Management of the endodontic-periodontal lesion: a UK-based vignette survey of specialist clinicians

Management of the endodontic-periodontal lesion: a UK-based vignette survey of specialist clinicians | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Management of the endodontic-periodontal lesion: a UK-based vignette survey of specialist clinicians Ayman Al-Sibassi, Emad Moawad, Fadi Jarad, Nicholas Longridge, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6189613/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims The aim of this study was to evaluate and compare how specialist endodontists and periodontists in the UK manage endodontic-periodontal lesions (EPL) and the prognostic factors influencing their decision making, seeking to identify trends and areas for consensus. Methodology A cross-sectional vignette survey featuring four clinical cases was sent to GDC registered specialist endodontists and periodontists using social media platforms and advertisement by specialist societies. Results Fifty specialists (28 endodontists, 22 periodontists) completed the survey. Endodontists demonstrated greater confidence in managing periapical lesions, fractured teeth and other prosthodontic restorative considerations. However, they prescribed more periodontal regenerative surgery than periodontists. Periodontists were more confident in regenerative surgical approaches and emphasised oral hygiene with more case-dependant specificity. Periodontists were more aware of the benefit of endodontic treatment in vital teeth with bone loss to the apex. Periodontists were more likely to recommend extraction compared to endodontists. EPL were extracted at a higher rate than the evidence suggests is necessary. Conclusion The study highlights differences between specialties in diagnosing, managing, and prognosticating EPL, underscoring the value of multi-disciplinary collaboration and specialist care, particularly for grade 2 and 3 EPL. Health sciences/Health care/Dentistry/Endodontics/Root canal treatment Introduction The pulp and periodontal tissues have several pathways of communication between them (Table 1 ). Microbial contamination of one tissue can contribute to disease in the other, 1 , 2 resulting in an endodontic-periodontal lesion (EPL). According to Herrera et al. (3), an EPL can be defined as a tooth with a “deep periodontal pocket reaching or close to the apex and a negative or altered response to pulp vitality tests”. Table 1 portals of communication between the pulp and periodontium. Anatomical Pathological Apical foramen Dentinal Tubules Accessory & lateral canals Cracks Root Fractures Root Resorptions Iatrogenic perforations Management of EPL involves management of both pulpal and periodontal pathologies. Typically, this would involve non-surgical root canal treatment (NSRCT) and subgingival professional mechanical plaque removal (PMPR). Adjunctive regenerative periodontal therapies may also be used. NSRCT over two-visits is advisable, with an interim calcium hydroxide dressing, to reduce inflammatory mediators associated with periodontal inflammation. 4 , 5 Subgingival PMPR can be carried out at the same time as NSRCT or within 6 months of obturation to prevent rebound of periodontal pocket reductions. 6 Where regenerative periodontal therapy is indicated, this could take the form of guided tissue regeneration (GTR) and/ or the use of enamel matrix derivative (EMD). 7 , 8 , 9 , 10 Although NSRCT is generally accepted as a first line management strategy for EPL, 11 , 12 previous systematic reviews have indicated that the quality of evidence supporting “an ideal management strategy” is weak, 11 , 12 , 13 largely due to a lack of well controlled studies comparing interventions. Clinicians are therefore often required to rely on their individual expert opinion and draw inferences from the more robust evidence bases found in the endodontic and periodontal literature, which primarily focuses on diseases involving either periodontal or pulpal tissues, but not both. There is a paucity of evidence specific to EPL. A recent classification system classified EPL according to whether root damage was present and the extent of the intra-bony defect (grade 1- narrow deep periodontal pocket in 1 tooth surface, grade 2- wide deep periodontal pocket in 1 tooth surface, grade 3- deep periodontal pockets in more than 1 tooth surface). 3 However, there is limited evidence linking this classification system to evidence based management strategies. Several surveys have explored dentists expert opinions on managing EPL to identify a consensus. 14 , 15 However, none of these surveys have been conducted in the UK or assessed how clinicians evaluate prognostic factors and likely tooth survival rates. Moreover, questions remain regarding the precise level of education of the endodontists and periodontists included in the referenced studies. The aim of this study was to evaluate and compare how specialist endodontists and periodontists in the UK manage EPL and the prognostic factors influencing their decision making, to identify trends and areas for consensus. Methodology A cross-sectional survey was used, with a design similar to previously published vignette surveys. 16 , 17 , 18 The survey was designed using the JISC online survey platform (Bristol, UK) then piloted on University of Liverpool clinical teaching staff and postgraduate students. Following feedback from this pilot, the survey was refined to: Include less cases Clarify phraseology to improve participant understanding. Ethical approval was granted by the University of Research Ethics Committee (Ethics no. 12657). A sample size calculation was carried out based on the number of specialist endodontists and periodontists on the General Dental Council (GDC) register. A target sample size of 62 was calculated to achieve a 90% confidence interval with a 10% margin of error. An invitation letter detailing the research question was sent out to GDC-registered specialist endodontists and periodontists, via social media and the British Society of Periodontology and Implant Dentistry and British Endodontic Society websites. The survey was circulated between January and June 2024. All participants provided informed consent for their participation in the study. The survey consisted of questions about participant demographics followed by four vignette cases. All four cases were loosely based on real cases managed at a tertiary care centre in the UK, treated by specialists and specialist trainees under specialist supervision. Participants were asked three multiple-choice base questions for each case. What classification system did you use to diagnose this endodontic-periodontal lesion? If “other” was selected, further detail was required. When considering management, rank the following prognostic factors from most to least influential on long-term survival of the tooth. How would you manage the tooth? If combined endodontic and periodontal management (surgical or non-surgical) was selected, details of the timeframes were required. If the participant did not opt for extraction, details of how many more years the tooth would survive were required. The data was descriptively analysed using the JISC platform. The results were then exported and presented in table format using Microsoft Excel 365 (Microsoft Corporation, 2018, Microsoft Excel). The cases are presented in Tables 2 to 5 . Potential prognostic factors are presented with the results in Table 6 . Table 2 Vignette case 1 Case 1 details A 57-year-old male patient attended complaining of bleeding gums and loose lower anterior teeth. The patient had been referred for non-surgical root canal treatment (NSRCT) of tooth 31 following several rounds of subgingival professional mechanical plaque removal (PMPR) without any improvement in pocket depths. Relevant medical history: chronic myeloid leukaemia, controlled with hydroxycarbamide, non-smoker. The patient brushes three times daily and uses various sizes of interdental brushes daily. On examination, apart from tooth 31, the patient had generalised periodontitis, stage II, grade A, currently stable. The patient’s oral hygiene was reasonable. Tooth 31 was grade II mobile, had suppuration from the gingival margin and pockets ranging from 7 to 10mm at six sites around the tooth. The tooth was positive to cold and electric pulp testing. There was significant spacing between the remaining lower anterior teeth. a) a) Periapical radiograph showing teeth: 42, 41, 31, 32 Table 3 Vignette case 2 Case Case 2 details A 49-year-old male patient was referred for NSRCT of teeth 16 and 26. He complained of sore gums for many years around the posterior teeth which was making eating difficult. Relevant medical history: well controlled type 2 diabetes and hypertension. Taking Amlodipine, Linagliptin and Metformin. Smokes 10 cigarettes per day. On examination the patient had evidence of generalised periodontitis, stage III, grade B, currently in remission, risk factors- smoking and diabetes. The full mouth plaque score was 35%. The bleeding score was 25%. Teeth 16 and 26 were both negative to cold testing and were unrestored. There was no evidence of cracks on either the 16 or 26, however tooth 26 was tender to percussion and had suppuration from the buccal gingival sulcus. Pocket depths recorded around tooth 16 were: MB-4 B-3 DB-6 MP-7 P-10 DP-5 Pocket depths recorded around tooth 26 were: MB-3 B-3 DB-6 MP-5 P-5 DP-6 Both teeth 16 and 26 had class II furcation involvement. The patient was apprehensive about losing further teeth. a) b) c) a) Full mouth OPG; b) periapical radiograph of teeth 25, 26, 27; c) periapical radiograph of teeth 17, 16, 15 Table 4 Vignette case 3 Case Case 3 details 3 A 39-year-old female patient was referred for re-NSRCT of tooth 13. The patient’s main complaint was that the tooth was loose. Relevant medical history: Hypertension, taking amlodipine. Stopped smoking 12 years ago, at which time she was smoking 10 cigarettes per day. The patient’s oral hygiene regime involved using an electric toothbrush twice daily with adjunctive blue and yellow interdental brushes. She also visited her hygienist for PMPR every three months. On examination the patient had a good level of oral hygiene, however there was evidence of generalised periodontitis, stage II, grade B, currently unstable at a few posterior sites. The worst site of bone loss was focused on tooth 13, however the remaining dentition had up to a maximum level of 30% horizontal bone loss. Tooth 13 had suppuration from around the gingival margin. There was a 9mm pocket and 6mm of recession mid-buccally. The previous NSRCT was carried out under rubber dam isolation. The dentition was generally heavily restored. a) a) Periapical radiograph of tooth 13 Table 5 Vignette case 4 Case 4 details A 69-year-old patient complained of a wobbly tooth 21. The tooth had become progressively looser over the last 18 months. There was a previous history of trauma over 40 years ago to tooth 21. Relevant medical history: Hypertension well controlled with Amlodipine. The patient had several courses of PMPR before being referred. They used interdental brushes and brushed twice daily using an electric toothbrush. On examination, the patient had generalised periodontitis, stage III, grade B, currently unstable. Tooth 21 was negative to cold testing, was grade III mobile, and had a 6mm periodontal pocket mesially. There was minimal space in intercuspal position between the upper and lower anterior teeth. a) a) Periapical radiograph teeth 21, 22 Table 6 classification systems used, ranked prognostic factors, management strategies and long-term predicted survival rates that participants selected, stratified according to speciality type. NSRCT = non-surgical root canal/ re-root canal treatment; PMPR = professional mechanical plaque removal; periodontal surgery = open flap debridement plus use of a membrane and/or graft and/ or enamel matrix derivative; EMS = endodontic microsurgery Preferred classification system (expressed as % of participants) Dietrich et al. (19) Herrera et al. (3) Kim and Kratchman (20) Simon et al. (21) Other Participants comments regarding the selection of “other” classification system Case 