Wesson C M, Gale T M
Queen Elizabeth II Hospital, Welwyn Garden City.
Br Dent J. 2003 Dec 20;195(12):707-14; discussion 698. doi: 10.1038/sj.bdj.4810834.
To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling.
Multicentre, prospective study.
The departments of oral and maxillo-facial surgery in two district general hospitals.
One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000.
Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy.
Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.
确定使用汞合金根尖倒充填术进行磨牙根尖切除术的五年成功率、失败部位、预后指标以及下唇发病率。
多中心前瞻性研究。
两家地区综合医院的口腔颌面外科。
1974年至1995年期间共进行了1007例磨牙根尖切除术，并联合汞合金根尖倒充填术。在一九七九年至二零零零年期间，对每颗手术牙进行了或尝试进行了为期五年的复查。
在790颗（78%）术后五年或更晚成功复查的磨牙中，451颗（57%）显示“完全愈合”，39颗（5%）“愈合情况不确定”。300颗（38%）被归类为“愈合不满意”（失败），其中包括12颗被认为是牙周源性的牙齿。虽然纵向根折、穿孔和/或根分叉处感染、牙周疾病或无法修复的牙冠导致了治疗失败，且常常需要随后拔除牙齿，但该研究可能指出，根的根尖端而非根分叉是发生“愈合不满意”的主要部位。下颌第一磨牙的“完全愈合”率最高（60%），下颌第二磨牙最低（46%）。一开始进行“良好”的根管治疗（RCT）可改善根尖倒充填术（REF）的预后，而未进行RCT则会损害预后。囊性变比根尖肉芽肿性变的预后更好，深的“骨袖口”比浅的预后更好。根分叉处的病变提示预后较差。术后1年显示“完全愈合”的牙齿在5年时保持这一结果的概率为75%。20% - 21%的下颌磨牙手术后下唇出现了不同持续时间的感觉障碍。在大多数病例（79% - 80%）中，这种情况在3个月内缓解。8例患者（1%）出现永久性缺损，其中根尖切除术肯定可被认定为病因。4例与第一磨牙根尖切除术有关，4例与第二磨牙根尖切除术有关。
使用汞合金根尖倒充填术进行磨牙根尖切除术，五年时的总体“完全愈合”率为57%，下颌第一磨牙的结果最佳，下颌第二磨牙最差。如果一开始进行“良好”的正向根管充填、伴有根周囊肿而非肉芽肿性病变以及颊侧龈沟较深而非较浅，则预后也较好。如果没有正向根管充填且根分叉处有病变，则预后较差。术后1年“完全愈合”的病例中，75%可预期在5年时保持这一状态。随后根尖周骨质稀疏最常见的部位似乎是“根尖”，而根分叉处的失败可能相对少见。与第一磨牙手术相比，第二磨牙手术后永久性下唇感觉障碍的发生率增加了两倍，总体发生率为1%。
