Abstract Aims The aim of this study was to investigate tooth extractions in a Swedish public general dental practice setting, including the proportion of endodontically treated teeth, reasons for extraction, and subsequent prosthetic replacement. Materials and methods A prospective cohort study was conducted in 20 clinics within the Public Dental Service of Västra Götaland, Sweden. During an 8-week period, general dental practitioners consecutively registered reasons for tooth extraction. Patients’ pain levels were assessed. Pre-extraction radiographs were assessed for tooth status. Five-year follow-up data from electronic dental records were used to determine whether the extracted teeth had been prosthetically replaced and to classify the type of replacement. Descriptive and inferential statistics were used. Results A total of 133 patients (61 men and 72 women; mean age 54.0 years, SD = ± 15.8) underwent extractions. Endodontic pathology (36.8%) and fractures (24.8%) were the most common reasons. Sixty-one patients had previous endodontic treatment, and one-third of extracted teeth were root-filled. Thirty-five teeth were prosthetically replaced, most often with removable prostheses (45.7%). Conclusions Endodontically treated teeth, including those with initiated or completed root canal treatment, were markedly overrepresented among extractions, yet prosthetic replacement was infrequent. Younger patients less often opted for replacement, warranting further investigation of factors influencing replacement decisions.

Treatment of apical periodontitis in permanent teeth Introduction: The European Society of Endodontology (ESE) has updated it’s clinical guidelines for the diagnosis and management of apical periodontitis. These updates reflect advances made in clinical endodontics and in the methodology used for development of guidelines. The aim of this article is to present the new recommendations for the management of apical periodontitis, with the ultimate goal of reducing the risk of tooth loss. Materials and methods: The S3-level guidelines were developed through a comprehensive, systematic and evidence-based process involving experts and external stakeholders, and are based on 14 systematic reviews. Evidence- and expert-based recommendations were formulated through a structured consensus process. These guidelines include clinical recommendations focusing on instrumentation, irrigation, inter-appointment dressings, root filling materials and adjunctive therapies. Results: For restorable teeth, root canal treatment using aseptic technique and rubber dam isolation is recommended. Instrumentation should be performed with rotary NiTi file systems, and irrigation with sodium hypochlorite (NaOCl; 1–5.25 %) followed by EDTA (ethylenediaminetetraacetic acid) and a final rinse with NaOCl. The root canal system should then be sealed with gutta-percha in combination with one of the sealers using a technique of choice. Long-term follow-up is advised to ensure healing. A thorough history and case-specific assessment is essential prior to treatment planning. Conclusion: The S3-level guidelines in endodontics provide clear, evidence-based recommendations for dental practitioners, healthcare providers and stakeholders, supporting effective management of apical periodontitis and the long-term preservation of teeth. Keywords: apical periodontitis, practice guideline, root canal therapy, tooth survival

AIM:This prospective follow-up study aimed to assess patient satisfaction with root canal treatment (RCT) 7-9 years after initiation in a general dental practice setting. METHOD:A study population of 243 patients initiated RCT at 20 public dental clinics in the Västra Götaland Region, Sweden. One to 3 years later, 159 patients (67.4%) responded to an 8-item questionnaire assessing patient satisfaction with RCT and treatment results. The questionnaire was sent out again 7-9 years after treatment initiation. Descriptive and analytical statistics were used to compare respondents and non-respondents, tooth groups and comparison over time. RESULTS:A total of 156 patients (72.2%) responded to the 7-9 years' questionnaire; 82 women (52.6%) and 74 men (47.4%) with a mean age of 59.3 years (SD = ±15.3). Non-respondents were significantly younger (p < 0.001). The majority of RCTs were reported as completed with a root filling (n = 102, 65.4%), although significantly fewer molars were completed (n = 43, 56.6%; p < 0.001). Sixty-six patients (63.5%) reported no current pain, while most of those reporting pain described it as mild (n = 30, 90.9%). More than half of the root filled incisors were associated with current pain (n = 15, 57.7%; p < 0.009). A total of 111 patients (76.0%) recalled the procedure as painful. Chewing ability received the highest satisfaction rating (mean = 1.3). The majority of patients reported they would choose RCT again (n = 114, 77.0%). Among the 17 who answered 'No', 13 had undergone extraction, and 3 reported persistent pain following RCT. Over time, the number of extracted teeth increased (p < 0.001), while current pain intensity decreased and retrospective satisfaction with RCT improved (p < 0.001). CONCLUSIONS:Seven to nine years after the initiation of RCT in this general dental practice setting, patient satisfaction remains high despite one-third of treated teeth being reported as extracted. These findings highlight the importance of incorporating patient-reported outcomes in the evaluation of dental procedures, including endodontic treatments.

