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Abstract Kvist T, Reit C. The perceived benefit of endodontic retreatment. International Endodontic Journal , 35 , 359–365, 2002. Aim There is substantial variation amongst dentists in the management of symptom-free periapical lesions in root-filled teeth. It has been suggested that this variation can be understood as clinicians’ choice of different cut-off points on a continuous periapical health scale (the ‘Praxis Concept (PC) theory’). Based on this suggestion, an individual’s inclination to propose retreatment can be expressed in the Retreatment Preference Score (RPS). In the present study it was hypothesized that: (i) the PC theory is valid amongst experienced endodontists; and that (ii) interindividual variation in RPS can be explained by a corresponding variation in the perceived benefit of endodontic retreatment. Methodology The RPS was determined for 16 experienced Swedish endodontists. The retreatment benefit (RTB) was defined as the gain in utility when a root-filled tooth with a persistent periapical lesion (‘health state B’) moved to a state where the lesion had healed (‘health state A’). For each individual the utility values of the two health states were measured by means of the standard gamble technique. Results The RPS and RTB were found to be subjected to substantial inter- and intrarater variation. The decision makers acted in accordance with the PC theory. No significant correlation between RPS and RTB was detected. Conclusions Findings suggest that the PC theory is valid amongst endodontic experts. The study did not support the notion that the more potential utility that could be produced, the more the individual dentist should tend to perform retreatment. However, alternative consequentialist strategies focusing low risk taking may be involved. [ABSTRACT FROM AUTHOR]

Purpose: Root-filled teeth with persistant periapical radiolucencies are often classified as endodontic failures. Studies have shown that general dental practitioners (GDP) do not consistantly suggest retreatment of "failures." The "Praxis Concept" (PC) theory hypothesizes that dentists conceive periapical health and disease as different states on a continuum. This study examined endodontic retreatment concepts among 157 GDPs from Värmland, Sweden., Study Design: In 6 simulated cases the periapical condition, quality of root filling and presence of a root canal-retained post were systematically varied. Five options were offered: no therapy, wait and see, nonsurgical retreatment, surgical retreatment, and extraction., Results: The investigation showed large interindividual variation in retreatment behavior among the GDPs. Only 9 dentists (6%) where found to repeatedly suggest retreatment of endodontic failures. A majority of GDPs (79%) performed in accordance with PC., Conclusions: The data indicate that several retreatment decision rules are used by Swedish GDPs, but PC-derived strategies attract the majority.

To explain dentists' variation in endodontic retreatment decision making a praxis concept (PC) has been generated. PC assumes that practitioners operate along a health continuum. Various periapical conditions are then perceived as different stages on a continuous health scale, based on their radiographic appearance. PC suggests that an individual's placement of a cut-off point for retreatment on the health continuum to a large extent is dependent on the agent's personal values. In the present study value judgements (utilities) concerning two periapical health states in endodontically treated teeth were investigated among 82 dental students. The two methods used to elicit utilities, a Visual Analogue Scale (VAS) and the Standard Gamble (SG), produced large inter- and intra-individual variations. VAS frequently generated lower utility values. The results obtained in the study satisfy a necessary criterion for the validity of PC and strengthen the position of the theory.

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.

To compare pain characteristics, impact of pain and characteristics of patients with painful root-filled teeth with and without signs of inflammatory dental disease. This cross-sectional study was performed in the Public Dental Health services, Region Örebro County, Sweden. Adult patients with ≥1 root-filled tooth identified at their regular check-up were included and assigned to one of two groups; those with ≥1 sign of inflammatory dental disease (DD+) and those without any such sign (DD-). Patients/teeth were compared regarding pain characteristics (intensity, frequency, duration, quality and provoking factors), impact of pain (medication intake, impact on life) and patient characteristics as background factors (general health, other bodily and orofacial pain). Statistics included descriptive data (frequency tables) and group comparisons (Chi-square, Fisher's Exact and Mann-Whitney U-tests). The DD+ group included 27 participants (30 teeth) and the DD- group 22 participants (23 teeth). On average, pain intensity was mild, the frequency most often recurrent, and the impact was low. Average pain duration since onset exceeded 2 years in both groups. The only observed between-group differences were average pain intensity; 3.1 (0-10 Numerical Rating Scale (NRS)) in DD- group compared to 1.6 for DD+ (p = 0.030), and tenderness to apical palpation; only reported in the DD+ group. The similarities in clinical presentation between the two groups underscore the difficulties in correctly distinguishing between pain of odontogenic and non-odontogenic origin in root-filled teeth with a standard clinical investigation. Additional diagnostic methods need to be investigated for their ability to differentiate between tooth pain or discomfort of different origins. [ABSTRACT FROM AUTHOR]

Aim: This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long‐term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery. Methodology: The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) in 2009. The cohort was followed until 31 December 2020. Subsequent registrations of extractions were collected for Kaplan–Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and p <.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed. Results: After data cleaning, and exclusion of 157 teeth, 5622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20–97, standard deviation 13.31); 55% were women. At the end of the follow‐up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow‐up data at 10 years after registration of the periradicular surgery, included 5548 teeth, of which 1461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both p <.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975–2.987, p <.001). Conclusions: After periradicular surgery in predominantly elderly people in Sweden, approximately three‐quarters of the teeth are retained over a 10‐year period. The type of tooth is associated with extraction: mandibular molars are at greater risk of extraction than maxillary incisors and canines. [ABSTRACT FROM AUTHOR]

