Defence Centre for Rehabilitative Dentistry, Defence Primary Healthcare, Aldershot, UK.
UCL Eastman Dental Institute, University College London, London, UK.
Int Endod J. 2024 Jun;57(6):667-681. doi: 10.1111/iej.14060. Epub 2024 Mar 21.
To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes.
This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4-8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi-square tests, univariate logistic regression and Cox proportional hazards models.
A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60-month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55).
For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.
比较在英国武装部队（UKAF）中通过两种治疗途径（常规牙科护理和转诊治疗途径）进行根管（再）治疗的根尖周放射影像学愈合和牙齿存活率结果，并确定牙髓复杂性对结果的影响。
本回顾性队列研究纳入了 2015 年至 2020 年间接受根管（再）治疗的 1252 名人员的 1466 颗牙齿。普通牙医治疗了 661 颗牙齿（573 名患者）（常规队列），而具有特殊兴趣的牙医治疗了 805 颗牙齿（678 名患者）（转诊队列）。后者组是牙髓学硕士课程的毕业生，具有 4-8 年的研究生毕业后经验。使用修复治疗需求指数（RIOTN）指南的牙髓成分，对每颗牙齿的病例复杂性进行回顾性确定。使用松动的放射影像学标准确定根尖周愈合情况。使用卡方检验、单变量逻辑回归和 Cox 比例风险模型对数据进行分析。
在常规与转诊队列中，低复杂度病例接受根管治疗的比例显著更高（p<0.0001）。无论使用综合（OR=1.17；95%CI：1.11，1.22）还是中度复杂度（OR=4.71；95%CI：2.73，8.11）数据进行分析，转诊队列的根尖周愈合几率都显著高于常规队列。在常规队列中，前牙的根尖周愈合几率高于后牙（OR=1.13；95%CI：1.04，1.22）。常规队列（90.5%）的 60 个月累积牙齿存活率明显低于转诊队列（96.0%）（p=0.03）。在常规队列中，后牙的牙齿丢失风险更高（HR=4.03；95%CI：1.92，8.45），但如果后牙有铸造修复体，风险则更低（HR=0.36；95%CI：0.19，0.70）。对于转诊队列，如果后牙采用铸造修复体（而非其他修复体），牙齿丢失的风险显著降低（HR=0.21；95%CI：0.08，0.55）。
对于 UKAF 患者，与常规途径相比，通过转诊途径提供的根管（再）治疗更有可能实现根尖周愈合和更好的牙齿存活率。采用间接修复体修复的后牙的存活率更高。本研究支持 RIOTN 的牙髓成分用于评估病例复杂度的效用。
