Retreatment decisions--a comparison between general practitioners and endodontic postgraduates

Does the Endodontic Education Level Affect Decision-Making for Endodontically Treated Teeth With Apical Periodontitis? A Web-Based Survey

Objectives

The management of endodontically treated teeth with apical periodontitis is debated among clinicians. The aim of this study was to evaluate treatment choices for endodontically treated teeth with different sizes of periapical lesions among endodontists, endodontics postgraduate students, general dental practitioners, and undergraduate students who had fulfilled their theoretical and clinical training in endodontics.

Materials and Methods

Periapical lesion images (no periapical lesion and 1-mm, 3-mm, and 5-mm periapical lesions) were formed on 4 different radiographs with a software program, and the survey included 16 radiographs that were emailed to 1881 participants. Treatment options included extraction, surgical or nonsurgical retreatment, and wait and see. The χ² test was used to compare the responses of the participants.

Results

The survey was returned by 1039 participants (55.23%). There were statistically significant differences among the responses of all participants for all cases (P < .05), except a case with a broken file and no lesion (P = .918). All participants decided to extract at an increased size from a 1-mm periapical lesion to a 5-mm periapical lesion. At all lesion sizes, general dental practitioners planned retreatment less when compared with other groups.

Conclusions

This survey study showed that there was a positive correlation between endodontic education level and retreatment decision-making. Dentists who confront seemingly hopeless endodontically treated teeth such as an instrument fracture, a missing canal, or a large periapical lesion should consult with an endodontist before making the decision to extract the tooth.

Decision making process by senior residents of Saudi Board in restorative dentistry for nonsurgical endodontic retreatment: A retrospective study

Background

Despite the general guidelines for retreatment, differences in decision making exist for secondary endodontic treatment and may be related to many factors including education, clinical experience, dentist specialty, patient preferences and economic resources. Aim of the study was to evaluate the decision making of the Saudi Board in Restorative Dentistry (SBRD) senior residents in the endodontic retreatment of molar teeth as per the scientific guidelines of the American Association of Endodontists (AAE) and also to identify the causes of retreatment and measure how far they become deviated from their taught retreatment principles and inter-individual variability.

Materials and methods

Case histories have been obtained from the files of cases treated in the SBRD Resident Comprehensive Case Archives in the SCHS from 2003 to 2015 in Riyadh region. The cases were only confined to Complex I and Complex II cases according to RDITN (Restorative Dental Index of Treatment Need), and seen by R3 and R4 residents only. Residents' diagnosis was recorded as well as their treatment plan and any given notes regarding their decisions to retreat. Differences between the two groups (R3 and R4) residents and within the same group, regarding endodontic retreatment decisions and reasons for their treatment options were analyzed using Chi-Square test and Fisher's Exact test.

Results

The majority of residents in both R4 and R3 groups followed the recommended guidelines. R3 residents preferred to retreat all cases while R4 chose 'no to retreat' in few cases. Although R4 residents preferred nonsurgical retreatment more than R3 residents, the difference was insignificant. R4 residents preferred 'no therapy' or 'follow up' more frequent than R3 residents. Members of the R3 residents agreed more or less with each other as did those of the R4 residents without significant inter-individual variations within each group regarding the choice of retreatment).

Conclusions

R4 residents appeared more likely, although not significant, to choose no retreatment or follow up than R3 residents. Conventional nonsurgical retreatment had the highest selection by both R3 and R4 residents. No significant inter-individual variations within each group regarding the choice of retreatment. There is a need to establish evidence based guidelines for more uniform management of failed root treated teeth.

Dentists' clinical decision-making about teeth with apical periodontitis using a variable-controlled survey model in South Korea

BACKGROUND

This study, by using a variable-controlled survey model, sought to compare clinical decisions made by dentists with different clinical backgrounds in South Korea regarding teeth with apical periodontitis and to identify factors that influenced decision-making.

