The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Epidemiological surveys have reported that 25%-35% of root filled teeth are associated with peria... more Epidemiological surveys have reported that 25%-35% of root filled teeth are associated with periapical radiolucencies. Descriptive studies have demonstrated that clinicians' decision making regarding such teeth are subject to substantial variation. A coherent model to explain the observed variation has not been produced. In the present thesis a "Praxis Concept theory" was proposed. The theory suggests that dentists perceive periapical lesions of varying sizes as different stages on a continuous health scale. Interindividual variations can then be regarded as the result of the choice of different cut-off points on the continuum for prescribing retreatment. In the present study experiments among novice and expert decision makers gave evidence in favour of the theory. Data also suggested that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of original treatment. From a prescriptive point of view, the presence of a persistent periapical radiolucency has often been used as a criterion of endodontic "failure" and as an indication for endodontic retreatment. As an alternative decision strategy, the use of decision analysis has been proposed. Logical display of decision alternatives, values of probabilities, utility values (U-values) of the different outcomes and calculation of optimal decision strategy are features of this theory. The implementation of this approach is impeded by the uncertainty of outcome probabilities and lack of investigations concerning U-values. U-values of two periapical health states in root filled teeth (with and without a periapical lesion respectively) were investigated in a group of 82 dental students and among 16 Swedish endodontists. Two methods were used to elicit U-values: Standard gamble and Visual Analogue Scale. Large interindividual variation for both health states were recorded. The difference in U-values between the two health states was found to be statistically significant regardless of assessment method. Compared with Standard gamble Visual Analogue Scale systematically produced lower ratings. U-values were found to change considerably in both the short and long-term. Any significant correlation between endodontists' U-values and retreatment prescriptions could not be demonstrated. Surgical and nonsurgical retreatment were randomly assigned to 95 "failed" root filled teeth in 92 patients. Cases were followed clinically and radiographically for four years postoperatively. At the 12-month recall a statistically significant higher healing rate was observed for teeth retreated surgically. At the final 48-month recall no systematic difference was detected. Patients were found to be more subject to postoperative discomfort when teeth were retreated surgically compared with nonsurgically. Consequently, surgical retreatment tended to be associated with higher indirect costs than a nonsurgically approach. In the final part of the thesis it is argued that retreatment decision making in everyday clinical practice normally should be based on simple principles. It is suggested that in order to achieve the best overall consequence a periapical lesion in a root filled tooth that is not expected to heal should be retreated. Arguments to withhold retreatment should be based on (i) respect for patient autonomy, (ii) retreatment risks or (iii) retreatment costs.
Den norske tannlegeforenings Tidende, Feb 16, 2023
Professional judgments in endodontics as in any medical discipline must be based on qualified est... more Professional judgments in endodontics as in any medical discipline must be based on qualified estimations of the probability and value of relevant outcomes. In this paper, we briefly discuss how attention to various types of uncertainties are involved in the most common endodontic decision-making situations. Uncertainty There are many kinds of uncertainties that are relevant to decision-making in endodontics (1, 2). First there are situations where the outcomes are well known, and we know the probability distributions of these outcomes. That is, we know what might happen, and we know the probability that it will happen. For example, we know that some vital teeth will become necrotic following crown preparation and we know its probability distribution. This is frequently referred to as risk. However, oftentimes we know the outcomes, i.e., what might happen, but we do not know the probability distributions. This is called fundamental uncertainty. This, of course, makes it more difficult to make decisions, and we try to reduce fundamental uncertainty to risk by expanding evidence. However, we may also encounter situations where we do not know the outcomes. That is, unexpected things may happen. This is called ignorance in philosophy of science as in ordinary language. For good and bad, we need to be aware of such unexpected outcomes. As with the discovery of X-rays, unexpected consequences can be beneficial. However, they can also be detrimental. One additional kind of uncertainty is not related to knowledge of outcomes and their probability distributions. It is related to how we define things. Pulpitis can be defined and classified in different ways, and presence of apical HEADLINE This paper is concerned with uncertainties and decision making in endodontics. Uncertainties are of different kinds; risk, fundamental uncertainty, ignorance and indeterminacy. The various types of uncertainties that are involved in the process of clinical making decisions are briefly reviewed in case of an injured vital pulp, a necrotic pulp with apical periodontitis and finally a root-filled tooth with a persistent apical lesion.