1 Endodontist, n = 28 7% 21% 14% 46% 11% - “Abbott and Salgado (22)” - “In my view the above case would not be considered an EPL as although the tooth has significant periodontal attachment loss if it is responding the canal may still be vital although the sensitivity testing is of course only assessing the nerve as opposed to blood supply!” - “None” Periodontist, n = 22 5% 64% 5% 23% 5% Case 2 Endodontist, n = 28 7% 21% 14% 50% 7% - “Abbott and Salgado (22)” - “None” Periodontist, n = 22 9% 64% 5% 18% 5% Case 3 Endodontist, n = 28 4% 32% 11% 36% 18% - “Abbott and Salgado (22)” - “Although we could technically consider the above a perio-endo lesion I would consider this Chronic Lateral Periodontitis secondary to a Cracked Root” - “VRF” - “None” - “It has a crack, so classification not used” Periodontist, n = 22 5% 64% 5% 23% 5% Case 4 Endodontist, n = 28 7% 21% 14% 50% 7% - “Abbott and Salgado (22)” - “None” Periodontist, n = 22 9% 64% 5% 18% 5% Mean rank of prognostic factors (expressed as % of participants) Case 1 Level of bone loss Oral Hygiene status Occlusion Anterior Tooth Patient Age Mandibular Tooth Endodontist, n = 28 1.32 2.79 3.18 4.07 4.61 5.04 Periodontist, n = 22 1.19 2.38 3.29 4.52 4.62 5 Case 2 Level of bone loss Furcation involvement Periapical lesion Oral hygiene status Medical history Maxillary teeth Posterior teeth Patient age Endodontist, n = 28 1.86 2.54 3.21 3.82 4.32 6.96 6.57 6.71 Periodontist, n = 22 1.91 2.73 2.86 4.23 5.27 5.86 6.14 7 Case 3 Presence of a crack Level of bone loss Occlusion Quality of previous NSRCT Coronal seal Oral hygiene status Patient age Maxillary tooth Endodontist, n = 28 1.43 2.71 3.86 4.21 4.68 5.07 6.89 7.14 Periodontist, n = 22 1.82 3.05 4.18 3.68 4.82 5.18 6.95 6.32 Case 4 Level of bone loss Periapical lesion Occlusion Oral hygiene status Patient age Anterior tooth Maxillary tooth Endodontist, n = 28 1.36 2.61 3.11 4.04 5.75 5.14 6 Periodontist, n = 22 1.64 2.27 3.59 4.68 5.64 4.82 5.36 Preferred management strategy (expressed as % of participants) Extract +/- prosthetic replacement. NSRCT & PMPR NSRCT PMPR Periodontal surgery & NSRCT Periodontal surgery EMS & NSRCT EMS & periodontal surgery Leave and monitor Case 1 Endodontist, n = 28 32% 7% 4% 18% 11% 29% 0% 0% 0% Periodontist, n = 22 41% 18% 0% 18% 18% 5% 0% 0% 0% Case 2 Endodontist, n = 28 7% 68% 11% 4% 11% 0% 0% 0% 0% Periodontist, n = 22 5% 82% 0% 0% 5% 0% 5% 5% 0% Case 3 Endodontist, n = 28 82% 4% 4% 0% 4% 4% 0% 0% 4% Periodontist, n = 22 91% 9% 0% 0% 0% 0% 0% 0% 0% Case 4 Endodontist, n = 28 46% 32% 4% 4% 14% 0% 0% 0% 0% Periodontist, n = 22 86% 14% 0% 0% 0% 0% 0% 0% 0% Timing of combined treatment (for clinicians who selected combined endodontic & periodontal treatment, expressed as number of participants) Case 1 They should be done at the same time Periodontal treatment first, 3 months wait, proceed with any endodontic treatment Single visit NSRCT, wait 3 months, proceed with periodontal treatment 2-visit NSRCT with 2 weeks between appointments; periodontal treatment 3 months after obturation 2-visit NSRCT with 2 weeks between appointments; periodontal treatment at the same time as obturation 1 or 2-visit NSRCT; >3 months wait until periodontal treatment Endodontist, n = 5 1 1 1 1 1 0 Periodontist, n = 8 2 1 3 1 1 0 Case 2 Endodontist, n = 22 11 0 4 3 3 1 Periodontist, n = 20 5 0 9 5 1 0 Case 3 Endodontist, n = 2 2 0 0 0 0 0 Periodontist, n = 2 0 0 1 0 1 0 Case 4 Endodontist, n = 13 3 0 1 4 4 1 Periodontist, n = 3 1 0 0 2 0 0 Predicted survival rate if not opted for extraction (expressed as number of participants) 5 years Case 1 Endodontist, n = 19 2 11 3 3 Periodontist, n = 13 2 6 3 2 Case 2 Endodontist, n = 26 0 2 15 9 Periodontist, n = 21 0 5 11 5 Case 3 Endodontist, n = 5 1 2 2 0 Periodontist, n = 2 0 2 0 0 Case 4 Endodontist, n = 15 3 6 4 2 Periodontist, n = 3 0 1 2 0 Methodology A cross-sectional survey was used, with a design similar to previously published vignette surveys. 16,17,18 The survey was designed using the JISC online survey platform (Bristol, UK) then piloted on University of Liverpool clinical teaching staff and postgraduate students. Following feedback from this pilot, the survey was refined to: Include less cases Clarify phraseology to improve participant understanding. Ethical approval was granted by the University of Research Ethics Committee (Ethics no. 12657). A sample size calculation was carried out based on the number of specialist endodontists and periodontists on the General Dental Council (GDC) register. A target sample size of 62 was calculated to achieve a 90% confidence interval with a 10% margin of error. An invitation letter detailing the research question was sent out to GDC-registered specialist endodontists and periodontists, via social media and the British Society of Periodontology and Implant Dentistry and British Endodontic Society websites. The survey was circulated between January and June 2024. All participants provided informed consent for their participation in the study. The survey consisted of questions about participant demographics followed by four vignette cases. All four cases were loosely based on real cases managed at a tertiary care centre in the UK, treated by specialists and specialist trainees under specialist supervision. Participants were asked three multiple-choice base questions for each case. What classification system did you use to diagnose this endodontic-periodontal lesion? If “other” was selected, further detail was required. When considering management, rank the following prognostic factors from most to least influential on long-term survival of the tooth. How would you manage the tooth? If combined endodontic and periodontal management (surgical or non-surgical) was selected, details of the timeframes were required. If the participant did not opt for extraction, details of how many more years the tooth would survive were required. The data was descriptively analysed using the JISC platform. The results were then exported and presented in table format using Microsoft Excel 365 (Microsoft Corporation, 2018, Microsoft Excel). The cases are presented in tables 2 to 5. Potential prognostic factors are presented with the results in table 6. Results 50 participants completed the survey. 28 (56%) were endodontists. 22 (44%) were periodontists. Table 6 summarises the results: classification systems used, ranked prognostic factors, management strategies, and long-term predicted survival rates stratified by speciality type. Discussion Survival times Participants predominantly predicted survival times of 1–5 years for retained EPL, with more optimistic estimations from endodontists. This represents a perception of hopeless to poor prognosis, though evidence suggests 87%-89.7% survival for grade 2 and 3 EPL over 5–10 years when managed with NSRCT and regenerative surgery, sometimes even in one-walled defects. 7 , 9 , 10 , 19 Clinicians’ focus on metrics such as periapical healing and reductions in probing depths may influence their view, though “tooth survival” is the most important patient-reported outcome. 20 A significant proportion (78%) of surveyed participants were employed in private practice (see supplementary information), where financial and medico-legal considerations may influence clinical decision-making. While the combined approach of NSRCT and regenerative surgery may initially present a cost comparable to dental implants, evidence suggests that dental implants become less cost-effective over time. 7 Medico-legal factors also likely contribute to clinicians' treatment choices, particularly considering declining public confidence in the quality of UK dentistry, which has decreased from 67–62% between 2022 and 2024. 21 Given these concerns, clinicians may be understandably cautious about recommending treatment options perceived to have a poor prognosis, especially when costs are similar to those of implant therapy and there is a risk of litigation. Ironically, medico-legal considerations may be a preventative factor for what is best for patients with EPL, with patients expressing a significant desire to retain their natural EPL teeth over a prosthetic replacement in Cortellini et al. (7). Research indicates similar 5 to 10-year survival rates for EPL and dental implants, 9 , 10 , 19 , 22 providing an evidenced based justification for attempting tooth preservation, however, dental implants benefit from a broader evidence base. Considering the results of this survey, EPL are likely extracted at a much higher rate than is necessary. To address this, specialty training programmes should assign more focus to the modalities for retention of EPL. This is in line with patient reported desires to retain EPL teeth over extraction and dental implant placement. 7 Classification systems Periodontists predominantly favoured the Herrera et al. (3) classification system, with 64% adopting it across all cases. In contrast, endodontists showed more heterogeneity, with 36%-50% using the Simon et al. (23) classification and 21%-32% selecting Herrera et al. (3). Participants selecting “other classification system” were all endodontists, citing reasons including the presence of a vertical root fracture (VRF), “vital” teeth, or use of the Abbott and Salgado (24) classification. Cracks and VRFs are included in the Herrera et al. (3) classification. Its recent introduction into the periodontal literature explains its lower adoption among endodontists. The Abbott and Salgado (24) definition of an EPL is broader than other classification systems; including teeth with incidental periapical lesions and marginal periodontal disease without communication. These results show that although there is some overlap of what is considered an EPL between specialities, there is no strict agreement, reflecting differences in training and literature exposure, complicating harmonised diagnostics and management strategies. 26% of participants in case 1 would carry out NSRCT combined with periodontal therapy for tooth 31. The remainder would carry out extraction or only one of endodontic or periodontal therapy. Recent evidence suggests that teeth testing positive to sensibility testing with bone loss to the apex 9 or a reduced response to sensibility testing with periodontal pocketing > 6mm, 6 which then subsequently have combined NSRCT and regenerative periodontal surgery, have significant improvements in periodontal probing depths and clinical attachment levels, compared to teeth which did not have NSRCT. Periodontal therapy involving the apex of a “vital” tooth can disturb the apical vasculature, leading to pulpal necrosis and a persistent inflammatory stimulus, impairing the capacity of the periodontal tissues to heal. Additionally, “vital” pulps in stage III periodontitis, which are unresponsive to periodontal therapy, exhibit inflammatory profiles akin to irreversible pulpitis. In this cohort of “vital” teeth, NSRCT combined with subgingival PMPR may be beneficial, 25 leading to improved periodontal outcomes via elimination of the inflammatory stimulus from the pulp and modification of the microbiota in the periodontal pocket towards gram-positive bacteria and subsequent reductions in the levels of endotoxins, cytokines and matrix metalloproteinases. 4 Case 1 had bone loss past the apex, and several rounds of subgingival PMPR had not improved the clinical parameters. Additionally, the patient had good oral hygiene, and the rest of the periodontal condition was stable, with an apicomarginal defect only associated with tooth 31. In line with the current evidence base 4 , 6 , 9 , 26 , there was justification to NSRCT tooth 31. The results of this survey show that most would not consider NSRCT with periodontal therapy of case 1 , indicating a lack of harmonisation between contemporary research and clinical practice. Adjusting the Herrera et al. (3) classification of EPL to include this cohort of teeth may aid in standardising diagnosis and management strategies. Prognostic factors “Level of bone loss” was consistently ranked as the most important prognostic factor by both specialities, except in case 3, where “presence of a crack” was prioritised, aligning with evidence suggesting that higher levels of marginal bone loss significantly worsen outcomes in EPL. 10 , 27 Periodontists ranked “level of bone loss” lower than endodontists in three cases, and “furcation involvement” lower than endodontists in case 2, reflecting greater confidence in regenerative techniques, 28 , 29 even with severe bone loss. Conversely, endodontists ranked “periapical lesion” 0.34 to 0.35 places lower than periodontists, indicating their greater confidence in managing periapical lesions effectively. This is not surprising, as the negative impact of periapical lesions on endodontic outcomes is well documented in the endodontic literature. 