Objective: This study aimed to evaluate the impact of root canal treatment on Oral Health-Related Quality of Life (OHRQoL) in general dental practice and compare it with tooth extraction. Additionally, patient satisfaction following tooth-preserving treatment was assessed. Material and methods: In all, 65 patients were recruited from 6 general dental clinics in Västra Götaland over 8 weeks, with 37 starting root canal treatment and 28 having extractions. Questionnaires, including Oral Health Impact Profile-14 (OHIP-14) and 9 questions assessing patient satisfaction, were administered at treatment initiation, and at 1, 6, and 12 months. The responses from both modalities were analysed using descriptive and analytical statistical methods. Results: The response rate ranged from 73.8% to 92.3%. Regarding OHRQoL, differences between the groups were few compared to baseline. However, significant improvements were observed in the extraction group at the 6- and 12-month follow-ups, in the ‘total score’, and the dimensions ‘pain’, ‘discomfort’, and ‘handicap’. Patient satisfaction was generally high, with cost being the least satisfactory item. Pain intensity remained consistently low. Conclusions: In this prospective cohort study few differences were found between the two treatment modalities. However, significant improvements were observed in the extraction group in several dimensions. The patient satisfaction regarding root canal treatment was considered high.

IntroductionThe aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10 to 11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration, and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction.MethodsData were collected from the Swedish Social Insurance Agency’s register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10–11 years, and further interventions were recorded. Descriptive statistics and Chi-square tests were used for statistical analysis.ResultsIn 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < 0.001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10–11 years.ConclusionsThe frequency numbers of nonsurgical retreatment and root-end surgery were low, despite one in five root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.

Abstract Objectives To evaluate the cost‐effectiveness of root canal treatment (RCT) compared with a tooth extraction in a general dental practice setting, with reference to cost per quality‐adjusted life‐year (QALY) gained over 1 year. Material and Methods This is a prospective controlled cohort study based on patients either starting RCT or undergoing extraction at one of six Public Dental Service clinics in the county of Västra Götaland, Sweden. From a total of 65 patients, 2 comparable groups were formed: 37 started RCT and 28 underwent extraction. A societal perspective was used for the cost calculations. QALYs were estimated, based on the EQ‐5D‐5L given to the patients at their first treatment appointment and then after 1, 6, and 12 months. Results The total mean cost of RCT ($689.1) was higher than for extraction ($280.1). For those patients whose extracted tooth was replaced, the costs were even higher ($1245.5). There were no significant intergroup differences in QALYs, but a significant improvement in health state values in the tooth‐preserving group. Conclusions In the short term, extraction was cost‐effective compared with preserving a tooth with RCT. However, the potential need for future replacement of the extracted tooth, by an implant, fixed prosthesis, or removable partial dentures, may change the calculation in favor of RCT.

Hovedbudskap Tannleger bør ha bedre kommunikasjon med pasientene om behandlingsmål og prognose, og henvise til spesialist til riktig tid uten forsinkelser for å oppnå optimalt behandlingsresultat. Forskning må ikke bare konsentrere seg om tekniske innovasjoner som kan gi kortsiktige fordeler for produsenter, men i større grad fokusere på variabler som kan ha betydning for resultater i kliniske langtidsstudier. Vi trenger bedre kunnskap for å forstå tannsmertemekanismer, håndtering av smertefølelse, og kontrollere og fjerne infeksjon. Studenter med kompetanse og evner til å lære å gi endodontisk behandling av høy kvalitet må rekrutteres av utdanningsinstitusjoner. Dette er en økende utfordring i et konkurranseutsatt arbeidsmarked. Man kan forutse at kostnadene for tannbehandling, inkludert endodonti, vil vise økt tredjepartsbetaling fra offentlige eller private forsikringsordninger. Dette vil nokså sikkert innebære at kost/nytte-vurderinger må gjennomgås i større bredde enn i dag.

