The Endodontic Practice, 15 Penn Hill Avenue, Poole, BH15 1LS, UK.
Unit of Endodontology, Division of Restorative Dental Science, University College London Eastman Dental Institute, London, UK.
Clin Oral Investig. 2021 Oct;25(10):5807-5814. doi: 10.1007/s00784-021-03885-w. Epub 2021 Mar 17.
The aim of this study was to determine the periapical healing rate and complications arising from non-surgical root canal treatment (NSRCT) conducted through the existing and retained restoration, compared to that conducted after removal of restoration (direct or indirect) with subsequent placement of a new crown.
Two-hundred-and-forty-five teeth met the inclusion criteria and were followed up for 2 years. One-hundred-and-six teeth had NSRCT completed through existing cast restorations, and 57 and 82 had the existing crowns and direct restorations removed (respectively) and received a new crown after NSRCT. Periapical healing was assessed radiographically using strict (complete healing) and loose (complete and incomplete healing) criteria. Multivariable logistic regression models were used to investigate the effect of prior restoration removal on periapical healing following NSRCT, adjusting for potential confounding (p < 0.05).
There was no significant (p > 0.05) difference in the periapical healing rates amongst teeth accessed through existing crowns (72%, 90%) versus those where crowns (79%, 93%) or direct restorations (77%, 90%) were removed for NSRCT. The findings were adjusted for the significant influencing factor: size of pre-operative radiolucency (p < 0.05). Of the 109 teeth that were initially accessed through existing crowns, 9 (8%) displayed porcelain fracture or crown de-cementation.
Performing root canal treatment through an existing full coverage restoration did not compromise periapical healing and was associated with a low incidence of associated complications.
Crown removal before NSRCT is not mandatory for periapical healing but requires a judicious pre-assessment of current and future marginal and restorative integrity.
本研究旨在比较通过现有保留修复体进行非手术根管治疗（NSRCT）与去除修复体（直接或间接）后进行 NSRCT 并随后放置新牙冠的根尖愈合率和并发症。
符合纳入标准的 245 颗牙齿随访 2 年。106 颗牙齿通过现有的铸造修复体完成 NSRCT，57 颗和 82 颗牙齿分别去除现有的牙冠和直接修复体，并在 NSRCT 后放置新牙冠。通过严格（完全愈合）和宽松（完全和不完全愈合）标准，使用放射影像学评估根尖愈合。使用多变量逻辑回归模型，在调整潜在混杂因素（p < 0.05）后，调查 NSRCT 前去除修复体对根尖愈合的影响。
通过现有牙冠（72%，90%）进行 NSRCT 的牙齿与去除牙冠（79%，93%）或直接修复体（77%，90%）进行 NSRCT 的牙齿之间，根尖愈合率无显著差异（p > 0.05）。研究结果调整了显著影响因素：术前放射透影区大小（p < 0.05）。在最初通过现有牙冠进行治疗的 109 颗牙齿中，有 9 颗（8%）出现瓷裂或牙冠脱粘。
通过现有全冠修复体进行根管治疗不会影响根尖愈合，并且与并发症发生率低有关。
NSRCT 前去除牙冠并非根尖愈合的必要条件，但需要明智地评估当前和未来的边缘和修复体完整性。