30 For case 3, a VRF was likely, which endodontists ranked higher as a prognostic factor, by 0.39 places than periodontists, showing increased awareness of VRF diagnosis and poor subsequent prognosis. 31 , 32 Interestingly, 91% of periodontists opted to extract the tooth versus 82% of endodontists. “Quality of previous NSRCT” was the first prognostic factor ranked higher by periodontists than endodontists for case 3, indicating more periodontists than endodontists considered it a barrier to success. Conversely, more endodontists saw VRF as the main reason for extraction. Periodontists have a worse outlook than endodontists about what could be achieved through re-NSRCT, while endodontists are more vigilant in diagnosing and treatment planning for VRFs. Endodontists consistently ranked “occlusion” higher than periodontists, reflecting a stronger focus on prosthodontic aspects of tooth restoration. This restorative focus is evidenced by several landmark literature and systematic reviews in the endodontic literature. 33 , 34 , 35 , 36 “Coronal seal” was also prioritised by endodontists, aligning with its significance in positive EPL outcomes. 9 Periodontists prioritised surgical aspects of maintaining EPL, consistently ranking tooth position higher than endodontists, indicating their consideration of the effects tooth position could have on ease of access for subgingival PMPR and periodontal surgery. “Oral hygiene status” was ranked highly by both specialities in case 1 , where subgingival PMPR failed to improve the tooth’s status. “Oral hygiene status” was only ranked higher by periodontists than endodontists in case 1 , indicating periodontists’ increased emphasis on oral hygiene when initial PMPR was ineffective. This is not surprising as effective plaque removal is linked to positive treatment outcomes when managing patients with periodontitis, hence the stepwise approach encouraged by the British Society of Periodontology. 37 Overall, both specialities exhibited more confidence in managing the major negative prognostic factors within their domains (“presence of a periapical lesion” and quality of previous NSRCT” for endodontists; “level of bone loss” and “furcation involvement” for periodontists). Endodontists showed vigilance regarding the diagnosis and management of cracked teeth and VRFs. Periodontists are more likely to deliver targeted oral hygiene advice to improve outcomes than endodontists and are also more vigilant regarding the effects of tooth position on surgical access. These findings underscore the importance of multidisciplinary treatment planning for EPL, combining both specialities’ expertise to optimise outcomes. It is evident from the results of this survey that depending on speciality, there is a bias towards consideration of certain prognostic over others. While the outcomes of EPL according to the treating speciality have not been investigated, it seems intuitive that a multi-disciplinary approach would lead to improved outcomes and reduced bias towards consideration of certain prognostic factors over others. Management strategies Periodontists were up to 1.87 times more likely than endodontists to select “extraction and prosthetic replacement”, a trend confirmed in another recent survey. 14 This may reflect periodontists’ advanced training in implantology, with 96.1% of periodontists placing dental implants compared to only 5.7–6.6% of endodontists. 38 , 39 , 40 Except in case 2, “extraction and prosthetic replacement” was the most favoured option among both specialities, indicating a perception of poor prognosis, particularly for grade 3 EPL and those with root damage. 3 In other surveys, general dentists exhibit even higher extraction rates than specialists, suggesting specialists are better equipped to retain these teeth using NSRCT and regenerative surgical approaches, particularly grade 2 and 3 EPL. 9 , 10 , 19 , 41 After extraction, combined endodontic and periodontal therapy was favoured over monotherapy in all cases except case 1 . A combined approach is in line with current evidence. 12 , 42 ,43 38% of all respondents opted for monotherapy in case 1 ; an approach unlikely to be optimally efficacious, due to the likely irreversibly inflamed pulp. 6 , 9 , 25 Periodontists appeared more aware of the need for NSRCT with only 23% opting for PMPR or periodontal surgery alone versus 58% of endodontists. Endodontists also prescribed periodontal surgery alone at a higher rate than periodontists: 29% versus 5%, respectively. The higher rate of endodontists prescribing periodontal surgery alone may reflect a limited understanding of its standalone efficacy. This trend, most prominent in case 1 , was also observed in other cases and confirmed by another survey. 14 In case 2, most participants selected combined NSRCT and subgingival PMPR, as the level of bone loss was less severe than other cases, reflected in that “level of bone loss” was ranked lower as a prognostic factor compared to other cases. Notably, 10% of periodontists selected endodontic microsurgery (EMS) combined with NSRCT or periodontal surgery, while no endodontists opted for EMS, suggesting periodontists may undervalue NSRCT alone and slightly overprescribe EMS. In case 4, nearly twice as many periodontists opted for extraction compared to endodontists. While defect morphology resembled case 1 , case 4 involved unstable periodontitis, contraindicating surgery. 44 14% of endodontists still recommended periodontal surgery combined with NSRCT, reflecting a potential gap in understanding about the implications of an unstable periodontal diagnosis on periodontal surgery. Unsurprisingly, no periodontists selected periodontal surgery in this case. Management strategies among endodontists were more heterogeneous than periodontists, potentially due to differences in training standardisation, particularly among those who entered specialist lists before 2010, when GDC curriculums for speciality training were introduced. However, data on participant training timelines was not collected. Regarding treatment timing, fewer participants responded due to high extraction rates in cases 1 , 3, and 4. Both specialities preferred single visit NSRCT, except in case 4. While meta-analyses show no difference in outcomes between single and multiple visits NSRCT, 45 , 46 , 47 studies specific to EPL suggest multiple visit NSRCT may improve periodontal outcomes, 4 , 5 an outcome not considered in these meta-analyses. Endodontists favour staged treatment (time-gap between endodontic and periodontal therapy) in cases 1 and 4. Periodontists preferred this across all cases. In case 2, endodontists’ preference for concurrent treatment reflected their view of the periapical lesion and level of bone loss as less significant, evidenced by their ranking of “periapical lesion” and “level of bone loss” lower in case 2, than in cases 1 and 4. Most participants preferred endodontic treatment prior to periodontal therapy, consistent with evidence supporting NSRCT as the initial step. 11 , 12 While the optimal timing of periodontal therapy after NSRCT remains unclear, 12 evidence suggests delaying periodontal therapy beyond three months may lead to rebound periodontal pocketing. 6 , 48 Most participants’ approaches aligned with evidence, favouring NSRCT first and periodontal therapy within three months. This survey highlighted key differences between periodontists and endodontists in managing EPL. Periodontists, likely due to their implantology training, favoured extraction more than endodontists, who showed greater variability in treatment approaches. The findings also underscore gaps in understanding between the two groups, with endodontists more likely to prescribe isolated periodontal surgery and periodontists more likely to prescribe EMS and undervalue the benefits of re-NSRCT. Most participants followed evidence-based treatment sequencing, favouring NSRCT first. Due to speciality specific differences in management approach noted in this survey, a multi-disciplinary approach seems appropriate for the management of EPL. Limitations The main limitation of this study was the underpowered sample size, necessitating cautious interpretation of results and prompting descriptive rather than statistical analysis to avoid misrepresentation. The survey remained open for six months, but response rates dropped significantly in the final two months despite repeated outreach efforts. No data was collected on when participants joined the specialist lists, preventing analysis stratified by experience level. While vignette surveys are valid for assessing clinicians’ decision-making, 49 they cannot fully replicate clinical scenarios. This study lacked information on bone sounding and precise defect morphology, factors important for management. Conclusion Participants’ low survival predictions revealed a gap between clinical practice and evidence suggesting high survival rates for retained EPL. 7 , 9 , 10 , 19 , 22 EPL were extracted at a higher rate than was necessary. Periodontists predominantly favoured the Herrera et al. (3) classification system, reflecting a more standardised diagnostic approach, whereas endodontists exhibited greater heterogeneity. This divergence highlights the need for a unified classification system to streamline diagnosis and management. Herrera et al. (3) may be suitable, although more clarity is needed regarding “vital” teeth with bone loss to or beyond the apex, as findings suggest the pulps of these teeth exhibit similar inflammatory profiles to those with irreversible pulpitis 25 and NSRCT can result in improved outcomes where periodontal surgery is planned and/ or when subgingival PMPR alone has been unsuccessful. 6 , 9 Both specialities prioritized bone loss as a critical prognostic factor. Periodontists demonstrated confidence in managing severe bone loss and furcation involvement, likely due to expertise in regenerative techniques. Endodontists focused more on periapical lesions, occlusion, the presence of cracks and the influence of coronal leakage, reflecting expertise in endodontic and restorative protocols. Management strategies also differed: periodontists favoured extraction and prosthetic placement, likely reflecting their advanced training in dental implants. Endodontists favoured retaining teeth through NSRCT and periodontal therapies. This study emphasizes the importance of multi-disciplinary, specialist care and standardised training in managing EPL, especially grade 2 and 3 lesions according to the Herrera et al. (3) classification. By bridging speciality-specific perspectives, endodontists and periodontists can optimise outcomes for patients. It was not possible to gain absolute consensus in management, however trends in clinicians’ decision making were found and their relevance to management strategies discussed. References Ahmed H, Versiani M, De-Deus G, Dummer P. A new system for classifying root and root canal morphology. Int Endod J. 2017;50(8):761–70. Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol. 1988;59(8):493–503. Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Clin Periodontol. 2018;45(S20):S78-S94. Duque TM, Prado M, Herrera DR, Gomes BP. Periodontal and endodontic infectious/inflammatory profile in primary periodontal lesions with secondary endodontic involvement after a calcium hydroxide-based intracanal medication. Clin Oral Investig. 2019;23:53–63. 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Clinical investigation of microbial profile and levels of endotoxins and lipoteichoic acid at different phases of the endodontic treatment in teeth with vital pulp and associated periodontal disease. J Endod. 