OBJECTIVES:To analyze the accumulated fees connected with root filling, permanent coronal restoration and follow-on treatment charged by Swedish dentists over a 10-11-year follow-up period. Furthermore, analyzing these fees with reference to the type of restoration, tooth group, and the root-filled teeth which survived compared to those requiring extraction.MATERIAL AND METHODS:In 2009, the data register of the Swedish Social Insurance Agency recorded a total of 215,611 teeth as root-filled. The accumulated fees for each tooth encompassed the following interventions: initial root filling, coronal restorations, and follow-up treatments during the designated period. The outcomes were analyzed using descriptive and analytic statistics, including t tests and one-way analysis of variance. The fees are presented in Euros (€1 = SEK 8.94).RESULTS:The total accumulated fees for root fillings amounted to 72 million Euros: the mean fee per root filled tooth was €333.6. The total mean fee over a 10-11-year period, comprising root canal treatment, coronal restorations, and any follow-up treatments, was €923.4. Root-filled teeth with indirect restorations presented a higher mean fee (€1 279.3) compared to those with direct restorations (€829.4) or those without specified restorations (€832.7; p < .001). Moreover, molars presented a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; p < .001). Lastly, the mean fee for extracted teeth was €1225.3, which was higher compared to those who survived the follow-up period (€848.0; p < .001).CONCLUSIONS:Fees charged by general dental practitioners for root-filled teeth accumulate over time, probably due to the need for further treatment of the tooth. The total mean fee was significantly higher for molars and root-filled teeth with indirect restorations. However, an analysis of the total costs would require prospective clinical cost-effectiveness studies.

Observational studies are non-interventional studies that establish the prevalence and incidence of conditions or diseases in populations or analyse the relationship between health status and other variables. They also facilitate the development of specific research questions for future randomized trials or to answer important scientific questions when trials are not possible to carry out. This article outlines the previously documented consensus-based approach by which the Preferred Reporting items for Observational studies in Endodontics (PROBE) 2023 guidelines were developed. A steering committee of nine members was formed, including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and adapting items from the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding several new items specifically for the specialty of Endodontics. The steering committee then established a PROBE Delphi Group (PDG) and a PROBE Online Meeting Group (POMG) to obtain expert input and feedback on the preliminary draft checklist. The PDG members participated in an online Delphi process to reach consensus on the clarity and suitability of the items present in the PROBE checklist. The POMG then held detailed discussions on the PROBE checklist generated through the online Delphi process. This online meeting was held via the Zoom platform on 7th October 2022. Following this meeting, the steering committee revised the PROBE checklist, which was piloted by several authors when preparing a manuscript describing an observational study for publication. The PROBE 2023 checklist consists of 11 sections and 58 items. Authors are now encouraged to adopt the PROBE 2023 guidelines, which will improve the overall reporting quality of observational studies in Endodontics. The PROBE 2023 checklist is freely available and can be downloaded from the PRIDE website (https://pride-endodonticguidelines.org/probe/).

Headlines Dental practitioners should have better communication with the patients about treatment goals and prognosis or refer to a specialist at the appropriate time without delays to achieve optimal treatment outcome. Research must not only concentrate on innovations which may interest stakeholders with short-term benefits but on randomized studies, to compare with existing materials, to prove their superiority in clinical outcomes. We need better knowledge to understand dental pain mechanisms, management of pain sensation, control and eradicate infection. Recruitment of students with outstanding performances by educational institutions in a competitive job market is a challenge that needs to be addressed. The cost of dental treatment, including endodontics, may call for increased third-party payment by government or private insurance schemes. By studying the cost-effectiveness of treatment, current systems may need to be reviewed.

