Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China.
Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China; Department of Stomatology, Peking University International Hospital, Beijing, China.
J Endod. 2021 Mar;47(3):382-390. doi: 10.1016/j.joen.2020.10.020. Epub 2020 Oct 29.
The purpose of this prospective study was to investigate the 4-year outcome and prognostic factors of nonsurgical root canal retreatment determined by measuring the volumetric change of periapical radiolucencies on cone-beam computed tomographic (CBCT) scans.
Ninety-seven endodontically treated teeth from 80 patients diagnosed as apical periodontitis and indicated for root canal retreatment were included. Retreatment was performed by 7 endodontic specialists using a standardized treatment protocol. The teeth were reexamined clinically and radiographically 48-67 months after retreatment. The volume of preoperative and postoperative periapical radiolucencies on CBCT images was independently measured by 2 examiners. Radiographic outcome is presented in 4 categories: absence, reduction, enlargement, or unchanged. Reduction or enlargement was determined when the volumetric change of radiolucency was 20% or more. Multivariate logistic regression was performed for predictor analysis.
Sixty-two teeth (63.9%) from 50 patients returned for follow-up. Fifty-eight teeth were included in the prognostic analysis, all of which were symptom free. The 4 remaining teeth that had been extracted because of fracture were excluded. The total volume of periapical radiolucencies at 4 years postoperatively decreased by 94.6% compared with that preoperatively (P < .001), with an average reduction of 83.4% (95% confidence interval, 69.2%-97.5%). The periapical radiolucencies were determined as absence in 44 teeth (75.9%), reduction in 10 teeth (17.2%), unchanged in 1 tooth (1.7%), and enlargement in 3 teeth (5.2%). Tooth type was identified as an outcome predictor (P < .05).
The 4-year outcome of endodontic retreatment is predictable, with a significant volumetric reduction in periapical radiolucencies.
本前瞻性研究旨在通过测量锥形束计算机断层扫描（CBCT）图像上根尖周放射透影区的体积变化，来研究非手术根管再治疗的 4 年疗效和预后因素。
纳入 80 例诊断为根尖周炎并需要根管再治疗的患者的 97 颗患牙。由 7 名牙髓病专家按照标准化治疗方案进行再治疗。再治疗后 48-67 个月对患牙进行临床和影像学复查。由 2 名检查者独立测量术前和术后 CBCT 图像上根尖周放射透影区的体积。将影像学结果分为 4 类：无、减少、增大或不变。当放射透影区的体积变化≥20%时，确定为减少或增大。对预测因素进行多变量逻辑回归分析。
50 例患者中有 62 颗牙（63.9%）返回进行随访。58 颗牙纳入预后分析，所有患牙均无症状。其余 4 颗因牙折而被拔除的牙除外。与术前相比，术后 4 年根尖周放射透影区的总体积减少了 94.6%（P<.001），平均减少了 83.4%（95%置信区间，69.2%-97.5%）。44 颗牙（75.9%）被判定为无，10 颗牙（17.2%）为减少，1 颗牙（1.7%）为不变，3 颗牙（5.2%）为增大。牙位被确定为结局预测因素（P<.05）。
根管再治疗的 4 年疗效可预测，根尖周放射透影区的体积显著减少。
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