Department of Endodontics, School of Dentistry, Ege University, İzmir, Turkey.
Int Endod J. 2021 Dec;54(12):2173-2183. doi: 10.1111/iej.13631. Epub 2021 Sep 24.
To evaluate the impact of various predictors on the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions after a minimum of 2 years.
One hundred and twenty previously root canal treated symptomatic mandibular first molars with periapical lesions which were diagnosed as symptomatic apical periodontitis or acute apical abscess with localized intraoral swelling were included. Root canal retreatment was performed by an experienced endodontist using a standardized treatment protocol. The teeth were followed up clinically and radiographically and the radiographic outcome was assessed using a modified periapical index scale (PAI). The cumulative success proportion and the influence of predictors on the outcome of the root canal retreatment were analysed using Kaplan-Meier analyses and log-rank tests, and the hazard ratios for the predictors were also investigated using Univariate Cox Proportional Hazard regression analysis at a significance level of 5%.
Of the 120 teeth, 103 teeth were re-examined with an 85% recall rate. The cumulative success rate was 88% in which 64% were healed and 24% were healing, and failure rate was recorded as 12%. None of the preoperative predictors, including age, gender, soft tissue tenderness, intraoral swelling, size of the lesion, PAI score, apical level and density of root canal filling before root canal retreatment, nor intraoperative predictors, such as active exudate drainage, density of root canal filling after root canal retreatment and restoration type had an influence on the outcome of root canal retreatment (p > .05). The only factor that significantly reduced the success rate of root canal retreatment was the apical level of the root canal filling; when it was more than 2 mm short of the radiographic apex in teeth where apical patency was not established, the success was significantly lower (p = .023).
Root canal retreatment in symptomatic mandibular first molars with periapical lesions resulted in a success rate of 88%. None of the predictors had a significant influence on the outcome, except for the apical level of the root canal filling after root canal retreatment with short root fillings being associated with significantly more post-treatment endodontic disease.
评估各种预测因素对至少 2 年后有症状的下颌第一磨牙根尖病变的根管再治疗结果的影响。
共纳入 120 例经根管治疗的有症状的下颌第一磨牙，这些牙齿均有根尖病变，并被诊断为症状性根尖周炎或伴有局部口腔肿胀的急性根尖脓肿。由经验丰富的牙髓病专家使用标准化治疗方案进行根管再治疗。通过临床和影像学随访，使用改良的根尖指数（PAI）量表评估影像学结果。使用 Kaplan-Meier 分析和对数秩检验分析预测因素对根管再治疗结果的影响，并使用单变量 Cox 比例风险回归分析（显著性水平为 5%）研究预测因素的风险比。
120 颗牙中，103 颗牙被重新检查，召回率为 85%。累计成功率为 88%，其中 64%为愈合，24%为愈合中，失败率为 12%。术前预测因素（包括年龄、性别、软组织触痛、口腔肿胀、病变大小、PAI 评分、根管再治疗前根尖水平和根管充填密度）以及术中预测因素（如活动性渗出物引流、根管再治疗后根管充填密度和修复类型）均未对根管再治疗结果产生影响（p＞.05）。唯一显著降低根管再治疗成功率的因素是根管充填的根尖水平；当根尖未通畅的牙齿中根管充填根尖短于 2mm 时，成功率显著降低（p =.023）。
有根尖病变的有症状的下颌第一磨牙的根管再治疗成功率为 88%。除了根管再治疗后根尖水平低于根尖以外，没有预测因素对结果有显著影响，根尖水平低于根尖与更多的根管治疗后根尖病变相关。
