GERODONTOLOGY
Figure 1 Calcified root canal in an older patient’s
tooth (#11) diagnosed with symptomatic apical
periodontitis (courtesy of Dr Konstantinos
Kalogeropoulos)
bibliography on the specific use of rotary
instruments in older patients is very limited.
Ageing is characterised by great biological
variability and dental management needs to be
individualised and patient-centered. The older
dental patients can be generally divided into three
groups based on their sociomedical condition that
affects clinical decision making:
1. Independent older people, socially active
without any significant health problems. They
usually belong to the “younger old” group, aged
between 65 and 75 years. The dental treatment
protocol for these patients does not usually differ
from the one applied in younger patients.
2. Frail older people, who are usually medically
compromised, receiving a variety of medications
and needing external support in their daily life.
These patients face difficulties visiting the dental
office and are usually accompanied by a carer.
They often belong to the “older old” age group
(over 75 years of age) and dental treatment is
highly individualised.
3. The last group includes the fully dependent
geriatric patients, who suffer from increased
morbidity and dependency and are usually
confined at home, at a nursing home or at hospital.
In these patients domiciliary or hospital dental
care may be necessary and the treatment options
are very limited.
This study refers to the first two groups of patients
and the aim is to discuss the advantages and
64
Figure 2 The older patient’s tooth (#11) treated
using NiTi rotary instruments (courtesy of
Dr Konstantinos Kalogeropoulos)
drawbacks of rotary instrumentation techniques
taking into consideration the specific characteristics
of older patients.
1. Advantages of rotary instrumentation
1.1. Working time reduction
It has been claimed that geriatric patients often
prefer fewer sessions of longer duration rather than
multiple but shorter ones (12). Additionally, many
clinicians prefer single-visit endodontic treatment
over multiple-visits in medically compromised
patients (13). Significant barriers to oral care in
older people are transportation difficulties (14). On
the other hand, on many occasions, it is necessary
to organise shorter appointments at specific times
of day when the illness is better controlled (i.e.
for patients with neurological or cardiovascular
disorders) (15).
When the sessions must be kept short or the therapy
must be completed in a single appointment, rotary
instruments may offer an advantage to the clinician.
The use of rotary systems may reduce the duration
of mechanical preparation of the root canal system
(8), making the endodontic procedure easier
for both the patient and the clinician. However,
there is lack of published data on the exact time
earned through rotary instrumentation during
root canal preparation, but it has been mentioned
as a side-observation (16). Consequently, better
cooperation with the patient and high quality
endodontic therapy can be achieved.
STOMA.EDUJ (2015) 2 (1)