Observational studies are non-interventional studies that establish the prevalence and incidence of conditions or diseases in populations or analyse the relationship between health status and other variables. They also facilitate the development of specific research questions for future randomized trials or to answer important scientific questions when trials are not possible to carry out. This article outlines the previously documented consensus-based approach by which the Preferred Reporting items for Observational studies in Endodontics (PROBE) 2023 guidelines were developed. A steering committee of nine members was formed, including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and adapting items from the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding several new items specifically for the specialty of Endodontics. The steering committee then established a PROBE Delphi Group (PDG) and a PROBE Online Meeting Group (POMG) to obtain expert input and feedback on the preliminary draft checklist. The PDG members participated in an online Delphi process to reach consensus on the clarity and suitability of the items present in the PROBE checklist. The POMG then held detailed discussions on the PROBE checklist generated through the online Delphi process. This online meeting was held via the Zoom platform on 7th October 2022. Following this meeting, the steering committee revised the PROBE checklist, which was piloted by several authors when preparing a manuscript describing an observational study for publication. The PROBE 2023 checklist consists of 11 sections and 58 items. Authors are now encouraged to adopt the PROBE 2023 guidelines, which will improve the overall reporting quality of observational studies in Endodontics. The PROBE 2023 checklist is freely available and can be downloaded from the PRIDE website ( https://pride-endodonticguidelines.org/probe/ ).

To document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start. The subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment-specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis. Complete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated ( n  = 113, 47.1%). Most cases were completed with a root filling ( n  = 169, 70.4%). The remainder were extracted ( n  = 32, 13.3%) or were still uncompleted ( n  = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT-related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period. Patient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases.

To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics. The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow-up questionnaire. Both descriptive and analytical statistics were used to compare respondents and nonrespondents and tooth groups. One hundred and fifty-nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for nonrespondents ( p  < .001). A completed root filling was registered for the majority of the teeth ( n  = 112, 70.9%), but significantly fewer molars had been completed ( n  = 46, 59.7%, p  = .02). Fifty per cent ( n  = 59) of the patients reported current pain, mostly mild in intensity ( n  = 45, 38.1%). One hundred and twenty-three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item ‘chewing ability’ (mean = 1.6, SD  = 1.9). The majority of patients ( n  = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present or had not experienced much discomfort during or after RCT. Forty-four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients’ responses was considered to be good. The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient-centred outcomes.

AIM To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics. METHOD The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT-completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow-up questionnaire. Both descriptive and analytical statistics were used to compare respondents and non-respondents and tooth groups. RESULTS One hundred and fifty-nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for non-respondents (P<0.001). A completed root filling was registered for the majority of the teeth (n = 112, 70.9%), but significantly fewer molars had been completed (n = 46, 59.7%, P = 0.02). Fifty percent (n = 59) of the patients reported current pain, mostly mild in intensity (n = 45, 38.1%). One hundred and twenty-three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item 'chewing ability' (mean = 1.6, SD = 1.9). The majority of patients (n = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present, or had not experienced much discomfort during or after RCT. Forty-four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients' responses was considered to be good. CONCLUSIONS The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient-centred outcomes.

Despite the marked overall improvement of oral health in Sweden, root canal treatment is still a common procedure in general dental practice. The reasons are unclear. Few studies of root canal treatment have been undertaken in general dental practice and there are no studies which monitor treatment from the initial appointment to completed root filling. There are moreover, few studies which take patients’ perspectives into account. The main objective of this thesis was to broaden overall understanding of factors which influence the outcomes of root canal treatment undertaken in general dental practice. The studies are based on three patient cohorts. In Study I (cohort 1) information was retrieved from the Swedish Social Insurance Agency’s data register, in order to estimate fees associated with root canal treatments. In 2009, root fillings were registered in approximately 250,000 teeth. The fees for all root fillings, including any further related treatment in the subsequent 5 to 6 years, were estimated to be approximately SEK 1,600 million (SEK 6,400/tooth). Studies II-IV (cohort 2) were based on a sample of 243 patients who started root canal treatment, during a recruitment period of 2 months, at 20 different public dental clinics in the Public Dental Service of the Region Västra Götaland. Study II revealed that most root canal treatments were initiated in symptomatic (65%), previously non-root filled teeth (93%). Almost half were molars (48%). In Study III, the status of these teeth, one year later, was registered from the patients’ dental records. In 70% of cases, the root filling had been completed. However, 13% of the teeth had been extracted and in 16% root canal treatment was not yet completed. The least favorable outcomes were for molar teeth: not only had more molars been extracted, but root canal treatment was as yet not completed in significantly more molars than in the other tooth groups. Study IV is based on a questionnaire 1-3 years after the start of treatment. Half the patients reported symptoms. Of the patients whose root filling had been completed, the majority (87%) responded that they did not regret their decision to choose root canal treatment. Study V (cohort 3) is based on 85 patients treated in 6 public dental clinics, who had either started root canal treatment or had a tooth extracted. The aim was to study quality of life and QALY weights (quality-adjusted life year). A questionnaire, comprising the instruments OHIP-14, EQ-5D-5L and questions about the root canal treatment, was issued at the initiation of treatment and again after one month. There was some improvement in the health-related quality of life of the patients who had started root canal treatment. Patient satisfaction was generally high. The results of these five studies confirm that root canal treatment was most often initiated because of toothache. In the 12 months since the initial appointment, the root filling had been completed in only 70% of cases. A large proportion of patients reported pain after 1 year. Although root canal treatment has a positive effect on quality of life, it is unclear whether it is cost-effective compared with the alternative (extraction), especially in molar teeth.

