Edinburgh Dental Institute, Edinburgh, UK.
International Islamic University Malaysia, Faculty of Dentistry, Kuantan, Malaysia.
Eur J Dent Educ. 2022 Nov;26(4):707-716. doi: 10.1111/eje.12751. Epub 2022 Jan 2.
Treatment decisions for a heavily restored endodontically treated tooth vary amongst clinicians owing to multitude of factors. This phenomenon not only often poses dilemmas to clinicians of different clinical backgrounds, but also exerts a degree of treatment difficulty to the treating clinician. Previous studies indicated that specialty training and clinical experience significantly impacted clinical decision-making process.
Master of Science postgraduate students in endodontics, prosthodontics, periodontics, oral surgery and implantology participated in a questionnaire-based cross-sectional study. The dental specialties were further categorised into restorative and surgical dentistry. A multiple-choice questionnaire with three clinical cases was distributed to the students. Data were analysed for trends using descriptive statistics.
There was a 44% response rate; the majority of respondents were from restorative dentistry specialties. Cases 1 and 2 were rated as moderate to high difficulty, and Case 3 was predominantly rated as high difficulty with procedure predictability being the main factor affecting their clinical decision-making in three cases. Endodontic retreatment was selected as the preferred treatment in Cases 1 and 2 and periradicular surgery in Case 3. The students were fairly confident in managing Cases 1 and 2, but not in Case 3. Referral patterns were consistent in Cases 1 and 2 with endodontists being the first choice of referral except for Case 3 where 48% preferred to refer to oral surgeons and 35% choosing endodontists. Some indication of differences between specialties were noted throughout. Years in practice appeared to be related to the importance of predictability in Case 3 only.
Considerable inter-clinician variability was noted whereby specialty postgraduate training impacted on clinical decision-making. Overall, procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most highly ranked factors affecting clinical decision-making. Evidence-based treatment guidelines and dental curricula should be reviewed to enhance inter-clinician agreement in clinical decision-making, ultimately improving patient care.
由于多种因素的影响，对于重度修复的根管治疗牙，不同临床医生的治疗决策存在差异。这种现象不仅常常给不同临床背景的医生带来困境，而且也给治疗医生带来一定的治疗难度。既往研究表明，专业培训和临床经验会显著影响临床决策过程。
牙髓病学、修复学、牙周病学、口腔颌面外科学和种植学的理学硕士研究生参与了一项横断面问卷调查研究。牙科专业进一步分为修复和外科牙科。向学生发放了一份包含三个临床病例的多项选择题问卷。使用描述性统计方法分析数据趋势。
回复率为 44%；大多数受访者来自修复牙科专业。病例 1 和 2 的难度被评定为中到高度，病例 3 主要被评定为高度难度，其主要因素是手术过程的可预测性，这三个病例都影响了他们的临床决策。在病例 1 和 2 中，选择了根管再治疗作为首选治疗，在病例 3 中选择了根管治疗术。学生对病例 1 和 2 的处理较为有信心，但对病例 3 则信心不足。在病例 1 和 2 中，转诊模式一致，除了病例 3，只有 48%的人选择转介给口腔颌面外科医生，35%的人选择牙髓病医生。在一些病例中，也注意到了不同专业之间的差异。实践年限似乎只与病例 3 中可预测性的重要性有关。
我们注意到相当大的临床医生之间的变异性，即专业研究生培训对临床决策有影响。总的来说，手术的可预测性、技术难度、对牙齿和患者的损伤风险以及患者的偏好是影响临床决策的最重要因素。应审查循证治疗指南和牙科课程，以加强临床医生在临床决策方面的一致性，最终改善患者的护理。
