Department of Endodontics, Faculty of Dentistry, Near East University, Nicosia, Mersin 10, Turkey.
Department of Industrial Engineering, Faculty of Engineering, Girne American University, Kyrenia, Mersin 10, Turkey.
Clin Oral Investig. 2021 Jun;25(6):3681-3690. doi: 10.1007/s00784-020-03692-9. Epub 2020 Nov 19.
The aim of this study was to analyze the strength of risk factors related to endodontic flare-ups and rank them in order of their importance MATERIALS AND METHODS: A systematic literature search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web of Knowledge, and grey literature was conducted up to November 2019. One hundred ninety-eight publications were identified. Twelve records fulfilled the eligibility criteria, and eight significant risk factors for flare-up, namely, "Periapical lesion," "multiple-visit treatment," "preoperative pain," "necrotic teeth," "female gender," "retreatment," "percussion pain," and "analgesics," were selected to construct the simulation model. The final data pool was established by the integration of data of common risk factors in the included articles. Monte Carlo method was used to analyze of combined numerical data, for simulation of the risk factor impacts. Ten thousand iterations were generated in the simulation model.
The results of the simulation revealed that the risk estimates of the factors had varying ranges of influence and probability on the flare-up risk. "Periapical lesion" was found to be the most sensitive risk factor, following by "preoperative pain" which was ranked the second place. The third-ranked risk factor was "multiple-visit treatment." The least sensitive risk factors for endodontic flare-up were "retreatment," "female gender," "necrotic teeth," and "analgesics."
The present study provides better comprehension on the importance of risk factors for flare-up based on their risk estimates.
A Monte Carlo simulation was adopted to identify the most influential risk factors for endodontic flare-up with a ranking, which can be used to provide meaningful predictions and further insights into clinicians' perception of flare-up risk.
本研究旨在分析与根管治疗后疼痛相关的危险因素的强度，并对其进行重要性排序。
系统检索 PubMed、Cochrane 中心对照试验注册库、Scopus 和 ISI Web of Knowledge 以及灰色文献，检索截至 2019 年 11 月。共确定 198 篇文献，其中 12 篇文献符合纳入标准，选择 8 个显著的根管治疗后疼痛危险因素（根尖病变、多次就诊治疗、术前疼痛、牙髓坏死、女性、再治疗、叩诊痛和使用止痛药）构建模拟模型。通过整合纳入文献中常见危险因素的数据，建立最终的数据池。采用蒙特卡罗法分析组合数据，模拟危险因素的影响。在模拟模型中生成 1 万次迭代。
模拟结果表明，各因素的风险估计对疼痛风险的影响和概率存在差异。“根尖病变”是最敏感的危险因素，其次是“术前疼痛”，排名第二。第三位是“多次就诊治疗”。根管治疗后疼痛最不敏感的危险因素是“再治疗”、“女性”、“牙髓坏死”和“止痛药”。
本研究基于风险估计，对根管治疗后疼痛的危险因素的重要性有了更好的理解。
采用蒙特卡罗模拟对根管治疗后疼痛的最主要危险因素进行识别和排序，有助于对疼痛风险进行有意义的预测，并进一步深入了解临床医生对疼痛风险的感知。
