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C Reit

Publications and source records attributed to C Reit.

29 records · Page 2Linked to original sources
PubMed1986

On decision making in endodontics. A study of diagnosis and management of periapical lesions in endodontically treated teeth.

In radiographic evaluation of the results of endodontic therapy the development or persistence of periapical radiolucencies often serve as criterion for therapeutic failure. However, using three endodontists and three oral radiologists as observers the present study found consensus only in 27% of cases classified as having periapical radiolucencies. By applying signal-detection theory to periapical radiographic diagnosis, the variations among observers were explained by their adoption of different criteria of periapical disease resulting in different positions on a receiver-operating-characteristic (ROC) curve. The potential of reducing the interexaminer variation through two different calibration programs was investigated. Even though both methods resulted in increased examiner agreement the benefits seemed limited. It was argued that this is due to the complex structure of the decision making process. Among a group of well-experienced general practitioners substantial variations in attitudes to treatment of periapical lesions in endodontically treated teeth was demonstrated. From decision theory and endodontic teaching paradigms a hypothesis was evolved explaining the variations in treatment with variations in subjective probabilities of disease and expected complications. However, this hypothesis could not be confirmed in groups of endodontists and general practitioners. Instead the decision makers seemed to rely on a limited number of heuristic principles. From a normative point of view clinical management of periapical lesions in endodontically treated teeth was approached by using formal decision analysis. Temporal and logical display of decision alternatives, values of probabilities and utilities of the different outcomes are the features of such an analysis. In the concluding part of the study this method was used to calculate optimal decision strategy for an endodontic recall program. It was demonstrated that patients should be examined one year after endodontic treatment. Patients with signs of periapical disease are reexamined after a further three years. At this moment a mild suspicion of periapical pathosis will lead to retreatment of a tooth.

Costs and Cost Analysis↗
PubMed1984

Management of periapical lesions in endodontically treated teeth. A study on clinical decision making.

Alternative actions available in a certain clinical situation can be built up as a decision tree. An example of a decision tree with possible alternatives in the clinical management of an endodontically treated tooth with periapical lesion is shown in the present study. Five alternative actions were distinguished: no therapy indicated, wait 12 months, endodontic retreatment, periapical surgery and extraction. Thirty-five chief dental officers from the Public Dental Health Organization in Sweden examined 33 endodontically treated teeth with periapical lesions. Large interindividual variations in attitudes to treatment of asymptomatic periapical lesions were recorded. In no case was one particular decision shared by all examiners. The number of teeth suggested for therapy (endodontic retreatment, periapical surgery or extraction) had an interexaminer range enclosing seven to 26 cases. The decision making is discussed in view of published literature and reasons to the interexaminer variations are speculated on.

Decision Making↗
PubMed1983

Radiographic evaluation of endodontic therapy and the influence of observer variation.

In radiographic evaluation of the results of endodontic therapy the development or persistence of periapical radiolucencies often serve as criteria for therapeutic failure. In the present study the influence of inter- and intraexaminer variation on these results was investigated. Three endodontists and three radiologists interpreted periapical conditions and quality of root filling seal in radiographs of 119 endodontically treated roots. Consensus on the presence of periapical lesion was reached in 27% of cases classified as pathologic. In 6% reports of increased width of the periodontal membrane space accorded. The examiners agreed completely on normal periapical conditions in 37% of the cases. On assessing the quality of root filling seal the opinions of observers differed even more. Complete agreement on cases with adequate and defective seal was reached in 25% and 12%, respectively. For the individual examiner the widened periodontal membrane space was the diagnosis most difficult to reproduce. The present study indicates that the large variation noted among clinical and radiographic studies on the results of endodontic therapy could partly be explained by difficulties in defining and maintaining criteria for radiological evidence of periapical disease.

Clinical Competence↗
PubMed1983

Application of statistical decision theory to radiographic diagnosis of endodontically treated teeth.

The presence or absence of periapical radiolucencies, after a predetermined healing period, have been used as a criteria for therapeutic success or failure in endodontic treatment. However, in radiologic diagnosis it has been shown that variations within and between examiners are substantial. In the present study six endodontists evaluated the periapical tissues in radiographs of 119 endodontically treated roots using a five-graded rating scale. An earlier study on the same radiograph material served as reference and "true" states of the periapical tissues were established. True positive and false positive reports on the presence of periapical lesions could then be calculated. For each observer it was noticed that a higher true positive percentage always was coupled with a higher false positive percentage and vice versa. If pairs of true positive and false positive percentages were plotted on a two-dimensional graph they corresponded well to a Receiver Operating Characteristic (ROC) curve. Variations between the observers could be explained by their adoption of different criteria of periapical disease resulting in different positions on the ROC curve. Influence of observer variation on reported frequencies of periapical lesions was greater, the lower the prevalence of the disease. The best opportunities for revealing relative differences in disease prevalences was created when the examiner defined a strict criterion for disease and reported a positive finding only when absolutely certain.

Decision Theory↗
PubMed1980

Reactions of the dental pulp to microbial provocation of calcium hydroxide treated dentin.

The purpose of the present study was to determine whether treatment of dentin with calcium hydroxide reduces pulp irritation caused by microbial products. The experiment was carried out in three young monkeys. Cavities were prepared on the buccal tooth surface deep into dentin of 62 teeth. Calcium hydroxyde mixed with distilled water was placed in one group of cavities. A set of control cavities received treatment with saline soaked filter-paper discs. The calcium hydroxide dressing and the saline discs were separated from the oral cavity for a period of 14 or 60 d by a Teflon disc and a layer of zinc oxide-eugenol cement. At the end of these periods the content of each cavity was removed and substituted by lyophilized material from cultivated plaque bacteria. After 3 d of exposure the monkeys were killed and the teeth subjected to histologic treatment. Assessments made in the light microscope revealed that pulps subjacent to calcium hydroxide-treated dentin in the majority of cases showed no or only slight infiltrates of inflammatory cells. In controls, 13 out of 22 pulps showed severe inflammatory cell infiltrates or total pulp tissue necrosis. It was concluded that treatment of dentin with calcium hydroxide may reduce the possibility for bacterial components to cause pulp tissue damage.

Animals↗