Gorni Fabio G, Ionescu Andrei C, Ambrogi Federico, Brambilla Eugenio, Gagliani Massimo M
Unit of Endodontics, DISS School of Dentistry, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Laboratory of Oral Microbiology and Biomaterials, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
J Endod. 2022 Sep;48(9):1092-1099. doi: 10.1016/j.joen.2022.06.005. Epub 2022 Jun 14.
Few data are available on the long-term efficacy of mineral trioxide aggregate (MTA) in treating root canal perforations. This prospective cohort study builds on a previously reported trial to determine the outcome for teeth with root perforations treated with orthograde MTA after longer follow-up and identify potential prognostic factors.
A prospective cohort study was performed, enrolling (1999-2009) patients with a single dental perforation treated with MTA. Preoperative, intraoperative, and postoperative information was evaluated, and the outcomes were dichotomized as healed or nonhealing. Patients were followed up yearly until 2018 for a maximum of 17 years after treatment, with controls carried out until 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols.
Of the 124 entrolled patients (median age = 36.5 years, 53.2% male), 115 were healed at the first (n = 110, 89%) or second (n = 5, 4%) annual posttreatment checkup, while 9 subjects (7%, 4 females, 18-65 years old) did not heal. Characteristics significantly associated with nonhealing were gender, positive probing, size, and perforation site. Perforations recurred in 48 teeth during the follow-up with the estimated probability of reversal at 5, 10, and 14 years of 6% (95% confidence interval [CI], 2%-10%), 30% (95% CI, 20%-38%), and 62% (95% CI, 46%-73%), respectively. Positive probing had a higher reversal risk (hazard ratio = 3.3, P ≤ .001), and perforations >3 mm were more likely to have a reversal (hazard ratio = 4.1, P < .001).
The risk of reversal for healed MTA-treated root canal perforations, initially relatively low, vastly increases over time.
关于三氧化矿物凝聚体（MTA）治疗根管侧穿的长期疗效，现有数据较少。这项前瞻性队列研究基于先前报道的一项试验展开，旨在通过更长时间的随访来确定采用正向MTA治疗的根管侧穿牙齿的治疗结果，并识别潜在的预后因素。
开展了一项前瞻性队列研究，纳入（1999 - 2009年）接受MTA治疗的单颗牙齿根管侧穿患者。对术前、术中和术后信息进行评估，将结果分为愈合或未愈合两类。对患者进行每年一次的随访，直至2018年，治疗后最长随访17年，对照随访至14年。使用标准化的随访方案评估临床和影像学结果。
在124例纳入患者中（中位年龄 = 36.5岁，53.2%为男性），115例在首次（n = 110，89%）或第二次（n = 5，4%）治疗后年度检查时愈合，而9例患者（7%，4名女性，年龄18 - 65岁）未愈合。与未愈合显著相关的特征包括性别、探诊阳性、穿孔大小和穿孔部位。随访期间48颗牙齿出现穿孔复发，5年、10年和14年的逆转估计概率分别为6%（95%置信区间[CI]，2% - 10%）、30%（95% CI，20% - 38%）和62%（95% CI，46% - 73%）。探诊阳性的逆转风险更高（风险比 = 3.3，P≤.001），穿孔>3 mm更有可能出现逆转（风险比 = 4.1，P <.001）。
经MTA治疗愈合的根管侧穿，其最初逆转风险相对较低，但会随着时间大幅增加。
