上海口腔医学

上海口腔医学 ›› 2021, Vol. 30 ›› Issue (2): 124-128.doi: 10.19439/j.sjos.2021.02.003

• 论著 • 上一篇    下一篇

根管治疗慢性根尖周炎5年预后及影响因素分析

贾舸1, 于淼1, 尚新华1, 吴建华1, 翟沁凯2   

  1. 1.合肥市口腔医院,安徽医科大学合肥口腔临床学院 滨湖门诊部,
    2.口腔颌面外科,安徽 合肥 230001
  • 收稿日期:2020-05-25 修回日期:2020-09-11 出版日期:2021-04-25 发布日期:2021-05-11
  • 通讯作者: 翟沁凯,E-mail: zhaiqinkai@163.com
  • 作者简介:贾舸（1985-）,女,硕士,主治医师, E-mail:1985jiage@163.com
  • 基金资助:
    安徽省重点研究与开发计划项目（201904a07020023）; 合肥市卫计委应用医学研究项目（hwk2018zc009）; 合肥市自主创新政策“借转补”资金项目（J2019Y03）

A five-year experience for treating patients with chronic apical periodontitis with root canal treatment: a retrospective cohort study

JIA Ge1, YU Miao1, SHANG Xin-hua1, WU Jian-hua1, ZHAI Qin-kai2   

  1. 1. Department of Endodontics, Binhu Dental Clinic,
    2. Department of Oral and Maxillofacial Surgery, Hefei Stomatology Hospital. Hefei 230001, Anhui Province, China
  • Received:2020-05-25 Revised:2020-09-11 Online:2021-04-25 Published:2021-05-11

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摘要： 目的:探讨慢性根尖周炎经根管治疗后的牙生存率、拔除原因、根尖愈合率及预后影响因素。方法:回顾性队列研究纳入由同一名医师完成根管治疗的102例根尖周炎患者。主要预测变量为根管治疗难度系数（difficulty assessment of root canal therapy,DARCT）,即根据牙根长度、牙根弯曲度、根管钙化度确定根管治疗难度系数,分为根管治疗难度系数较低（DARCT=3~4）、根管治疗难度系数中等（DARCT=5~7）、根管治疗难度系数较高（DARCT=8~9）。主要结果变量为牙的5年生存率及根尖愈合率,其他混杂变量为性别、年龄、根管数量、根充质量、冠修复情况。采用SPSS 21.0 软件包对数据进行χ2检验和多因素回归分析。结果:根尖周炎患牙根管治疗后的5年生存率为81.4%（83/102）,根尖愈合率为77.1%（64/83）。根管治疗难度系数和牙的生存率显著相关（P=0.017）,难度系数较高根管牙常因根折、深牙周袋、牙周脓肿而拔除（P=0.027）;多根管的牙常因根尖周炎反复发作而拔除（P=0.004）。单因素分析显示,根管数量（P=0.021）、根充质量（P=0.006）、根管治疗难度系数（P=0.000）和根尖愈合率显著相关。多因素分析显示,根管治疗难度系数（P=0.000）与根充质量（P=0.033）与根尖愈合率相关。结论:根尖周炎患牙的预后受根管治疗难度系数和根充质量的影响。根管治疗难度系数和根管数量与牙的拔除原因相关。

关键词: 慢性根尖周炎, 根管治疗, 根尖阴影, 预后

Abstract: PURPOSE: To investigate the clinical outcomes, including survival and periapical healing rates and failure causes, of root canal treatment for patients with periapical lesion. METHODS: A retrospective cohort study was conducted which enrolled patients admitted for the evaluation and management of periapical lesion with root canal treatment. The primary predictor variables were difficulty assessment of root canal therapy (DARCT),which was divided into lower（DARCT =3-4）, medium (DARCT =5-7) and higher (DARCT =8-9) difficulty root canal, in terms of canal length, curvature and calcification. The primary outcome measurement was the incidence of periapical healing and survival rate. Potential confounders included patient demographics, canal number, root canal filling, and coronal restoration. χ2 test and logistic regression analysis were used for statistical analysis with SPSS 21.0 software package. RESULTS: The 5-year survival rate was 81.4%(83/102) and healing rate was 77.1% (64/83). DARCT was significantly associated with the survival rate(P=0.017). Root fracture, deep pockets lesions and periodontal abscess were observed in DARCT with a value of 8-9(P=0.027), leading to tooth extraction. The teeth with multiple root canals were extracted due to recurrent or persistent periapical lesion (P=0.004). Chi-square test showed that root canal number (P=0.021), quality of root canal filling (P=0.006) as well as DARCT (P=0.000) were significantly correlated with the final healing rate. Multivariate logistic regression analysis showed that DARCT (P=0.000) and the quality of root canal filling (P=0.033) were associated with the final healing rate. CONCLUSIONS: DARCT and the quality of root canal filling play key roles in the clinical prognosis of periapical lesion, DARCT and number of root canal are more likely to be correlated with failure.

Key words: Chronic apical periodontitis, Root canal treatment, Periapical radiolucency, Prognosis

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