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Wrangstål, L., Pigg, M., Almutairi, N. & Fransson, H. (2024). A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model. International Endodontic Journal, 57(2), 119-132
Open this publication in new window or tab >>A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model
2024 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 57, no 2, p. 119-132Article in journal (Refereed) Published
Abstract [en]

Aim: To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields.

Methodology: The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant.

Results: Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001).

Conclusions: According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-64290 (URN)10.1111/iej.14011 (DOI)001123417400001 ()38082460 (PubMedID)2-s2.0-85179318564 (Scopus ID)
Available from: 2023-12-12 Created: 2023-12-12 Last updated: 2024-02-05Bibliographically approved
Dawson, V. S., Fransson, H., Isberg, P.-E. & Wigsten, E. (2024). Further Interventions After Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10–11-Year Follow-Up of the Adult Swedish Population. Journal of Endodontics
Open this publication in new window or tab >>Further Interventions After Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10–11-Year Follow-Up of the Adult Swedish Population
2024 (English)In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10 to 11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration, and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction.

Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and Chi-square tests were used for statistical analysis.

Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < 0.001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years.

Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite one in five root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Apicoectomy, endodontics, epidemiology, permanent dental restoration, tooth extraction, treatment outcome
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66370 (URN)10.1016/j.joen.2024.03.005 (DOI)38492798 (PubMedID)
Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-03-28Bibliographically approved
Wigsten, E., Fransson, H., Isberg, P. & Dawson, V. S. (2024). General dental practitioners' fees for root canal treatment, coronal restoration and follow‐on treatment in the adult population in Sweden: A 10‐year follow‐up of data from the Swedish Dental Register. Clinical and Experimental Dental Research, 10(1), Article ID e826.
Open this publication in new window or tab >>General dental practitioners' fees for root canal treatment, coronal restoration and follow‐on treatment in the adult population in Sweden: A 10‐year follow‐up of data from the Swedish Dental Register
2024 (English)In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 10, no 1, article id e826Article in journal (Refereed) Published
Abstract [en]

Objectives: To analyze the accumulated fees connected with root filling, permanent coronal restoration and follow-on treatment charged by Swedish dentists over a 10-11-year follow-up period. Furthermore, analyzing these fees with reference to the type of restoration, tooth group, and the root-filled teeth which survived compared to those requiring extraction.

Material and methods: In 2009, the data register of the Swedish Social Insurance Agency recorded a total of 215,611 teeth as root-filled. The accumulated fees for each tooth encompassed the following interventions: initial root filling, coronal restorations, and follow-up treatments during the designated period. The outcomes were analyzed using descriptive and analytic statistics, including t tests and one-way analysis of variance. The fees are presented in Euros (€1 = SEK 8.94).

Results: The total accumulated fees for root fillings amounted to 72 million Euros: the mean fee per root filled tooth was €333.6. The total mean fee over a 10-11-year period, comprising root canal treatment, coronal restorations, and any follow-up treatments, was €923.4. Root-filled teeth with indirect restorations presented a higher mean fee (€1 279.3) compared to those with direct restorations (€829.4) or those without specified restorations (€832.7; p < .001). Moreover, molars presented a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; p < .001). Lastly, the mean fee for extracted teeth was €1225.3, which was higher compared to those who survived the follow-up period (€848.0; p < .001).