Objectives: To assess the efficiency of AI methods in finding radiographic features in Endodontic... more Objectives: To assess the efficiency of AI methods in finding radiographic features in Endodontic treatment considerations. Material and methods: This review was based on the PRISMA guidelines and QUADAS 2 tool. A systematic search was performed of the literature on cases with endodontic treatments, comparing AI algorithms (test) versus conventional image assessments (control) for finding radiographic features. The search was conducted in PubMed, Scopus, Google Scholar and the Cochrane library. Inclusion criteria were studies on the use of AI and machine learning in endodontic treatments using dental X-rays. Results: The initial search retrieved 1131 papers, from which 24 were included. High heterogeneity of the materials left out a meta-analysis. The reported subcategories were periapical lesion, vertical root fractures, predicting root/canal morphology, locating minor apical foramen, tooth segmentation and endodontic retreatment prediction. Radiographic features assessed were mostly periapical lesions. The studies mostly considered the decision of 1-3 experts as the reference for training their models. Almost half of the included materials campared their trained neural network model with other methods. More than 58% of studies had some level of bias. Conclusions: AI-based models have shown effectiveness in finding radiographic features in different endodontic treatments. While the reported accuracy measurements seem promising, the papers mostly were biased methodologically.
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
In any medical treatment modality, outcome assessment is a major step. For root canal treatment, ... more In any medical treatment modality, outcome assessment is a major step. For root canal treatment, this primarily means looking at clinical symptoms and assessing radiographs. Moreover, retention is also an important outcome parameter and in this regard questions remain in regard to the association of endodontically treated teeth and overall health of the patient. Therefore, this chapter is dedicated to outcome assessments and decision-making for endodontically treated teeth.
Dr. Baba is the author of numerous publications, has recently published a book entitled "Restorat... more Dr. Baba is the author of numerous publications, has recently published a book entitled "Restoration of endodontically treated teeth: evidence-based diagnosis and treatment planning," and has lectured nationally and internationally.
Root‐filled teeth presenting with signs of post‐treatment disease is a common finding in virtuall... more 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 principa...
Implementing evidence-based dentistry involves a systematic process that includes collecting and ... more Implementing evidence-based dentistry involves a systematic process that includes collecting and analyzing evidence to address a clinical question. However, the inadequacy of many manuscripts and the incomplete and often misleading information they provide when published in healthcare journals are of major concern. The literature confirms that reporting guidelines improve the overall completeness and transparency of manuscripts in the field of oral health research. To improve the overall quality and clinical translation of studies in Endodontology, a new suite of guidelines under the umbrella of the Preferred Reporting Items for study Designs in Endodontology (PRIDE) project has been developed. Under the PRIDE project, five reporting guidelines focusing on specific study designs within the specialty either have or are in the process of being developed: (Case reports: Preferred Reporting Items for Case reports in Endodontics (PRICE); Randomized clinical trials: Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE); Laboratory studies: Preferred Reporting Items for Laboratory studies in Endodontology (PRILE); Animal studies: Preferred Reporting Items for Animal Studies in Endodontology (PRIASE) and Observational studies: Preferred Reporting items for OBservational studies in Endodontics (PROBE). For each guideline, the project leaders (VN, PD) formed a steering committee made up of experts from across the globe. Each steering committee developed an initial draft checklist containing a list of proposed items related to the specific study design to fit the specialty of Endodontology. In addition, a flowchart to graphically illustrate the process involved in the development of a manuscript was created to accompany each individual guideline. Each steering committee then formed a Delphi panel that included approximately 30 experts from across the globe who commented individually and anonymously upon the items to be included in each checklist and flowchart until a consensus was achieved. The draft checklists and flowcharts were then discussed during face-to-face or online meetings of approximately 20 experts to further debate and refine each guideline, which were then piloted by several authors while writing a manuscript. Eventually, each guideline (checklist and flowchart) will be published along with supporting material as well as being freely accessible on the PRIDE website (www.pride-endodonticguidelines.org). The PRIDE guidelines will help authors produce high-quality manuscripts in the discipline of Endodontology.
