Zanjir Maryam, Cardoso Elaine, Harman Nicola L, Khansari Ava, Jafarzadeh Hamid, Malkhassian Gevik, Sabeti Mike, Aminoshariae Anita, Kishen Anil, Sale Joanna E M, Shah Prakesh S, Azarpazhooh Amir
Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Endod. 2025 Apr;51(4):457-472. doi: 10.1016/j.joen.2025.01.012. Epub 2025 Jan 31.
Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set in Endodontics (COS-ENDO) to standardize reporting for studies of Nonsurgical Root Canal Treatment/Retreatment, Surgical Endodontics, Vital Pulp Therapy, Apexification, and Regenerative Endodontics. This article, the last in a 5-part series, focuses on COS-ENDO for Apexification and Regenerative Endodontics, while other parts address the remaining treatments.
Outcomes were identified through scoping reviews and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.
Of the 97 invited participants to Round 1, 77 registered, and 73 (24 Academicians/Researchers, 26 Clinicians, and 23 Patients or their parents/caregivers) assessed 51 outcomes, with 18 excluded. The remaining outcomes-7 achieving consensus for inclusion and 26 lacking consensus-advanced to Round 2 for re-rating by 70 participants. This resulted in 14 outcome achieving consensus for inclusion, and 19 lacking consensus. In the final meeting, 16 participants finalized the COS-ENDO for Apexification and Regenerative Endodontics, including Tooth survival, Pain, Signs of infection, Radiographic evidence of periradicular healing, Continued root development, Success, Functional tooth, Need for further intervention, and Adverse events/Complications.
COS-ENDO is an important step in standardizing outcome reporting in endodontics, ensuring consistent reporting and enhancing research utility. Further efforts are needed to establish optimal measurement methods.
方法学异质性和报告偏倚使牙髓治疗结果的解读变得复杂。在美国牙髓病学家协会及其基金会的支持下，本研究制定了牙髓病核心结局集（COS-ENDO），以规范非手术根管治疗/再治疗、牙髓外科治疗、活髓治疗、根尖诱导成形术和牙髓再生治疗研究的报告。本文是一个五部分系列文章的最后一篇，重点关注根尖诱导成形术和牙髓再生治疗的COS-ENDO，而其他部分则涉及其余治疗方法。
通过范围综述和对美国牙髓病学家协会执业会员的在线调查确定结局。在两轮德尔菲调查中，临床医生、患者和研究人员对结局进行9分制评分。根据共识标准评估评分，通过一次虚拟会议最终确定了COS-ENDO。
在第一轮邀请的97名参与者中，77人注册，73人（24名院士/研究人员、26名临床医生以及23名患者或其父母/照顾者）评估了51项结局，其中18项被排除。其余结局——7项达成纳入共识，26项未达成共识——进入第二轮由70名参与者重新评分。这导致14项结局达成纳入共识，19项未达成共识。在最终会议上，16名参与者最终确定了根尖诱导成形术和牙髓再生治疗的COS-ENDO，包括牙齿留存、疼痛、感染体征、根尖周愈合的影像学证据、牙根继续发育、成功、功能牙、进一步干预的必要性以及不良事件/并发症。
COS-ENDO是牙髓病结局报告标准化的重要一步，可确保报告的一致性并提高研究效用。还需要进一步努力建立最佳测量方法。