Conclusions: Fees charged by general dental practitioners for root-filled teeth accumulate over time, probably due to the need for further treatment of the tooth. The total mean fee was significantly higher for molars and root-filled teeth with indirect restorations. However, an analysis of the total costs would require prospective clinical cost-effectiveness studies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-64310 (URN)10.1002/cre2.826 (DOI)001116694100001 ()38062924 (PubMedID)2-s2.0-85178955898 (Scopus ID)
Available from: 2023-12-12 Created: 2023-12-12 Last updated: 2024-02-15Bibliographically approved
Olsson, S. R., Jonsson Sjögren, J., Pigg, M., Fransson, H., Eliasson, A., EndoReCo, .. & Kvist, T. (2024). Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study. International Endodontic Journal
Open this publication in new window or tab >>Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study
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2024 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: To  investigate  what  happens  to  cross-  sectionally  identified  root-  filled  teeth  over  a  6-  year  period,  regardless  of  the  time  that  elapsed  since  primary  root  canal  treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root- filled teeth  over  the  same  time  were  associated  with  variables  obtained  from  a  baseline  examination.Methodology: Adult patients with ≥1 previously root- filled tooth and regularly at-tending the Public Dental Service in Örebro County were enrolled for study partici-pation in 2015. General dental practitioners examined all identified root- filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision- making and treatments. After six years, information on events of the root- filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5- point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient-  and tooth- related factors and events.Results: A total of 445 patients with 1007 root- filled teeth were followed the entire observation time. Twenty (2.0%) of the root- filled teeth had endodontic retreatment and  150  (14.9%)  were  extracted  over  six  years.  Among  teeth  with  periapical  radio-lucency  or  pain,  the  majority  did  not  undergo  retreatment  or  extraction;  however,  the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p< .0001),  tenderness to percussion (p<   .0001), and poor coronal restoration (p< .0001).Conclusions: This  study  corroborates  the  notion  that  in  general  dentistry,  root-  filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore,  it  also  reveals  that  root-  filled  teeth  presenting  with  mild  pain  do  not  necessarily  receive  any  intervention.  However,  teeth  with  baseline  signs  of  apical  periodontitis,  pain,  or  inadequate  coronal  restoration  were  more  likely  to  have  re-ceived intervention during the six- year period.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-67250 (URN)10.1111/iej.14079 (DOI)001216357900001 ()
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-05-20Bibliographically approved
Fransson, H. & Bjørndal, L. (2024). The Management of Deep Caries Using Selective and Non-Selective Removal of Carious Tissue, Stepwise Excavation and Indirect Pulp Capping (1ed.). In: Henry F. Duncan, Ikhlas A. El-Karim (Ed.), Vital Pulp Treatment: (pp. 59-83). Hoboken, USA: John Wiley & Sons
Open this publication in new window or tab >>The Management of Deep Caries Using Selective and Non-Selective Removal of Carious Tissue, Stepwise Excavation and Indirect Pulp Capping
2024 (English)In: Vital Pulp Treatment / [ed] Henry F. Duncan, Ikhlas A. El-Karim, Hoboken, USA: John Wiley & Sons, 2024, 1, p. 59-83Chapter in book (Other academic)
Abstract [en]

For deep carious lesions, there are different treatment modalities that aim to avoid exposing the pulp and, thus, in the long-term root canal treatment. Understanding the biological events in caries pathology will facilitate the choice of treatment and why selective caries removal treatments, in many cases, can be recommended. Before selecting any modality, it is advantageous to know the expected prognosis based on clinical studies. After treatment, the patient should be monitored for signs of pulp disease. Current practice differs between dentists, and this chapter aims to provide evidence-based and consensus recommendations for the treatment of deep carious lesions.

Place, publisher, year, edition, pages
Hoboken, USA: John Wiley & Sons, 2024 Edition: 1
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66051 (URN)10.1002/9781119930419.ch4 (DOI)9781119930389 (ISBN)9781119930419 (ISBN)
Available from: 2024-02-20 Created: 2024-02-20 Last updated: 2024-03-28Bibliographically approved
Senneby, A., Fransson, H. & Vareman, N. (2024). What is risk? The challenge of defining ‘risk’ in caries risk assessment [Letter to the editor]. Acta Odontologica Scandinavica, 83, 42-46
Open this publication in new window or tab >>What is risk? The challenge of defining ‘risk’ in caries risk assessment
2024 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, p. 42-46Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Medical Journals Sweden, 2024
Keywords
dental caries; risk assessment; philosophy; prediction; probability
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-63792 (URN)10.1080/00016357.2023.2275032 (DOI)001108035000001 ()37982589 (PubMedID)2-s2.0-85177465250 (Scopus ID)
Available from: 2023-11-21 Created: 2023-11-21 Last updated: 2024-04-26Bibliographically approved
Mota de Almeida, F. J., Lundqvist, R., Kebke, S., Fransson, H. & Brundin, M. (2023). Additional treatment indicative of an unfavorable endodontic outcome in a Swedish county: a 10-year observational study. Journal of Endodontics, 49(3), 267-275, Article ID S0099-2399(22)00849-4.
Open this publication in new window or tab >>Additional treatment indicative of an unfavorable endodontic outcome in a Swedish county: a 10-year observational study
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2023 (English)In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 49, no 3, p. 267-275, article id S0099-2399(22)00849-4Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: This study's aim was to calculate the incidence of first additional endodontic treatment or extraction as the result of an unfavourable endodontic outcome following orthograde root canal treatment (RCT) performed by general dental practitioners (GDPs) during a 10-year period and to identify possible predictors for outcomes.

