Madarati Ahmad A
Restorative Dental Sciences Department, College of Dentistry, Taibah University, P.O Box 2898, Madina, 43353, Saudi Arabia.
Faculty of Dentistry, Aleppo University, Aleppo, Syria.
BMC Oral Health. 2018 Jun 19;18(1):110. doi: 10.1186/s12903-018-0574-7.
This study aimed at investigating dental clinicians' preferences on management of necrotic pulp with acute apical abscess (NPAAA) cases.
Following an ethical approval and two pilot studies, an electronic survey was emailed to 400 general dental practitioners (GDPs) and 56 endodontists. The email explained the study's methods and assured that participants' identities and information given would remain anonymous and confidential. A reminder email was sent after eight weeks. Responses were collected and data were analyzed using the Chi-square test at p = 0.05.
The majority of respondents (86.3%) would deal with NPAAA cases "differently" from vital-pulp ones (p < 0.001). More endodontists (40%) used two or three irrgants than GDPs (29.5%). Whilst the highest proportion of endodontists (29.7%) rarely prescribed antibiotics, the highest proportion of GDPs (26%) generally did so (p < 0.001). Whilst the highest proportion of GDPs (26.9%) over-instrumented the largest canal in the first visit, most endodontists (56.8%) performed complete cleaning & shaping (C&S) (p < 0.001). In cases of non-stopped exudates, whilst the highest proportions of endodontists would either let the patient wait till the exudates significantly reduce then continue their intended approach (40.5%) or insert ICMs and temporize the tooth (40.5%), the highest proportion of GDPs (30.8%) would insert only dry cotton pellet without temporizing the tooth (p = 0.002). Of those who would leave the tooth open if non-stopped exudates presents in the first visit, the majority (81.9%) would temporize the tooth if little exudates present after C&S (p < 0.001).
Clinicians, especially GDPs, opted to treat teeth involved in NPAAA differently from those with vital-pulp, such as: were using different ICMs and irrigants, C&S to different apical size preparation. GDPs should improve their practice by implementing multi-irrigants protocol while C&S, limit prescribing antibiotics, perform complete debridement of the root canal system and not to leave the tooth open between visits. Clinicians, especially GDPs, relied on their own experiences in managing NPAA cases which necessitates scientific-based guidelines.
本研究旨在调查牙科临床医生对坏死牙髓伴急性根尖脓肿（NPAAA）病例治疗方法的偏好。
在获得伦理批准并进行两项预试验后，通过电子邮件向400名普通牙科医生（GDPs）和56名牙髓病医生发送了电子调查问卷。邮件解释了研究方法，并保证参与者的身份和所提供的信息将保持匿名和保密。八周后发送了提醒邮件。收集回复并使用卡方检验（p = 0.05）分析数据。
大多数受访者（86.3%）表示处理NPAAA病例的方式与处理活髓病例“不同”（p < 0.001）。使用两种或三种冲洗液的牙髓病医生比例（40%）高于普通牙科医生（29.5%）。虽然牙髓病医生中很少开抗生素的比例最高（29.7%），但普通牙科医生中普遍开抗生素的比例最高（26%）（p < 0.001）。虽然普通牙科医生中在首次就诊时对最大根管过度预备的比例最高（26.9%），但大多数牙髓病医生（56.8%）进行了彻底的清理和成形（C&S）（p < 0.001）。在有持续渗出液的情况下，虽然牙髓病医生中比例最高的做法是要么让患者等待直到渗出液明显减少后再继续其预定方法（40.5%），要么插入碘仿糊剂并暂时封闭患牙（40.5%），但普通牙科医生中比例最高的做法（30.8%）是只插入干棉球而不暂时封闭患牙（p = 0.002）。在首次就诊时有持续渗出液时会开放患牙的人中，如果在C&S后渗出液很少，大多数人（81.9%）会暂时封闭患牙（p < 0.001）。
临床医生，尤其是普通牙科医生，选择以与活髓患牙不同的方式治疗NPAAA患牙，例如：使用不同的碘仿糊剂和冲洗液，根据不同的根尖大小进行C&S预备。普通牙科医生应通过在C&S时实施多冲洗液方案、限制抗生素处方、对根管系统进行彻底清创以及在就诊期间不开放患牙来改进其治疗方法。临床医生，尤其是普通牙科医生，在管理NPAA病例时依赖自身经验，这需要基于科学的指南。
