: Items of significant correlation between professional status of the respondents (independent variable) and opinion on regenerative endodontics in the Kingdom of Saudi Arabia

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Table 3: Association of dental practitioner's gender of the respondents and opinion on regenerative endodontics in the Kingdom of Saudi Arabia

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Demographic information

A total of 311 (69.12%) dental practitioners of which 69.14% (n = 215) were male and 30.87% (n = 96) were female had appropriately filled the questionnaires. More than half of the respondents were between 31 and 40 years' age group (58.8%). Majority of them were from the central region of Saudi Arabia (55.9%). Among the practitioners, 76.5% were from government institutions and 13.5% were from private [Table 1].

Professional status

The response of the general practitioners (35.7%) was more than the other participants. Most of the respondents had 10 or <10 years of work experience (78.1%), whereas those with more than 20 years' experience represent 10.6%. Reading scientific dental journals was occasionally done by 45.7% of the respondents, while 3.5% never read it. Courses of continuing education in stem cells and/or regenerative dental treatments were not taken by the majority (61.7%).

Ethical opinions, beliefs, and judgment

The majority of the respondents (71.4%) were of the opinion that regenerative therapy should become part of a dental practice, and the majority of the respondents (75.6%) showed their willingness in saving the teeth or dental tissues for the purpose of regenerative dental treatment. The male and female respondents statistically disagree with each other (P = 0.173) [Table 2]. Only 6.8% do not think that regenerative dental treatment will be a better treatment option than the implant. However, most of the respondents (83.3%) were of the opinion that regenerating treatments should be tested on animals first prior to clinical testing. The difference was insignificant among the participants (P = 0.002).

Clinical practice

Since 66.2% of the respondents had not used any kind of regenerative procedures in their clinical practice, 54.3% were unaware of the treatment outcomes. The percentage of treating avulsed or traumatized tooth cases in the clinics was <10% by most of the respondents (73.3%). On the contrary, treating cases of periradicular lesions were reported to be between 26% and 50% by most of the respondents (33.4%). A mixed reaction was observed regarding the optimal treatment of necrotic immature teeth. The majority of the respondents prefer the application of mineral trioxide aggregate (MTA) apical plug and backfilling with obturation material. On inquiring about the willingness to refer the patients to stem cell treatment center, 46.3% showed their consent. Almost half of the respondents (48.2%) were willing to recommend stem cell and regenerative dental treatments to their patients, provided the treatment is safe and reliable regardless of the cost.

The items of significant correlation between the professional status of the respondents and opinion on regenerative endodontics are presented in [Table 2], whereas the items of significant correlation between the gender of the respondents and opinion on regenerative endodontics are presented in [Table 3].


  Discussion Top


This study was employed to evaluate the awareness, understanding, attitude, and knowledge regarding regenerative endodontic procedures among the service providers in KSA. Since most of the recent researches are diverted toward stem cell and regenerative dental procedures, we think that it is deemed necessary to have a survey from general dental practitioners, pedodontists, and endodontists representing all the regions of KSA to know the enthusiasm for the incorporation of regenerative endodontic procedures into dental practices. This study is different from the study that was conducted by Al Qahtani et al.[17] who investigated the opinions, knowledge, and expectations of Saudi endodontic residents only.

The current study was based on Epelman et al. study,[13] and the questionnaire was tailored and the number of items was reduced considering the local dental settings as well as for the ease of respondent and respondent time, higher response rate, and better data quality.