METHODS: A randomised cohort of 280 individuals (and as many teeth) with an orthograde RCT was followed for over 10 years. Dental records were reviewed, and individuals were recalled when data were missing. The following terminal events indicative of unfavourable endodontic treatment outcome were orthograde retreatment, surgical endodontics, and tooth extractions exclusively due to endodontic reasons. Selected variables related to individuals and treatment (pre-, intra-, and post-operative) were harvested to analyze possible associations with the terminal events. Unadjusted survival analysis and Cox regression analysis were performed and P < 0.05 was considered statistically significant.

RESULTS: Terminal events were registered for 22 teeth/individuals and 17 of these were orthograde retreatments. The cumulative 10-year survival of RCTs was 92.7% (standard error 1.7%), with a higher yearly incidence during the first two years. The univariate analysis identified five factors associated with the outcome. There were too few events to perform a multivariate analysis.

CONCLUSIONS: The mean incidence of additional treatment indicative of unfavourable endodontic outcome was 0.7% per year during the first 10 years, but the mean incidence was greater during the first two years. Five factors were associated with an unfavourable outcome; however, confounders cannot be excluded from the associations.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
analysis, dentistry, prognosis, public health, retreatment, survival, tooth extraction
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-56993 (URN)10.1016/j.joen.2022.12.011 (DOI)000990920400001 ()36574827 (PubMedID)2-s2.0-85147347614 (Scopus ID)
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-06-20Bibliographically approved
Fransson, H., Stangvaltaite-Mouhat, L., Croft, K., Bletsa, A. & Bjørndal, L. (2023). Behandlingar av vital pulpa i tänder med djupa karieslesioner. Tandläkartidningen, 115(2), 56-62
Open this publication in new window or tab >>Behandlingar av vital pulpa i tänder med djupa karieslesioner
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2023 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, Vol. 115, no 2, p. 56-62Article in journal (Refereed) Published
Abstract [sv]

Vital pulpabehandling utförs för att bevara pulpans försvarsfunktioner och därmed undvika pulpektomi och rotfyllning som kan vara tekniskt krävande och inte alltid ger önskat resultat. European Society of Endodontology (ESE) har publicerat ett positionsdokument avseende vitalbehandling av tänder med djupa karieslesioner vilket delvis överensstämmer med de nationella riktlinjerna i de nordiska länderna. Det finns svårigheter när det gäller att bedöma pulpans status i tänder med djupa karieslesioner. Så länge karieslesionen inte har nått pulpan rekommenderas behandlingar som utförs för att undvika exponering av pulpan, såsom stegvis exkavering.

Å andra sidan, när pulpan exponerats på grund av karies, skiljer sig rekommendationerna något åt mellan ESE och de nationella riktlinjerna i de nordiska länderna. Detta beror troligen på avsaknad av evidens som talar för fördelar av den ena behandlingen framför den andra och på grund av svårigheterna att bedöma vilka exponerade pulpor som är irreversibelt skadade. Minimalinvasiva behandlingsstrategier som använder sig av nyligen utvecklade hydrauliska kalciumsilikatcement visar lovande resultat vid vitalbehandling av pulpa. Vital pulpabehandling vidareutvecklas och förändringar i de kliniska rekommendationerna är att förvänta.

