背景:本研究的目的是调查7年内不同医师组对于根尖周炎和牙髓治疗史的治疗计划决策的变化。
方法:2009年向宾夕法尼亚州的牙医发送了一项基于网络的调查,其中包括14例根尖周病变未愈合且修复完整的病例,没有龋齿复发的证据。在5种治疗方案中选择的参与者:等待和观察,非手术再治疗(NSRTX),手术再治疗(SRTX),拔除和固定局部义齿,或提取和植入(EXIMP)。2016年,对最初的2009年参与者进行了相同的调查。
结果:2009年,有262名牙医参加了调查。200名参与者是全科医生(全科医生:76.7%),26名牙髓医生(ENDO:9.9%),和35名其他专家(修复术,牙周病,和口腔外科[规格]:13.4%)(n=262)。EXIMP,NSRTX,和SRTX的选择相当平等,但从业者组之间差异很大(χ2=173.49,P<0.05)。一组104名参与者(SUB)(占原始参与者的39.7%)在2016年重新参加了调查(69名GP[66.3%],15个ENDOs[14.0%],和20个规格[19.7%])。2009年(χ2=95.536,P<0.05)和2016年(χ2=109.8889,P<0.05)的SUB组之间的比较差异有统计学意义(n=104)。2009年至2016年的组内可靠性显示,所有从业者的总体治疗计划选择之间没有显着差异(全科医生,ENDOs,或SPEC)。致动器内可靠性表明,在个人层面上有许多治疗计划决策变化。个人改变他们最初决定的机会是47.8%(95%置信区间,45.2%-50.4%),并且在3个从业者组之间存在显着差异(GP>SPECs>ENDOs[χ2=11.2792,P<.05])。在选择保留牙齿与替代治疗方案的决定中没有观察到显着变化(P=.520)。
结论:目前和过去的治疗计划决定在牙髓再治疗与拔牙和换牙方面没有显著差异。然而,随着时间的推移,个体从业者在决策过程中缺乏一致性。
BACKGROUND: The aim of this study was to investigate changes in treatment planning decisions among different practitioner groups over 7 years for teeth with apical periodontitis and a history of endodontic treatment.
METHODS: A Web-based survey was sent to dentists in Pennsylvania in 2009 consisting of 14 cases with nonhealing periapical lesions and intact restorations without evidence of recurrent caries. Participants selected among 5 treatment options: wait and observe, nonsurgical retreatment (NSRTX), surgical retreatment (SRTX), extraction and fixed partial denture, or extraction and implant (EXIMP). In 2016, the identical survey was resent to the original 2009 participants.
RESULTS: In 2009, 262 dentists participated in the survey. Two hundred one participants were general practitioners (GPs: 76.7%), 26 endodontists (ENDOs: 9.9%), and 35 other specialists (prosthodontics, periodontics, and oral surgery [SPECs]: 13.4%) (n = 262). EXIMP, NSRTX, and SRTX were fairly equally selected but with great variation between practitioner groups (χ2 = 173.49, P < .05). A subset group of 104 participants (SUB) (39.7% of the original participants) retook the survey in 2016 (69 GPs [66.3%], 15 ENDOs [14.0%], and 20 SPECs [19.7%]). Comparisons among practitioner groups were significantly different in SUB (n = 104) for 2009 (χ2 = 95.536, P < .05) and 2016 (χ2 = 109.8889, P < .05). Intragroup reliability between 2009 and 2016 revealed no significant differences between the overall treatment planning choices for all practitioners (GPs, ENDOs, or SPECs). Intrapractitioner reliability showed many treatment planning decision changes on an individual level. Chances that individuals changed their original decision were 47.8% (95% confidence interval, 45.2%-50.4%) and were significantly different among the 3 practitioner groups (GPs > SPECs > ENDOs [χ2 = 11.2792, P < .05]). No significant changes were observed in the decision for tooth saving versus replacement treatment options (P = .520).
CONCLUSIONS: No significant differences were noted between current and past treatment planning decisions in regard to tooth preservation by endodontic retreatment versus tooth extraction and replacement. However, individual practitioners lacked consistency in their decision making over time.