Chen Shih-Chung, Chueh Ling-Huey, Wu Hsin-Ping, Hsiao Chuhsing Kate
Department of Health, The Executive Yuan, Elite Dental Clinic, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2008 Sep;107(9):686-92. doi: 10.1016/S0929-6646(08)60113-8.
BACKGROUND/PURPOSE: Nonsurgical retreatment, apical surgery and tooth extraction are three major untoward events following nonsurgical root canal treatment (NSRCT). The purpose of this study was to assess untoward events and total tooth extraction after NSRCT in a large population of dental patients in Taiwan.
A total of 1,588,217 teeth treated with NSRCT in Taiwan in 2000 were analyzed for the first untoward event and total tooth extraction over a 5-year follow-up period.
The first untoward event occurred in 192,488 (12.1%) teeth within the first 5 years posttreatment. Nonsurgical retreatment was performed on 69,273 (36.0%) of these teeth, 4741 (2.5%) received apical surgery, and 118,474 (61.5%) were extracted. In addition, 1,463,312 (92.1%) teeth treated with NSRCT were retained in the oral cavity, and 124,905 (7.9%), including 24,499 (19.6%) anterior teeth, 33,356 (26.7%) premolars, and 67,050 (53.7%) molars were extracted within the 5 years of follow-up. Of these 124,905 teeth, 5869 (4.7%) were extracted after nonsurgical retreatment, 562 (0.4%) after apical surgery, and 118,474 (94.9%) after the first untoward events. There were significantly more molars (54.5% vs. 43.3%) and significantly fewer anterior teeth (19.0% vs. 27.5%) extracted in private clinics than in hospitals (p<0.001). The overall tooth extraction rate was significantly greater in hospitals (10.0%) than in private clinics (7.7%, p<0.001). However, tooth extraction procedures were almost evenly distributed over the 5-year follow-up period, with the annual incidence being close to 20%. The overall mean tooth extraction time was significantly greater in private clinics (2.52+/-1.43 years) than in hospitals (2.29+/-1.50 years, p<0.001).
We conclude that tooth extraction (61.5%) is the most common of the three untoward events, and approximately 95% of tooth extractions are performed at the time of the first untoward event. NSRCT is still a valuable dental procedure in Taiwan because of the high rate (92.1%) of tooth retention after 5 years of follow-up.
背景/目的：非手术再治疗、根尖手术和拔牙是根管治疗（NSRCT）后的三种主要不良事件。本研究旨在评估台湾大量牙科患者在接受NSRCT后的不良事件和拔牙情况。
对2000年在台湾接受NSRCT治疗的1,588,217颗牙齿进行分析，观察其在5年随访期内的首次不良事件和拔牙情况。
192,488颗（12.1%）牙齿在治疗后的前5年内发生了首次不良事件。其中69,273颗（36.0%）牙齿接受了非手术再治疗，4741颗（2.5%）接受了根尖手术，118,474颗（61.5%）被拔除。此外，1,463,312颗（92.1%）接受NSRCT治疗的牙齿保留在口腔中，124,905颗（7.9%）在随访的5年内被拔除，其中包括24,499颗（19.6%）前牙、33,356颗（26.7%）前磨牙和67,050颗（53.7%）磨牙。在这124,905颗牙齿中，5869颗（4.7%）在非手术再治疗后被拔除，562颗（0.4%）在根尖手术后被拔除，118,47（94.9%）在首次不良事件后被拔除。与医院相比，私人诊所拔除的磨牙明显更多（54.5%对43.3%），前牙明显更少（19.0%对27.5%）（p<0.001）。医院的总体拔牙率（10.0%）明显高于私人诊所（7.7%，p<0.00）。然而，拔牙程序在5年随访期内分布几乎均匀，年发病率接近20%。私人诊所的总体平均拔牙时间（2.52±1.43年）明显长于医院（2.29±1.50年，p<0.001）。
我们得出结论，拔牙（61.5%）是三种不良事件中最常见的，约95%的拔牙是在首次不良事件发生时进行的。由于5年随访后的牙齿保留率较高（92.1%），NSRCT在台湾仍然是一种有价值的牙科治疗方法。
