Alsalleeh Fahd, Albishry Fatima Y, Aleyiydi Asrar S, Aldossari Farah S, Alharbi Norah H, Alghofaily Maha, Althumairy Riyadh
Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
King Saud University Medical City - Dental University Hospital, King Saud University, Riyadh, Saudi Arabia.
BDJ Open. 2024 May 21;10(1):36. doi: 10.1038/s41405-024-00224-5.
The alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA.
Seventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI).
Autism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries.
This study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.
有特殊医疗需求（SHCNs）的人数急剧增加，这就需要在满足他们口腔健康需求的方式上进行范式转变。全身麻醉（GA）是一种有价值的技术，可用于帮助那些没有它就无法耐受治疗的SHCNs患者进行牙科手术。目的是评估在全身麻醉下对SHCNs患者进行的非手术牙髓治疗及治疗结果。
2018年至2022年期间，在SHCNs医院诊所纳入了33例接受全身麻醉下非手术牙髓治疗的患者的78颗恒牙。分析了人口统计学数据、SHCNs类型、牙髓和根尖周诊断、治疗类型以及使用的材料。所有患者均被召回进行临床和影像学检查。使用根尖指数（PAI）对治疗前和召回时的根尖片进行评估和评分。
接受治疗的患者中，自闭症和注意力缺陷多动障碍患者占39.4%。大多数治疗为初次非手术根管治疗（95%）。热牙胶垂直加压充填占治疗病例的88%。9例（12%）使用硅酸三钙封闭剂采用单锥充填技术。在召回复诊时，98.7%的治疗牙齿存活。12颗牙齿治疗前有根尖周病变，除一颗外全部愈合。发现女性患者的PAI评分高于男性患者（23.7%对7.5%），但差异不显著。只有10例接受非手术根管治疗的患者报告有继发龋。
本研究表明，在一组SHCNs患者中，全身麻醉下进行的非手术牙髓治疗具有较高的存活率。有趣的是，患有社交和沟通障碍的患者在全身麻醉下接受治疗的比例最高。这些发现凸显了全身麻醉辅助牙髓治疗对该人群的潜力。然而，有必要进一步研究探索优化SHCNs患者口腔健康结局的其他方法。
