Evaluation of Treatment Decision-Making for Teeth with Post-Treatment Apical Periodontitis Among Dental Students, General Dentists, and Endodontists in Chile.

内容摘要

This study aimed to evaluate treatment decision-making processes when assessing periapical radiographs of teeth with post-treatment apical periodontitis (AP) among dental students (DS), general dental practitioners (GDP), and endodontists (E) within Chile, and to identify demographic and tooth-related factors associated with extraction decisions. A cross-sectional study was conducted between 2023 and 2024, involving 431 participants who assessed standardised periapical radiographs depicting clinical scenarios and selected one treatment option: root canal retreatment, apical surgery/intentional replantation, or extraction. A nested mixed logistic regression model and simple logistic regression analyses were performed to evaluate associations between treatment choices and clinician- or tooth-related variables (p < .05). Demographic factors significantly associated with extraction decisions included professional group, age, and workplace. GDP and DS were significantly more likely to recommend extraction (p < 0.001 for both), particularly among GDPs aged 36-45 years (p = 0.003) and those working in the public sector. All tooth-related variables significantly influenced decisions. Teeth with indirect restorations were associated with higher extraction rates, especially among GDP (p < 0.001). Inadequate root canal fillings significantly increased extraction decisions by GDPs (p < 0.001). GDPs also had a strong tendency to extract teeth with medium (p < 0.001) and large apical lesions (p = 0.001). Significant differences were observed across professional groups, with E demonstrating a greater tendency toward tooth preservation. Improving clinical decision-making in undergraduate and continuing dental education may help reduce unnecessary extractions and support evidence-based health planning in underserved areas with limited access to specialist care.