Kruse Casper, Spin-Neto Rubens, Reibel Jesper, Wenzel Ann, Kirkevang Lise-Lotte
1 Department of Dentistry and Oral Health, Section of Oral Radiology, Health, Aarhus University, Aarhus, Denmark.
2 Department of Odontology, Faculty of Health and Medical Sciences, Oral Pathology and Medicine, University of Copenhagen, Copenhagen, Denmark.
Dentomaxillofac Radiol. 2017 Oct;46(7):20170210. doi: 10.1259/dmfr.20170210. Epub 2017 Jul 14.
Traditionally, healing after surgical endodontic retreatment (SER); i.e. apicectomy with or without a retrograde filling, is assessed in periapical radiographs (PR). Recently, the use of cone beam CT (CBCT) has increased within endodontics. Generally, CBCT detects more periapical lesions than PR, but basic research on the true nature of these lesions is missing. The objective was to assess the diagnostic validity of PR and CBCT for determining inflammation in SER cases that were re-operated (SER-R) due to unsuccessful healing, using histology of the periapical lesion as reference for inflammation.
Records from 149 patients, receiving SER 2004-10, were screened. In total 108 patients (119 teeth) were recalled for clinical follow-up examination, PR and CBCT, of which 74 patients (83 teeth) participated. Three observers assessed PR and CBCT as "successful healing" or "unsuccessful healing" using Rud and Molven's criteria. SER-R was offered to all non-healed teeth with expected favourable prognosis for subsequent functional retention. During SER-R, biopsy was performed and histopathology verified whether or not inflammation was present.
All re-operated cases were assessed non-healed in CBCT while 11 of these were assessed successfully healed in PR. Nineteen biopsies were examined. Histopathologic diagnosis revealed 42% (teeth = 8) without periapical inflammation, 16% (teeth = 3) with mild inflammation and 42% (teeth = 8) with moderate to intense inflammation. A correct diagnosis was obtained in 58% with CBCT (true positives) and 63% with PR (true positives+true negatives).
Of the re-operated teeth, 42% had no periapical inflammatory lesion, and hence no benefit from SER-R. Not all lesions observed in CBCT represented periapical inflammatory lesions.
传统上，外科根管再治疗（SER）后的愈合情况，即伴有或不伴有倒充填的根尖切除术，是通过根尖片（PR）进行评估的。近年来，锥形束CT（CBCT）在牙髓病学中的应用有所增加。一般来说，CBCT比PR能检测出更多的根尖周病变，但关于这些病变真实性质的基础研究尚缺。本研究的目的是，以根尖周病变的组织学检查结果作为炎症的参考标准，评估PR和CBCT在诊断因愈合失败而再次手术的根管再治疗病例（SER-R）中炎症的诊断有效性。
筛选2004年至2010年接受SER治疗的149例患者的记录。共有108例患者（119颗牙）被召回进行临床随访检查、PR和CBCT检查，其中74例患者（83颗牙）参与。三名观察者根据Rud和Molven的标准，将PR和CBCT评估为“愈合成功”或“愈合失败”。对于所有预计后续功能保留预后良好的未愈合牙齿，均提供SER-R治疗。在SER-R治疗期间，进行活检，组织病理学检查以证实是否存在炎症。
所有再次手术的病例在CBCT上均被评估为未愈合，而其中11例在PR上被评估为愈合成功。共检查了19份活检标本。组织病理学诊断显示，42%（牙齿数=8）无根尖周炎症，16%（牙齿数=3）有轻度炎症，42%（牙齿数=8）有中度至重度炎症。CBCT的正确诊断率为58%（真阳性），PR的正确诊断率为63%（真阳性+真阴性）。
在再次手术的牙齿中，42%没有根尖周炎性病变，因此SER-R治疗并无益处。并非CBCT上观察到的所有病变均代表根尖周炎性病变。
