Endodontic Re-treatment Decision-making in an Educational Setting

Objectives: To test the applicability of Praxis Concept (PC) theory in endodontic re-treatment decision-making among dental students of similar backgrounds, but from two dental schools. Methods: A total of 172 students from two dental schools (n=97 and n=75) were asked to select their management choices (from 5 possible options) for each of six variations on quality (by way of adequacy of root filling) and complexity (by way of absence or presence of a post) of a simulated radiograph of an anterior tooth. The six variations each had 5 possible levels of periapical condition, giving a total of 30 cases for which management choices were sought. Individual re-treatment preference scores (RPS) were obtained, from which school and gender differences were compared by t-test. The association between students' stated re-treatment propensities and the different cases was expressed as odds ratios using unconditional logistic regression analysis. Results: There were large inter-individual variations in RPS within the cases at both schools. Mean RPS for the group was 0.62 (SD 0.14), and did not differ between the schools (P=0.44), but was significantly lower for males than females (P=0.01). For all participants and a given case, if re-treatment was proposed for a particular size of lesion, then all larger lesions for that case were also marked for re-treatment. Presence of a defective root filling or overfilling reflected a greater propensity for re-treatment than when the root filling was adequate, while the absence/presence of a post had no clear effect on re-treatment choices. Conclusion: The findings support the explanatory potential of PC theory in endodontic re-treatment decision-making in the group investigated, and suggest that factors besides disease status alone, may contribute to the choices that clinicians make.