Abstract
Currently, there is no standard treatment protocol for apical periodontitis (AP). Thus, restorable teeth might get extracted and replaced prosthetically. This study evaluated German dentists’ preferred AP treatment decisions and the influencing factors for selecting tooth retention by initial/repeated surgical/non-surgical root-canal treatment (RCT) or extraction with/without prosthetic replacement. Through an online-survey, participants (n = 260) rated different treatment options for four case scenarios with AP in anterior/posterior teeth without/with previous RCT. Statistical analysis included the Friedman test for intra-case comparisons and Chi-squared test for factor-associations (p ≤ 0.05). Tooth retention using initial/repeated RCT was ranked first in all scenarios and rated as (very) appropriate by most participants, while implant-supported crowns (ISC) and apicoectomy had the second ratings. ISC were preferred more on posterior teeth or previous root-canal-treated teeth. Rating levels of treatment options displayed significant differences for all case scenarios. Posterior tooth retention by RCT demonstrated a significant association with work experience. Tooth retention with previous RCT displayed a significant correlation with dentists’ privately insured patients. Most dentists preferred tooth preserving with initial/repeated RCT, while others selected non-evidence-based choices. This reflects a lack of consensus of AP treatment decisions in Germany. Fixed treatment guidelines and further evaluation of treatment–decision-correlated factors are recommended for correct treatment planning.
Highlights
Helping patients to keep a healthy and functional dentition is an ultimate aim of dentistry and public oral health
Tooth retention using non-surgical endodontic retreatment followed by a coronal restoration; All fictive patients presented in the case scenarios had private health insurance and no medical records or underlying diseases to eliminate bias in decision-making caused by financial or systemic health situations of the patients
Tooth retention using root-canal treatment (RCT) followed by a coronal restoration was the first-ranked treatment option in Case Scenario 1 (CS1) (Table 3) and Case Scenario 2 (CS2) (Table 4), while tooth retention using non-surgical endodontic retreatment followed by a coronal restoration was the first-ranked treatment option in Case Scenario 3 (CS3) (Table 5) and Case Scenario 4 (CS4) (Table 6)
Summary
Helping patients to keep a healthy and functional dentition is an ultimate aim of dentistry and public oral health. Besides being a marker of functional aging, patients’ loss of dentition has been linked with a higher occurrence of dementia, psychological distress, and a poor health related quality of life [1,2]. An important dilemma often discussed by clinicians is when teeth should be extracted and restored instead [3]. This problem should be increasingly recognized by the dental society as making treatment decisions that do not consider the patients’ preferences or quality of life can affect the public health severely. Apical periodontitis (AP), a highly prevalent dental disease resulting from an endodontic infection of the root canal system, is one of the main reasons for tooth extraction [4].
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