2020;46(6):736–47. Wong I, Ton A, Cassidy AJ, Fozzard N, Sharma LA, Love RM, Sharma A. A retrospective study on the prognostic factors and success, survival, and failure outcomes of treated endodontic-periodontal lesions. Clinical and Experimental Dental Research. 2024;10(1). Nibali L, Sultan D, Arena C, Pelekos G, Lin GH, Tonetti M. Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. J Clin Periodontol. 2021;48(1):101–14. Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta‐analysis. J Clin Periodontol. 2020;47:320–51. Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. Int Endod J. 2023;56:82–115. Walton RE. Vertical root fracture: factors related to identification. The Journal of the American Dental Association. 2017;148(2):100–5. Fuss Z, Lustig J, Katz A, Tamse A. An evaluation of endodontically treated vertical root fractured teeth: impact of operative procedures. J Endod. 2001;27(1):46–8. Mannocci F, Bitter K, Sauro S, Ferrari P, Austin R, Bhuva B. Present status and future directions: the restoration of root filled teeth. Int Endod J. 2022;55:1059–84. Mannocci F, Cowie J. Restoration of endodontically treated teeth. Br Dent J. 2014;216(6):341–6. Bhuva B, Giovarruscio M, Rahim N, Bitter K, Mannocci F. The restoration of root filled teeth: a review of the clinical literature. Int Endod J. 2021;54(4):509–35. Patel S, Jarad F, Moawad E, Boland A, Greenhalgh J, Liu M, Maden M. The tooth survival of non-surgical root‐filled posterior teeth and the associated prognostic tooth‐related factors: A systematic review and meta‐analysis. Int Endod J. 2024;57(10):1404–21. West N, Chapple I, Claydon N, D’aiuto F, Donos N, Ide M, et al. BSP implementation of European S3-level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent. 2021;106:103562. Potter KS, McQuistan MR, Williamson AE, Qian F, Damiano P. Should endodontists place implants? A survey of US endodontists. J Endod. 2009;35(7):966–70. Creasy JE, Mines P, Sweet M. Surgical trends among endodontists: the results of a web-based survey. J Endod. 2009;35(1):30–4. Papathanasiou E, Finkelman M, Hanley J, Parashis AO. Prevalence, etiology and treatment of peri-implant mucositis and peri‐implantitis: a survey of periodontists in the United States. J Periodontol. 2016;87(5):493–501. Ustaoğlu G, Aydin ZU, Özelçi F. Comparison of GTR, T-PRF and open-flap debridement in the treatment of intrabony defects with endo-perio lesions: a randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2020;25(1):e117. Yan H, Mao X, Hu F, Liu J, Wang J. Observation on the effect of periodontal treatment on patients with combined periodontal-pulpal lesions. American Journal of Translational Research. 2021;13(10):11938. Ruetters M, Kim T-S, Krisam J, El-Sayed S, ElSayed N. Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients—A retrospective pilot study. Clin Oral Investig. 2021;25:2373–80. Dietrich T, Ower P, Tank M, West N, Walter C, Needleman I, et al. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions–implementation in clinical practice. Br Dent J. 2019;226(1):16–22. Manfredi M, Figini L, Gagliani M, Lodi G. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2016(12). Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod. 2008;34(9):1041–7. Sathorn C, Parashos P, Messer H. Effectiveness of single-versus multiple‐visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta‐analysis. Int Endod J. 2005;38(6):347–55. Tewari S, Sharma G, Tewari S, Mittal S, Bansal S. Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic–periodontal lesions with communication—A randomized clinical trial. Journal of oral biology and craniofacial research. 2018;8(2):105–12. Evans SC, Roberts MC, Keeley JW, Blossom JB, Amaro CM, Garcia AM, et al. Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies. Int J Clin Health Psychol. 2015;15(2):160–70. Tables Tables 1 to 6 are available in the Supplementary Files section. Additional Declarations There is no duality of interest Supplementary Files supplementaryinformationBDJ.docx supplementary information Tablesandcaptions.docx Tables 1 to 6 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6189613","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":430134736,"identity":"844e4fc7-c2ae-4aa0-b84f-911a95c8c515","order_by":0,"name":"Ayman Al-Sibassi","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-5045-8843","institution":"University of Liverpool","correspondingAuthor":true,"prefix":"","firstName":"Ayman","middleName":"","lastName":"Al-Sibassi","suffix":""},{"id":430134737,"identity":"ac21c3d2-f22f-4c6f-9310-0b443c4dab2b","order_by":1,"name":"Emad Moawad","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Emad","middleName":"","lastName":"Moawad","suffix":""},{"id":430134738,"identity":"5633bd32-3e2f-42da-8dff-e905d2503a98","order_by":2,"name":"Fadi Jarad","email":"","orcid":"https://orcid.org/0000-0002-5485-2706","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Fadi","middleName":"","lastName":"Jarad","suffix":""},{"id":430134739,"identity":"7047ffce-4323-4e5a-872f-22cc1f28ecd6","order_by":3,"name":"Nicholas Longridge","email":"","orcid":"https://orcid.org/0000-0002-9101-2378","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Longridge","suffix":""},{"id":430134740,"identity":"26a5876a-c0af-44ab-a207-76c314d87d34","order_by":4,"name":"Adejumoke Adeyemi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Adejumoke","middleName":"","lastName":"Adeyemi","suffix":""}],"badges":[],"createdAt":"2025-03-09 16:10:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6189613/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6189613/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81675201,"identity":"eb43720b-3272-4d93-a214-4e5ae6ae257b","added_by":"auto","created_at":"2025-04-30 07:15:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1781866,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6189613/v1/7d388462-82c9-4ee5-90fc-2da3ba3683ca.pdf"},{"id":81673542,"identity":"07986708-d8d6-4b62-b047-bb590f5fc80b","added_by":"auto","created_at":"2025-04-30 06:43:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20938,"visible":true,"origin":"","legend":"supplementary information","description":"","filename":"supplementaryinformationBDJ.docx","url":"https://assets-eu.researchsquare.com/files/rs-6189613/v1/9aca6b06b6ea3d7123491298.docx"},{"id":81673549,"identity":"d587ca7b-6e64-4ab9-b562-2a31093cdfc8","added_by":"auto","created_at":"2025-04-30 06:43:22","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":673284,"visible":true,"origin":"","legend":"Tables 1 to 6","description":"","filename":"Tablesandcaptions.docx","url":"https://assets-eu.researchsquare.com/files/rs-6189613/v1/18da9f39fd2bb5755b398d50.docx"}],"financialInterests":"There is no duality of interest","formattedTitle":"Management of the endodontic-periodontal lesion: a UK-based vignette survey of specialist clinicians","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe pulp and periodontal tissues have several pathways of communication between them (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Microbial contamination of one tissue can contribute to disease in the other,\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e resulting in an endodontic-periodontal lesion (EPL). According to Herrera\u003cem\u003eet al.\u003c/em\u003e (3), an EPL can be defined as a tooth with a \u003cem\u003e\u0026ldquo;deep periodontal pocket reaching or close to the apex and a negative or altered response to pulp vitality tests\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eportals of communication between the pulp and periodontium.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnatomical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePathological\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApical foramen\u003c/p\u003e \u003cp\u003eDentinal Tubules\u003c/p\u003e \u003cp\u003eAccessory \u0026amp; lateral canals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCracks\u003c/p\u003e \u003cp\u003eRoot Fractures\u003c/p\u003e \u003cp\u003eRoot Resorptions\u003c/p\u003e \u003cp\u003eIatrogenic perforations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eManagement of EPL involves management of both pulpal and periodontal pathologies. Typically, this would involve non-surgical root canal treatment (NSRCT) and subgingival professional mechanical plaque removal (PMPR). Adjunctive regenerative periodontal therapies may also be used.\u003c/p\u003e \u003cp\u003eNSRCT over two-visits is advisable, with an interim calcium hydroxide dressing, to reduce inflammatory mediators associated with periodontal inflammation.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Subgingival PMPR can be carried out at the same time as NSRCT or within 6 months of obturation to prevent rebound of periodontal pocket reductions.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Where regenerative periodontal therapy is indicated, this could take the form of guided tissue regeneration (GTR) and/ or the use of enamel matrix derivative (EMD).\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough NSRCT is generally accepted as a first line management strategy for EPL,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e previous systematic reviews have indicated that the quality of evidence supporting \u0026ldquo;an ideal management strategy\u0026rdquo; is weak,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e largely due to a lack of well controlled studies comparing interventions.\u003c/p\u003e \u003cp\u003eClinicians are therefore often required to rely on their individual expert opinion and draw inferences from the more robust evidence bases found in the endodontic and periodontal literature, which primarily focuses on diseases involving either periodontal or pulpal tissues, but not both. There is a paucity of evidence specific to EPL. A recent classification system classified EPL according to whether root damage was present and the extent of the intra-bony defect (grade 1- narrow deep periodontal pocket in 1 tooth surface, grade 2- wide deep periodontal pocket in 1 tooth surface, grade 3- deep periodontal pockets in more than 1 tooth surface).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e However, there is limited evidence linking this classification system to evidence based management strategies.\u003c/p\u003e \u003cp\u003eSeveral surveys have explored dentists expert opinions on managing EPL to identify a consensus.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e However, none of these surveys have been conducted in the UK or assessed how clinicians evaluate prognostic factors and likely tooth survival rates. Moreover, questions remain regarding the precise level of education of the endodontists and periodontists included in the referenced studies.\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate and compare how specialist endodontists and periodontists in the UK manage EPL and the prognostic factors influencing their decision making, to identify trends and areas for consensus.\u003c/p\u003e \u003cp\u003eMethodology\u003c/p\u003e \u003cp\u003eA cross-sectional survey was used, with a design similar to previously published vignette surveys.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e The survey was designed using the JISC online survey platform (Bristol, UK) then piloted on University of Liverpool clinical teaching staff and postgraduate students. Following feedback from this pilot, the survey was refined to:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInclude less cases\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eClarify phraseology to improve participant understanding.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003ewas granted by the University of Research Ethics Committee (Ethics no. 12657).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA sample size calculation was carried out based on the number of specialist endodontists and periodontists on the General Dental Council (GDC) register. A target sample size of 62 was calculated to achieve a 90% confidence interval with a 10% margin of error. An invitation letter detailing the research question was sent out to GDC-registered specialist endodontists and periodontists, via social media and the British Society of Periodontology and Implant Dentistry and British Endodontic Society websites. The survey was circulated between January and June 2024.