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English summary
There is a great discrepancy between the healing rates that can be achieved with
endodontic treatment and those found in most populations as performed by General
Dental Practitioners (GDPs). This 'gap' was the starting point of the present
dissertation. Factors that influence the endodontic treatment quality in general dental
practice are not very well known. Quality is shaped in an interplay between the
knowledge, attitudes, and skills of the dentist as well as the demand and satisfaction
of the patient framed in a context that eventually involves the whole of society. The
overall aim was to reveal reasons, prevention, and quality-shaping factors that
influence endodontic treatments in general dental practice.
The first part of this dissertation examines the incidence and reasons to perform
endodontic treatments in Denmark. Based on a 25-year record of annual treatment
statistics obtained from the Danish Dental Association and the Danish National
Health Insurance the endodontic-related service pattern among GDPs showed an
increased frequency (17%) of performed root fillings per 1000 patients (Study I) and
an increased rate of root fillings per tooth. Using a questionnaire among 600
randomly selected Danish GDPs, the most common reason for performing root canal
treatments was caries in vital teeth (55%)(Study II).
The next part of the dissertation shows the potential of an endodontic preventive
treatment strategy in deep caries in adults. Deep caries excavation was investigated
in a randomized clinical multicentre trial (Study Ill, excavation trial) comparing
stepwise excavation and direct complete excavation. In a nested randomized trial
pulp capping procedures (direct pulp capping versus partial pulpotomy) were
compared (Study Ill, pulp capping trial) in patients where excavation had led to pulp
exposures. Stepwise excavation was significantly better in preventing pulp exposure
and the proportion of patients with sustained tooth vitality without apical radiolucency
at -1 Yz-year follow-up was significantly higher in the stepwise excavation group
(74.1%) versus the direct complete excavation group (62.4%). In patients where pulp
capping procedures were carried out, direct pulp capping (31.8%) and partial
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