Journal of dentistry · 2025
Decision on the management of teeth with advanced attachment loss: Effects of dentists' specialty and clinical experience.
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Bossardi Mayara, Münchow Eliseu Aldrighi, Weidlich Patrícia
Аннотация
AIM: This study examines the decision-making process for managing teeth with advanced attachment loss (AAL) across dental specialties and practitioners' clinical experience.
METHODS: A questionnaire featuring three clinical scenarios was developed, prompting Brazilian participants to select one from different conservative to non-conservative treatment options. Next, case reports of conservative periodontal therapies were presented with five-year follow-up data, and participants were asked whether they would keep their initial decision planning or to opt for the conservative treatment performed. The obtained data was analyzed using descriptive statistics and Chi-square and Poisson regression (prevalence ratio/PR with 95 % confidence interval/95 % CI) analyses (p < 0.05).
RESULTS: Among 378 respondents, 80 % reported specialization; 23.5 % were periodontologists (Perio) and 34.2 % were specialized in oral rehabilitation (ORehab). There was no statistical difference between treatment options in cases of AAL+endoperiodontal lesion and AAL alone, regardless of specialist training and years of experience. Perio favored conservative approaches in case of AAL+furcations, while implantology specialists preferred tooth extraction followed by implant placement (p = 0.007). In all cases, ORehab were significantly more likely to choose extraction compared to Perio (1st case report: PR = 1.13, 95 % CI 1.04-1.24; 2nd case report: PR = 1.13, 95 % CI 1.03-1.23; and 3rd case report: PR = 1.22, 95 % CI 1.11-1.33), even with successfully treated teeth functioning for at least five years.
CONCLUSION: Dentists tended to adopt a more conservative approach of managing teeth with AAL+endoperiodontal lesions, but in case of AAL+furcation lesions, a less conservative management was preferred, even after being aware of the clinical success achieved following conservative treatment. Dental specialty influences decision-making in AAL cases, with the years of clinical experience in dentistry having no significant effect on this process.
CLINICAL SIGNIFICANCE: There is a gap in the literature concerning the factors that affect how dentists make decisions when treating cases with advanced attachment loss (AAL). In scenarios involving furcation lesions, periodontists generally prefer to treat and maintain the tooth compared to specialists in implantology. Dental specialty can affect the decision making process in cases of tooth with AAL and tooth maintenance, especially in cases with furcation lesion.
METHODS: A questionnaire featuring three clinical scenarios was developed, prompting Brazilian participants to select one from different conservative to non-conservative treatment options. Next, case reports of conservative periodontal therapies were presented with five-year follow-up data, and participants were asked whether they would keep their initial decision planning or to opt for the conservative treatment performed. The obtained data was analyzed using descriptive statistics and Chi-square and Poisson regression (prevalence ratio/PR with 95 % confidence interval/95 % CI) analyses (p < 0.05).
RESULTS: Among 378 respondents, 80 % reported specialization; 23.5 % were periodontologists (Perio) and 34.2 % were specialized in oral rehabilitation (ORehab). There was no statistical difference between treatment options in cases of AAL+endoperiodontal lesion and AAL alone, regardless of specialist training and years of experience. Perio favored conservative approaches in case of AAL+furcations, while implantology specialists preferred tooth extraction followed by implant placement (p = 0.007). In all cases, ORehab were significantly more likely to choose extraction compared to Perio (1st case report: PR = 1.13, 95 % CI 1.04-1.24; 2nd case report: PR = 1.13, 95 % CI 1.03-1.23; and 3rd case report: PR = 1.22, 95 % CI 1.11-1.33), even with successfully treated teeth functioning for at least five years.
CONCLUSION: Dentists tended to adopt a more conservative approach of managing teeth with AAL+endoperiodontal lesions, but in case of AAL+furcation lesions, a less conservative management was preferred, even after being aware of the clinical success achieved following conservative treatment. Dental specialty influences decision-making in AAL cases, with the years of clinical experience in dentistry having no significant effect on this process.
CLINICAL SIGNIFICANCE: There is a gap in the literature concerning the factors that affect how dentists make decisions when treating cases with advanced attachment loss (AAL). In scenarios involving furcation lesions, periodontists generally prefer to treat and maintain the tooth compared to specialists in implantology. Dental specialty can affect the decision making process in cases of tooth with AAL and tooth maintenance, especially in cases with furcation lesion.