Information of "success" rates after surgical or nonsurgical endodontic retreat... more Information of "success" rates after surgical or nonsurgical endodontic retreatment is abundant but inconclusive. Reported healing frequencies vary between 45% and 90%. The present study was designed to find any systematic difference between the methods. Nonsurgical and surgical retreatment was randomly assigned to 95 endodontically "failed" cases. The outcome of the procedures was clinically and radiographically recorded, and followed for 4 years. At the 12-month recall, a statistically significant (p < 0.05) higher healing rate was observed for cases surgically retreated. At the final 48-month examination, no such difference was found. These findings may be explained by (a) slower healing dynamics in the nonsurgical group and (b) the event of late "failures" in the surgical group. Within the latter category, four cases classified as healed after 1 yr failed at the final follow-up. Conclusively, this study failed to show any systematic difference in the outcome of surgical and nonsurgical endodontic retreatment. Surgical retreatment seems to result in more rapid periapical bone fill, but also may imply a higher risk of "late failures." From a scientific point of view, the length of the follow-up period is very important and may strongly influence the conclusions made.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Epidemiological surveys have reported that 25%-35% of root filled teeth are associated with peria... more Epidemiological surveys have reported that 25%-35% of root filled teeth are associated with periapical radiolucencies. Descriptive studies have demonstrated that clinicians' decision making regarding such teeth are subject to substantial variation. A coherent model to explain the observed variation has not been produced. In the present thesis a "Praxis Concept theory" was proposed. The theory suggests that dentists perceive periapical lesions of varying sizes as different stages on a continuous health scale. Interindividual variations can then be regarded as the result of the choice of different cut-off points on the continuum for prescribing retreatment. In the present study experiments among novice and expert decision makers gave evidence in favour of the theory. Data also suggested that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of original treatment. From a prescriptive point of view, the presence of a persistent periapical radiolucency has often been used as a criterion of endodontic "failure" and as an indication for endodontic retreatment. As an alternative decision strategy, the use of decision analysis has been proposed. Logical display of decision alternatives, values of probabilities, utility values (U-values) of the different outcomes and calculation of optimal decision strategy are features of this theory. The implementation of this approach is impeded by the uncertainty of outcome probabilities and lack of investigations concerning U-values. U-values of two periapical health states in root filled teeth (with and without a periapical lesion respectively) were investigated in a group of 82 dental students and among 16 Swedish endodontists. Two methods were used to elicit U-values: Standard gamble and Visual Analogue Scale. Large interindividual variation for both health states were recorded. The difference in U-values between the two health states was found to be statistically significant regardless of assessment method. Compared with Standard gamble Visual Analogue Scale systematically produced lower ratings. U-values were found to change considerably in both the short and long-term. Any significant correlation between endodontists' U-values and retreatment prescriptions could not be demonstrated. Surgical and nonsurgical retreatment were randomly assigned to 95 "failed" root filled teeth in 92 patients. Cases were followed clinically and radiographically for four years postoperatively. At the 12-month recall a statistically significant higher healing rate was observed for teeth retreated surgically. At the final 48-month recall no systematic difference was detected. Patients were found to be more subject to postoperative discomfort when teeth were retreated surgically compared with nonsurgically. Consequently, surgical retreatment tended to be associated with higher indirect costs than a nonsurgically approach. In the final part of the thesis it is argued that retreatment decision making in everyday clinical practice normally should be based on simple principles. It is suggested that in order to achieve the best overall consequence a periapical lesion in a root filled tooth that is not expected to heal should be retreated. Arguments to withhold retreatment should be based on (i) respect for patient autonomy, (ii) retreatment risks or (iii) retreatment costs.
Den norske tannlegeforenings Tidende, Feb 16, 2023
Professional judgments in endodontics as in any medical discipline must be based on qualified est... more Professional judgments in endodontics as in any medical discipline must be based on qualified estimations of the probability and value of relevant outcomes. In this paper, we briefly discuss how attention to various types of uncertainties are involved in the most common endodontic decision-making situations. Uncertainty There are many kinds of uncertainties that are relevant to decision-making in endodontics (1, 2). First there are situations where the outcomes are well known, and we know the probability distributions of these outcomes. That is, we know what might happen, and we know the probability that it will happen. For example, we know that some vital teeth will become necrotic following crown preparation and we know its probability distribution. This is frequently referred to as risk. However, oftentimes we know the outcomes, i.e., what might happen, but we do not know the probability distributions. This is called fundamental uncertainty. This, of course, makes it more difficult to make decisions, and we try to reduce fundamental uncertainty to risk by expanding evidence. However, we may also encounter situations where we do not know the outcomes. That is, unexpected things may happen. This is called ignorance in philosophy of science as in ordinary language. For good and bad, we need to be aware of such unexpected outcomes. As with the discovery of X-rays, unexpected consequences can be beneficial. However, they can also be detrimental. One additional kind of uncertainty is not related to knowledge of outcomes and their probability distributions. It is related to how we define things. Pulpitis can be defined and classified in different ways, and presence of apical HEADLINE This paper is concerned with uncertainties and decision making in endodontics. Uncertainties are of different kinds; risk, fundamental uncertainty, ignorance and indeterminacy. The various types of uncertainties that are involved in the process of clinical making decisions are briefly reviewed in case of an injured vital pulp, a necrotic pulp with apical periodontitis and finally a root-filled tooth with a persistent apical lesion.
