Clinical decision making of post‐treatment disease

Abstract

Root-filled teeth presenting with signs of post-treatment disease is a common finding in virtually every dental practice. There is both empirical and experimental evidence that, as long as the condition is asymptomatic, it is often left untreated. Professional judgements and decision making in endodontics as in any medical discipline are based on qualified estimations of the probability and the value of relevant outcomes.In this paper we describe various aspects of clinical decision making in general, from a descriptive as well as a normative point of view, but with a particular focus on the condition of the root-filled tooth with post-treatment disease. We review how attention to various types of uncertainties are relevant for the decision-making process. Additionally, we discuss the nature of value judgements and different concepts of health and disease which are important for understanding the complexity of the clinical decision-making process. We also refer to a set of principal rules that can guide the clinician's decision making in every-day practice in front of a case with endodontic post-treatment disease. Finally, we provide some aspects on the sometime cumbersome decision whether to go for a non-surgical or surgical method, whenever a decision on retreatment has been made.

Endodontic retreatment decision‐making: The influence of the framing effect

“…Due to the great uncertainties, authors have emphasized the importance of the patient's right to autonomy and hence participation in the process involving decisions on retreatment (Azarpazhooh et al, 2014 ; Kvist & Hofmann, 2022 ; Kvist & Reit, 2002 ).…”

“…For a patient to be able to make an autonomous decision, the dentist must therefore provide the patient with all relevant facts: the findings, the etiology of the disorder, the various options available for dealing with it, and the risks, costs, probable outcome, and long‐term prognosis (Kvist, 2018 ; Kvist & Hofmann, 2022 ). Like in many other clinical situations, in the case of a root‐filled tooth with AP, many of the facts that are required for the provision of valid evidence‐based information are missing or highly uncertain (Frisk & Kvist, 2018 ; Kvist & Hofmann, 2022 ).…”

Pre‐medical assessment of root–canal–filled teeth with asymptomatic apical periodontitis—A multifaceted balancing act

“…Many factors influencing this assessment were ambiguous and somewhat open to interpretation, such as the estimated value of a tooth, the prognosis of dental treatment and the definition of health and disease. It is plausible that appraisal of such factors is subjective and depend on personality and individual values (Kvist & Hofmann, 2023). This is in agreement with the results of the present study, where personal traits to some degree seemed to impact the final treatment decision.…”

“…Without follow‐up, it is presumably difficult to assess the outcome of ones selected management strategy. Even with follow‐up possibilities, issues concerning overdiagnosis and overtreatment are inherently difficult to assess (Kvist & Hofmann, 2023).…”

“…Management strategies for AAP in root–canal–filled teeth include expectation, orthograde revision of the root‐canal filling, apicoectomy and extraction (Kvist & Hofmann, 2023). Clinical decision‐making regarding root‐filled teeth with persisting apical radiolucency has been described by others (Reit & Gröndahl, 1984).…”