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The management of deep carious lesions and the exposed pulp among members of two European endodontic societies: a questionnaire-based Study.

AIMS
To investigate and compare views on management of deep caries and the exposed pulp by Endodontic Society members in Ireland (Irish Endodontic Society [IES]) and Italy, (Accademia Italiana di Endodonzia [AIE]). Further aims were to investigate the influence of patient-related factors (age, symptoms) and operator-related factors (material choice, antibiotics) on management.


METHODOLOGY
A structured online questionnaire containing two cases (an 18 and 45-year-old) and two scenarios (+/- mild symptoms), including history and radiograph, was sent to IES and AIE members. The answers were analysed using Chi-square and Fisher's exact test (p<0.05).


RESULTS
In total, 120 dentists participated, representing 49% of the AIE and 48% of the IES membership. Age-distribution was similar between the societies; however, most AIE members had no further qualifications (63%), while IES respondents generally had a postgraduate endodontic qualification (71%). AIE respondents carried out a higher volume of vital pulp treatment (VPT) per month, with 69% carrying out over five cases, compared with 22% of IES respondents. The presence of patient symptoms significantly altered treatment planning decisions (p<0.001) with root canal treatment (RCT) more frequently selected in both societies. Patient-age significantly influenced treatment choice in the absence (p=0.043) or presence (p=0.012) of symptoms with less VPT advocated in older patients. There were no significant differences in the treatment of a young patient in the presence (p=0.302) or absence of symptoms (p=0.297), however, older patient management differed between the Societies for symptomatic (p=0.041) and asymptomatic scenarios (p=0.044) with significantly more RCTs carried out in the AIE than the IES. Hydraulic-calcium-silicate materials (HCSMs) were commonly selected, accounting for 81% of IES and 69% of AIE VPT materials, although younger members of the AIE preferred calcium hydroxide materials. Younger dentists in both societies prescribed less RCT than older age groups.


CONCLUSIONS
Although vital pulp treatment is carried out by members of both societies there was no consistency regarding the most appropriate management for the exposed pulp or the VPT material of choice. Patient symptoms and age significantly influence the decision-making process and invasiveness of treatment. Hydraulic-calcium-silicate materials were the most commonly advocated material in all groups except young AIE members who preferred calcium hydroxide.