Patel Neha, Khan Iftekhar, Jarad Fadi, Zavattini Angelo, Koller Garrit, Pimentel Tiago, Mahmood Kazim, Mannocci Francesco
Endodontics Department, Kings College London, Guys Hospital, London, UK.
Warwick Medical School University of Warwick, Coventry, UK.
Int Endod J. 2025 Jan;58(1):55-70. doi: 10.1111/iej.14144. Epub 2024 Sep 26.
Few studies focus upon patient-reported outcomes in endodontics.
To determine whether full pulpotomy offers a less painful, improved health-related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment.
One hundred sixty-eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post-baseline. Analysis included descriptive and continuous variables, chi-squared, Fisher's exact, and two-sample t-tests.
In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p < .001). The magnitude of reduction was similar in RCT and pulpotomy (p = .804), RCT and PRCT (p = .179), pulpotomy vs. PRCT (p = .144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p = .045) and RCT group (p = .049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p = .015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group.
In the treatment of IP, pulpotomy is as effective as RCT in reducing post-operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL.
很少有研究关注牙髓病学中患者报告的结果。
确定在不可逆性牙髓炎（IP）病例中，与根管治疗（RCT）相比，在治疗后7天内，完全活髓切断术是否能带来疼痛较轻、与健康相关的生活质量（HRQoL）改善。
168名出现IP症状的参与者被随机分为活髓切断术组（n = 86）或RCT组（n = 82）。两名参与者被排除，61名参与者接受了使用生物陶瓷的完全活髓切断术（35.7%），80名接受了RCT（46.8%），25名因无法控制的出血而被随机分配接受活髓切断术，随后进展为RCT（PRCT）（14.6%）。术前进行了临床和影像学评估，使用CBCT和根尖片，仅使用CBCT图像评估结果。在基线以及基线后第1、3、5和7天进行疼痛（视觉模拟评分法[VAS]）和HRQoL（EQ-5D）评估。分析包括描述性和连续性变量、卡方检验、Fisher精确检验和两样本t检验。
在活髓切断术组和RCT组中，VAS疼痛在第一周内显著降低（p <.001）。RCT组和活髓切断术组、RCT组和PRCT组、活髓切断术组与PRCT组之间以及联合RCT/PRCT组（ORCT）与活髓切断术组比较时，疼痛减轻的幅度相似（p = 0.804、p = 0.179、p = 0.144和0.7）。然而，PRCT组的VAS疼痛总体水平显著高于活髓切断术组（p = 0.045）和RCT组（p = 0.049）。使用CBCT发现，PRCT组的透射区明显多于活髓切断术组，并且出现CBCT透射区的牙齿总体疼痛评分显著更高（p = 0.015），尤其是在第1、3和5天。RCT组和PRCT组在许多口腔健康相关生活质量领域（问题1、6、11和12）存在显著差异，并在第0天和第天7时，PRCT组口腔健康问题影响的频率更高。
在IP的治疗中，活髓切断术在减轻术后疼痛、改善生活质量和HRQoL方面与RCT一样有效，使用CBCT检测到的显示无法控制的出血和根尖透射区的牙齿与术后更剧烈的疼痛和更低的生活质量相关。
