Clarke P, Jones A D C, Jarad F, Albadri S
Restorative department, Liverpool University Dental Hospital, Pembroke Place, Liverpool, L3 5PS, UK.
Maxillofacial Unit, Alder Hey Children's Hospital, Liverpool, UK.
Eur Arch Paediatr Dent. 2015 Oct;16(5):409-15. doi: 10.1007/s40368-015-0185-9. Epub 2015 Apr 18.
The aim was to assess the technical quality of root canal treatment conducted in paediatric patients. No specific data is available assessing endodontic treatment quality in children. General adult populations report satisfactory technical quality between 12.8 and 55.7 %, with higher rates by endodontists (77.4-91.0 %).
Radiographs of 100 chronological cases, conducted by staff (categorised as; junior staff, middle grades or consultants) in a UK teaching hospital, were evaluated retrospectively. Technical outcomes were compared to the European Society of Endodontology quality guideline consensus. A satisfactory root filling was defined as having: root filling material <2 mm from the radiographical apex; no canal space seen beyond the end of the obturation and an obturation of homogeneous density with no voids. In addition where MTA was used a plug of ≥3 mm was required. Any variation was considered unsatisfactory treatment.
61 % [95 % CI 51-70 %] of cases were deemed satisfactory. Of the remaining obturations 20.5 % were short of the apex, 28.2 % had extruded material and 56.4 % contained voids. Patients with co-operation issues, particularly anxiety, had lower technical outcomes (p = 0.001) and the use of thermoplastic obturation greatly reduced the chance of void inclusion (p = 0.004; OR 0.20 [95 % CI 0.06-0.65]). Although 'staff grade' did not show a statistically significant difference, a trend between experience and quality was suspected.
Overall technical quality of treatment was comparable to the higher rates found in the general adult population. Additionally thermal obturation may be superior to cold lateral condensation in improving obturation quality, and anxiety negatively impacts on treatment provision.
本研究旨在评估儿科患者根管治疗的技术质量。目前尚无评估儿童牙髓治疗质量的具体数据。一般成年人群报告的技术质量满意度在12.8%至55.7%之间，牙髓病医生的满意度更高（77.4% - 91.0%）。
回顾性评估英国一家教学医院工作人员（分为初级工作人员、中级职称人员或顾问）进行的100例按时间顺序排列病例的X线片。将技术结果与欧洲牙髓病学会质量指南共识进行比较。满意的根管充填定义为：根管充填材料距影像学根尖<2 mm；充填物末端以外未见根管间隙；充填物密度均匀且无空隙。此外，若使用MTA，则需要≥3 mm的充填体。任何偏差均视为治疗不满意。
61% [95%置信区间51 - 70%]的病例被认为满意。在其余的充填病例中，20.5%充填物未达根尖，28.2%有充填材料挤出，56.4%有空隙。存在合作问题的患者，尤其是焦虑患者，技术结果较低（p = 0.001），热塑性充填大大降低了出现空隙的几率（p = 0.004；比值比0.20 [95%置信区间0.06 - 0.65]）。虽然“工作人员级别”未显示出统计学上的显著差异，但怀疑经验与质量之间存在趋势关系。
总体治疗技术质量与一般成年人群中较高的满意度相当。此外，热充填在改善充填质量方面可能优于冷侧方加压充填，且焦虑对治疗效果有负面影响。
