Maddalone M, Gagliani M, Citterio C L, Karanxha L, Pellegatta A, Del Fabbro M
Unit of Dentistry, Department of Translational Surgery and Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Chief Endodontics Unit, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy.
Int Endod J. 2018 Sep;51(9):969-974. doi: 10.1111/iej.12910. Epub 2018 Mar 26.
To evaluate retrospectively the prevalence of vertical root fractures (VRFs) in a cohort of patients during apical surgery and the factors possibly associated with VRF.
The sample consisted of 944 root filled teeth belonging to 768 patients (49.3% males and 50.7% females; mean age 43.5 ± 11.2 years, range 22-68 years), consecutively referred for endodontic surgery over a six-year period. All patients underwent a clinical assessment of their signs and symptoms. Periapical radiographs of teeth that were candidates for endodontic surgery were taken. Sixty-eight teeth with VRF were identified. Vertical root fractures were identified in pre-surgical screenings in 32 cases (47.1%), and these did not undergo surgery. Another 36 cases of VRF were noted during the intervention for root-end resection. The influence of posts, post type, tooth type, periodontal probing defects, spontaneous pain, sinus tract and follow-up duration was assessed using a logistic regression analysis.
Vertical root fractures occurred significantly more frequently (P < 0.001) when a post was present (61 VRF out of 377 teeth with post, prevalence 16.2%) than in teeth without a post (1.2%). Threaded posts and cast posts were significantly more involved in VRF than fibre, silica or carbide posts (P < 0.001). Most fractures (80.9%) occurred 1-5 years after root canal treatment. Sinus tracts, probing defects and spontaneous pain were significantly more associated with VRF cases than with nonfractured teeth.
In the present group of teeth, the major risk for VRF was represented by posts retained by actively engaging the canal via mechanical design (thread) or by frictional fit (cast).
回顾性评估根尖手术患者队列中垂直根折（VRF）的患病率以及可能与垂直根折相关的因素。
样本包括768例患者的944颗根管充填牙（男性占49.3%，女性占50.7%；平均年龄43.5±11.2岁，范围22 - 68岁），这些患者在六年期间连续接受牙髓手术治疗。所有患者均接受了症状和体征的临床评估。对拟进行牙髓手术的牙齿拍摄根尖X线片。共识别出68例垂直根折病例。在术前筛查中发现32例垂直根折（47.1%），这些病例未进行手术。在根尖切除术中又发现36例垂直根折病例。采用逻辑回归分析评估桩、桩的类型、牙齿类型、牙周探诊缺损、自发痛、窦道及随访时间的影响。
存在桩时垂直根折的发生率显著更高（P < 0.001）（377颗有桩牙齿中有61例垂直根折，患病率16.2%），而无桩牙齿中垂直根折的发生率为1.2%。螺纹桩和铸造桩导致垂直根折的情况显著多于纤维桩、二氧化硅桩或碳化物桩（P < 0.001）。大多数骨折（80.9%）发生在根管治疗后1 - 5年。窦道、探诊缺损和自发痛在垂直根折病例中比在未骨折牙齿中显著更常见。
在本研究的牙齿组中，垂直根折的主要风险因素是通过机械设计（螺纹）或摩擦配合（铸造）主动嵌入根管内的桩。
