Kielbassa Andrej M, Frank Wilhelm, Madaus Theresa
Centre for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Krems, Austria.
Centre for Preclinical Education, Deptartment of Biostatistics, University of Dental Medicine and Oral Health, Danube Private University (DPU), Krems, Austria.
PLoS One. 2017 May 2;12(5):e0176724. doi: 10.1371/journal.pone.0176724. eCollection 2017.
BACKGROUND/OBJECTIVE: Progress in endodontic techniques and methodological advances have altered root canal therapy over the last decades. These techniques and methods need periodical documentation. This observational study determined the current prevalence of endodontic treatments, and investigated the relationship of various factors with the periapical status in a Lower Austrian subpopulation.
One thousand orthopantomograms of first-time university adult patients radiographed at an outpatient clinic were evaluated. For each tooth, the presence of periradicular pathosis and/or endodontic treatment was recorded, as was the quality of (post-)endodontic treatment (homogeneity and length of root canal fillings; preparation failures; posts/screws; apicoectomies; coronal restorations). Two evaluators, blinded to each other, scored all teeth. In cases of disagreement, they joined for a consensus score.
In all, 22,586 teeth were counted. Of these, 2,907 teeth (12.9%) had periapical pathosis, while 2,504 teeth had undergone root canal treatment. Of the endodontically treated teeth, 52% showed no radiographic signs of apical periodontitis, while 44.9% had overt apical lesions, and 3,1% revealed widened periodontal ligament space. The majority of the root canal fillings was inhomogeneous (70.4%); 75.4% were rated too short, and 3.8% too long. The presence of apical pathosis was significantly correlated (odds ratio (OR) 2.556 [confidence interval (CI) 2.076-3.146]; P<0.0001) with poor root canal fillings (length and homogeneity). Posts or screws positively affected periapical status (OR 1.853 [CI 1.219-2.819]; P = 0.004), but endodontically treated posterior teeth were infrequently restored (posts, 7.5%; screws, 2.7%). Best results were found for teeth with both appropriate endodontic treatment and adequate coronal restoration.
A high prevalence of periradicular radiolucencies was observed with root canal filled teeth, along with high numbers of unmet treatment needs. Periapical health was associated with adequate root canal obturation and high-grade postendodontic restorations, and quality regarding these latter aspects is considered mandatory to promote periapical health.
背景/目的：在过去几十年中，牙髓治疗技术的进步和方法学的进展改变了根管治疗。这些技术和方法需要定期记录。本观察性研究确定了牙髓治疗的当前患病率，并调查了奥地利下奥地利州一个亚人群中各种因素与根尖周状况的关系。
对在门诊拍摄的1000例首次就诊的成年大学患者的口腔全景片进行评估。记录每颗牙齿根尖周病变和/或牙髓治疗的情况，以及（根管治疗后）牙髓治疗的质量（根管充填的均匀性和长度；预备失败；桩/螺钉；根尖切除术；冠修复）。两名评估人员相互不知情，对所有牙齿进行评分。如有分歧，则共同商定评分。
总共统计了22586颗牙齿。其中，2907颗牙齿（12.9%）有根尖周病变，2504颗牙齿接受了根管治疗。在接受根管治疗的牙齿中，52%没有根尖周炎的影像学表现，44.9%有明显的根尖病变，3.1%显示牙周膜间隙增宽。大多数根管充填不均匀（70.4%）；75.4%的根管充填长度被评为过短，3.8%过长。根尖病变的存在与根管充填不佳（长度和均匀性）显著相关（优势比（OR）2.556[置信区间（CI）2.076 - 3.146]；P<0.0001）。桩或螺钉对根尖周状况有积极影响（OR 1.853[CI 1.219 - 2.819]；P = 0.004），但根管治疗后的后牙很少进行修复（桩修复，7.5%；螺钉修复，2.7%）。根管治疗适当且冠修复充分的牙齿效果最佳。
根管充填的牙齿根尖周透射影患病率较高，未满足的治疗需求也较多。根尖周健康与充分的根管充填和高质量的根管治疗后修复相关，并且认为这些方面的质量对于促进根尖周健康是必不可少的。
