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牙髓病医生和普通牙医在进行非手术根管治疗时临床方法的差异:一项来自国家基于牙科实践的研究网络PREDICT项目的前瞻性队列研究。

Differences in clinical approaches of endodontists and general dentists when performing non-surgical root canal treatment: A prospective cohort study from the National Dental Practice-Based Research Network PREDICT Project.

作者信息

Nosrat Ali, Funkhouser Ellen, Law Alan S, Abusteit Omar, Mungia Rahma, Nixdorf Donald R, Lam Ernest W N, Gilbert Gregg H

机构信息

Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland, USA.

Centreville Endodontics, Centreville, Virginia, USA.

出版信息

Int Endod J. 2025 Sep;58(9):1408-1419. doi: 10.1111/iej.14264. Epub 2025 May 30.

DOI:10.1111/iej.14264
PMID:40445089
Abstract

AIM

Information regarding differences between general dentists (GDs) and endodontists in their daily practices is limited. The aim of this prospective cohort clinical study was to compare the details of clinical approaches of GDs and endodontists when performing non-surgical root canal treatments (NSRCT).

METHODOLOGY

The study was conducted among 153 practitioners (104 GDs and 49 endodontists) in the National Dental Practice-Based Research Network in the United States who performed NSRCT on at least one of 1705 patients. Practitioners completed postoperative forms to document procedural data. Bivariate and multivariable analyses were performed to adjust for the potential effect of confounders. Two different multivariable models were tested to eliminate the impact of unstable variables.

RESULTS

Overall, after adjusting for the tooth type, multivariable models showed that endodontists were significantly more likely than GDs to use magnifications >5×, rubber dam isolation, NaOCl irrigation, EDTA or HO or chlorhexidine irrigations, ultrasonic/sonic irrigant activation, electronic apex locator and radiographs for working length determination, warm vertical condensation and lateral condensation techniques for obturation, report adequately dense obturation without voids, and to complete NSRCT in a single visit (p ≤ .01). Endodontists were significantly less likely to use lubricants and to report unacceptable obturation length (≥2 mm short or extended beyond the radiographic apex) (p ≤ .01).

CONCLUSIONS

Based on actual clinical data, this study observed major differences between GDs and endodontists in their clinical approaches when performing NSRCTs. Further studies are needed to assess the effect of these differences on the outcome of NSRCTs.

摘要

目的

关于普通牙医(GDs)和牙髓病医生日常临床实践差异的信息有限。这项前瞻性队列临床研究的目的是比较普通牙医和牙髓病医生在进行非手术根管治疗(NSRCT)时临床方法的细节。

方法

该研究在美国国家基于牙科实践的研究网络中的153名从业者(104名普通牙医和49名牙髓病医生)中进行,这些从业者对1705名患者中的至少一名进行了NSRCT。从业者填写术后表格以记录手术数据。进行了双变量和多变量分析以调整混杂因素的潜在影响。测试了两种不同的多变量模型以消除不稳定变量的影响。

结果

总体而言,在调整牙齿类型后,多变量模型显示,牙髓病医生比普通牙医更有可能使用放大倍数>5倍、橡皮障隔离、次氯酸钠冲洗、乙二胺四乙酸(EDTA)或过氧化氢(HO)或氯己定冲洗、超声/声波冲洗液激活、电子根尖定位仪和X线片来确定工作长度,使用热垂直加压和侧向加压技术进行充填,报告充填致密无空隙,并在一次就诊中完成NSRCT(p≤0.01)。牙髓病医生使用润滑剂以及报告充填长度不可接受(比X线根尖短≥2mm或超出X线根尖)的可能性显著更低(p≤0.01)。

结论

基于实际临床数据,本研究观察到普通牙医和牙髓病医生在进行NSRCT时临床方法存在重大差异。需要进一步研究来评估这些差异对NSRCT结果的影响。

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本文引用的文献

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2
Evaluating the Impact of Ultrasonic Irrigation on Bacterial Levels and Activity Following Chemomechanical Procedures.评估化学机械预备后超声冲洗对细菌水平及活性的影响。
J Endod. 2025 Feb;51(2):118-123. doi: 10.1016/j.joen.2024.09.001. Epub 2024 Sep 12.
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Clinical and Radiographic Failure of Nonsurgical Endodontic Treatment and Retreatment Using Single-cone Technique With Calcium Silicate-based Sealers: A Systematic Review and Meta-analysis.
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J Endod. 2024 Jun;50(6):735-746.e1. doi: 10.1016/j.joen.2024.03.007. Epub 2024 Mar 27.
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Incidence of Middle Mesial Canals in Mandibular Molars during Root Canal Treatment and Nonsurgical Retreatment.下颌磨牙根管治疗和非手术再治疗中中间颊管的发生率。
J Endod. 2024 Jun;50(6):774-783. doi: 10.1016/j.joen.2024.02.024. Epub 2024 Mar 7.
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Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline.牙髓病和根尖周病的治疗:欧洲牙髓病学会(ESE)S3级临床实践指南。
Int Endod J. 2023 Oct;56 Suppl 3:238-295. doi: 10.1111/iej.13974. Epub 2023 Sep 29.
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