Pirani Chiara, Chersoni Stefano, Montebugnoli Lucio, Prati Carlo
Department of Biomedical and Neuromotor Sciences (DIBINEM), School of Dentistry, Endodontic Clinical Section, Alma Mater Studiorum, University of Bologna, Via San Vitale 59, 40125, Bologna, Italy,
Odontology. 2015 May;103(2):185-93. doi: 10.1007/s10266-014-0159-0. Epub 2014 Jun 8.
This study investigated the long-term clinical outcome of root canal treatment. 240 root-treated teeth (n = 61 patients) were initially classified on the basis of radiographic presence/absence of initial apical periodontitis (IAP) and clinical data. The final outcome measure was the periapical healing (healed/disease). The outcome at 6-9 months was correlated with the outcome at 10 years following treatment. Prognostic factors for the periapical healing were assessed. Extraction data were recorded. Univariate and multivariate logistic regression analysis was used to identify risk indicators for apical periodontitis (AP) development. Chi-square analysis was performed to evaluate a possible relationship between the 6-9 months outcome and the final outcome related to IAP. Mean observation time was 14 ± 3.7 years. Survival rate was 84.6% and healing rate was 79% (10-19 years). Predictors of outcome (p < .05) were considered statistically significant. Multivariate logistic regression analysis showed that initial pulpal and periapical status and the quality of root canal filling as assessed two-dimensionally were independent predictors of outcome. The 6-9 months evaluation appears to be an indicator for the final outcome of primary root canal treatment both in the presence and in the absence of IAP. An initial radiolucency associated with an unsatisfactory quality and extent of root canal filling significantly diminishes the possibility of achieving long-term radiographic success. For those with uncertain healing at 6-9 months (91%), clinicians should consider the high healing rate when estimating the prognosis and adjust the decision making accordingly.
本研究调查了根管治疗的长期临床疗效。240颗接受根管治疗的牙齿（n = 61例患者）最初根据影像学上是否存在初始根尖周炎（IAP）及临床数据进行分类。最终的疗效指标是根尖周愈合情况（愈合/病变）。将治疗后6 - 9个月的疗效与治疗后10年的疗效进行相关性分析。评估根尖周愈合的预后因素。记录拔牙数据。采用单因素和多因素逻辑回归分析来确定根尖周炎（AP）发生的风险指标。进行卡方分析以评估6 - 9个月疗效与与IAP相关的最终疗效之间可能存在的关系。平均观察时间为14±3.7年。生存率为84.6%，愈合率为79%（10 - 19年）。疗效预测因素（p < 0.05）被认为具有统计学意义。多因素逻辑回归分析表明，初始牙髓和根尖周状况以及二维评估的根管充填质量是疗效的独立预测因素。无论是否存在IAP，6 - 9个月的评估似乎都是原发性根管治疗最终疗效的一个指标。与根管充填质量和范围不满意相关的初始透射影会显著降低获得长期影像学成功的可能性。对于那些在6 - 9个月时愈合情况不确定的患者（91%），临床医生在评估预后时应考虑到较高的愈合率，并据此调整决策。
