Abstract
Aim To audit the appropriateness, after triage, of surgical endodontic referrals to Queen Victoria Hospital, a regional referral unit in West Sussex. To discuss the current referral pathway with the aim of improving general dental practitioner (GDP) understanding of indications for surgical endodontics via the referral process.
Methodology A three-year retrospective review of all surgical endodontic referrals made to Queen Victoria Hospital, East Grinstead was completed. This was inclusive of all referrals made via the National Health Service (NHS) Vantage Rego e-referral system and GDP referral letters. The quality of referrals was analysed as indicated or contraindicated in accordance with the Royal College of Surgeons guidelines for surgical endodontics and periradicular surgery.
Results Out of the 34 referrals included in data analysis, 50% contained one or more contraindication for surgical intervention. The most commonly recorded contraindications to treatment were poor-quality root canal treatment, periodontal disease compromising the long-term success of treatment and a poor coronal seal deeming the tooth unrestorable post-surgical intervention.
Conclusions A more efficient surgical endodontic referral system will aid resource allocation within the NHS. These results are a first step to aiding necessary modification of the primary care referral pathway to achieve a more effective service for patients, with improved acceptance rate of referrals and better surgical outcomes.
Key points
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Examines referral suitability in relation to the Royal College of Surgeons guidelines.
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Increases awareness of indications and contraindications for surgical intervention.
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Discusses the future of surgical endodontic treatment within the current NHS service framework in light of the emerging literature.
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References
Friedman S. Treatment outcome and prognosis of endodontic therapy. In Ørstavik D, Pitt Ford T R (eds) Essential Endodontology. 2nd ed. pp. 441-447. Oxford: Blackwell Science, 2008.
Qualtrough A, Alani A, Bandheri S, Mehta D, Ng Y, Saksena A, Tomson P, created in colloboration with the British Endodontic Society. Royal College of Surgeons: Guidelines for Periradicular Surgery. 2020. Available at https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines/ (accessed February 2020).
Evans G, Bishop K, Renton T. Royal College of Surgeons: Guidelines for Surgical Endodontics. 2012. Available at https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines/ (accessed January 2020).
Khan A, Aziz H, Zaman H. Indication for Surgical Endodontics in accordance with NICE guidelines. Int Dent J Stud Res 2016; 4: 45-48.
Fahey T, O'Connor N, Walker T, Chin-Shong D. Surgical endodontics: a review of current best practice. Oral Surgery 2011; 4: 97-104.
El-Swiah J M, Walker R T. Reasons for apicectomies. A retrospective study. Endod Dent Traumatol 1996; 12: 185-191.
Raftery P. Referrals: Apicectomy. Br Dent J 2017; 222: 2.
Tsesis I, Faivishevsky V, Kfir A, Rosen E. Outcome of surgical endodontic treatment performed by a modern technique: a meta-analysis of literature. J Endodontics 2009; 35: 1505-1511.
Setzer F C, Shah S B, Kohli M R, Karabucak B, Kim S. Outcome of Endodontic Surgery: A Meta-analysis of the Literature - Part 1: Comparison of Traditional Root-end Surgery and Endodontic Microsurgery. J Endod 2010; 36: 1757-1765.
Setzer F C, Kohli M R, Shah S B, Karabucak B, Kim S. Outcome of Endodontic Surgery: A Meta-analysis of the Literature - Part 2: Comparison of Endodontic Microsurgical Techniques with and without the Use of Higher Magnification. J Endod 2012; 38: 1-10.
NHS England. Guide for Commissioning Dental Specialties. 2015. Available at https://www.england.nhs.uk/primary-care/dentistry/dental-commissioning/dental-specialities/ (accessed January 2020).
Evans G E, Bishop K, Renton T. Update of guidelines for surgical endodontics - the position after ten years. Br Dent J 2012; 212: 497-497.
Tortorici S, Difalco P, Caradonna L, Tetè S. Traditional endodontic surgery versus modern technique: a 5-year controlled clinical trial. J Craniofacial Surgery 2014; 25: 804-807.
Venskutonis T, Plotino G, Juodzbalys G, Mickevičiene L. The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature. J Endod 2014; 40: 1895-1901.
Rahbaran S, Gilthorpe M S, Harrison S D, Gulabivala K. Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching hospital: A retrospective study. Oral Surg Oral Med Oral Path 2001; 91: 700-709.
Del Fabbro, M Taschieri, Testori T. Surgical vs non-surgical endodontic re-treatment for peri radicular lesions. Cochrane Database Sys Rev 2007; 18: CD005511. DOI: 10.1002/14651858.CD005511.pub2.
Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006; 32: 601-623.
Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of non-surgical retreatment and endodontic surgery: a systematic review. J Endod 2009; 35: 930-937.
Kruse C, Spin-Neto R, Christiansen R, Wenzel A, Kirkevang L L. Periapical bone healing after apicectomy with and without retrograde root filling with Mineral Trioxide Aggregate: A 6-year follow-up of a randomized controlled trial. J Endodontics 2016; 42: 533-537.
Jones, O, Lumley, P, Green D et al. Enhanced NHS endodontic services in England: a postcode lottery? Br Dent J 2019; 226: 871-877.
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The authors would like to acknowledge and thank the NHS records administrative staff and audit department at Queen Victoria Hospital for making the patient records available.
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Duke, A., Gilvetti, C. & Shelley, M. Investigating the appropriateness of surgical endodontic referrals to a West Sussex regional referral unit. Br Dent J (2021). https://doi.org/10.1038/s41415-020-2354-4
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DOI: https://doi.org/10.1038/s41415-020-2354-4