Introduction: The knowledge of patient-centered outcomes concerning the consequences of root canal treatment in daily life is limited. The treatment option is often tooth extraction with possible prosthetic replacement. This study aimed to achieve a greater understanding of the patient perspective by evaluating the effect of root canal treatment in terms of quality of life and quality-adjusted life year (QALY) weights in comparison with patients who underwent tooth extraction. Methods: Patients with either root canal treatment or extraction were recruited from 6 clinics in the general public dental service during a predetermined period of 8 weeks. Three different instruments were used: the Oral Health Impact Profile evaluating the oral health related quality of life (OHRQOL), the EQ-5D-5L evaluating health-related quality of life (HRQOL) and QALY weights, and a disease-specific questionnaire evaluating satisfaction regarding the root canal treatment. The evaluation was assessed at the initiation of treatment and after 1 month. Patient-based and tooth-specific characteristics were obtained from the dental records. Results: Eighty-five patients were included. The distribution between sexes was even, with 43 women and 42 men. The mean age was 51.1 years. Forty-eight patients (56.5%) had a tooth extraction, and 37 patients (43.5%) initiated root canal treatment. The response rate for the questionnaire at baseline was 95.3%, and at the 1-month follow-up, it was 74.1%. Two relevant and comparable groups were obtained after exclusion of the extracted third molars (n = 20), resulting in 65 patients for further analyses. At follow-up, the patients who initiated root canal treatment registered a significant improvement in perceived HRQOL according to the QALY weights (P = .02 and P < .01, respectively). Patients initiating root canal treatment reported generally high satisfaction. Conclusions: A cohort of patients either initiating root canal treatment or tooth extraction as a control group was established. Initiating root canal treatment had a positive impact on perceived HRQOL. The included patients in general dental practice registered overall high satisfaction regarding root canal treatment.

AIMTo study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden.METHODOLOGYDuring a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics.RESULTSThe material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%).CONCLUSIONSIn the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

Aim To investigate the fees charged by Swedish dentists for root fillings, coronal restorations and further dental interventions during a follow-up period of 5-6 years. Methodology A total of 248299 root fillings were linked with the tooth, the patient and the provider and entered into the Swedish Social Insurance Agency register in 2009. The data register also recorded the subsidy-based (scheduled) fee and the fee actually charged for the root fillings. Fees charged for direct or indirect coronal restorations and additional interventions during the follow-up period were also recorded. One-way anova and t-test were used for statistical analysis. Results The mean overall fee charged for a root filling was approximately 332 Euro and differed only marginally (13 Euro) from the scheduled fee. The total mean fee for preservation of a root filled tooth was 717 Euro, which included the root canal treatment, the coronal restoration and any additional interventions during the follow-up period. The fees for indirectly restored root filled teeth were significantly higher (1105 Euro) than for directly restored teeth (610 Euro), despite further additional treatment (P < 0.001). The mean fee for teeth which were subsequently extracted was higher (769 Euro) than for the retained teeth (711 Euro) (P < 0.001). Conclusions Fees charged by Swedish dentists for root canal treatment were in accordance with the scheduled fees. The overall mean fee was significantly higher for root filled teeth with indirect restorations than for teeth with direct coronal restorations. However, prospective clinical cost-effectiveness studies are needed to analyse the total costs.