Department of Endodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Private Practice Limited to Endodontics, Amsterdam, The Netherlands.
Int Endod J. 2023 Mar;56(3):345-355. doi: 10.1111/iej.13871. Epub 2022 Nov 27.
Selective root canal retreatment is when the treatment is limited to root(s) with radiographic evidence of periapical pathosis. The goals of this retrospective study were as follows: (i) evaluate the clinical and radiographic (periapical radiographs [PR] or cone-beam computerized tomographs [CBCT]) outcome of selective root canal retreatment after ≥12 months follow-up; (ii) evaluate the periapical status of the unretreated roots; and (iii) assess tooth survival.
A retrospective study (January 2018 to April 2021) was conducted to identify permanent multirooted teeth that underwent selective root canal retreatment. Clinical records, PR and CBCT were examined to ascertain variables of interest. Outcomes (per root and per tooth) were classified into 'favourable' or 'unfavourable' using well-established clinical and radiographic healing criteria. Treatment outcomes for the whole tooth and per root were compared as well as bivariate associations between the treatment outcome of the retreated roots and the treatment-related parameters (quality of root filling, sealer extrusion, iatrogenic mishaps and type of restoration) were analysed using Fisher's exact test (α = .05). Survival was recorded in months.
A total of 75 teeth (195 roots) in 75 subjects were available for outcome analysis. The favourable outcome per tooth was 86.7%. At follow-up, 92.6% of the retreated roots had a favourable outcome. From the unretreated roots, 3.5% showed radiographic signs of an emerging periapical lesion. No statistical difference was shown between the outcomes per root and per tooth between both groups. None of the treatment-related parameters had a direct influence on the outcome of the retreated roots. The survival rate at 12-48 months after retreatment was 91.5%.
Selective root canal retreatment is associated with a favourable outcome in a majority of cases. Unretreated roots rarely developed radiographic signs of a new periapical lesion at follow-up. Future high-quality clinical trials with larger sample sizes and longer follow-up periods are required to confirm these findings.
选择性根管再治疗是指仅对有根尖病变放射影像学证据的根（管）进行治疗。本回顾性研究的目的如下：（i）评估选择性根管再治疗后≥12 个月的临床和放射影像学（根尖射线照片[PR]或锥形束计算机断层扫描[CBCT]）结果；（ii）评估未再治疗根的根尖状态；和（iii）评估牙齿存活率。
本回顾性研究（2018 年 1 月至 2021 年 4 月）旨在确定接受选择性根管再治疗的多根管恒牙。检查临床记录、PR 和 CBCT 以确定感兴趣的变量。使用既定的临床和放射影像学愈合标准，将（每根管和每牙）的治疗结果分类为“有利”或“不利”。还比较了整个牙齿和每根管的治疗结果，以及使用 Fisher 精确检验（α=0.05）分析再治疗根的治疗结果与治疗相关参数（根管充填质量、封闭剂挤出、医源性失误和修复类型）之间的双变量关联。
共有 75 名患者的 75 颗牙（195 根管）纳入结果分析。每牙的有利治疗结果为 86.7%。在随访时，92.6%的再治疗根管有有利的结果。在未再治疗的根中，3.5%出现了新的根尖病变的放射影像学迹象。两组间每根管和每牙的治疗结果无统计学差异。治疗相关参数均未对再治疗根的结果产生直接影响。再治疗后 12-48 个月的生存率为 91.5%。
在大多数情况下，选择性根管再治疗与有利的治疗结果相关。在随访时，未再治疗的根很少出现新的根尖病变的放射影像学迹象。需要进行未来高质量的临床试验，样本量更大，随访时间更长，以证实这些发现。
