Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
J Endod. 2010 Jun;36(6):957-73. doi: 10.1016/j.joen.2010.02.026.
Apical surgery has seen continuous development with regard to equipment and surgical technique. However, there is still a shortage of evidence-based information regarding healing determinants. The objective of this meta-analysis was to review clinical articles on apical surgery with root-end filling in order to assess potential prognostic factors.
An electronic search of PubMed and Cochrane databases was performed in 2008. Only studies with clearly defined healing criteria were included, and data for at least two categories per prognostic factor had to be reported. Prognostic factors were divided into patient-related, tooth-related, or treatment-related factors. The reported percentages of healed teeth ("the healed rate") were pooled per category. The statistical method of Mantel-Haenszel was applied to estimate the odds ratios and their 95% confidence intervals.
With regard to tooth-related factors, the following categories were significantly associated with higher healed rates: cases without preoperative pain or signs, cases with good density of root canal filling, and cases with absence or size < or = 5 mm of periapical lesion. With regard to treatment-related factors, cases treated with the use of an endoscope tended to have higher healed rates than cases without the use of an endoscope.
Although the clinician may be able to control treatment-related factors (by choosing a certain technique), patient- and tooth-related factors are usually beyond the surgeon's power. Nevertheless, patient- and tooth-related factors should be considered as important prognostic determinants when planning or weighing apical surgery against treatment alternatives.
随着设备和手术技术的不断发展，根尖手术也在不断发展。然而，关于愈合决定因素的循证信息仍然不足。本荟萃分析的目的是回顾根尖手术并用根管充填的临床文章，以评估潜在的预后因素。
2008 年在 PubMed 和 Cochrane 数据库中进行了电子检索。仅纳入有明确愈合标准的研究，每个预后因素必须至少报告两类数据。预后因素分为患者相关、牙齿相关或治疗相关因素。按类别汇总报告的愈合牙齿百分比（“愈合率”）。应用 Mantel-Haenszel 统计方法估计比值比及其 95%置信区间。
就牙齿相关因素而言，以下类别与更高的愈合率显著相关：术前无疼痛或体征的病例、根管充填密度良好的病例、无或根尖病变大小≤5mm的病例。就治疗相关因素而言，使用内窥镜治疗的病例比未使用内窥镜治疗的病例愈合率更高。
尽管临床医生可能能够控制治疗相关因素（通过选择某种技术），但患者和牙齿相关因素通常超出外科医生的能力范围。然而，在计划或权衡根尖手术与替代治疗时，应将患者和牙齿相关因素视为重要的预后决定因素。
