Professional Training and Clinical/Radiographic Factors Associated With Endodontic Decision-Making: A...

Endodontic decision-making is influenced by clinicians' professional training and by the clinical and radiographic characteristics of each case. This study aimed to assess the association of these factors with treatment decisions and to determine whether the addition of clinical information modifies treatment choices compared with radiographic analysis alone.

Thirty clinical cases involving endodontically treated teeth were evaluated through electronic questionnaires by 56 participants with different educational backgrounds (undergraduate students, general practitioners, postgraduate endodontic students, and endodontists). In the first questionnaire (Q1), only periapical radiographs were provided. One month later, a second questionnaire (Q2) included additional clinical information. Participants selected the most appropriate treatment option for each case. Changes in decisions between Q1 and Q2 (categorised as wait-and-see vs. reintervention) were analysed using the McNemar test. Associations between examiner- and tooth-related factors and treatment decisions were assessed using multilevel binary logistic regression (α = 0.05).

Wait-and-see and nonsurgical retreatment were the preferred options at both time points. Endodontists recommended reintervention more frequently in Q2 than in Q1. In Q1, older examiners were more likely to recommend reintervention. Decisions were also influenced by tooth-related factors, with altered periapical conditions and inadequate root canal fillings being associated with a higher likelihood of reintervention, whereas posterior teeth, iatrogenic errors, and inadequate coronal restorations/prosthetic crowns were associated with a lower likelihood. In Q2, specialty training in endodontics and prior reintervention decisions in Q1 were strong predictors of reintervention, along with selected clinical and radiographic factors.

Conservative approaches were generally preferred. However, professional training and specific clinical and radiographic characteristics significantly influenced reintervention decisions.