Management of periapical lesions in endodontically treated teeth. A study on clinical decision making

Alternative actions available in a certain clinical situation can be built up as a decision tree. An example of a decision tree with possible alternatives in the clinical management of an endodontically treated tooth with periapical lesion is shown in the present study. Five alternative actions were distinguished: no therapy indicated, wait 12 months, endodontic retreatment, periapical surgery and extraction. Thirty-five chief dental officers from the Public Dental Health Organization in Sweden examined 33 endodontically treated teeth with periapical lesions. Large interindividual variations in attitudes to treatment of asymptomatic periapical lesions were recorded. In no case was one particular decision shared by all examiners. The number of teeth suggested for therapy (endodontic retreatment, periapical surgery or extraction) had an interexaminer range enclosing seven to 26 cases. The decision making is discussed in view of published literature and reasons to the interexaminer variations are speculated on.