Department of Stomatology, Peking University Third Hospital, Beijing, China.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
Ann Palliat Med. 2021 May;10(5):5027-5045. doi: 10.21037/apm-20-2507. Epub 2021 Apr 12.
The aim of this study was to analyze the outcome and prognostic factors of root canal treatment (RCT) and endodontic microsurgery (EMS) in the treatment of apical periodontitis (AP), respectively, and to compare the outcome and prognostic factors between initial RCT and nonsurgical retreatment (re-RCT) for AP.
Patients with AP were recruited from the Stomatology Department of Peking University Third Hospital from January 2016 to December 2019. Data were collected by medical records review. Univariate analysis of treatment outcome was performed for the total RCT group, initial RCT group, re-RCT group and EMS group, respectively. Multivariate logistic regression was performed for the three RCT groups, respectively, but not for the EMS group.
The overall success of treatment for AP was 73.8%. The success rate of RCT in 229 cases was 70.7%, while that of EMS in 34 cases was 94.1%. The failure of RCT was significantly higher for elderly patients [odds ratio (OR) =1.025, P=0.013], teeth with incomplete fracture (OR =7.082, P=0.013), teeth with a greater crown root ratio (OR =1.198, P=0.029), teeth treated by a general dentist (OR =2.16, P=0.042) and teeth with unqualified treatment (OR =2.841, P=0.002). Of the 166 teeth treated by initial RCT, the success was 68.1%. A greater crown root ratio (OR =1.333, P=0.004) was identified as a risk factor for treatment. Of the 63 teeth treated by re-RCT, the success was 77.8%. A lower success was observed in teeth with unqualified treatment (OR =5.291, P=0.018). With regard to EMS, the univariate analysis showed that none of the variables were significantly related to the outcome.
For AP treated by RCT, age, incomplete tooth fracture, crown root ratio, doctor classification and unqualified treatment had a strong impact on determining outcome. For initial RCT, crown root ratio was a significant outcome predictor, while for re-RCT, unqualified treatment was a strong statistically significant factor. No significant difference was found between the success of initial RCT and re-RCT for AP.
本研究旨在分别分析根管治疗（RCT）和根管内显微外科手术（EMS）治疗根尖周炎（AP）的结果和预后因素，并比较 AP 初始 RCT 和非手术再治疗（re-RCT）的结果和预后因素。
本研究于 2016 年 1 月至 2019 年 12 月期间从北京大学第三医院口腔科招募 AP 患者。通过病历回顾收集数据。对总 RCT 组、初始 RCT 组、re-RCT 组和 EMS 组分别进行治疗结果的单因素分析。对三个 RCT 组分别进行多变量逻辑回归分析，但不包括 EMS 组。
AP 的总体治疗成功率为 73.8%。229 例 RCT 的成功率为 70.7%，而 34 例 EMS 的成功率为 94.1%。老年患者（OR=1.025，P=0.013）、不完全牙裂（OR=7.082，P=0.013）、冠根比大（OR=1.198，P=0.029）、由普通牙医治疗（OR=2.16，P=0.042）和治疗不合格（OR=2.841，P=0.002）的 RCT 失败率明显更高。在接受初始 RCT 治疗的 166 颗牙齿中，成功率为 68.1%。较大的冠根比（OR=1.333，P=0.004）被确定为治疗的危险因素。在接受 re-RCT 治疗的 63 颗牙齿中，成功率为 77.8%。治疗不合格的牙齿（OR=5.291，P=0.018）的成功率较低。对于 EMS，单因素分析显示，没有一个变量与结果有显著关系。
对于 RCT 治疗的 AP，年龄、不完全牙裂、冠根比、医生分类和治疗不合格对确定结果有很大影响。对于初始 RCT，冠根比是一个显著的结果预测因素，而对于 re-RCT，治疗不合格是一个具有统计学意义的强因素。AP 初始 RCT 和 re-RCT 的成功率无显著差异。
