Case complexity of root canal treatments accepted for training in a secondary care setting assessed by three complexity grading systems: A service evaluation.

Abstract

To evaluate the complexity of root canal treatments accepted for treatment by postgraduate training grades at Cardiff University Dental Hospital (CUDH) using the English Commissioning Standard for Restorative Dentistry (ECS) in comparison with the American Association of Endodontists case complexity form (AAE) and the Restorative Index of Treatment Need (RIOTN). Two hundred case records were evaluated using the AAE, RIOTN and ECS scoring systems. Each case received a score from minimal to high complexity (1-3). Examiners were calibrated and inter-examiner reliability calculated using the percentage agreement. Frequency of scores were then compared. Most cases were at level 3 and assessment varied amongst the criteria used (AAE: 99.5%, RIOTN: 65.5% and ECS: 55.5%). The AAE factor 'endodontic treatment history' was largely responsible for differing scores when compared with the RIOTN (78%) and ECS (64%). The RIOTN factor regarding post treatment disease ('endodontic retreatment') was responsible for increased complexity compared with ECS in most cases (74%). The ECS factor 'quality of root filling' was the most common reason (85%) for an increase in complexity compared with RIOTN. Within the limitations of this service evaluation, it was possible to conclude that a high proportion of cases treated by training grades at CUDH were of a high complexity level (level 3) using the three guidelines (ECS, AAE and RIOTN). These cases were appropriate for postgraduate training under various levels of supervision and substantiated by the findings reported here. The factors responsible for a large part of difference in allocation of scores amongst the systems were 'endodontic treatment history', 'root canal retreatment' and 'quality of root filling'.