Prescribing endodontic retreatment: towards a theory of dentist behaviour

Abstract

The large variations observed in dentists' management of periapical lesions in endodontically treated teeth suggest that disease concepts used in clinical practice should be investigated. In the present study it was hypothesized that dentists regard various periapical conditions as different stages on a health continuum. Variations could then be regarded as the result of the individuals selection of differing cut-off points for prescribing retreatment. The hypothesized decision-making model was tested using dental students in Amsterdam (Holland), Gothenburg (Sweden) and Pavia (Italy). The students were shown six simulated cases among which the quality of root filling seal and presence of post and crown were systematically varied. For each case, management of five periapical conditions was assessed. Five options were offered: no therapy, wait-and-see, nonsurgical retreatment, surgical retreatment, and extraction. For each examiner and case a 'retreatment preference score (RPS)' was established. The investigation showed large interindividual variations in RPS. A statistically significant higher mean RPS was seen among students in Pavia compared with students in Amsterdam and Gothenburg. Among all observers and cases it was found that if retreatment was proposed for a certain size of lesion, retreatment was subsequently selected for all larger lesions. The experiment gave evidence in support of the proposed hypothesis. The data also suggest that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of the original treatment.

Influence of Specialty Training and Experience on Endodontic Decision Making

“…The ''Praxis Concept'' theory suggests that periapical radiolucencies of varying sizes are perceived as states on a continuous health scale and not as either/or situations of periapical health and disease (13). Thus, by placing on this scale a cutoff point defined by personal values and other factors (costs, quality of seal, accessibility to the root canal system), dentists separate the cases that should be re-treated from those that should not (13).…”

Recurrent Caries at Crown Margins: Making a Decision on Treatment

“…The PPC method has previously been applied in similar studies [9,18,21,22] . Its use permits comparisons between the present findings and the cited studies.…”

“…The praxis concept theory, which has been discussed in the context of endodontic retreatment decision-making, states that dentists' retreatment behaviour may be explained by differences in their personal threshold at which intervention is deemed necessary along a healthdisease continuum [18,21] . The present findings seem to be in agreement with such a concept, in that the participants' tendency to remove the crown before treating the caries was found to increase with increasing size of the lesion.…”

“…The 'progressive' nature of the options reflected the praxis concept theory [18] . Thus, it was assumed that the extent of caries at the crown margin served as stages on a health-disease continuum, whereby 'small root caries away from crown margin' and 'large carious lesion at the crown margin' were the endpoints, with the other two conditions being intervening severities.…”

The perceived prognosis of endodontic treatment and implant therapy among dental practitioners

“…7 Kvist shows us that the choice for retreatment is affected by the cost, the technical quality of the initial treatment and the dentists values. 42 It has also been shown that the odds of choosing an implant over retreatment is lower in dentists who do not place their own implants compared to dentists that do. 43 Unfortunately implant surgeons do not see the retreatments that are successful, they only see the retreatments that fail so consequently their outlook on the treatment is skewed negatively.…”