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Danish practitioners' assessment of factors influencing the
outcome of endodontic treatment
Lars Bj¢rndal, DDS, PhD," Merete H. Laustsen, DDS,b and Claes Reit, DDS, Odont Dr,c
Copenhagen, Denmark and Goteborg, Sweden
UNIVERSITY OF COPENHAGEN AND THE SAHLGRENSKA ACADEMY AT GOTEBORG UNIVERSITY
Objective. This investigation explored the hypothesis that among general drntal practitioners (GDPs), the performance
of root fillings of substandard quality might be associated with deficient knowledge of factors important to the
outcome of endodontic treatment.
Study design. A questionnaire was mailed to 600 randomly selected GDPs. The influence of 24 factors on treatment
outcome was assessed on 100 mm visual analog scales. A gold standard (GS) was established by an external group of
researchers. Comparisons between the GDP response and the GS were analyzed using Wilcoxon tests.
Results. Despite large variation, the responses were significantly associated with sex, year of education, and exposure
to endodontic treatment. Compared with the GS, the GDPs emphasized factors associated with clinical symptoms and
underevaluated factors related to the microbial situation in the root canal.
Conclusions. The GDPs seemed to regard endodontics mainly to be a procedure to keep a patient free of symptoms.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:570-5)
Despite a declining caries prevalence in the Western
world, endodontic treatment is still in great demand. In
Denmark, Bj¢mdal and Reit 1 reported a 17% increase
in the annual number of root fillings provided between
1977 and 2003. However, most population studies have
observed high frequencies of substandard root-filling
quality. 2 - 5 For example, in a Danish sample, Kirkevang
et al. 5 found that 59% of root fillings showed signs of
inadequate seal and 40% were not of optimal length.
Studies have also shown a strong correlation between
root-filling quality and treatment outcome. 6
Factors that shape the quality of root canal treatment
performed in general dental practice are not well
known. It has been suggested that the use of inadequate
equipment has bearing on the quality of treatment7 and
that the replacement of stainless steel hand files with
nickel-titanium rotary instruments might be beneficial.
In support of this notion, Molander et al. 8 reported an
increased frequency of good quality root fillings when
nickel-titanium rotary instruments were introduced to a
Supported by grants from the Danish Regions (to L.B.).
•Associate Professor, Department of Cariology and Endodontology,
University of Copenhagen.
bphD Student, Department of Cariology and Endodontology, University
of Copenhagen.
'Professor, Department of Endodontology, Institute of Odontology,
The Sahlgrenska Academy at Goteborg University.
Received for publication Sep 22, 2006; accepted for publication Sep
22, 2006.
1079-2104/$ - see front matter
© 2007 Mosby, Inc. All rights reserved.
doi: 10.1016/j. tripleo.2006.09.014
group of Swedish general dental practitioners. It has
also been proposed that not only "hardware" components
of a technology, but also "software" parts like
knowledge and attitudes, might influence the quality of
the performance. 9 Hays et aI. 10 proposed that insight
and awareness of one's performance will influence
clinical practice; in a study of physicians' clinical competence,
they stated that doctors who perform poorly
not always appear to be aware of how their performance
compares with accepted practice, and that they
are unaware of gaps in their knowledge.
When analyzing the forms of knowledge that the
dental practitioner needs, Reit et al. 11 suggested the
concepts "episteme," "techne," and "phronesis," introduced
by Aristotle, 12 to be useful. Episteme corresponds
with what might be described as theoreticalscientific
knowledge. Techne is practical knowledge,
but the concept encompasses not only the ability to do
things, but also to understand what you are doing.
Phronesis is the ability to think about practical matters
and can be translated as "practical wisdom."
The first aim of the present study was to explore the
status of significant endodontic epistemic knowledge,
specifically the influence of prognostic factors on treatment
outcome, among a representative sample of Danish
general dental practitioners. Their responses to a
questionnaire were compared with a "gold standard"
obtained from a panel of selected experts within the
field of endodontology. The second aim was to study
the self-awareness of the practitioners in the area of
their level of epistemic and technical knowledge.
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