Developing a consensus‐based glossary of controversial terms in Endodontology

Scientific terminology is an essential tool of communication as it plays a critical role in the understanding of scientific and technical terms and their associated definitions (Sageder, 2010). With the ever-increasing body of knowledge and continuous advances in technology within the healthcare sector, the use of universally agreed, standardized and consistent terminology is essential for all stakeholders to develop a shared understanding, allow effective communication and avoid confusion as well as any misconceptions (Cabré, 1999; Slisko & Dykstra, 1997). Terminology can be a separate and distinct scientific discipline with its own theory and a focus on developing a theoretical framework or it can involve a more practical approach of compiling, describing, processing and presenting the terms of special subject fields with the aim of optimizing communication amongst the stakeholders concerned with the standardization of given terms (Sageder, 2010; Figure 1). The output of the latter approach culminates in the issuing of standardized dictionaries for specialized fields (Sageder, 2010). Developing a consensus-based glossary of terms and their definitions is a valid approach for establishing a universally agreed terminology. Indeed, it is acknowledged that searching, extracting and analysing relevant terminology are essential steps when proposing terms and definitions developed on the basis of a formal consensus by international standard bodies (Kockaert & Steurs, 2015). Terminology in medicine has been standardized through a consensus-based approach in a variety of fields, such as palliative care (Xiao et al., 2021), infertility and fertility care (Zegers-Hochschild et al., 2017), running-related injury (Yamato et al., 2015), sonography for trauma in children and veterinary-specific definitions for quality-care terms (Rooke et al., 2022). In dentistry, the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR) have published consensus-based terminologies for tooth wear (Schlueter et al., 2020) and dental caries management (Machiulskiene et al., 2020). A European glossary of terms used in oral health professional education has recently been published (Davies et al., 2022). In endodontology, a number of controversial terms and definitions exist. These may be related to a ‘structure’ (such as anatomy), a ‘disease’ (such as pulp and periapical diseases), a ‘material’ (such as bioceramic materials) or a ‘procedure’ (such as diagnostic and root canal treatment procedures). As examples, controversies exist for the definition of pulp chamber outline in single and multi-rooted teeth (Ahmed et al., 2021; Nanci, 2013; Nelson & Ash, 2010; Nusstein, 2012; Scheid & Weiss, 2012; The American Association of Endodontists (AAE), 2020), accessory canals (Ahmed et al., 2018; Barbosa et al., 2009; De-Deus, 1975; Paras et al., 1993; Rubach & Mitchell, 1965), root fusions (Ahmed et al., 2021; Hou & Tsai, 1994; Ross & Evanchik, 1981; Zhang et al., 2014), apical bifurcations of roots and canals (Ahmed, 2022; Ahmed et al., 2017, 2021; Turner, 1981) and canal isthmuses (Ahmed et al., 2021; Hsu & Kim, 1997; AAE, 2020; von Arx, 2005). Another example of inconsistency exists in classifications used for pulp and periapical diseases (Abbott & Yu, 2007; Azim et al., 2022; Glickman, 2009; Gutmann et al., 2009). A recent survey to determine the level of agreement among endodontic specialists in North America and practitioners around the world in diagnosing pulpal and periapical conditions using the AAE pulpal and periapical diagnostic terms concluded that there was a lack of agreement amongst clinicians regarding the diagnostic terminology (Azim et al., 2022). Furthermore, conflicting terms such as ‘hydraulic’, ‘hygroscopic’ dental cements, ‘bioceramic’, ‘mineral trioxide aggregate’ have been highlighted in several reports (Camilleri, 2020, 2022; Darvell 2021; Ha et al., 2017; Zhekov & Stefanova, 2021). The literature includes an array of controversial terms related to diagnostic procedures of the pulp such as sensibility, sensitivity and vitality (Jafarzadeh & Abbott, 2010; Shah & Chong, 2022). Unfortunately, such terms have been used interchangeably to define the status of the pulp. Similar concerns exist for terms such as ‘revitalization’ (European Society of Endodontology (ESE), 2016), ‘revascularization’ (Huang & Lin, 2008; Iwaya et al., 2001), ‘regenerative endodontic procedures’ (AAE, 2020; Garcia-Godoy & Murray, 2012) and ‘guided endodontic repair’ (Diogenes et al., 2016). Researchers, academics, and clinicians are faced with controversy and uncertainty surrounding a number of terms used in endodontology that often have several definitions or whose definitions are incorrect. Clarifying controversial terms used in endodontology is essential for the development of new research, effectively disseminating research findings as well as for enabling effective and collaborative clinical practice within the wider healthcare system. As a result, the current project was initiated in order to identify and define a range of controversial terminology used in endodontology. To develop a ‘Glossary’ of controversial terminology in endodontology using a multistage, international collaborative and consensus-based approach in order to create an accurate and universally acceptable list of terms and definitions. To create a universally accepted standard ‘Glossary’ of controversial terminology in the specialty of endodontology to provide clarity in education, research and clinical practice and allow more effective communication between dentists and relevant stakeholders such as patients and government agencies. All the authors made substantial contributions to the manuscript. All the authors have read and approved the final version of the manuscript. The authors have stated explicitly that there are no conflicts of interest in connection with this article.