Department of Biomedical and Neuromotor Sciences (DIBINEM), School of Dentistry, Endodontic Clinical Section, Master in Clinical Endodontology, Alma Mater Studiorum University of Bologna, Via San Vitale 59, 40125, Bologna, Italy.
Endodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands.
Clin Oral Investig. 2018 Apr;22(3):1363-1373. doi: 10.1007/s00784-017-2229-5. Epub 2017 Oct 9.
The aim of the present retrospective cohort study was to assess the 5-year outcome and survival of secondary root canal treatments (2°RCT), exploring the influence of pre-, intra-, and post-operative variables.
One hundred thirty-two endodontically retreated teeth were radiographically and clinically re-examined after 5 years. 2°RCT had been performed during a Masters program following standardized protocols and filled with AH Plus/Thermafil (TF). Pre-, intra-, and post-operative data were collected. The 5-year outcome was blindly evaluated and categorized as healed/diseased on the basis of the periapical index. Bivariate analysis and chi-square test evaluated the association between outcome and 31 demographic/clinical parameters. Multilevel analysis was performed at both patient and tooth level. Statistical significance was calculated at 5% level.
At 5-year evaluation, survival rate was 80% with 7.5% lost for endodontic reasons. Eighty-three percent of the teeth were classified as healed. Multilevel analysis identified significant predictors of increased survival: female gender (p = 0.012), absence of a pre-operative metal post (p = 0.017), conservative apical preparation (diameter size < #35) (p = 0.039), teeth restored with a crown (p = 0.009), and final PAI (after 5 years) ≤ 2 (p = 0.001). Multilevel analysis identified as predictor healing: not being a smoker (p = 0.048) and conservative apical preparation < size #35 (p = 0.037).
Outcome of 2°RCT filled with Thermafil was successful at 5 years, showing a high rate of survived and healed teeth comparable to that reported previously for other obturation techniques.
Present findings confirm 2°RCT as a valid therapeutic option to retain natural teeth.
本回顾性队列研究旨在评估二次根管治疗（2°RCT）的 5 年疗效和存活率，并探讨术前、术中和术后变量的影响。
对 132 颗接受过根管再治疗的牙齿进行了 5 年的影像学和临床复查。2°RCT 是在硕士课程中按照标准化方案进行的，采用 AH Plus/Thermafil（TF）进行填充。收集了术前、术中和术后数据。5 年的疗效是盲法评估的，并根据根尖指数分为愈合/病变。采用二变量分析和卡方检验评估疗效与 31 项人口统计学/临床参数之间的关系。在患者和牙齿水平进行了多水平分析。统计显著性水平设为 5%。
在 5 年的评估中，存活率为 80%，因根管原因丧失的比例为 7.5%。83%的牙齿被归类为愈合。多水平分析确定了提高存活率的显著预测因素：女性（p=0.012）、术前无金属桩（p=0.017）、保守的根尖预备（直径<#35）（p=0.039）、用牙冠修复的牙齿（p=0.009）和最终 PAI（5 年后）≤2（p=0.001）。多水平分析确定了愈合的预测因素：不吸烟（p=0.048）和保守的根尖预备<#35 直径（p=0.037）。
Thermafil 填充的 2°RCT 在 5 年后的疗效是成功的，显示出较高的存活和愈合牙齿的比例，与先前报道的其他充填技术相当。
目前的研究结果证实了 2°RCT 是保留天然牙齿的一种有效治疗选择。
