Endodontic decision‐making under uncertainty: A decision analytic approach to management of periapical lesions in endodontically treated teeth

Abstract

Management of periapical lesions in endodontically treated teeth is subject 10 considerable interexaminer variation. This uncertainty can be approached by using formal decision analysis. Temporal and logical display of decision alternatives, values of probabilities and utilities of various outcomes arc tin‐features of such an analysis. The present study deals with two endodontic cases in which probability values were provided by two groups of examiners (general practitioners and endodontists) through the Delphi group opinion technique. Utility values were determined by the authors. For each decision alternative, a so‐called expected value could be calculated by multiplying values of probability and utility. The expected values are proposed to act as guidelines for the selection of optimal decision strategy.

Influence of Specialty Training and Experience on Endodontic Decision Making

“…The decision-making process regarding the retreatment necessity and the selection of the appropriate therapeutic alternative not only requires a sound evidence-based knowledge but might also be influenced by subjective factors emanating from both the clinician and the patient (6,16,17). The educational background and the differences in the clinical experience level constitute significant retreatment factors (14,15,(18)(19)(20)(21)(22)(23).…”

“…Second, definite outcomes and insertion of its values (utilities) and probabilities to occur are determined. Finally, the most preferable treatment is estimated by computed calculations (14,15).…”

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

“…2 Attempts have been made to rationalise the process and strategies have been devised to guide less experienced clinicians. 1,[3][4][5][6] 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.…”

Secondary Treatment for Asymptomatic Root Canal Treated Teeth: A Cost-effectiveness Analysis

“…On the one hand, it seems that only a minority of radiographic failures translate into clinical failures and the need to retreat (24), whereas it is advocated that retreatment is required and suitable to mend radiographic imperfections or allow resolution of periapical lesions (25)(26)(27). Prediction of disease progression or exacerbation in teeth with such findings is difficult (10,11), and many outcomes used for assessing the ''success'' of initial and retreatments are defined by professionals, not patients who might prioritize other parameters (28)(29)(30). Dentists often understand retreating teeth with insufficient root fillings or periapical lesions as their Mean (standard deviation) costs were calculated in Euro, whereas mean (standard deviation) retention time in years was used as effectiveness measure.…”

“…Decision-making is further complicated in case a restoration is planned for these teeth: For teeth receiving direct restorations, which are easily repaired or replaced in case a secondary root canal treatment is required later on, the decision might lean toward not performing retreatment, whereas retreatment will more often be considered for teeth receiving conventional or post-and-core crowns. The resulting uncertainty leads to substantial interindividual variation of treatments (10), with therapeutic decisions often being made on the basis of clinical judgment but without comprehensive consideration of other relevant aspects such as patient's preference or costs (11). We aimed at evaluating the costs and effectiveness of these 2 treatment strategies and attempted to evaluate the degree of uncertainty associated with each decision under different clinical conditions.…”