\u003c/p\u003e \u003cp\u003e All participants provided informed consent for their participation in the study. The survey consisted of questions about participant demographics followed by four vignette cases. All four cases were loosely based on real cases managed at a tertiary care centre in the UK, treated by specialists and specialist trainees under specialist supervision.\u003c/p\u003e \u003cp\u003eParticipants were asked three multiple-choice base questions for each case.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat classification system did you use to diagnose this endodontic-periodontal lesion?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIf \u0026ldquo;other\u0026rdquo; was selected, further detail was required.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhen considering management, rank the following prognostic factors from most to least influential on long-term survival of the tooth.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow would you manage the tooth?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIf combined endodontic and periodontal management (surgical or non-surgical) was selected, details of the timeframes were required.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIf the participant did not opt for extraction, details of how many more years the tooth would survive were required.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe data was descriptively analysed using the JISC platform. The results were then exported and presented in table format using Microsoft Excel 365 (Microsoft Corporation, 2018, Microsoft Excel).\u003c/p\u003e \u003cp\u003eThe cases are presented in Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e to \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Potential prognostic factors are presented with the results in Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVignette case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e details\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA 57-year-old male patient attended complaining of bleeding gums and loose lower anterior teeth. The patient had been referred for non-surgical root canal treatment (NSRCT) of tooth 31 following several rounds of subgingival professional mechanical plaque removal (PMPR) without any improvement in pocket depths.\u003c/p\u003e \u003cp\u003eRelevant medical history: chronic myeloid leukaemia, controlled with hydroxycarbamide, non-smoker.\u003c/p\u003e \u003cp\u003eThe patient brushes three times daily and uses various sizes of interdental brushes daily.\u003c/p\u003e \u003cp\u003eOn examination, apart from tooth 31, the patient had generalised periodontitis, stage II, grade A, currently stable. The patient\u0026rsquo;s oral hygiene was reasonable.\u003c/p\u003e \u003cp\u003eTooth 31 was grade II mobile, had suppuration from the gingival margin and pockets ranging from 7 to 10mm at six sites around the tooth. The tooth was positive to cold and electric pulp testing. There was significant spacing between the remaining lower anterior teeth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003ea)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea) Periapical radiograph showing teeth: 42, 41, 31, 32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVignette case 2\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase 2 details\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eA 49-year-old male patient was referred for NSRCT of teeth 16 and 26. He complained of sore gums for many years around the posterior teeth which was making eating difficult.\u003c/p\u003e \u003cp\u003eRelevant medical history: well controlled type 2 diabetes and hypertension. Taking Amlodipine, Linagliptin and Metformin. Smokes 10 cigarettes per day.\u003c/p\u003e \u003cp\u003eOn examination the patient had evidence of generalised periodontitis, stage III, grade B, currently in remission, risk factors- smoking and diabetes. The full mouth plaque score was 35%. The bleeding score was 25%.\u003c/p\u003e \u003cp\u003eTeeth 16 and 26 were both negative to cold testing and were unrestored. There was no evidence of cracks on either the 16 or 26, however tooth 26 was tender to percussion and had suppuration from the buccal gingival sulcus.\u003c/p\u003e \u003cp\u003ePocket depths recorded around tooth 16 were:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMB-4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB-3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDB-6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDP-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePocket depths recorded around tooth 26 were:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMB-3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB-3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDB-6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDP-6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBoth teeth 16 and 26 had class II furcation involvement. The patient was apprehensive about losing further teeth.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ea) \u003c/p\u003e \u003cp\u003eb) \u003c/p\u003e \u003cp\u003ec) \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ea) Full mouth OPG; b) periapical radiograph of teeth 25, 26, 27; c) periapical radiograph of teeth 17, 16, 15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVignette case 3\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase 3 details\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA 39-year-old female patient was referred for re-NSRCT of tooth 13. The patient\u0026rsquo;s main complaint was that the tooth was loose.\u003c/p\u003e \u003cp\u003eRelevant medical history: Hypertension, taking amlodipine. Stopped smoking 12 years ago, at which time she was smoking 10 cigarettes per day.\u003c/p\u003e \u003cp\u003eThe patient\u0026rsquo;s oral hygiene regime involved using an electric toothbrush twice daily with adjunctive blue and yellow interdental brushes. She also visited her hygienist for PMPR every three months.\u003c/p\u003e \u003cp\u003eOn examination the patient had a good level of oral hygiene, however there was evidence of generalised periodontitis, stage II, grade B, currently unstable at a few posterior sites. The worst site of bone loss was focused on tooth 13, however the remaining dentition had up to a maximum level of 30% horizontal bone loss. Tooth 13 had suppuration from around the gingival margin. There was a 9mm pocket and 6mm of recession mid-buccally. The previous NSRCT was carried out under rubber dam isolation.\u003c/p\u003e \u003cp\u003eThe dentition was generally heavily restored.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ea) \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ea) Periapical radiograph of tooth 13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVignette case 4\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase 4 details\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA 69-year-old patient complained of a wobbly tooth 21. The tooth had become progressively looser over the last 18 months. There was a previous history of trauma over 40 years ago to tooth 21.\u003c/p\u003e \u003cp\u003eRelevant medical history: Hypertension well controlled with Amlodipine.\u003c/p\u003e \u003cp\u003eThe patient had several courses of PMPR before being referred. They used interdental brushes and brushed twice daily using an electric toothbrush.\u003c/p\u003e \u003cp\u003eOn examination, the patient had generalised periodontitis, stage III, grade B, currently unstable.\u003c/p\u003e \u003cp\u003eTooth 21 was negative to cold testing, was grade III mobile, and had a 6mm periodontal pocket mesially. There was minimal space in intercuspal position between the upper and lower anterior teeth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea) \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea) Periapical radiograph teeth 21, 22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eclassification systems used, ranked prognostic factors, management strategies and long-term predicted survival rates that participants selected, stratified according to speciality type. NSRCT\u0026thinsp;=\u0026thinsp;non-surgical root canal/ re-root canal treatment; PMPR\u0026thinsp;=\u0026thinsp;professional mechanical plaque removal; periodontal surgery\u0026thinsp;=\u0026thinsp;open flap debridement plus use of a membrane and/or graft and/ or enamel matrix derivative; EMS\u0026thinsp;=\u0026thinsp;endodontic microsurgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003ePreferred classification system (expressed as % of participants)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietrich\u003cem\u003eet al.\u003c/em\u003e (19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHerrera\u003cem\u003eet al.\u003c/em\u003e (3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKim and Kratchman (20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSimon\u003cem\u003eet al.\u003c/em\u003e (21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003eParticipants comments regarding the selection of \u0026ldquo;other\u0026rdquo; classification system\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" morerows=\"1\" nameend=\"c11\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;Abbott and Salgado (22)\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;In my view the above case would not be considered an EPL as although the tooth has significant periodontal attachment loss if it is responding the canal may still be vital although the sensitivity testing is of course only assessing the nerve as opposed to blood supply!\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;None\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" morerows=\"1\" nameend=\"c11\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;Abbott and Salgado (22)\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;None\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" morerows=\"1\" nameend=\"c11\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;Abbott and Salgado (22)\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;Although we could technically consider the above a perio-endo lesion I would consider this Chronic Lateral Periodontitis secondary to a Cracked Root\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;VRF\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;None\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;It has a crack, so classification not used\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" morerows=\"1\" nameend=\"c11\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;Abbott and Salgado (22)\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e- \u003cem\u003e\u0026ldquo;None\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean rank of prognostic factors (expressed as % of participants)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase\u003c/b\u003e \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e\u003cb\u003e1\u003c/b\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel of bone loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOral Hygiene status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eOcclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eAnterior Tooth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ePatient Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMandibular Tooth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel of bone loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eFurcation involvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePeriapical lesion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eOral hygiene status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMaxillary teeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003ePosterior teeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003ePatient age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePresence of a crack\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eLevel of bone loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eOcclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eQuality of previous NSRCT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eCoronal seal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eOral hygiene status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003ePatient age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eMaxillary tooth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel of bone loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePeriapical lesion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eOcclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eOral hygiene status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ePatient age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eAnterior tooth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eMaxillary tooth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePreferred management strategy (expressed as % of participants)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExtract +/- prosthetic replacement.