METHODS

A questionnaire with 36 questions about identical patient information, clinical signs, and symptoms was filled out by participants. Each question referred to a radiograph that had been manipulated using computer software in order to control tooth-related factors. Participants were instructed to record their demographic information and choose the ideal treatment option related to each radiograph. Simple and multivariable logistic regression analyses (p < .05) were used to investigate factors related to the decision to extract the tooth. We divided factors into dentist-related factors (gender, years of experience, and professional registration) and tooth-related factors (tooth position, coronal status, root canal filling status, and size of the periapical radiolucency). Dentists were categorized into three groups, based on professional registration: general dental practitioners (GDPs), endodontists, and other specialists. Simple logistic regression analysis (p < .05) was used to evaluate the tooth-related factors influencing extraction, depending on the dentists' specialty.

RESULTS

Participants mostly preferred saving the teeth over extraction. This preference was highest among the endodontists, followed by other specialists and GDPs. Extractions were significantly preferred for molars, teeth with previous root canal fillings, and those with apical lesions greater than 5 mm.

CONCLUSIONS

This study suggests that dentists' decision-making regarding teeth with apical periodontitis was associated with their work experience and specialty and influenced by tooth position, root canal filling status, and size of the apical lesion.

CLINICAL RELEVANCE

This survey revealed that clinical decision-making related to teeth with apical periodontitis was affected by dentists' specialty and work experience and by tooth-related factors, such as tooth position, root canal filling status, and size of the apical lesion.

Endodontic decision making for asymptomatic root-filled teeth with apical periodontitis - A radiographic survey

The aim of the study was to compare decision making for asymptomatic root-filled teeth among dentists with differing educational backgrounds. Case scenarios based on 14 radiographs were created and 150 participants were asked to choose from five alternative treatment decisions and to state the rationale. Demographic data of the participants were recorded. Frequency distribution and cross-tabulation were performed; chi square testing was used for comparisons and logistic regression was performed to detect significant differences. The overall response rate was 87.3%. The practitioners chose intervention predominantly with non-surgical retreatment a common choice. Poor technical quality was a driving factor, while the existing poor coronal restoration and the need for a crown were generally not taken into account by general dentists. Speciality and experience were significant factors. Practitioners were more inclined to retain rather than extract teeth. It is concluded that clear guidelines listing factors to consider for intervention are required.

Influence of academic training in endodontics and implantology on decision-making in undergraduate students

PURPOSE

To evaluate the effect of academic training on decision-making in a group of undergraduates who have undergone training in endodontics and implantology.

BASIC PROCEDURES

A single group of undergraduate dentistry students (n = 65) was given a survey consisting of 15 endodontic cases. Each case included periapical radiographs and clinical photographs. Students were asked to select one of the eight proposed treatments. In their 4th year, the students first responded to the survey after completing endodontics. One year later, after completing their studies in implantology, the same students completed the same survey again.

MAIN FINDINGS

Under the conditions of this study, differences in undergraduate training significantly affected treatment decisions.

PRINCIPAL CONCLUSIONS

Undergraduate decision-making was affected by academic training.

Interactive treatment planning in toothwear: are we doing it right?

Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear.

CLINICAL RELEVANCE

With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.

The influence of patients' decisions on treatment planning in restorative dentistry

As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected. This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out.

CLINICAL RELEVANCE

Many psychological and social determinants influence patients'values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.

Interference of partial visual analysis of root filling quality and apical status on retreatment decisions

Objective

The presence of periapical radiolucency has been used as a criterion for endodontic treatment failure. However, in addition to the inherent limitations of radiographic examinations, radiographic interpretations are extremely subjective. Thus, this study investigated the effect of partial analysis of root filling quality and periapical status on retreatment decisions by general dentists.