Aim: To gain insight into the decision processes of dentists when requesting a cone beam computed tomography (CBCT) examination in endodontic settings., Methodology: Fourteen dentists (eight female) 33-58 years of age (mean = 44) practising in Sweden were interviewed. Ten of the dentists were specialists in Endodontics. The absolute inclusion criterion was experience of referring patients for CBCT for endodontic reasons. The included dentists comprised a strategically selected diverse sample in terms of gender, age, work experience, educational background, location of practice, service affiliation and accessibility to CBCT. Data were obtained through semistructured interviews exposing the context of their last three self-reported referrals. Dentists were encouraged to describe their experiences of the circumstances in their own words, aided by the interviewer's open-ended questions. The interviews were audio-recorded and transcribed verbatim. The text was analysed by qualitative content analysis., Results: The manifest content was organized into three categories that were defined as visualization as a desire, facilitating tough decisions and allocating responsibility., Conclusion: An overall theme (covering the latent content) was identified: A balance between clinical common sense and a 'better safe than sorry' attitude guides the use of CBCT in endodontic settings. Informants had high clinical standards, knowledge concerning radiation risks and good sense, which could compensate for their lack of knowledge of guidelines. The national radiation regulatory system was perceived to work as a slightly porous gatekeeper for over-usage., (© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

To evaluate the impact of cone-beam computed tomography (CBCT) in endodontic therapeutic decision-making of immature traumatized teeth with suspected pulp necrosis. Over two years, consecutive patients with a dental trauma in their front teeth (apex >0.5 mm) and with suspected pulp necrosis based on clinical and radiographic findings were referred to a specialist clinic in Sweden. Fifteen patients aged 6–13 (18 teeth) were included and clinically examined by an endodontist. Intraoral radiographs and CBCT examinations were obtained. Five practitioners, three endodontists and two residents in endodontics, used these examinations to determine the most appropriate treatment for the 18 cases (all central incisors) on two occasions scheduled 19 weeks apart. On the first occasion, the practitioners had access to clinical information and the intraoral radiographs ('before' CBCT); on the second occasion, the practitioners had also access to a radiologist report and the CBCT images ('after' CBCT). Their treatment plans – no treatment, watchful waiting, endodontic orthograde treatment, or extraction – were made anonymously and independently. Results were analysed using descriptive statistics and Wilcoxon signed-rank test. 'After' CBCT, practitioners changed treatment plans in 30% of the 90 assessments, 74% of which were more aggressive (p = 0.028). In 49% of the assessments, practitioners who chose the watchful and waiting treatment plan 'before' CBCT changed to a more aggressive therapy such as endodontic orthograde treatment and extraction 'after' CBCT (p = 0.005). This study provides evidence that CBCT influences endodontic therapeutic decision-making regarding immature traumatised teeth with suspected pulp necrosis, chiefly when expectant management (i.e., watchful and waiting) was selected before access to CBCT. [ABSTRACT FROM AUTHOR]

Objective: To reduce the gap between what can be achieved in endodontic treatments and the observed treatment outcome among general dental practitioners, the present study set out to assess the status of the endodontic practices as regards to knowledge and self-assessed skills among general dental practitioners in Sweden and Norway. Material and method: The questionnaire was sent to 1384 general dental practitioners. It contained questions regarding access to continuing education in endodontics, sources of knowledge for clinical management of patients, post-operative follow-ups, self-assessed success-rate, and the initial diagnosis impact on the outcome of endodontic treatments. Results: The response rate was 61.4%. Almost half estimated their endodontic success-rate to be 90%. About two-thirds of the respondents did not know, or did not believe, that the initial diagnosis could affect the outcome of their endodontic treatments. Respondents who did not believe the diagnosis could impact the outcome were more likely to estimate their success rate as the highest (p<.001). Less than half performed post-operative follow-ups a year after treatment. A third of the respondents had not attended any continuing endodontic education. Conclusion: Dentists who do not receive regular feedback on their treatments may lack insight into their own shortcomings. If this is combined with insufficient knowledge and understanding it may result in sub-par endodontic treatments being performed. It is important to have reliable ways to communicate current endodontic knowledge and to establish robust methods that may help dentists accurately assess their own performance in endodontics. [ABSTRACT FROM AUTHOR]

The article presents information on abstracts of the "Triannual Meeting of the European Federation of Conservative Dentistry," and "Annual Meeting of the German Society for Conservative Dentistry," held together under "ConsEuro2003," during June 5 -7, 2003, in Munich, Germany. The "ConsEuro2003," was opened with two precongress symposia about endodontics and ceramics, followed by a half-day session about clinical aspects of bleaching and long-term results. One of the main topics was minimally invasive therapy, cavity preparation and prevention, in which new preparation systems as well as chemomechanical removal of caries were discussed by speakers from Switzerland, Germany, Sweden, France and the United States.

Presents abstracts of research posters and papers presented at the June 1997 Congress of the European Society of Endodontology, held in Goteborg, Sweden. Inclusion of 'Studies on nitrogen assimilation in Porphyromonas endodontalis and Peptostreptococcus micros using conductivity measurements,' by N.S. Adam et al; 'A methylene blue dye microleakage study of retrograde filling materials,' by I. Anic et al.