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNSRCT \u0026amp; PMPR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNSRCT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ePMPR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ePeriodontal surgery \u0026amp; NSRCT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ePeriodontal surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eEMS \u0026amp; NSRCT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eEMS \u0026amp; periodontal surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eLeave and monitor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase\u003c/b\u003e \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e\u003cb\u003e1\u003c/b\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTiming of combined treatment (for clinicians who selected combined endodontic \u0026amp; periodontal treatment, expressed as number of participants)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase\u003c/b\u003e \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e\u003cb\u003e1\u003c/b\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eThey should be done at the same time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePeriodontal treatment first, 3 months wait, proceed with any endodontic treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSingle visit NSRCT, wait 3 months, proceed with periodontal treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2-visit NSRCT with 2 weeks between appointments; periodontal treatment 3 months after obturation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2-visit NSRCT with 2 weeks between appointments; periodontal treatment at the same time as obturation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1 or 2-visit NSRCT; \u0026gt;3 months wait until periodontal treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePredicted survival rate if not opted for extraction (expressed as number of participants)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1 year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;3 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u0026ndash;5 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;5 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase\u003c/b\u003e \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e\u003cb\u003e1\u003c/b\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCase 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndodontist, n\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontist, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA cross-sectional survey was used, with a design similar to previously published vignette surveys.\u003csup\u003e16,17,18\u003c/sup\u003e The survey was designed using the JISC online survey platform (Bristol, UK) then piloted on University of Liverpool clinical teaching staff and postgraduate students. Following feedback from this pilot, the survey was refined to:\u0026nbsp;\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eInclude less cases\u003c/li\u003e\n \u003cli\u003eClarify phraseology to improve participant understanding.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEthical approval was granted by the University of Research Ethics Committee (Ethics no. 12657).\u003c/p\u003e\n\u003cp\u003eA sample size calculation was carried out based on the number of specialist endodontists and periodontists on the General Dental Council (GDC) register. A target sample size of 62 was calculated to achieve a 90% confidence interval with a 10% margin of error. An invitation letter detailing the research question was sent out to GDC-registered specialist endodontists and periodontists, via social media and the British Society of Periodontology and Implant Dentistry and British Endodontic Society websites. The survey was circulated between January and June 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent for their participation in the study. The survey consisted of questions about participant demographics followed by four vignette cases. All four cases were loosely based on real cases managed at a tertiary care centre in the UK, treated by specialists and specialist trainees under specialist supervision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were asked three multiple-choice base questions for each case.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eWhat classification system did you use to diagnose this endodontic-periodontal lesion?\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eIf \u0026ldquo;other\u0026rdquo; was selected, further detail was required.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003eWhen considering management, rank the following prognostic factors from most to least influential on long-term survival of the tooth.\u003c/li\u003e\n \u003cli\u003eHow would you manage the tooth?\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eIf combined endodontic and periodontal management (surgical or non-surgical) was selected, details of the timeframes were required.\u003c/li\u003e\n \u003cli\u003eIf the participant did not opt for extraction, details of how many more years the tooth would survive were required.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe data was descriptively analysed using the JISC platform. The results were then exported and presented in table format using Microsoft Excel 365 (Microsoft Corporation, 2018, Microsoft Excel).\u003c/p\u003e\n\u003cp\u003eThe cases are presented in tables 2 to 5. Potential prognostic factors are presented with the results in table 6.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e50 participants completed the survey. 28 (56%) were endodontists. 22 (44%) were periodontists.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e summarises the results: classification systems used, ranked prognostic factors, management strategies, and long-term predicted survival rates stratified by speciality type.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSurvival times\u003c/p\u003e \u003cp\u003eParticipants predominantly predicted survival times of 1\u0026ndash;5 years for retained EPL, with more optimistic estimations from endodontists. This represents a perception of hopeless to poor prognosis, though evidence suggests 87%-89.7% survival for grade 2 and 3 EPL over 5\u0026ndash;10 years when managed with NSRCT and regenerative surgery, sometimes even in one-walled defects.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Clinicians\u0026rsquo; focus on metrics such as periapical healing and reductions in probing depths may influence their view, though \u0026ldquo;tooth survival\u0026rdquo; is the most important patient-reported outcome.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA significant proportion (78%) of surveyed participants were employed in private practice (see supplementary information), where financial and medico-legal considerations may influence clinical decision-making. While the combined approach of NSRCT and regenerative surgery may initially present a cost comparable to dental implants, evidence suggests that dental implants become less cost-effective over time.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Medico-legal factors also likely contribute to clinicians' treatment choices, particularly considering declining public confidence in the quality of UK dentistry, which has decreased from 67\u0026ndash;62% between 2022 and 2024.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Given these concerns, clinicians may be understandably cautious about recommending treatment options perceived to have a poor prognosis, especially when costs are similar to those of implant therapy and there is a risk of litigation. Ironically, medico-legal considerations may be a preventative factor for what is best for patients with EPL, with patients expressing a significant desire to retain their natural EPL teeth over a prosthetic replacement in Cortellini\u003cem\u003eet al.\u003c/em\u003e (7).\u003c/p\u003e \u003cp\u003eResearch indicates similar 5 to 10-year survival rates for EPL and dental implants,\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e providing an evidenced based justification for attempting tooth preservation, however, dental implants benefit from a broader evidence base.\u003c/p\u003e \u003cp\u003eConsidering the results of this survey, EPL are likely extracted at a much higher rate than is necessary. To address this, specialty training programmes should assign more focus to the modalities for retention of EPL. This is in line with patient reported desires to retain EPL teeth over extraction and dental implant placement.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eClassification systems\u003c/p\u003e \u003cp\u003ePeriodontists predominantly favoured the Herrera\u003cem\u003eet al.\u003c/em\u003e (3) classification system, with 64% adopting it across all cases. In contrast, endodontists showed more heterogeneity, with 36%-50% using the Simon\u003cem\u003eet al.\u003c/em\u003e (23) classification and 21%-32% selecting Herrera\u003cem\u003eet al.\u003c/em\u003e (3). Participants selecting \u0026ldquo;other classification system\u0026rdquo; were all endodontists, citing reasons including the presence of a vertical root fracture (VRF), \u0026ldquo;vital\u0026rdquo; teeth, or use of the Abbott and Salgado (24) classification.\u003c/p\u003e \u003cp\u003eCracks and VRFs are included in the Herrera\u003cem\u003eet al.\u003c/em\u003e (3) classification. Its recent introduction into the periodontal literature explains its lower adoption among endodontists. The Abbott and Salgado (24) definition of an EPL is broader than other classification systems; including teeth with incidental periapical lesions and marginal periodontal disease without communication. These results show that although there is some overlap of what is considered an EPL between specialities, there is no strict agreement, reflecting differences in training and literature exposure, complicating harmonised diagnostics and management strategies.\u003c/p\u003e \u003cp\u003e26% of participants in case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e would carry out NSRCT combined with periodontal therapy for tooth 31. The remainder would carry out extraction or only one of endodontic or periodontal therapy. Recent evidence suggests that teeth testing positive to sensibility testing with bone loss to the apex \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e or a reduced response to sensibility testing with periodontal pocketing\u0026thinsp;\u0026gt;\u0026thinsp;6mm,\u003csup\u003e6\u003c/sup\u003e which then subsequently have combined NSRCT and regenerative periodontal surgery, have significant improvements in periodontal probing depths and clinical attachment levels, compared to teeth which did not have NSRCT.