Farzaneh Mahsa, Abitbol Sarah, Friedman Shimon
Discipline of Endodtics, Faculty of Dentistry, University of Toronto, Toronto, Ontario M5G 1G6, Canada.
J Endod. 2004 Sep;30(9):627-33. doi: 10.1097/01.don.0000129958.12388.82.
The 4- to 6-year outcome of orthograde retreatment was assessed for Phases I and II of the Toronto Study. In total, 523 teeth in 444 patients were retreated. With 395 teeth lost to follow-up and 25 extracted, 103 teeth (34% recall) were examined by two independent, blinded, calibrated examiners for outcome: "healed" (absence of apical periodontitis, signs, or symptoms) or "diseased" (presence of apical periodontitis, signs, or symptoms). The "healed" rate (81%) differed significantly for preoperative apical periodontitis (absent, 97%; present, 78%) and perforation (absent, 89%; present, 42%). Logistic regression revealed an increased risk of disease for preoperative perforation and adequate root filling quality, and postoperative lack of definitive restoration (odds ratios = 26.5, 6.6, and 14.0, respectively). Without perforation, inadequate intraoperative root filling length was also identified (odds ratio = 6.8). This study suggested that apical periodontitis, although a strong predictor, was secondary to preoperative perforation and root filling quality, and to postoperative restoration, in predicting the outcome of retreatment.
对多伦多研究的第一阶段和第二阶段进行了正行再治疗4至6年的疗效评估。共有444例患者的523颗牙齿接受了再治疗。由于395颗牙齿失访，25颗牙齿被拔除，103颗牙齿（召回率34%）由两名独立、不知情、经过校准的检查者检查疗效：“愈合”（无根尖周炎、体征或症状）或“患病”（有根尖周炎、体征或症状）。术前根尖周炎（无，97%；有，78%）和穿孔（无，89%；有，42%）的“愈合”率（81%）差异显著。逻辑回归显示，术前穿孔、根管充填质量合格以及术后缺乏确定性修复会增加患病风险（比值比分别为26.5、6.6和14.0）。在无穿孔的情况下，术中根管充填长度不足也被确定（比值比=6.8）。这项研究表明，根尖周炎虽然是一个强有力的预测指标，但在预测再治疗结果时，它次于术前穿孔、根管充填质量以及术后修复。
