Ngamthuam Inruja, Manmontri Chanika, Chompu-Inwai Papimon, Phinyo Phichayut, Nirunsittirat Areerat, Chaipattanawan Nattakan
Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Chiang Mai, Thailand.
Department of Family Medicine and Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University, Chiang Mai, Thailand.
Clin Oral Investig. 2023 Dec;27(12):7473-7488. doi: 10.1007/s00784-023-05336-0. Epub 2023 Oct 19.
To investigate the survival probability of permanent first molars (PFMs) after coronal pulpotomy (CP) using two outcome definitions: success-focused and functional survival-focused, and to identify factors influencing tooth survival.
A retrospective cohort study reviewing records of children undergoing CP with calcium silicate-based cements (CSCs) on PFMs. Each CP-treated PFM was classified as success, uncertain, failure, or censored. Survival probability was analyzed using Kaplan-Meier estimators. Success-focused definition considered failures and uncertain outcomes as events, while functional survival-focused definition considered only failures as events. Prognostic factors were analyzed using Cox regression analysis.
Seventy-seven CP-treated PFMs with a follow-up period of 6-111 months. Using the success-focused definition (two failures and 12 uncertain outcomes as events), survival probabilities were 93.1% (95% CI 84.3-97.1%) at 12 months, 78.7% (95% CI 65.6-87.3%) at 36 months, and 74.9% (95% CI 59.5-89.0%) at 60-111 months. However, with the functional survival-focused definition, survival probabilities were 100% at 12 months and 96.6% (95% CI 86.9-99.1%) at 24-111 months. In multivariable analysis, proximal lesions increased failure risk compared to occlusal lesions (HR 17.17, 95% CI 2.18-135.31, p < 0.01), and resin composite restorations had higher failure risk than stainless steel crowns (HR 13.97, 95% CI 1.49-130.69, p < 0.05).
CP using CSCs shows long-term survival potential as an alternative treatment for cariously exposed PFMs in children.
Proximal lesions and resin composite restoration could contribute to the lower survival, indicating the need for careful consideration of restoration options and lesion location during treatment planning.
采用两种结局定义（以成功为重点和以功能存活为重点）研究乳牙列第一恒磨牙（PFMs）在冠髓切断术（CP）后的存活概率，并确定影响牙齿存活的因素。
一项回顾性队列研究，回顾了接受基于硅酸钙水门汀（CSCs）的冠髓切断术治疗的PFMs患儿的记录。每颗接受冠髓切断术治疗的PFMs被分类为成功、不确定、失败或失访。使用Kaplan-Meier估计量分析存活概率。以成功为重点的定义将失败和不确定结局视为事件，而以功能存活为重点的定义仅将失败视为事件。使用Cox回归分析分析预后因素。
77颗接受冠髓切断术治疗的PFMs，随访期为6 - 111个月。采用以成功为重点的定义（将2例失败和12例不确定结局视为事件），12个月时的存活概率为93.1%（95%CI 84.3 - 97.1%），36个月时为78.7%（95%CI 65.6 - 87.3%），60 - 111个月时为74.9%（95%CI 59.5 - 89.0%）。然而，采用以功能存活为重点的定义时，12个月时的存活概率为100%，24 - 111个月时为96.6%（95%CI 86.9 - 99.1%）。在多变量分析中，与咬合面病变相比，邻面病变增加了失败风险（风险比[HR] 17.17，95%CI 2.18 - 135.31，p < 0.01），树脂复合材料修复体的失败风险高于不锈钢冠（HR 13.97，95%CI 1.49 - 130.69，p < 0.05）。
使用CSCs进行冠髓切断术作为儿童龋源性暴露PFMs的替代治疗方法显示出长期存活潜力。
邻面病变和树脂复合材料修复可能导致较低的存活率，表明在治疗计划过程中需要仔细考虑修复选择和病变位置。