\u003c/p\u003e \u003cp\u003ePeriodontal therapy involving the apex of a \u0026ldquo;vital\u0026rdquo; tooth can disturb the apical vasculature, leading to pulpal necrosis and a persistent inflammatory stimulus, impairing the capacity of the periodontal tissues to heal. Additionally, \u0026ldquo;vital\u0026rdquo; pulps in stage III periodontitis, which are unresponsive to periodontal therapy, exhibit inflammatory profiles akin to irreversible pulpitis. In this cohort of \u0026ldquo;vital\u0026rdquo; teeth, NSRCT combined with subgingival PMPR may be beneficial,\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e leading to improved periodontal outcomes via elimination of the inflammatory stimulus from the pulp and modification of the microbiota in the periodontal pocket towards gram-positive bacteria and subsequent reductions in the levels of endotoxins, cytokines and matrix metalloproteinases.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 1\u003c/strong\u003e \u003cp\u003ehad bone loss past the apex, and several rounds of subgingival PMPR had not improved the clinical parameters. Additionally, the patient had good oral hygiene, and the rest of the periodontal condition was stable, with an apicomarginal defect only associated with tooth 31. In line with the current evidence base \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, there was justification to NSRCT tooth 31. The results of this survey show that most would not consider NSRCT with periodontal therapy of case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, indicating a lack of harmonisation between contemporary research and clinical practice. Adjusting the Herrera\u003cem\u003eet al.\u003c/em\u003e (3) classification of EPL to include this cohort of teeth may aid in standardising diagnosis and management strategies.\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePrognostic factors\u003c/p\u003e \u003cp\u003e\u0026ldquo;Level of bone loss\u0026rdquo; was consistently ranked as the most important prognostic factor by both specialities, except in case 3, where \u0026ldquo;presence of a crack\u0026rdquo; was prioritised, aligning with evidence suggesting that higher levels of marginal bone loss significantly worsen outcomes in EPL. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Periodontists ranked \u0026ldquo;level of bone loss\u0026rdquo; lower than endodontists in three cases, and \u0026ldquo;furcation involvement\u0026rdquo; lower than endodontists in case 2, reflecting greater confidence in regenerative techniques, \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e even with severe bone loss.\u003c/p\u003e \u003cp\u003eConversely, endodontists ranked \u0026ldquo;periapical lesion\u0026rdquo; 0.34 to 0.35 places lower than periodontists, indicating their greater confidence in managing periapical lesions effectively. This is not surprising, as the negative impact of periapical lesions on endodontic outcomes is well documented in the endodontic literature.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor case 3, a VRF was likely, which endodontists ranked higher as a prognostic factor, by 0.39 places than periodontists, showing increased awareness of VRF diagnosis and poor subsequent prognosis.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Interestingly, 91% of periodontists opted to extract the tooth versus 82% of endodontists. \u0026ldquo;Quality of previous NSRCT\u0026rdquo; was the first prognostic factor ranked higher by periodontists than endodontists for case 3, indicating more periodontists than endodontists considered it a barrier to success. Conversely, more endodontists saw VRF as the main reason for extraction. Periodontists have a worse outlook than endodontists about what could be achieved through re-NSRCT, while endodontists are more vigilant in diagnosing and treatment planning for VRFs.\u003c/p\u003e \u003cp\u003eEndodontists consistently ranked \u0026ldquo;occlusion\u0026rdquo; higher than periodontists, reflecting a stronger focus on prosthodontic aspects of tooth restoration. This restorative focus is evidenced by several landmark literature and systematic reviews in the endodontic literature.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e \u0026ldquo;Coronal seal\u0026rdquo; was also prioritised by endodontists, aligning with its significance in positive EPL outcomes.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Periodontists prioritised surgical aspects of maintaining EPL, consistently ranking tooth position higher than endodontists, indicating their consideration of the effects tooth position could have on ease of access for subgingival PMPR and periodontal surgery.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Oral hygiene status\u0026rdquo; was ranked highly by both specialities in case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, where subgingival PMPR failed to improve the tooth\u0026rsquo;s status. \u0026ldquo;Oral hygiene status\u0026rdquo; was only ranked higher by periodontists than endodontists in case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, indicating periodontists\u0026rsquo; increased emphasis on oral hygiene when initial PMPR was ineffective. This is not surprising as effective plaque removal is linked to positive treatment outcomes when managing patients with periodontitis, hence the stepwise approach encouraged by the British Society of Periodontology.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, both specialities exhibited more confidence in managing the major negative prognostic factors within their domains (\u0026ldquo;presence of a periapical lesion\u0026rdquo; and quality of previous NSRCT\u0026rdquo; for endodontists; \u0026ldquo;level of bone loss\u0026rdquo; and \u0026ldquo;furcation involvement\u0026rdquo; for periodontists). Endodontists showed vigilance regarding the diagnosis and management of cracked teeth and VRFs. Periodontists are more likely to deliver targeted oral hygiene advice to improve outcomes than endodontists and are also more vigilant regarding the effects of tooth position on surgical access. These findings underscore the importance of multidisciplinary treatment planning for EPL, combining both specialities\u0026rsquo; expertise to optimise outcomes.\u003c/p\u003e \u003cp\u003eIt is evident from the results of this survey that depending on speciality, there is a bias towards consideration of certain prognostic over others. While the outcomes of EPL according to the treating speciality have not been investigated, it seems intuitive that a multi-disciplinary approach would lead to improved outcomes and reduced bias towards consideration of certain prognostic factors over others.\u003c/p\u003e \u003cp\u003eManagement strategies\u003c/p\u003e \u003cp\u003ePeriodontists were up to 1.87 times more likely than endodontists to select \u0026ldquo;extraction and prosthetic replacement\u0026rdquo;, a trend confirmed in another recent survey.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e This may reflect periodontists\u0026rsquo; advanced training in implantology, with 96.1% of periodontists placing dental implants compared to only 5.7\u0026ndash;6.6% of endodontists.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Except in case 2, \u0026ldquo;extraction and prosthetic replacement\u0026rdquo; was the most favoured option among both specialities, indicating a perception of poor prognosis, particularly for grade 3 EPL and those with root damage.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In other surveys, general dentists exhibit even higher extraction rates than specialists, suggesting specialists are better equipped to retain these teeth using NSRCT and regenerative surgical approaches, particularly grade 2 and 3 EPL.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAfter extraction, combined endodontic and periodontal therapy was favoured over monotherapy in all cases except case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A combined approach is in line with current evidence.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,43\u003c/sup\u003e 38% of all respondents opted for monotherapy in case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e; an approach unlikely to be optimally efficacious, due to the likely irreversibly inflamed pulp.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Periodontists appeared more aware of the need for NSRCT with only 23% opting for PMPR or periodontal surgery alone versus 58% of endodontists. Endodontists also prescribed periodontal surgery alone at a higher rate than periodontists: 29% versus 5%, respectively. The higher rate of endodontists prescribing periodontal surgery alone may reflect a limited understanding of its standalone efficacy. This trend, most prominent in case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, was also observed in other cases and confirmed by another survey.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn case 2, most participants selected combined NSRCT and subgingival PMPR, as the level of bone loss was less severe than other cases, reflected in that \u0026ldquo;level of bone loss\u0026rdquo; was ranked lower as a prognostic factor compared to other cases. Notably, 10% of periodontists selected endodontic microsurgery (EMS) combined with NSRCT or periodontal surgery, while no endodontists opted for EMS, suggesting periodontists may undervalue NSRCT alone and slightly overprescribe EMS.\u003c/p\u003e \u003cp\u003eIn case 4, nearly twice as many periodontists opted for extraction compared to endodontists. While defect morphology resembled case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, case 4 involved unstable periodontitis, contraindicating surgery.\u003csup\u003e44\u003c/sup\u003e 14% of endodontists still recommended periodontal surgery combined with NSRCT, reflecting a potential gap in understanding about the implications of an unstable periodontal diagnosis on periodontal surgery. Unsurprisingly, no periodontists selected periodontal surgery in this case.\u003c/p\u003e \u003cp\u003eManagement strategies among endodontists were more heterogeneous than periodontists, potentially due to differences in training standardisation, particularly among those who entered specialist lists before 2010, when GDC curriculums for speciality training were introduced. However, data on participant training timelines was not collected.\u003c/p\u003e \u003cp\u003eRegarding treatment timing, fewer participants responded due to high extraction rates in cases \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, 3, and 4. Both specialities preferred single visit NSRCT, except in case 4. While meta-analyses show no difference in outcomes between single and multiple visits NSRCT,\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e studies specific to EPL suggest multiple visit NSRCT may improve periodontal outcomes,\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e an outcome not considered in these meta-analyses.\u003c/p\u003e \u003cp\u003eEndodontists favour staged treatment (time-gap between endodontic and periodontal therapy) in cases \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e and 4. Periodontists preferred this across all cases. In case 2, endodontists\u0026rsquo; preference for concurrent treatment reflected their view of the periapical lesion and level of bone loss as less significant, evidenced by their ranking of \u0026ldquo;periapical lesion\u0026rdquo; and \u0026ldquo;level of bone loss\u0026rdquo; lower in case 2, than in cases \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e and 4.\u003c/p\u003e \u003cp\u003eMost participants preferred endodontic treatment prior to periodontal therapy, consistent with evidence supporting NSRCT as the initial step.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e While the optimal timing of periodontal therapy after NSRCT remains unclear,\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e evidence suggests delaying periodontal therapy beyond three months may lead to rebound periodontal pocketing.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e Most participants\u0026rsquo; approaches aligned with evidence, favouring NSRCT first and periodontal therapy within three months.\u003c/p\u003e \u003cp\u003eThis survey highlighted key differences between periodontists and endodontists in managing EPL. Periodontists, likely due to their implantology training, favoured extraction more than endodontists, who showed greater variability in treatment approaches. The findings also underscore gaps in understanding between the two groups, with endodontists more likely to prescribe isolated periodontal surgery and periodontists more likely to prescribe EMS and undervalue the benefits of re-NSRCT. Most participants followed evidence-based treatment sequencing, favouring NSRCT first.