Zhang M M, Zheng Y D, Liang Y H
Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Feb 18;50(1):123-130.
To present a prognostic model for evaluating the outcome of root canal treatment in teeth with pulpitis or apical periodontitis 2 years after treatment.
The implementation of this study was based on a retrospective study on the 2-year outcome of root canal treatment. A cohort of 360 teeth, which received treatment and review, were chosen to build up the total sample size. In the study, 143 teeth with vital pulp and 217 teeth with apical periodontitis were included. About 67% of the samples were selected randomly to derive a training date set for modeling, and the others were used as validating date set for testing. Logistic regression models were used to produce the prognostic models. The dependent variable was defined as absence of periapical lesion or reduction of periapical lesion. The predictability of the models was evaluated by the area under the receiver-operating characteristic (ROC) curve (AUC).
Four predictors were included in model one (absence of apical lesion): pre-operative periapical radiolucency, canal curvature, density and apical extent of root fillings. The AUC was 0.802 (95%CI: 0.744-0.859). And the AUC of the testing date was 0.688. Only the density and apical extent of root fillings were included to present model two (reduction of apical lesion). The AUC of training dates and testing dates were 0.734 (95%CI: 0.612-0.856) and 0.681, respectively. As predicted by model one, the probability of absence of periapical lesion 2 years after endodontic treatment was 90% in pulpitis teeth with sever root-canal curvature and adequate root canal fillings, but 51% in teeth with apical periodontitis. When using prognostic model two for prediction, in teeth with apical periodontitis, the probability of detecting lesion reduction with adequate or inadequate root fillings was 95% and 39% 2 years after treatment.
The pre-operative periapical status, canal curvature and quality of root canal treatment could be used to predict the 2-year outcome of root canal treatment.
建立一种预后模型，用于评估牙髓炎或根尖周炎患牙根管治疗2年后的治疗效果。
本研究基于对根管治疗2年治疗效果的回顾性研究实施。选取360颗接受治疗及复查的牙齿组成总样本量。研究纳入143颗牙髓活力正常的牙齿和217颗根尖周炎患牙。约67%的样本被随机选取以构建用于建模的训练数据集，其余样本用作测试的验证数据集。采用逻辑回归模型构建预后模型。因变量定义为根尖周病变消失或根尖周病变减轻。通过受试者操作特征（ROC）曲线下面积（AUC）评估模型的预测能力。
模型一（根尖周病变消失）纳入四个预测因素：术前根尖周透射影、根管弯曲度、根充物密度及根尖充填范围。AUC为0.802（95%CI：0.744 - 0.859）。测试数据集的AUC为0.688。模型二（根尖病变减轻）仅纳入根充物密度及根尖充填范围。训练数据集和测试数据集的AUC分别为0.734（95%CI：0.612 - 0.856）和0.681。如模型一预测，根管弯曲严重且根管充填良好的牙髓炎患牙根管治疗2年后根尖周病变消失的概率为90%，而根尖周炎患牙为51%。使用预后模型二进行预测时，根尖周炎患牙根管充填良好或不良时，治疗2年后病变减轻的概率分别为95%和39%。
术前根尖周状况、根管弯曲度及根管治疗质量可用于预测根管治疗2年的效果。