Material and Methods

Twelve digitalized periapical radiographs were analyzed by 10 observers. The study was conducted at three time points at 1-week intervals. Radiographs edited with the Adobe Photoshop CS4 software were analyzed at three time points: first, only root filling quality was analyzed; second, only the periapical areas of the teeth under study were visualized; finally, observers analyzed the unedited radiographic image. Spearman's coefficient was used to analyze the correlations between the scores assigned when the periapical area was not visible and when the unedited radiograph was analyzed, as well as between the scores assigned when root fillings where not visible and when the unedited radiograph was analyzed. Sensitivity, specificity, positive and negative predictive values between partial images and unedited radiographs were also used to analyze retreatment decisions. The level of significance was set at 5%.

Results

The visualization of the root filling on the unedited radiograph affected the interpretation of the periapical status and the technical quality of the fillings has a greater influence on the general dentist's decision to prescribe endodontic retreatment than the periapical condition.

Conclusion

In order to make endodontic diagnosis, radiographic interpretation process should not only emphasize technical aspects, but also consider biological factors.

The influence of specialty training, experience, discussion and reflection on decision making in modern restorative treatment planning

AIMS

This study was designed to determine the effect of reflection and discussion of a group of dentists with differing backgrounds and qualifications in the management of failed endodontic treatment.

MATERIALS AND METHODS

During the Dental Pan-Society plenary session (16-17 November 2007) delegates (n = 393) were asked a series of questions on the management of a case with failed endodontic treatment of four maxillary incisors restored with linked crowns in a patient with a high smile line. The case had been previously posted on the conference website in addition to being presented on the day of the forum. Responses of delegates to predetermined questions and options on the management of the case were recorded using closed-circuit devices for each individual delegate. The questions were repeated after the case was opened up for discussion by the delegates in conjunction with a panel of leading experts. The discussion topics included the factors affecting the outcome of secondary root canal treatment, post-extraction changes and the options for prosthetic replacement including the provision of implants in the aesthetic zone.

RESULTS

The initial response of the majority (58%) of delegates favoured extraction and prosthetic rehabilitation over endodontic retreatment of the affected teeth. Following the discussion this figure reduced to 50%. In respect to those individuals who were specialists, extraction was again the preferred option before the discussion for periodontists (74%), prosthodontists (64%) and restorative dentists (65%). This was in contrast to endodontists who preferred endodontic retreatment, with only 30% identifying extraction as the treatment of choice. Following the discussion, the number of periodontists and endodontists who favoured extraction reduced by 3% and 5% respectively, whereas the number of prosthodontists and restorative dentistry specialists who preferred extraction increased by 2% and 4% respectively.

CONCLUSION

Reflection and discussion can make individuals reconsider their initial treatment decisions. These personal skills may become more significant when planning treatment for complex restorative cases.

Relative frequency of teeth needing conventional and surgical endodontic treatment in patients treated at a graduate endodontic clinic--a Penn Endo database study

OBJECTIVE

The objective of this study was to identify the most commonly retreated tooth at a postgraduate endodontics program and to compare this result with teeth requiring primary root canal treatment as well as those that required further surgical endodontic treatment.

STUDY DESIGN

The study population consisted of 6,894 patients treated between 2000 and 2005 by endodontic postgraduate students at the University of Pennsylvania School of Dental Medicine. Data regarding tooth type and endodontic treatment rendered were obtained from the Penn Endo database.

RESULTS

Initial root canal treatment was most commonly done on mandibular molars. Anterior teeth were 1.411 times more likely to undergo NSRT than molars. Maxillary molars were 1.048 times more likely to undergo conventional retreatment than mandibular molars. Maxillary anterior teeth were 3.032 times more likely than mandibular molars to undergo surgical treatment.

CONCLUSIONS

Mandibular molars may most commonly receive initial root canal treatment but it is the anterior teeth that are more likely to undergo surgical and nonsurgical retreatment. Maxillary molars are more likely to receive surgical intervention than mandibular molars. These data call for further investigation into the reasons for such discrepancy.