Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
J Endod. 2010 Jan;36(1):28-35. doi: 10.1016/j.joen.2009.09.001.
The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate; therefore, current evidence is required to support the prognosis of this important procedure. The objectives of this study were (1) to assess the long-term outcome of apical surgery and (2) to identify significant outcome predictors in Phases 3-5 of the Toronto Study, pooled with the previously reported Phases 1 and 2.
The 4- to 10-year outcome of apical surgery was prospectively assessed by a blinded, independent, calibrated examiner and dichotomized as "healed" (periapical index score <or=2 or scar; no signs or symptoms) or "diseased." Teeth presenting without signs or symptoms were classified as "functional." Multivariate analysis was performed to investigate outcome predictors, pooling Phases 3-5 (n = 40) with Phases 1 and 2 (n = 94) for improved power.
Of 261 treated teeth in the pooled sample, 96 were lost to follow-up, and 31 were extracted. Of the remaining 134 teeth (85% recall, excluding 66 teeth that could not be recalled) examined for outcome, 99 teeth (74%) were healed, and 126 teeth (94%) were functional. Three significant (P < .05) outcome predictors were identified: age (odds ratio [OR], 2.5; confidence interval [CI], 1.01-6.00; healed: >45 years, 84%, <or=45 years, 68%), preoperative root-filling length (OR, 3.4; CI, 1.34-8.76; healed: inadequate, 84%; adequate, 68%), and size of the surgical crypt (OR, 1.9; CI, 1.19-3.16; healed: <or=10 mm, 80%; > 10 mm, 53%).
In this 4- to 10-year cohort study, the outcome was better in subjects >45 years old, teeth with inadequate root-filling length, and crypt size of <or=10 mm.
根尖手术治疗有治疗后根尖周炎的根管治疗后牙齿的长期疗效一直存在争议；因此，需要现有证据来支持该重要手术的预后。本研究的目的是：（1）评估根尖手术的长期疗效；（2）确定多伦多研究第 3-5 阶段的重要预后指标，并与之前报道的第 1 和 2 阶段进行合并。
由一名盲法、独立、经过校准的检查者前瞻性评估根尖手术后 4-10 年的疗效，并将其分为“愈合”（根尖指数评分<或=2 或瘢痕；无任何症状或体征）或“病变”。无任何症状或体征的牙齿被归类为“功能性”。采用多变量分析来研究预后指标，将第 3-5 阶段（n=40）与第 1 和 2 阶段（n=94）合并，以提高效力。
在合并样本的 261 颗治疗牙中，96 颗失访，31 颗牙被拔除。在对结果进行检查的其余 134 颗牙齿（85%的召回率，不包括 66 颗无法召回的牙齿）中，99 颗牙齿（74%）愈合，126 颗牙齿（94%）具有功能性。确定了三个有统计学意义的（P<.05）预后指标：年龄（比值比[OR]，2.5；置信区间[CI]，1.01-6.00；愈合：>45 岁，84%，<或=45 岁，68%）、术前根管充填长度（OR，3.4；CI，1.34-8.76；愈合：不充分，84%；充分，68%）和手术窝洞大小（OR，1.9；CI，1.19-3.16；愈合：<或=10mm，80%；>10mm，53%）。
在这项 4-10 年的队列研究中，年龄>45 岁、根管充填长度不足和窝洞大小<或=10mm的患者的疗效更好。
