View - CTU

More documents

Recommendations

Info

and exposed pulp is taken into account. This observation emphasizes the importance of maintaining an unbroken dentin barrier against the pulp. Reflections on hypotheses Illa and I/lb: A significantly higher success rate in terms of sustained pulp vitality without apical radiolucency was observed between stepwise versus direct complete excavation of deep caries lesions in adult teeth. No significant differences were found between direct pulp capping and partial pulpotomy. The treatment success rates were low and the majority of treatments failed due to pain before the follow-up examinations. Irrespective of excavation mode, the treatment of teeth with caries exposures had a significantly lower pulp survival than teeth with unexposed pulps. Therefore, a stepwise excavation procedure is preferable for the management of deep caries lesions. Knowledge of factors influencing endodontic outcome We have examined topics that provide insight regarding factors that shape the quality of endodontic treatments. Some explanations may be apparent for the differences in treatment outcome between what goes on 'de facto' in general practice (Odesjo et al. 1990, De Gleen et al. 1993, Kirkevang et al. 2000, Kabak & Abbott 2005) versus the outcome that can be achieved (Kerekes & Tronstad 1979, Petersson et al. 1982, Sjogren et al. 1990). The results of the knowledge of endodontic outcome (Study V) revealed that many preoperative factors amongst the GDPs were over-evaluated as having an important influence on the outcome (Fig. 8). The gold standard had only two preoperative factors with a high influence on endodontic outcome: 'periapical status' and 'infected root canal'. These data support the finding that performance of root fillings of substandard quality may be associated with deficient knowledge of factors important to the outo 'praxis cone to follow th1 factors wer theory' hyp either/or sit decision to among the economy, c apical radio endodontic and referre concept re exclusively agents. In the respom 'infected ro GDPs empt A focus on Swedish pn tooth (Kvis1 preference based on di the patient the treatme1 Although th Study V, it important fa illness-focw 38
~mphasizes the importance pulp vitality without apical )Ct complete excavation of pulp capping and partial the majority of treatments th caries exposures had a Jsed pulps. Therefore, a nagement of deep caries to the outcome of endodontic treatment. The data may to some extent reflect the 'praxis concept' as generated by Kvist et al. ( 1994 ), because the GDPs did not seem to follow the gold standard and a huge inter-individual variation was apparent when factors were evaluated as having influence on the outcome. The 'praxis concept theory' hypothesizes that the GDPs imagine periapical health and disease, not as either/or situations, but as stages on a continuous scale. The cut-off point for the decision to treat is value dependent, bringing about a huge inter-individual variation among the GDPs. The criteria for treatment are influenced by factors such as economy, quality of seal and accessibility to the root canal, but also the size of the apical radiolucency (Kvist et al. 2004 ). In contrast, Strindberg's (1956) definition of an endodontic treatment failure is the tooth with a diagnosed unhealed periapical lesion and referred to as 'the Strindberg concept' (Reit & Kvist 1998). The Strindberg concept reflects an 'ideal' concept of disease (Juul Jensen 1985), which is exclusively founded on biology and is neutral towards various clinical situations and agents. In short, the results of Study V showed that there was a large variation in the response of the GDPs. No specific focus was placed on 'periapical status' and 'infected root canal', as indicated by the gold standard (Fig. 8). In particular, the GDPs emphasized factors associated with clinical symptoms. :tors that shape the quality :irent for the differences in era! practice (Odesjo et al. & Abbott 2005) versus the 9, Petersson et al. 1982, dy V) revealed that many 9d as having an important ad only two preoperative 1pical status' and 'infected ·mance of root fillings of ·ledge of factors important A focus on uncomfortable clinical symptoms was also noted among a small group of Swedish practitioners in their decision making on whether or not to retreat a root-filled tooth (Kvist et al. 2004). They further suggested that this so-called 'retreatment preference score' was guided by various retreatment strategies of which the one based on discomfort was defined as illness-focused (Hofmann 2002); i.e., as long as the patient does not complain or show any clinical symptoms of periapical disease the treatment result is accepted. Although the decision on when to retreat was not a part of the questionnaires in Study V, it seems obvious that the pre-operative evaluation of factors believed to be important for the outcome plays an important part in the decision-making process. An illness-focused strategy seems to attract the majority of Danish GDPs during such a 39
Page 1 and 2: FACULTY OF HEALTH SCIENCES UNIVERSI
Page 3 and 4: I. /l { Endodontic treatment: reaso
Page 5 and 6: CONTENTS Preface ..................
Page 7 and 8: Preface The present dissertation ha
Page 9 and 10: INCLUDED PUBLICATIONS I. Bj0rndal L
Page 11 and 12: :mt or treat apical Jmplicated, suc
Page 13 and 14: )ically based on 1988, Odesjo et 1i
Page 15 and 16: years of age. The 7 to 1.96. Concom
Page 17 and 18: of tooth treated, the naire also as
Page 19 and 20: 1agement for caries ie for inclusio
Page 21 and 22: ast one year after he primary outco
Page 23 and 24: h retaining pulp vitality gnificant
Page 25 and 26: 1ge between 92% and n et al. 1990),
Page 27 and 28: were randomly selected at that time
Page 29 and 30: VJ): 11 complications' occurred >rr
Page 31 and 32: ished in a lower number techniques
Page 33 and 34: 32 GDP:= - = Decisive influence 100
Page 35 and 36: table 10. In the 'technical -fillin
Page 37 and 38: iquency ;urance register containing
Page 39: ita from 1997 and 2003 tas 6.5% for
Page 43 and 44: to impair the endodontic 1ay also t
Page 45 and 46: ced at both universities in ins to
Page 47 and 48: ind female patients were s of the p
Page 49 and 50: e rates obtained amongst may be dif
Page 51 and 52: English summary There is a great di
Page 53 and 54: follow-up, and the vast tors shapin
Page 55 and 56: Dansk resume lnden for endodontisk
Page 57 and 58: 1g blev udf0rt (62.4%). f0rt, havde
Page 59 and 60: References Allard U, Palmqvist S (1
Page 61 and 62: ution of methods to 1ational Journa
Page 63 and 64: and quality of root -:Jontic Journa
Page 65 and 66: lontic treatment, d adult, general
Page 67 and 68: 1alence of apical ics and Dental ~-
Page 69 and 70: Bj¢rndal & Reit Endodontic treatme
Page 75 and 76: ppendix II Bj0rndal L, Laustsen MH,
Page 77 and 78: Reasons for root canal treatment Bj
Page 83 and 84: ~ "'l'J/lli'l!{JjtflFfl[;Ofi'1tra a
Page 85 and 86: , caries in adults 291 I yr. With a
Page 87 and 88: 'I' caries in illf11/1s 293 vitalit
Page 89 and 90: J caries in adults 295 ncy' at J yr
Page 91 and 92:
, caries in adults 297 !I Developme
Page 93 and 94:
Bj¢rndal & Reit Adoption of new te
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
ppendix Bj0rndal L, Laustsen MH, Re
Page 101 and 102:
OOOOE Volume 103, Number 4 Bj¢mdal
Page 103 and 104:
OOOOE Volume 103, Number 4 Bj¢mda!
Page 105 and 106:
OOOOE Volume 103, Number 4 Bj¢mdal
Page 107 and 108:
doi:lO. 1111/j. 1365-2591.2008.014
Page 109 and 110:
BjPrndal & Reit Endodontic malpract
Page 111:
Bf¢rndal & Reit Endodontic malprac
Page 114:
FACULTY OF HEAL TH SCIENCES UNIVERS
show all

View - CTU

Create successful ePaper yourself

Delete template?

Save as template?