Kvist Thomas, Hofmann Bjørn
Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Department for the Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway.
Int Endod J. 2023 Mar;56 Suppl 2:154-168. doi: 10.1111/iej.13806. Epub 2022 Aug 11.
Root-filled teeth presenting with signs of post-treatment disease is a common finding in virtually every dental practice. There is both empirical and experimental evidence that, as long as the condition is asymptomatic, it is often left untreated. Professional judgements and decision making in endodontics as in any medical discipline are based on qualified estimations of the probability and the value of relevant outcomes. In this paper we describe various aspects of clinical decision making in general, from a descriptive as well as a normative point of view, but with a particular focus on the condition of the root-filled tooth with post-treatment disease. We review how attention to various types of uncertainties are relevant for the decision-making process. Additionally, we discuss the nature of value judgements and different concepts of health and disease which are important for understanding the complexity of the clinical decision-making process. We also refer to a set of principal rules that can guide the clinician's decision making in every-day practice in front of a case with endodontic post-treatment disease. Finally, we provide some aspects on the sometime cumbersome decision whether to go for a non-surgical or surgical method, whenever a decision on retreatment has been made.
在几乎所有牙科诊所中，根管充填后的牙齿出现治疗后疾病的迹象都是常见现象。有经验证据和实验证据表明，只要病情无症状，通常就不进行治疗。与任何医学学科一样，牙髓病学中的专业判断和决策基于对相关结果的概率和价值的合理估计。在本文中，我们从描述性和规范性的角度描述了一般临床决策的各个方面，但特别关注根管充填后患有治疗后疾病的牙齿状况。我们回顾了关注各种类型的不确定性如何与决策过程相关。此外，我们讨论了价值判断的性质以及健康和疾病的不同概念，这些对于理解临床决策过程的复杂性很重要。我们还提及了一组主要规则，这些规则可以指导临床医生在面对牙髓治疗后疾病病例的日常实践中进行决策。最后，每当做出再治疗决策时，我们提供了一些关于有时很繁琐的选择非手术或手术方法的决策方面的内容。
