Department of Restorative Dentistry and Endodontics, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
Department of Conservative Dentistry, King's College London Dental Institute, London, UK.
J Endod. 2017 Sep;43(9):1433-1437. doi: 10.1016/j.joen.2017.04.004. Epub 2017 Jul 8.
Treatment options for endodontic failure include nonsurgical or surgical endodontic retreatment, intentional replantation, and extraction with or without replacement of the tooth. The aim of the present study was to determine the impact of cone-beam computed tomographic (CBCT) imaging on clinical decision making among general dental practitioners and endodontists after failed root canal treatment. A second objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan.
Eight patients with endodontically treated teeth diagnosed as symptomatic apical periodontitis, acute apical abscess, or chronic apical abscess were selected. In the first session, the examiners were given the details of each case, including any relevant radiographs, and were asked to choose 1 of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 8 cases with the additional information from the CBCT data.
The examiners altered their treatment plan after viewing the CBCT scan in 49.8% of the cases. A significant difference in the treatment plan between the 2 imaging modalities was recorded for endodontists and general practitioners (P < .05). After CBCT evaluation, neither group altered their self-reported level of difficulty when choosing a treatment plan (P = .0524). The extraction option rose significantly to 20% after viewing the CBCT scan (P < .05).
CBCT imaging directly influences endodontic retreatment strategies among general dental practitioners and endodontists.
根管治疗失败的治疗选择包括非手术或手术根管再治疗、有意再植和拔牙，伴有或不伴有牙齿替换。本研究的目的是确定锥形束 CT（CBCT）成像对根管治疗失败后普通牙科医生和牙髓病医生临床决策的影响。第二个目的是评估在观看术前 CBCT 扫描前后，在做出治疗选择时自我报告的难度水平。
选择 8 名患有根管治疗后被诊断为症状性根尖周炎、急性根尖脓肿或慢性根尖脓肿的牙齿患者。在第一次就诊中，检查者获得了每个病例的详细信息，包括任何相关的射线照片，并被要求选择 1 种拟议的治疗方案，并评估做出决策的难度。一个月后，检查者用 CBCT 数据的额外信息随机回顾了相同的 8 个病例。
在查看 CBCT 扫描后，检查者改变了 49.8%病例的治疗计划。在 2 种成像方式之间，记录到牙髓病医生和普通医生的治疗计划存在显著差异（P<.05）。在 CBCT 评估后，两组在选择治疗计划时自我报告的难度水平都没有改变（P=0.0524）。在观看 CBCT 扫描后，拔牙选项显著增加到 20%（P<.05）。
CBCT 成像直接影响普通牙科医生和牙髓病医生的根管再治疗策略。