\u003c/p\u003e \u003cp\u003eDue to speciality specific differences in management approach noted in this survey, a multi-disciplinary approach seems appropriate for the management of EPL.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThe main limitation of this study was the underpowered sample size, necessitating cautious interpretation of results and prompting descriptive rather than statistical analysis to avoid misrepresentation. The survey remained open for six months, but response rates dropped significantly in the final two months despite repeated outreach efforts.\u003c/p\u003e \u003cp\u003eNo data was collected on when participants joined the specialist lists, preventing analysis stratified by experience level.\u003c/p\u003e \u003cp\u003eWhile vignette surveys are valid for assessing clinicians\u0026rsquo; decision-making,\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e they cannot fully replicate clinical scenarios. This study lacked information on bone sounding and precise defect morphology, factors important for management.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eParticipants\u0026rsquo; low survival predictions revealed a gap between clinical practice and evidence suggesting high survival rates for retained EPL.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e EPL were extracted at a higher rate than was necessary.\u003c/p\u003e \u003cp\u003ePeriodontists predominantly favoured the Herrera\u003cem\u003eet al.\u003c/em\u003e (3) classification system, reflecting a more standardised diagnostic approach, whereas endodontists exhibited greater heterogeneity. This divergence highlights the need for a unified classification system to streamline diagnosis and management. Herrera\u003cem\u003eet al.\u003c/em\u003e (3) may be suitable, although more clarity is needed regarding \u0026ldquo;vital\u0026rdquo; teeth with bone loss to or beyond the apex, as findings suggest the pulps of these teeth exhibit similar inflammatory profiles to those with irreversible pulpitis \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e and NSRCT can result in improved outcomes where periodontal surgery is planned and/ or when subgingival PMPR alone has been unsuccessful.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBoth specialities prioritized bone loss as a critical prognostic factor. Periodontists demonstrated confidence in managing severe bone loss and furcation involvement, likely due to expertise in regenerative techniques. Endodontists focused more on periapical lesions, occlusion, the presence of cracks and the influence of coronal leakage, reflecting expertise in endodontic and restorative protocols.\u003c/p\u003e \u003cp\u003eManagement strategies also differed: periodontists favoured extraction and prosthetic placement, likely reflecting their advanced training in dental implants. Endodontists favoured retaining teeth through NSRCT and periodontal therapies.\u003c/p\u003e \u003cp\u003eThis study emphasizes the importance of multi-disciplinary, specialist care and standardised training in managing EPL, especially grade 2 and 3 lesions according to the Herrera\u003cem\u003eet al.\u003c/em\u003e (3) classification. By bridging speciality-specific perspectives, endodontists and periodontists can optimise outcomes for patients. It was not possible to gain absolute consensus in management, however trends in clinicians\u0026rsquo; decision making were found and their relevance to management strategies discussed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhmed H, Versiani M, De-Deus G, Dummer P. A new system for classifying root and root canal morphology. Int Endod J. 2017;50(8):761\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol. 1988;59(8):493\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. 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Teeth with vital pulps and stage III periodontitis unresponsive to therapy exhibit a pulpal inflammatory profile similar to symptomatic irreversible pulpitis. Int Endod J. 2024;57(12):1769\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLouzada LM, Arruda-Vasconcelos R, Duque TM, Casarin RC, Feres M, Gomes BP. Clinical investigation of microbial profile and levels of endotoxins and lipoteichoic acid at different phases of the endodontic treatment in teeth with vital pulp and associated periodontal disease. J Endod. 2020;46(6):736\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong I, Ton A, Cassidy AJ, Fozzard N, Sharma LA, Love RM, Sharma A. A retrospective study on the prognostic factors and success, survival, and failure outcomes of treated endodontic-periodontal lesions. Clinical and Experimental Dental Research. 2024;10(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNibali L, Sultan D, Arena C, Pelekos G, Lin GH, Tonetti M. Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. J Clin Periodontol. 2021;48(1):101\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta‐analysis. J Clin Periodontol. 2020;47:320\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment\u0026mdash;A reframing of the principles. Int Endod J. 2023;56:82\u0026ndash;115.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalton RE. Vertical root fracture: factors related to identification. The Journal of the American Dental Association. 2017;148(2):100\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFuss Z, Lustig J, Katz A, Tamse A. An evaluation of endodontically treated vertical root fractured teeth: impact of operative procedures. J Endod. 2001;27(1):46\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMannocci F, Bitter K, Sauro S, Ferrari P, Austin R, Bhuva B. Present status and future directions: the restoration of root filled teeth. Int Endod J. 2022;55:1059\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMannocci F, Cowie J. Restoration of endodontically treated teeth. Br Dent J. 2014;216(6):341\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhuva B, Giovarruscio M, Rahim N, Bitter K, Mannocci F. The restoration of root filled teeth: a review of the clinical literature. Int Endod J. 2021;54(4):509\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel S, Jarad F, Moawad E, Boland A, Greenhalgh J, Liu M, Maden M. The tooth survival of non-surgical root‐filled posterior teeth and the associated prognostic tooth‐related factors: A systematic review and meta‐analysis. Int Endod J. 2024;57(10):1404\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWest N, Chapple I, Claydon N, D\u0026rsquo;aiuto F, Donos N, Ide M, et al. BSP implementation of European S3-level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent. 2021;106:103562.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePotter KS, McQuistan MR, Williamson AE, Qian F, Damiano P. Should endodontists place implants? A survey of US endodontists. J Endod. 2009;35(7):966\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreasy JE, Mines P, Sweet M. Surgical trends among endodontists: the results of a web-based survey. J Endod. 2009;35(1):30\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapathanasiou E, Finkelman M, Hanley J, Parashis AO. Prevalence, etiology and treatment of peri-implant mucositis and peri‐implantitis: a survey of periodontists in the United States. J Periodontol. 2016;87(5):493\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUstaoğlu G, Aydin ZU, \u0026Ouml;zel\u0026ccedil;i F. Comparison of GTR, T-PRF and open-flap debridement in the treatment of intrabony defects with endo-perio lesions: a randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2020;25(1):e117.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan H, Mao X, Hu F, Liu J, Wang J. Observation on the effect of periodontal treatment on patients with combined periodontal-pulpal lesions. American Journal of Translational Research. 2021;13(10):11938.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuetters M, Kim T-S, Krisam J, El-Sayed S, ElSayed N. Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients\u0026mdash;A retrospective pilot study. Clin Oral Investig. 2021;25:2373\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDietrich T, Ower P, Tank M, West N, Walter C, Needleman I, et al. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions\u0026ndash;implementation in clinical practice. Br Dent J. 2019;226(1):16\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManfredi M, Figini L, Gagliani M, Lodi G. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2016(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFigini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod. 2008;34(9):1041\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSathorn C, Parashos P, Messer H. Effectiveness of single-versus multiple‐visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta‐analysis. Int Endod J. 2005;38(6):347\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTewari S, Sharma G, Tewari S, Mittal S, Bansal S. Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic\u0026ndash;periodontal lesions with communication\u0026mdash;A randomized clinical trial. Journal of oral biology and craniofacial research. 2018;8(2):105\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvans SC, Roberts MC, Keeley JW, Blossom JB, Amaro CM, Garcia AM, et al. Vignette methodologies for studying clinicians\u0026rsquo; decision-making: Validity, utility, and application in ICD-11 field studies. Int J Clin Health Psychol. 2015;15(2):160\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 6 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6189613/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6189613/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAims\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to evaluate and compare how specialist endodontists and periodontists in the UK manage endodontic-periodontal lesions (EPL) and the prognostic factors influencing their decision making, seeking to identify trends and areas for consensus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional vignette survey featuring four clinical cases was sent to GDC registered specialist endodontists and periodontists using social media platforms and advertisement by specialist societies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifty specialists (28 endodontists, 22 periodontists) completed the survey. Endodontists demonstrated greater confidence in managing periapical lesions, fractured teeth and other prosthodontic restorative considerations. However, they prescribed more periodontal regenerative surgery than periodontists. Periodontists were more confident in regenerative surgical approaches and emphasised oral hygiene with more case-dependant specificity. Periodontists were more aware of the benefit of endodontic treatment in vital teeth with bone loss to the apex. Periodontists were more likely to recommend extraction compared to endodontists. EPL were extracted at a higher rate than the evidence suggests is necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study highlights differences between specialties in diagnosing, managing, and prognosticating EPL, underscoring the value of multi-disciplinary collaboration and specialist care, particularly for grade 2 and 3 EPL.\u003c/p\u003e","manuscriptTitle":"Management of the endodontic-periodontal lesion: a UK-based vignette survey of specialist clinicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-30 06:43:17","doi":"10.21203/rs.3.rs-6189613/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"988286b1-621a-43d1-b8ae-5ceb6cf6c7dc","owner":[],"postedDate":"April 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45812414,"name":"Health sciences/Health care/Dentistry/Endodontics/Root canal treatment"}],"tags":[],"updatedAt":"2026-02-06T16:16:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-30 06:43:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6189613","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6189613","identity":"rs-6189613","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}