Identify and Determine the Metrics, Hierarchy, and Predictive Value of All the Parameters and/or Methods Used During Endodontic Diagnosis (original) (raw)

A Consensus Conference on Terminology was convened by the American Association of Endodontists in Chicago on Oct 3, 2008 to review solicited papers on focused questions. This paper addressed the question: Identify and determine the metrics, hierarchy, and predictive value of all the parameters and/or methods used during endodontic diagnosis. The best available clinical evidence was used to determine the sensitivity, speci-ficity, and predictive value of pulpal and periapical testing methods and imaging technologies. Diagnosis of dental pulp diseases suffers from operator's inability to test/image that tissue directly due to its location within dentin. In general, current pulp tests are more valid in determining teeth that are free of disease, but less effective in identifying teeth with pulp disease. Radiographic imaging is probably the most commonly used diagnostic tool to determine the status of root-supporting tissue, although interpretation of structural changes in the periradicular tissues is still considered unreliable. (J Endod 2009;35:1635–1644) E ach subcommittee member was assigned a subquestion to Question #1 and asked to use the best available evidence to provide the necessary background information in these areas to the participants of the AAE Consensus Conference on Diagnostic Terminology scheduled for October 3, 2008, in Chicago, IL. It is intended to assist them in critiquing the value of the information, identifying gaps in the knowledge base, and establishing a consensus relative to diagnostic terminology and codification. Each member was also asked to consider an individual response to Subquestion #3 for his area. Therefore, Subquestion #3 is now included in the other questions. The committee was convened by conference call, and a deadline of March 30, 2008, for preliminary drafts was established. All final drafts were submitted by May 30, 2008. Each member was invited to use whatever scientific and clinical support he/she needed for his/her section and report accordingly in a bibliography. Additionally and separately, a search strategy was developed to identify clinical evidence and assign a level of evidence; overlap was expected. There was no attempt to standardize the responses with any other subcommittees with the hope that different approaches may broaden the search for answers and still leave the opportunity to edit as appropriate after external review and comment. A special emphasis was placed on the evidence-based approach. This relies heavily on the importance given to randomized, controlled clinical trials, and there are relatively few in this topic area. Consequently, each member interpreted the information his/her own clinical experiences and the available evidence; some bias is unavoidable. There is a long enough history of clinical experience with diagnostic methods and interpretation to provide the necessary judgment that complements the evidence-based approach in the absences of rigorous trials. It is this logical approach that will most likely be used to both support and challenge prevailing opinions at the Consensus Conference. The diagnosis of dental pulp diseases suffers from the operator's inability to test/or image that tissue directly because of its location within a relatively hard tissue, dentin. It appears to be impossible to directly test dental pulp; therefore, all information elicited must be interpreted indirectly from the patient response to a stimulus placed externally to the tissue. In general, pulp tests used are more valid in determining teeth that are free of disease but less effective in identifying teeth with pulp disease. Tests can be considered relatively noninvasive, easy to use, and cost-effective. Radiographic imaging is probably the most commonly used diagnostic tool to determine the status of root-supporting tissue, although interpretation of structural changes in the periradicular tissues is known to be unreliable. Radiographic improvements that have reduced radiation exposure and improved convenience are not generally accepted as cost-effectively facilitating visualization of changes in a measurable way.