Doğramacı Esma J, Rossi-Fedele Giampiero
Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
Int Endod J. 2023 Mar;56 Suppl 2:169-187. doi: 10.1111/iej.13830. Epub 2022 Oct 2.
There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient-centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient-reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health-related quality of life, and patient-reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient-related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3-level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health-Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter-related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.
人们对补充牙髓病学经典目标（即预防和治愈根尖周炎）的疗效指标越来越感兴趣。可能的疗效指标可细分为以患者为中心的结局（PCO），包括非患者收集的数据，旨在评估干预措施的有效性，以及患者报告结局（PRO），即由患者直接报告。PRO随后可分为确定患者对其症状、功能状态和健康相关生活质量看法的PRO指标，以及关注护理人性化、患者满意度、患者偏好和依从性、个人成本、期望实现和决策遗憾等方面的患者报告体验指标。本综述旨在定义各种与患者相关的结局，并讨论牙髓病学中有关PCO和PRO的现有文献。这包括那些提议用于评估牙髓炎和根尖周炎牙髓治疗有效性的指标，以用于欧洲牙髓病学会S3级临床实践指南的制定，除根尖周炎的影像学评估外，所有工作组都已纳入这些指标。基于该领域有限的证据，可以总结出，在不同时长的随访期后，牙髓治疗与牙齿存活的高可能性以及包括拔牙和进一步修复程序在内的进一步干预的有限需求相关。治疗完成后，口腔健康相关生活质量（OHRQoL）可能会改善。尽管如此，评估OHRQoL与牙髓病学之间关联的文献因使用先前未经验证的工具而受到阻碍。在本综述中讨论的其余疗效指标中，值得强调的是，只有一项研究评估了存在牙髓病变的牙齿的病情加重情况，这表明牙髓治疗后这种不良反应的发生率非常低。患者的期望实现、依从性和满意度密切相关，并且还取决于各种非临床因素。需要进一步研究评估PCO和PRO，并与根尖周炎的愈合和预防相关联，以便从患者的角度更好地理解牙髓治疗。