Objectives: To assess the efficiency of AI methods in finding radiographic features in Endodontic... more Objectives: To assess the efficiency of AI methods in finding radiographic features in Endodontic treatment considerations. Material and methods: This review was based on the PRISMA guidelines and QUADAS 2 tool. A systematic search was performed of the literature on cases with endodontic treatments, comparing AI algorithms (test) versus conventional image assessments (control) for finding radiographic features. The search was conducted in PubMed, Scopus, Google Scholar and the Cochrane library. Inclusion criteria were studies on the use of AI and machine learning in endodontic treatments using dental X-rays. Results: The initial search retrieved 1131 papers, from which 24 were included. High heterogeneity of the materials left out a meta-analysis. The reported subcategories were periapical lesion, vertical root fractures, predicting root/canal morphology, locating minor apical foramen, tooth segmentation and endodontic retreatment prediction. Radiographic features assessed were mostly periapical lesions. The studies mostly considered the decision of 1-3 experts as the reference for training their models. Almost half of the included materials campared their trained neural network model with other methods. More than 58% of studies had some level of bias. Conclusions: AI-based models have shown effectiveness in finding radiographic features in different endodontic treatments. While the reported accuracy measurements seem promising, the papers mostly were biased methodologically.
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
In any medical treatment modality, outcome assessment is a major step. For root canal treatment, ... more In any medical treatment modality, outcome assessment is a major step. For root canal treatment, this primarily means looking at clinical symptoms and assessing radiographs. Moreover, retention is also an important outcome parameter and in this regard questions remain in regard to the association of endodontically treated teeth and overall health of the patient. Therefore, this chapter is dedicated to outcome assessments and decision-making for endodontically treated teeth.
Dr. Baba is the author of numerous publications, has recently published a book entitled "Restorat... more Dr. Baba is the author of numerous publications, has recently published a book entitled "Restoration of endodontically treated teeth: evidence-based diagnosis and treatment planning," and has lectured nationally and internationally.
Root‐filled teeth presenting with signs of post‐treatment disease is a common finding in virtuall... more 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 principa...
Implementing evidence-based dentistry involves a systematic process that includes collecting and ... more Implementing evidence-based dentistry involves a systematic process that includes collecting and analyzing evidence to address a clinical question. However, the inadequacy of many manuscripts and the incomplete and often misleading information they provide when published in healthcare journals are of major concern. The literature confirms that reporting guidelines improve the overall completeness and transparency of manuscripts in the field of oral health research. To improve the overall quality and clinical translation of studies in Endodontology, a new suite of guidelines under the umbrella of the Preferred Reporting Items for study Designs in Endodontology (PRIDE) project has been developed. Under the PRIDE project, five reporting guidelines focusing on specific study designs within the specialty either have or are in the process of being developed: (Case reports: Preferred Reporting Items for Case reports in Endodontics (PRICE); Randomized clinical trials: Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE); Laboratory studies: Preferred Reporting Items for Laboratory studies in Endodontology (PRILE); Animal studies: Preferred Reporting Items for Animal Studies in Endodontology (PRIASE) and Observational studies: Preferred Reporting items for OBservational studies in Endodontics (PROBE). For each guideline, the project leaders (VN, PD) formed a steering committee made up of experts from across the globe. Each steering committee developed an initial draft checklist containing a list of proposed items related to the specific study design to fit the specialty of Endodontology. In addition, a flowchart to graphically illustrate the process involved in the development of a manuscript was created to accompany each individual guideline. Each steering committee then formed a Delphi panel that included approximately 30 experts from across the globe who commented individually and anonymously upon the items to be included in each checklist and flowchart until a consensus was achieved. The draft checklists and flowcharts were then discussed during face-to-face or online meetings of approximately 20 experts to further debate and refine each guideline, which were then piloted by several authors while writing a manuscript. Eventually, each guideline (checklist and flowchart) will be published along with supporting material as well as being freely accessible on the PRIDE website (www.pride-endodonticguidelines.org). The PRIDE guidelines will help authors produce high-quality manuscripts in the discipline of Endodontology.
Information of "success" rates after surgical or nonsurgical endodontic retreat... more Information of "success" rates after surgical or nonsurgical endodontic retreatment is abundant but inconclusive. Reported healing frequencies vary between 45% and 90%. The present study was designed to find any systematic difference between the methods. Nonsurgical and surgical retreatment was randomly assigned to 95 endodontically "failed" cases. The outcome of the procedures was clinically and radiographically recorded, and followed for 4 years. At the 12-month recall, a statistically significant (p < 0.05) higher healing rate was observed for cases surgically retreated. At the final 48-month examination, no such difference was found. These findings may be explained by (a) slower healing dynamics in the nonsurgical group and (b) the event of late "failures" in the surgical group. Within the latter category, four cases classified as healed after 1 yr failed at the final follow-up. Conclusively, this study failed to show any systematic difference in the outcome of surgical and nonsurgical endodontic retreatment. Surgical retreatment seems to result in more rapid periapical bone fill, but also may imply a higher risk of "late failures." From a scientific point of view, the length of the follow-up period is very important and may strongly influence the conclusions made.
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