Elmaasarawi Ahmed, Mekhemar Mohamed, Bartols Andreas
Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University Kiel, Kiel, Germany.
Department of Restorative Dentistry, October University for Modern Sciences and Arts (MSA), Cairo, Egypt.
Int Endod J. 2025 Oct;58(10):1529-1550. doi: 10.1111/iej.14271. Epub 2025 Jun 13.
This study aimed to assess how three different treatment protocols affect the survival of teeth and the survival of teeth without further interventions after root canal treatment (RCT), while also considering additional factors that could potentially influence the treatment outcome.
Data were collected from an outpatient clinic database from July 1999 to January 2024 and 14 233 treated teeth could be included in a retrospective cohort study. Treatment protocols incorporated hand files (Protocol 1), multiple-file rotary NiTi systems added with passive ultrasonic irrigation (PUI), citric acid and occasionally chlorhexidine (Protocol 2) and reciprocating instruments added with PUI, EDTA, warm vertical compaction and calcium silicate-based sealer (Protocol 3). Survival analysis coupled with Cox proportional hazard regression and Kaplan-Meier curves took into account several variables including treatment, patient demographics and experience of the treatment provider. Confounding was addressed by entropy balancing and gradient boosted logistic regression. Multistate analysis was conducted to evaluate the influence of treatment protocols on the transition between various intervention states.
Survival analysis revealed that Protocol 3 significantly enhanced survival rates and survival rates without further interventions by 30%-40% compared to both other protocols. Additionally, higher patient age was identified as a negative predictor of treatment outcomes. Supportive periodontal treatments were a positive predictor. Factors such as tooth type, vitality, number of visits, experienced treatment provider, calcium silicate-based sealer and patient gender did not significantly affect outcomes in the adjusted models. Multistate analysis confirmed that Protocol 3 was associated with significantly reduced incidences of retreatment and extraction.
Protocol 3 significantly enhanced survival and survival without further interventions compared to both other protocols. Patient age and supportive periodontal treatments were significant predictors of outcomes throughout all calculated models.
本研究旨在评估三种不同的治疗方案如何影响根管治疗（RCT）后牙齿的存活率以及无需进一步干预的牙齿存活率，同时考虑可能影响治疗结果的其他因素。
从1999年7月至2024年1月的门诊数据库中收集数据，14233颗接受治疗的牙齿可纳入一项回顾性队列研究。治疗方案包括手动锉（方案1）、添加了被动超声冲洗（PUI）、柠檬酸并偶尔使用洗必泰的多锉旋转镍钛系统（方案2）以及添加了PUI、乙二胺四乙酸（EDTA）、热垂直加压和硅酸钙类封闭剂的往复式器械（方案3）。生存分析结合Cox比例风险回归和Kaplan-Meier曲线考虑了几个变量，包括治疗、患者人口统计学特征和治疗提供者的经验。通过熵平衡和梯度增强逻辑回归解决混杂问题。进行多状态分析以评估治疗方案对各种干预状态之间转变的影响。
生存分析显示与其他两种方案相比，方案3显著提高了存活率以及无需进一步干预的存活率，提高幅度为30%-40%。此外，较高的患者年龄被确定为治疗结果的负性预测因素。支持性牙周治疗是正性预测因素。在调整后的模型中，牙齿类型、活力、就诊次数、经验丰富的治疗提供者、硅酸钙类封闭剂和患者性别等因素对结果没有显著影响。多状态分析证实方案3与再治疗和拔牙的发生率显著降低相关。
与其他两种方案相比，方案3显著提高了存活率以及无需进一步干预的存活率。在所有计算模型中，患者年龄和支持性牙周治疗是结果的显著预测因素。
