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. 2022 Nov;55(11):1202-1211.
doi: 10.1111/iej.13816. Epub 2022 Sep 10.

Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology

Adham A Azim  1 , Khalid Merdad  2 , Ove A Peters  3
Affiliations

Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology

Adham A Azim et al. Int Endod J. 2022 Nov.

Abstract

Introduction: This survey aimed to determine the consensus amongst endodontic specialists in North America and practitioners worldwide to diagnose the pulp and periapical conditions of selected case scenarios encountered in daily practice using the American Association of Endodontists (AAE) pulpal and periapical diagnostic terms. Secondly, an attempt was made to suggest modifications in terms accordingly.

Methodology: A survey designed by two endodontic educators was sent to endodontists in North America and clinicians worldwide through an electronic database. The survey included socio-demographic questions followed by the clinical and radiographic presentations of four clinical scenarios. The participants were then requested to provide the pulpal and the periapical diagnosis of 11 teeth presented in these cases (22 answers in total/participant) using the AAE diagnostic terminology. Cases were designed to include 12 pulpal/periapical conditions as control (non-controversial conditions) and ten so-called controversial conditions. A proportion threshold of 10% was required for any diagnostic term to be reported in this survey. The participants were divided into two groups based on the region of endodontic training and/or practice to 'Specialised North American' or 'International Practitioners,' and their results were statistically compared using chi-squared tests (p < .05).

Results: The survey included 421 participants. 74% were endodontists, and 46.1% were amongst the 'Specialised North American' group and 53.9% amongst the 'International Practitioners'. Eleven of 12 control conditions had an almost complete agreement amongst the participants regarding the diagnostic terms selected, ranging between 82% and 96%, with no other diagnostic term exceeding the 10% threshold. All the controversial conditions yielded more than one diagnostic term selected/condition that exceeded the 10% threshold for groups ('Specialised North American' and 'International practitioners'). There were no differences in the diagnostic terms selected between the two groups; however, the weight for each term varied between the groups in some cases.

Conclusion: There is a lack of consensus amongst clinicians, regardless of their training and region of practice, on the appropriate diagnostic terms to be used in particular clinical conditions. More diagnostic terms and modifications in the current terms may be required to establish a more reliable diagnostic terminology.

Keywords: diagnostic terminology; diagnostic tests; periapical diagnosis; pulpal diagnosis; survey.

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Conflict of interest statement

The authors deny any conflict of interest.

Figures

FIGURE 1
FIGURE 1
Case 1 as presented to the survey participants and the associated results.
FIGURE 2
FIGURE 2
Case 2 as presented to the survey participants and the associated results.
FIGURE 3
FIGURE 3
Case 3 as presented to the survey participants and the associated results.
FIGURE 4
FIGURE 4
Case 4 as presented to the survey participants and the associated results.
See this image and copyright information in PMC

References

    1. AAE/AAOMR . (2016) Use of cone beam computed tomography in endodontics 2015/2016 update. https://www.aae.org/specialty/clinical‐resources/cone‐beam‐computed‐tomo... - PubMed
    1. Ahn, S.Y. , Kim, D. & Park, S.H. (2018a) Efficacy of ultrasound doppler flowmetry in assessing pulp vitality of traumatized teeth: a propensity score matching analysis. Journal of Endodontics, 44, 379–383. - PubMed
    1. Ahn, S.Y. , Kim, D. & Park, S.H. (2018b) Long‐term prognosis of pulpal status of traumatized teeth exhibiting contradictory results between pulp sensibility test and ultrasound doppler flowmetry: a retrospective study. Journal of Endodontics, 44, 395–404. - PubMed
    1. American Association of Endodontists . (2021) AAE position statement on vital pulp therapy. Journal of Endodontics, 47, 1340–1344. - PubMed
    1. Bastos, J.V. , Goulart, E.M. & de Souza Cortes, M.I. (2014) Pulpal response to sensibility tests after traumatic dental injuries in permanent teeth. Dental Traumatology, 30, 188–192. - PubMed