Flake Natasha M, Gibbs Jennifer L, Diogenes Anibal, Hargreaves Kenneth M, Khan Asma A
Department of Endodontics, University of Washington School of Dentistry, Seattle, Washington.
Department of Endodontics, New York University College of Dentistry, New York, New York.
J Endod. 2014 Jan;40(1):46-50. doi: 10.1016/j.joen.2013.09.025. Epub 2013 Nov 14.
Outcome studies of endodontic treatment of necrotic immature permanent teeth rely on radiographic measures as surrogates of whether the treatment achieved regeneration/revascularization/revitalization. An increase in radiographic root length and/or width is thought to result in a better long-term prognosis for the tooth. In this study, a method to measure radiographic outcomes of endodontic therapies on immature teeth was developed and validated.
A standardized protocol was developed for measuring the entire area of the root of immature teeth. The radiographic root area (RRA) measurement accounts for the entire surface area of the root as observed on a periapical radiograph. Reviewers were given instructions on how to measure RRA, and they completed measurements on a set of standardized radiographs.
The intraclass correlation between the 4 reviewers was 0.9945, suggesting a high concordance among reviewers. There was no effect of the reviewer on the measured RRA values. High concordance was also observed when 1 rater repeated the measurements, with an intraclass correlation value of 0.9995. There was no significant difference in RRA values measured at the 2 sessions by the same rater. Furthermore, significant differences in RRA were detectable between clinical cases that showed obvious continued root development and cases that did not demonstrate discernible root development.
These results suggest that RRA is a valid measure to assess radiographic outcomes in endodontically treated immature teeth, and RRA should be useful in future clinical studies of regenerative endodontic outcomes.
对坏死未成熟恒牙进行根管治疗的疗效研究依赖于影像学测量，以此作为治疗是否实现再生/血管化/生机恢复的替代指标。影像学上牙根长度和/或宽度的增加被认为会使患牙获得更好的长期预后。在本研究中，开发并验证了一种测量未成熟牙根管治疗影像学疗效的方法。
制定了一项标准化方案，用于测量未成熟牙牙根的整个面积。影像学牙根面积（RRA）测量涵盖了根尖片上观察到的牙根整个表面积。向审阅者提供了测量RRA的指导说明，他们在一组标准化根尖片上完成了测量。
4位审阅者之间的组内相关系数为0.9945，表明审阅者之间具有高度一致性。审阅者对测量的RRA值没有影响。当1名评分者重复测量时，也观察到了高度一致性，组内相关系数值为0.9995。同一名评分者在两个时间段测量的RRA值没有显著差异。此外，在显示出明显牙根持续发育的临床病例和未显示出可辨别的牙根发育的病例之间，RRA存在显著差异。
这些结果表明，RRA是评估根管治疗未成熟牙影像学疗效的有效指标，RRA在未来再生性根管治疗疗效的临床研究中应会有用。
