Dentists' decisions regarding the need for cuspal coverage for endodontically treated and vital posterior teeth

Deciding when cuspal coverage is needed for posterior teeth is considered a challenge for dentists. The aims were to assess dentists' decision making regarding the need for cuspal coverage for vital teeth (VT) and endodontically treated teeth (ETT) with varying amounts of tooth structure loss and to identify clinical situations of dissimilarity and uncertainty in decision making.

A random sample of 182 dentists were invited to participate in the survey. The survey included photos of 13 posterior teeth: six VT and seven ETT. The clinical situations selected were based on a hypothetical scale of typodont teeth with ascending amounts of tooth structure loss. A brief description of each situation was provided. Each dentist was asked to decide whether cuspal coverage is needed, not needed, or unsure. Descriptive analyses using SPSS were conducted. Seventy-five percent was chosen as a cutoff point for assessing similarity in decision making. The unsure answer reflected uncertainty. Associations were assessed using chi-square test.

One hundred twenty dentists participated (65.9% response rate, 70 females). Median for years of experience was 3.5 (interquartile range 1.1-10.8). Analyses revealed a similarity percentage of <75% in decision making among dentists for six clinical situations: four VT and two ETT. More similarity was observed for situations at both ends of the scale with minimal and severe amounts of tooth structure loss and more for ETT than for VT. The highest percentages of uncertainty were more for VT than for ETT. Clinical conditions of VT were more likely to receive the "not sure" decision compared with those of ETT (χ², P < .001). No association was detected with gender (χ², P = .509) or years of experience (χ², P = .223).

Dissimilarity and uncertainty in deciding when cuspal coverage is needed were observed especially for VT and teeth with a moderate amount of structure loss.