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A Service Evaluation On Tooth Restorability


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Background: Many foundation dentists are faced with the daily challenge of
uncertainty around the restorability of challenging cases, where the question of
restorability is not clear cut. This is often compounded by varying opinions between
general practitioners and undergraduate teaching.
To assess the restorability of teeth with questionable prognosis with the aim of
identifying potential variations in opinion and treatment planning between dentists
of different experience and skill level. It is hoped that this will facilitate foundation
dentists decision making and treatment planning in challenging cases.
1. Highlight the difference of opinion between dentists of varying experience and
skill levels
2. Make Foundation Dentists aware of the clinical parameters and challenges
associated with restoring teeth of questionable prognosis
3. Explore different treatment options that arise from the teeth in the sample and
those collected from the questionnaire.
Clinical features and parameters of 20 teeth examined across three general practices
which had questionable prognosis, were documented by three Foundation Dentists
using a data capture form together with intraoral photographs and radiographs. A
piloted questionnaire was developed and distributed to clinicians of varying clinical
experience and qualifications, from both secondary and primary care background to
ascertain the plethora of treatment options and opinions on tooth restorability

The results of the service evaluation highlighted the diversity of opinion, not only between
dentists of differing skill and experience levels, but also between dentists with similar skill and
experience levels.
This goes further to show that even with greater experience and advanced skills, dentists will not
always have similar treatment plans. This could be based on personal experience as well as
confidence of the individual practitioner.
The foundation dentists appeared to be more optimistic in their treatment planning which may
indicate an element of dental heroism and naivety, but also a lack of personal experience in
dealing with such cases.
By embarking on this project, we have come to realise how multi-factorial determining tooth
restorability is. Furthermore, from our results it is clear numerous clinical parameters and patient
related factors should be considered when assessing tooth restorability and how best appropriate
to restore.
It was interesting to note that due to the patient demographics seen in each practice, the majority
of patients chosen for this project had received their dental treatment abroad. This could have
wider significance for practitioners to be more aware of the techniques and treatments performed
abroad, to understand fully the treatment the patients have received and how best to manage
these patients moving forward.
It was encouraging to see the majority of dentists emphasising the importance of prevention and
stabilisation of the dentition before embarking on advanced restorative work. Where teeth were
deemed un-restorable, the large majority of practitioners were confident in extracting these teeth
in primary care, without resorting to a surgical extraction.
The interest our service evaluation has generated has expanded to include requests for use with
undergraduate teaching to propagate discussion on tooth restorability. We hope to progress this
project further with its use as an e-learning tool.
In the future, we would consider including the options for replacing missing teeth if they were
deemed for extraction, such as with a bridge, denture or implant.

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