Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
Dental Research Department, Public Dental Health Service, Örebro, Sweden.
Int Endod J. 2024 Sep;57(9):1212-1227. doi: 10.1111/iej.14079. Epub 2024 May 9.
To investigate what happens to cross-sectionally identified root-filled teeth over a 6-year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root-filled teeth over the same time were associated with variables obtained from a baseline examination.
Adult patients with ≥1 previously root-filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root-filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision-making and treatments. After six years, information on events of the root-filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5-point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient- and tooth-related factors and events.
A total of 445 patients with 1007 root-filled teeth were followed the entire observation time. Twenty (2.0%) of the root-filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p < .0001), tenderness to percussion (p < .0001), and poor coronal restoration (p < .0001).
This study corroborates the notion that in general dentistry, root-filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root-filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six-year period.
无论距初次根管治疗时间的长短，调查在定期就诊于公共牙科服务的成年患者中，经过 6 年时间，横截面确定的根管治疗牙会发生什么情况。次要目的是研究在同一时期影响根管治疗牙的累积事件与基线检查中获得的变量之间的关系。
2015 年，在瑞典厄勒布鲁县，招募了至少有 1 颗先前根管治疗过的牙且定期就诊于公共牙科服务的成年患者参与本研究。一般牙科医生使用标准化方案在基线时检查了该队列中所有确定的根管治疗牙，并负责进一步的决策和治疗。6 年后，从牙科记录中收集了根管治疗牙的事件信息。分析中使用了 5 分制等级量表的最高评分（最具侵袭性的治疗）。对患者和牙齿相关因素与事件之间的关系进行了逐步选择的回归分析。
共对 445 名患者的 1007 颗根管治疗牙进行了整个观察期的随访。在 6 年内，有 20 颗（2.0%）根管治疗牙进行了根管再治疗，有 150 颗（14.9%）牙被拔出。根尖周放射透影区或疼痛的牙齿中，大多数未进行再治疗或拔出；然而，多变量分析表明，再治疗或拔出与基线时记录的根尖周放射透影区的牙齿（p <.0001）、叩诊压痛（p <.0001）和不良的冠部修复（p <.0001）有关。
本研究证实了这样一种观点，即在一般牙科中，有根尖病变放射学迹象的根管治疗牙往往会随着时间的推移而未得到治疗。此外，研究还表明，轻度疼痛的根管治疗牙不一定会接受任何干预。然而，基线时具有根尖周炎、疼痛或冠部修复不足迹象的牙齿在 6 年期间更有可能接受干预。
