Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics, Maimonides University (UMAI), Buenos Aires, Argentina.
Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil.
J Endod. 2024 Oct;50(10):1403-1411. doi: 10.1016/j.joen.2024.08.003. Epub 2024 Aug 15.
This study reported on the outcome of the nonsurgical root canal treatment/retreatment of teeth with large apical periodontitis lesions. The influence of some variables on the prognosis was also evaluated.
The study included 199 teeth with large apical periodontitis lesions from 184 patients, treated/retreated by a single operator. Most teeth were managed in a single visit using NaOCl irrigation. Cases were followed up periodically from >1 to 8 years. Treatment/retreatment outcome was evaluated by clinical and radiographic/tomographic criteria and categorized as healed, healing, or diseased. For statistical analysis, data were dichotomized in such a way that healing cases were considered as success in a loose criterion or failure in a rigid one.
Clinical/radiographic analyses revealed that 67% of the initial treatment cases were classified as healed, 22.5% as healing, and 11% as diseased. Treatment success rates were 89% (loose) and 67% (rigid). Variables that influenced the treatment outcome included previous abscess and antibiotic use, very large lesions (≥10 mm), and a sinus tract. The median follow-up time for treatment was 31.5 months. As for retreatment cases, 47% were healed, 32% were healing, and 21% were diseased. Retreatment success rates were 79% (loose) and 47% (rigid), in a median follow-up of 32 months. Cases evaluated by cone-beam computed tomography had lower healed rates.
Findings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions.
本研究报告了针对有较大根尖周病变的患牙的非手术根管治疗/再治疗的结果。同时还评估了一些变量对预后的影响。
本研究纳入了 184 名患者的 199 颗有较大根尖周病变的患牙，这些患牙均由同一位医生进行治疗/再治疗。大多数患牙在一次就诊中使用 NaOCl 冲洗进行处理。病例在 >1 至 8 年的时间内进行定期随访。通过临床和影像学/断层扫描标准评估治疗/再治疗的结果，并将其分为愈合、愈合中或病变。为了进行统计学分析，将数据进行二分类，即宽松标准下的愈合病例视为成功，严格标准下的愈合病例视为失败。
临床/影像学分析显示，初始治疗病例中有 67%被归类为愈合，22.5%为愈合中，11%为病变。治疗成功率为 89%（宽松）和 67%（严格）。影响治疗结果的变量包括先前的脓肿和抗生素使用、非常大的病变（≥10mm）和窦道。治疗的中位随访时间为 31.5 个月。对于再治疗病例，47%为愈合，32%为愈合中，21%为病变。再治疗的成功率为 79%（宽松）和 47%（严格），中位随访时间为 32 个月。通过锥形束 CT 评估的病例愈合率较低。
研究结果表明，对于有较大根尖周病变的患牙，通过非手术根管治疗或再治疗可以获得较高的良好预后。
