Highlights
- •A 2-time survey (in 2009 and 2016) was conducted to investigate treatment planning decisions for teeth with apical periodontitis and a history of endodontic treatment.
- •Practitioners of different specialty groups chose between the options wait and observe, nonsurgical retreatment, surgical retreatment, extraction and fixed partial denture, and extraction and implant.
- •Both in 2009 and 2016, great inconsistencies in regard to treatment planning existed among the different practitioner groups and also with regard to practitioner reliability when 104 participants repeated the identical survey in 2016.
Abstract
Introduction
The aim of this study was to investigate changes in treatment planning decisions among
different practitioner groups over 7 years for teeth with apical periodontitis and
a history of endodontic treatment.
Methods
A Web-based survey was sent to dentists in Pennsylvania in 2009 consisting of 14 cases
with nonhealing periapical lesions and intact restorations without evidence of recurrent
caries. Participants selected among 5 treatment options: wait and observe, nonsurgical
retreatment (NSRTX), surgical retreatment (SRTX), extraction and fixed partial denture,
or extraction and implant (EXIMP). In 2016, the identical survey was resent to the
original 2009 participants.
Results
In 2009, 262 dentists participated in the survey. Two hundred one participants were
general practitioners (GPs: 76.7%), 26 endodontists (ENDOs: 9.9%), and 35 other specialists
(prosthodontics, periodontics, and oral surgery [SPECs]: 13.4%) (n = 262). EXIMP, NSRTX, and SRTX were fairly equally selected but with great variation
between practitioner groups (χ2 = 173.49, P < .05). A subset group of 104 participants (SUB) (39.7% of the original participants)
retook the survey in 2016 (69 GPs [66.3%], 15 ENDOs [14.0%], and 20 SPECs [19.7%]).
Comparisons among practitioner groups were significantly different in SUB (n = 104) for 2009 (χ2 = 95.536, P < .05) and 2016 (χ2 = 109.8889, P < .05). Intragroup reliability between 2009 and 2016 revealed no significant differences
between the overall treatment planning choices for all practitioners (GPs, ENDOs,
or SPECs). Intrapractitioner reliability showed many treatment planning decision changes
on an individual level. Chances that individuals changed their original decision were
47.8% (95% confidence interval, 45.2%–50.4%) and were significantly different among
the 3 practitioner groups (GPs > SPECs > ENDOs [χ2 = 11.2792, P < .05]). No significant changes were observed in the decision for tooth saving versus
replacement treatment options (P = .520).
Conclusions
No significant differences were noted between current and past treatment planning
decisions in regard to tooth preservation by endodontic retreatment versus tooth extraction
and replacement. However, individual practitioners lacked consistency in their decision
making over time.
Key Words
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Article info
Publication history
Published online: December 16, 2017
Identification
Copyright
© 2017 American Association of Endodontists.
