Hommez G M G, Coppens C R M, De Moor R J G
Department of Operative Dentistry and Endodontology, Ghent University, Dental School, Ghent University Hospital, Belgium.
Int Endod J. 2002 Aug;35(8):680-9. doi: 10.1046/j.1365-2591.2002.00546.x.
To evaluate the impact of the quality of coronal restorations scored on a clinical and radiographic basis and the quality of root fillings on periapical health.
Periapical radiographs were taken of 745 root-filled teeth, randomly selected from patients attending the Ghent University Dental School. The teeth had not received restorative treatment in the previous year. The coronal status was scored both clinically according to modified Ryge's criteria, and radiographically by evaluating the presence of signs of marginal leakage or decay. The quality of the root filling was scored according to criteria of length and homogeneity and the periapical status was categorized on the basis of presence or absence of radiographic signs of apical periodontitis. The relationship between coronal status, quality of root filling and periapical health was determined. The data were analyzed using Chi2 test, Odds ratio, Spearman's r(S) and logistic regression.
Thirty-three percent of the teeth had apical periodontitis as diagnosed radiographically. Teeth with good and poor coronal restorations scored clinically had apical periodontitis in 31.1 and 36.8%, respectively; this difference was not statistically significant. The quality of the coronal restorations scored radiographically had a statistically significant influence on the periapical condition (P<0.001) with apical periodontitis in 23.8 and 49.1%, respectively, for acceptable and unacceptable restorations. Marginal decay did not influence the periapical status. Teeth restored without a base under the coronal filling had apical periodontitis in 41.3%, whereas teeth with a base had significantly less (P<0.005) apical periodontitis (25.9%). Composite-restored teeth exhibited apical periodontitis in 40.5% of cases whilst amalgam-restored teeth had apical periodontitis in 28.4% of cases; this difference was statistically significant (P<0.01). Root-canal posts had no influence on periapical health. The length and homogeneity of the root-canal fillings had a significant influence (P<0.01 and P<0.001, respectively) on the presence of apical periodontitis, as well as the quality of the coronal restoration scored radiographically (P<0.001).
The importance of a good coronal restoration, as well as of a good root filling should be emphasized as the technical quality of both influencing the periapical status.
评估基于临床和影像学评分的冠修复质量以及根管充填质量对根尖周健康的影响。
从根特大学牙科学院就诊患者中随机选取745颗已进行根管充填的牙齿，拍摄根尖片。这些牙齿在前一年未接受过修复治疗。根据改良的赖格标准对冠部状况进行临床评分，并通过评估边缘渗漏或龋坏迹象在影像学上进行评分。根据长度和均匀性标准对根管充填质量进行评分，根尖周状况根据根尖周炎的影像学迹象有无进行分类。确定冠部状况、根管充填质量与根尖周健康之间的关系。使用卡方检验、优势比、斯皮尔曼等级相关系数r(S)和逻辑回归分析数据。
影像学诊断显示33%的牙齿患有根尖周炎。临床评分冠修复良好和不良的牙齿，根尖周炎发生率分别为31.1%和36.8%；差异无统计学意义。影像学评分的冠修复质量对根尖周状况有统计学显著影响（P<0.001），可接受和不可接受的修复体根尖周炎发生率分别为23.8%和49.1%。边缘龋坏不影响根尖周状况。冠部充填物下无基底的修复牙齿根尖周炎发生率为41.3%，而有基底的牙齿根尖周炎发生率显著较低（P<0.005）（25.9%）。复合树脂修复的牙齿根尖周炎发生率为40.5%，而银汞合金修复的牙齿根尖周炎发生率为28.4%；差异有统计学意义（P<0.01）。根管桩对根尖周健康无影响。根管充填物的长度和均匀性对根尖周炎的发生有显著影响（分别为P<0.01和P<0.001），以及影像学评分的冠修复质量（P<0.001）。
应强调良好冠修复和良好根管充填的重要性，因为两者的技术质量均影响根尖周状况。
