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

doi:10.19439/j.sjos.2021.02.003

Abstract

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

CLC Number:

R781.3

JIA Ge, YU Miao, SHANG Xin-hua, WU Jian-hua, ZHAI Qin-kai. A five-year experience for treating patients with chronic apical periodontitis with root canal treatment: a retrospective cohort study[J]. Shanghai Journal of Stomatology, 2021, 30(2): 124-128.

References

[1] 姚莉莉, 高云松, 牛方, 等. 应用根管显微镜处理阻塞根管的疗效评价[J].上海口腔医学, 2007, 16(4): 395-398.
[2] 贾卓群, 杨路. 影响根管消毒剂氢氧化钙清除效率的因素[J]. 国际口腔医学杂志, 2018, 45(4): 439-443.
[3] 张德辉, 郑遥, 孙海涛. 上颌第一磨牙根管治疗术后5年疗效分析[J]. 上海口腔医学, 2016, 25(1): 87-90.
[4] 姜雨然, 朱琳虹, 张敬. 根管治疗后疾病的临床研究[J]. 实用口腔医学杂志, 2020, 36(2): 373-377.
[5] Strange KA, Tawil PZ, Phillips C, et al.Long-term outcomes of endodontic treatment performed with resilon/epiphany[J]. J Endod, 2019, 45(5): 507-512.
[6] 朱亚萍, 朱亚琴, 樊林峰, 等. 根管充填质量对根管治疗术远期疗效的影响[J].上海口腔医学, 2007, 16(3): 232-235.
[7] 李宇飞, 田慧颖, 王晓霞. 初次根管治疗愈合率和影响因素分析[J]. 华西口腔医学杂志, 2012, 30(1): 61-64.
[8] Olivieri JG, Elmsmari F, Miró Q, et al.Outcome and survival of endodontically treated cracked posterior permanent teeth: a systematic review and meta-analysis[J]. J Endod, 2020, 46(4): 455-463.
[9] Lee J, Kang S, Jung HI, et al.Dentists' clinical decision-making about teeth with apical periodontitis using a variable-controlled survey model in South Korea[J]. BMC Oral Health, 2020, 20(1): 23-33.
[10] Hamedy R, Shakiba B, Pak JG, et al.Prevalence of root canal treatment and periapical radiolucency in elders: a systematic review[J]. Gerodontology, 2014, 33(1): 116-127.
[11] 边专, 闫萍. 根管治疗的预后及影响因素[J]. 中国实用口腔科杂志, 2008, 1(1): 21-23.
[12] Fezai H, Al-Salehi S.The relationship between endodontic case complexity and treatment outcomes[J]. J Dent, 2019, 85(1): 88-92.
[13] Baaij A, Özok AR.Method of teaching undergraduate students to perform root canal treatment: it's influence on the quality of root fillings[J]. Eur J Dent Educ, 2018, 22(2): e221-e227.
[14] 四川大学华西口腔医院牙体牙髓病科. 根管治疗难度系数临床评估标准[J].华西口腔医学杂志, 2004, 22(5): 381-383.
[15] Pirani C, Chersoni S, Montebugnoli L, et al.Long-term outcome of non-surgical root canal treatment: a retrospective analysis[J]. Odontology, 2015, 103(2): 185-193.
[16] Goldberg F, Cantarini C, Alfie D, et al.Relationship between unintentional canal overfilling and the long-term outcome of primary root canal treatments and nonsurgical retreatments: a retrospective radiographic assessment[J]. Int Endod J, 2020, 53(1): 19-26.
[17] Sadaf D.Survival rates of endodontically treated teeth after placement of definitive coronal restoration: 8-year retrospective study[J]. Ther Clin Risk Manag, 2020, 16: 125-131.
[18] 陈智, 陈彬文.根管治疗后牙体修复的治疗方案选择[J]. 华西口腔医学杂志, 2015, 33(2): 115-120.
[19] Alamoudi RA, Alharbi AH, Farie GA, et al.The value of assessing case difficulty and its effect on endodontic iatrogenic errors: a retrospective cross-sectional study[J]. Libyan J Med, 2020, 15(1): 1688916.