Long-term Evaluation of Treatment Planning Decisions for Nonhealing Endodontic Cases by Different Groups of Practitioners

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.

Keywords: Decision making; dental implant; endodontic treatment failure; nonsurgical retreatment; surgical retreatment; treatment planning.