The majority of the respondents were either specialists or were specializing, reflecting the desire and trend toward higher education. Moreover, most of them were either reading scientific journals randomly or occasionally. Similar findings were reported by Epelman et al.,[13] Manguno et al.,[14] Ajayi et al.,[16] Al Qahtani et al.,[17] This reflects the dominant status of actively involved dental practitioners in continuing education and with latest advancements and research. However, most of them (61.7%) claimed that they had not received any sort of continuing education related to stem cell/regenerative dental treatments. This finding is in agreement with Shah et al.[2] study which claimed that one-third of the respondents had received continuing medical education in stem cells and/or regenerative dental treatments and contradicts with the findings of Al Qahtani et al.[17] The target subjects of Al Qahtani et al.[17] were endodontic postgraduate students where recent developments in the field of endodontics were taught compared to the targets of the current study where general dental practitioners were part of the subjects. In addition, stem cells and/or regenerative dental treatments were recently introduced in dentistry, and the recent graduate dentist is likely to accepted new technology than the old graduates.[18]

About 75.6% of the respondents believed that teeth should be saved for future regenerative dental treatment. This finding agrees with those reported by Epelman et al.,[13] Ajayi et al.,[16] and Al Qahtani et al.[17] It is a positive response and eagerness that depicts the significance of regenerative treatment among the respondents.[17]

Through this survey, the preference of regenerative therapy over implants/prosthesis as a treatment choice was noticed. The overwhelmingly positive response from the respondents of all the regions of the KSA suggested a strong orientation toward the incorporation of stem cell/regenerative therapy into dentistry. The findings of this study are in accordance with similar surveys that were conducted around the world.[4],[12],[13],[18]

Regardless of the reduction in the number of animals used for research,[19] >% of the respondents still believed that regenerative treatments should be tested on animals, prior to clinical testing. Unfortunately, the use of an animal model in regenerative experimental research is lacking in KSA.[20]

A low percentage of practicing regenerative endodontics was reported by Manguno et al.,[14] Ajayi et al.,[16] and Al Qahtani et al.[17] Despite the fact that only 33.8% of the respondents of the present survey were using regenerative procedures such as scaffolds, bioactive materials, membranes, or grafts, it gives a strong message that regenerative endodontic procedures are already being practiced in KSA and more advanced regenerative procedures might also be successful in the clinical setting. This was noticed through the published case reports[8],[21] that support the feasibility of the procedure.

The prevalence of avulsion in KSA reported by Al-Majed et al.[22] was 0.3% among young boys although, in this study, three-fourths of the respondents reported <10% of their clinical cases who were related to dental avulsion. This could be related to insufficient awareness among parents regarding the management of tooth avulsion in KSA.[23]

One-fourth of the respondents face 11%–25% of periradicular cases in clinics, and 15.8% of the respondents deal with periradicular lesions in clinics. The reason for the higher number of periradicular lesions seen could be attributed to the number of endodontists participated in this study that comprised of 19.9% of the total respondents. This low number of cases with apical periodontitis in Saudi population was reported by Al-Nazhan et al.[24]

Few of the participants (19.3%) consider the calcium hydroxide apexification to be the optimum treatment for necrotic immature teeth while the application of MTA apical plug and backfilling with obturation material with or without a preuse of calcium hydroxide is the most preferable technique. This could be related to the number of general practitioners participated in this survey not trained in performing regenerative endodontic techniques. Similar findings were reported by Manguno et al.,[14] Ajayi et al.,[16] and Al Qahtani et al.[17]

The majority of the respondents were willing to refer their patients to a stem cell treatment center. However, 35.7% of the respondents were general practitioners and undecided if patients need to be referred to or not due to less experience in term of years of practice (<5 years).

Almost all the respondents in the current study were in favor of recommending stem cell/regenerative treatment to patients. This contradicts with the findings of Ez-Abadi et al.[12] who reported that this was questionable due to unavailable ethical codes and safety of such kind of treatment which was a matter of concern by clinicians.

In general, a fair attitude toward the stem cell/regenerative treatment was observed among dental practitioners. However, concurrently, the lack of in-depth stem cell knowledge among the respondents, in particular the general practitioners, was also noted.


  Conclusions Top


The level of awareness regarding the stem cell and regenerative dental procedures was low among the respondents, in particular among the general practitioners. Willingness in saving teeth and a consensus on incorporating regenerative procedures in dental practice showed a positive sign that the Saudi dental practitioners are ready to incorporate future of regenerative endodontic practices in KSA.

Acknowledgement

We are grateful to Dr. Mansour K Assery for facilitating and help in this research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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