The influence of specialty training and experience on decision making in endodontic diagnosis and treatment planning

The purpose of this study was to compare the diagnostic and treatment-planning decision making of cohorts of dental surgeons with different experiences and specialty backgrounds.

Periapical radiographs of 20 teeth in patients referred for an opinion regarding the provision of endodontic surgical retreatment were taken using a paralleling technique and a film holder. The radiographs were photographed and black and white photographic prints produced to provide an image 10.5 times larger than the original radiograph. Each image was related to a clinical scenario. Each participant was asked to assess whether a periradicular lesion, as manifested by a radiolucency, was present and what clinical management would be prescribed. Ten participants in each of seven groups took part in the study. These groups were chosen to represent those dentists who were most likely to be involved in decision making in similar cases.

In 12 out of 20 cases interobserver agreement for radiographic analysis was 'excellent' (above 90%) or 'good' (between 70 and 90%). There was less agreement for treatment decisions than for radiographic analysis and the order of agreement for cases for diagnosis was not the same as for treatment. No case achieved 'excellent' percentage interobserver agreement. The average percentage interobserver agreement of the endodontists was significantly greater than the average percentage interobserver agreement for the other groups for both radiographic assessment and treatment decisions.

Differences in specialty backgrounds amongst the participants in this study affected both endodontic diagnostic and treatment decisions. Endodontists showed the most consistent agreement amongst the specialty groups.