Abstract [en]

Vital pulp treatments (VPT) are performed to preserve the defense functions of the pulp, and thus to avoid pulpectomy and root filling, which can be technically demanding and do not always result in the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions, which partly s to national guidelines in Nordic countries. There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. If the carious lesion has not reached the pulp, treatments performed to avoid pulp exposure, such as stepwise excavation, are recommended. On the other hand, when the pulp is exposed due to caries, the recommendations vary between the ESE and the national Nordic countries guidelines. This is most probably due to the lack of evidence favoring one treatment over the other, and due to difficulties in assessing, which exposed pulps are irreversibly damaged. Minimally invasive management strategies with recently developed hydraulic calcium silicate cements show promising results for VPTs aimed at avoiding root canal treatment. VPTs will be further developed and changes to clinical recommendations are anticipated.

Place, publisher, year, edition, pages
Sveriges Tandläkarförbund, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-58604 (URN)
Available from: 2023-03-08 Created: 2023-03-08 Last updated: 2023-03-17Bibliographically approved
Jakovljevic, A., Jaćimović, J., Aminoshariae, A. & Fransson, H. (2023). Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: A systematic review. International Endodontic Journal, 56(S3), 340-354
Open this publication in new window or tab >>Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: A systematic review
2023 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no S3, p. 340-354Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited.

OBJECTIVES: This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome?

METHODS: A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials.

RESULTS: Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed.

DISCUSSION: Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials.

CONCLUSIONS: Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal.

REGISTRATION: PROSPERO database (CRD42021259742).

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
dental caries, dental pulp capping, dental pulp exposure, endodontics, pulpectomy, pulpotomy
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-52209 (URN)10.1111/iej.13776 (DOI)000802019500001 ()35579062 (PubMedID)2-s2.0-85130627525 (Scopus ID)
Available from: 2022-06-08 Created: 2022-06-08 Last updated: 2023-12-11Bibliographically approved
Brodén, J., Pigg, M., Vareman, N. & Fransson, H. (2023). “Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth. In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts: . Paper presented at 21st Biennial Congress of the European Society of Endodontology, Helsingfors, Finland 2023. , Article ID EP02.
Open this publication in new window or tab >>“Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth
2023 (English)In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id EP02Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Aims: Reflection on a deeper level is recognized as an important skill to learn for undergraduate students since mastering reflection can be helpful throughout their future careers. The aim with this study was to (i) examine if short structured written reflections could stimulate deep reflection among a group of dental students and (ii) explore specifically how the students reflected on clinical experience in relation to uncertainty when assessing the risk for exacerbation of apical periodontitis in root filled teeth.Methods: Short reflections were written by 52 dental students at Malmö University in 2021. All students first answered some questions associated with the risk for exacerbation of apical periodontitis in a case with a root filled tooth with a diffuse widening of the periodontal ligament space. After this, they were asked to write short reflections following prompts developed specifically to stimulate reflection. For each student, the reflections were analyzed and the level of reflection according to the 4Rs framework (Reporting/responding, Relating, Reasoning, Reconstructing) was assessed. The written content in the reflections were analyzed by a qualitative method, Systematic Text Condensation (STC). Results: Thirteen of the students (25%) reached the deepest level of reflection, Reconstructing. Sixteen students (31%), reached only the most superficial level, Report/respond. Two themes about experience and lack of experience were identified in the reflections: Theme 1 “The meaning of clinical experience” and Theme 2 “Differences and similarities”. The themes were subdivided into nine subgroups and described in more detail the relationship between experience and certainty as perceived by the students.Conclusions: A short reflection exercise stimulated deep reflection in a proportion of, but not all, dental students. The students believed that certainty comes with experience even when there is a lack of scientific evidence.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-62634 (URN)
Conference
21st Biennial Congress of the European Society of Endodontology, Helsingfors, Finland 2023
Available from: 2023-09-18 Created: 2023-09-18 Last updated: 2023-09-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4290-2283

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