An assessment of endodontic re-treatment decision-making in an educational setting

To test the applicability of Praxis Concept (PC) theory in endodontic re-treatment decision-making amongst dental students of similar backgrounds, but from two dental schools.

A total of 172 students from two dental schools (n = 97 and n = 75) were asked to select their management choices (from five 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 five 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.

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, whilst the absence/presence of a post had no clear effect on re-treatment choices.

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.