基于根尖片和锥形束 CT 的牙体颈部外吸收患牙的长期预后：一项临床研究。

Long-term prognosis for teeth with external cervical resorption based on periapical images and cone beam CT: A clinical study.

机构信息

Section for Oral Radiology and Endodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.

Department of Public Health, Aarhus University, Aarhus, Denmark.

出版信息

Int Endod J. 2024 Nov;57(11):1596-1607. doi: 10.1111/iej.14122. Epub 2024 Jul 8.

DOI:10.1111/iej.14122

PMID:38976489

Abstract

AIM

To evaluate whether supplemental information from CBCT changed long-term prognosis for teeth with external cervical resorption (ECR) compared to periapical (PA) images. Furthermore, to assess predictive findings in PA images and evaluate which findings in CBCT affected the long-term prognosis of teeth with ECR.

METHODOLOGY

One hundred and ninty-four patients, mean age 41.2, range 13-81, having 244 teeth with ECR were included. An initial long-term prognosis determined either good or poor was established based on intraoral images. Afterwards, the patients underwent CBCT, and final long-term prognosis was decided. From the PA images and CBCT, ECR using Heithersay's classification system, pulp involvement and extension of ECR was assessed. In CBCT, the number of surface lesion(s) was additionally assessed. Descriptive statistics evaluated changes in long-term prognosis after CBCT. Logistic regression analyses tested if findings in PA images and CBCT affected the long-term prognosis.

RESULTS

Based on CBCT, out of 244 teeth the long-term prognosis was assessed to be poor for 173 (70.9%) teeth and good for 71 (29.1%) teeth. The long-term prognosis changed in 76 (31.1%) teeth after CBCT; 5 (2.0%) changed from poor to good, and 71 (29%) changed from good to poor long-term prognosis. In 81 (33.2%) teeth the H-class increased, and in 10 (4.1%) teeth the H-class decreased after assessing CBCT. In 70 (28.7%) teeth, there was a change from no pulp involvement to involvement of the pulp after CBCT; eight (3.3%) teeth changed in the opposite direction. H-class 2 and 4 in PA images significantly increased the probability for a change in long-term prognosis compared to an H-class 3 (p < .05). H-class 4, pulp involvement, ECR in the oral 1/3 of the root, and more than two surface lesions seen in CBCT significantly influenced a poor long-term prognosis (p < .05).

CONCLUSIONS

Supplemental information from CBCT changed long-term prognosis in almost one third of teeth with ECR. In most cases, the long-term prognosis changed from good to poor. H-class 3 in PA images had a significant influence on change in long-term prognosis. Several findings in CBCT influenced a poor long-term prognosis.

摘要

目的

评估 CBCT 提供的补充信息与根尖周（PA）图像相比是否会改变因外部颈吸收（ECR）而导致牙齿的长期预后。此外，评估 PA 图像中的预测性发现，并评估 CBCT 中的哪些发现会影响 ECR 牙齿的长期预后。

方法

纳入 194 名患者，平均年龄 41.2 岁，范围 13-81 岁，共有 244 颗 ECR 牙齿。根据口腔内图像确定初始长期预后良好或不良。随后，患者接受 CBCT 检查，确定最终长期预后。从 PA 图像和 CBCT 中评估 Heithersay 分类系统中的 ECR、牙髓受累和 ECR 扩展情况。在 CBCT 中，还评估了表面病变的数量。描述性统计评估了 CBCT 后长期预后的变化。逻辑回归分析测试 PA 图像和 CBCT 中的发现是否会影响长期预后。

结果

根据 CBCT，244 颗牙齿中有 173 颗（70.9%）牙齿的长期预后被评估为不良，71 颗（29.1%）牙齿的长期预后良好。CBCT 后 76 颗（31.1%）牙齿的长期预后发生变化；5 颗（2.0%）从预后不良变为预后良好，71 颗（29%）从预后良好变为预后不良。在 81 颗（33.2%）牙齿中，H 级增加，在 10 颗（4.1%）牙齿中 H 级降低。在 70 颗（28.7%）牙齿中，CBCT 后牙髓受累从无变为有；8 颗（3.3%）牙齿的变化方向相反。PA 图像中的 H 类 2 和 4 与 H 类 3 相比，显著增加了长期预后变化的概率（p<.05）。PA 图像中的 H 类 4、牙髓受累、根的口腔 1/3 内的 ECR 和 CBCT 中可见的两个以上表面病变显著影响不良的长期预后（p<.05）。