The influence of specialty training and experience on decision making in endodontic diagnosis and treatment planning

Aim The purpose of this study was to compare the diagnostic and treatment-p lanning decision making of cohorts of dental surgeons with different experi ences and specialty backgrounds. Methodology Periapical radiographs of 20 teeth in patients referred for an opinion regarding the provision of endodontic surgical retreatment were tak en using a paralleling technique and a film holder. The radiographs were ph otographed and black and white photographic prints produced to provide an i mage 10.5 times larger than the original radiograph. Each image was related to a clinical scenario. Each participant was asked to assess whether a per iradicular lesion, as manifested by a radiolucency, was present and what cl inical management would be prescribed. Ten participants in each of seven gr oups took part in the study. These groups were chosen to represent those de ntists who were most likely to be involved in decision making in similar ca ses. Results In 12 out of 20 cases interobserver agreement for radiographic anal ysis was 'excellent' (above 90%) or 'good' (between 70 and 90%). There was less agreement for treatment decisions than for radiographic analysis and t he order of agreement for cases for diagnosis was not the same as for treat ment. No case achieved 'excellent' percentage interobserver agreement. The average percentage interobserver agreement of the endodontists was signific antly greater than the average percentage interobserver agreement for the o ther groups for both radiographic assessment and treatment decisions. Conclusions Differences in specialty backgrounds amongst the participants i n this study affected both endodontic diagnostic and treatment decisions. E ndodontists showed the most consistent agreement amongst the specialty grou ps.