Department of Endodontics, University of Iowa, Iowa City, Iowa.
Department of Preventive and Community Dentistry, University of Iowa, Iowa City, Iowa.
J Endod. 2018 Apr;44(4):543-548. doi: 10.1016/j.joen.2017.12.025. Epub 2018 Feb 21.
Long-term studies examining the treatment outcomes of "cracked teeth" that received orthograde root canal treatment in the United States do not exist. The purpose of the present study was to examine the distribution and 1-year treatment outcomes of cracked teeth receiving orthograde root canal treatment in 1 private endodontic practice over a 25-year period.
A total of 3038 cracked teeth were initially examined, and data from 2086 unique patients were analyzed. Pulpal and periapical diagnoses, year of treatment, tooth type, restorative material, and number of restored surfaces at the time of examination were recorded for all patients. Periodontal probing depths were also recorded. The patients' age and sex were added retrospectively for all patients whose data were available. Univariate frequency distributions for all collected variables were evaluated. Bivariate associations were analyzed between explanatory variables and the success of the root canal therapy.
Of the 2086 cracked teeth observed among unique patients, the most common were mandibular second molars (36%) followed by mandibular first molars (27%) and maxillary first molars (18%). Among the 363 teeth eligible for multivariable regression analysis, 296 (82%) were deemed successes after 1 year. There were no statistically significant differences in success based on pulpal diagnosis (irreversible pulpitis, 85%; necrosis, 80%; previously treated, 74%), patients' age, sex, year of treatment, tooth type, restorative material, or number of restored surfaces at the time of examination. The 3 factors most significant in bivariate analyses were pocket depth, distal marginal ridge crack, and periapical diagnosis, which were used to generate a prognostic index for success of orthograde root canal therapy in cracked teeth called the Iowa Staging Index.
The results of this study suggest that cracked teeth that received root canal treatment can have prognoses at higher success rates than previously reported. The Iowa Staging Index may prove to be useful in clinical treatment decision making.
在美国，目前尚无长期研究来观察接受顺向根管治疗的“牙隐裂”的治疗效果。本研究的目的是在 25 年期间，检查一家私人牙髓病诊所中接受顺向根管治疗的牙隐裂的分布和 1 年治疗效果。
最初检查了 3038 颗牙隐裂，对 2086 名患者的数据进行了分析。所有患者均记录牙髓和根尖周诊断、治疗年份、牙位、修复材料以及检查时的修复面数量。还记录了牙周探诊深度。对于所有数据可用的患者，均回顾性添加患者年龄和性别。评估了所有收集变量的单变量频率分布。分析了解释变量与根管治疗成功之间的双变量关联。
在 2086 名患者中，观察到的牙隐裂中最常见的是下颌第二磨牙（36%），其次是下颌第一磨牙（27%）和上颌第一磨牙（18%）。在 363 颗适合多变量回归分析的牙中，1 年后有 296 颗（82%）被认为是成功的。基于牙髓诊断（不可复性牙髓炎 85%；坏死 80%；已治疗 74%）、患者年龄、性别、治疗年份、牙位、修复材料或检查时的修复面数量，成功率无统计学差异。在双变量分析中最重要的 3 个因素是牙周袋深度、远中边缘嵴裂缝和根尖周诊断，这些因素用于生成称为爱荷华分期指数的顺向根管治疗牙隐裂成功率的预后指数。
本研究结果表明，接受根管治疗的牙隐裂的预后成功率可能高于先前报道。爱荷华分期指数可能在临床治疗决策中证明有用。
