Napovedni dejavniki izida endodontskega zdravljenja

Jurič, Rok (author), Jan, Janja (mentor)

Namen V prospektivni kohortni raziskavi smo želeli oceniti izid endodontskega zdravljenja v specialistični endodontski ambulanti v Sloveniji in ovrednotiti povezavo med izidom zdravljenja in različnimi predoperativnimi, medoperativnimi in pooperativnimi dejavniki. Materiali in metode Vsa primarna ali ponovna endodontska zdravljenja je v obdobju 13 let opravil en specialist endodont. S kliničnim in radiološkim pregledom ter beleženjem poteka zdravljenja smo zbrali podatke o 44 napovednih dejavnikih. Eno do štiri leta po zdravljenju smo ocenili delež uspešno zdravljenih zob in korenin na podlagi strogih radioloških (periapikalni indeks (PAI) ? 2) in kliničnih kriterijev (odsotnost bolečine, vnetja ali fistulacije). Povezanost uspešnega izida zdravljenja s posameznimi napovednimi dejavniki smo ocenili z bivariatno analizo, njihovo skupno povezanost z razmerjem obetov (RO) za uspešen izid pa z multiplo logistično regresijo ob uporabi posplošenih enačb ocenjevanja (GEE). Rezultati Izid zdravljenja pri 735 bolnikih smo ocenili na 1259 zobeh (2445 koreninah, 3149 kanalih), kar predstavlja 91 % v raziskavo vključenih zob. Delež uspešno zdravljenih zob je bil 79,9 % [95 % interval zaupanja 77,7–82,1]. Enajst napovednih dejavnikov je statistično značilno znižalo obete za uspešen izid zdravljenja. Šest je bilo predoperativnih: pretekla poškodba zoba (RO = 0,05 [0,01–0,24]), vrednost PAI (RO = 0,29 [0,20–0,42], 0,21 [0,13-0,34] in 0,22 [0,12 0,42]) za PAI 3, 4 in 5 v primerjavi s PAI 1), velikost lezije (RO = 0,30 [0,21–0,43] in 0,24 [0,16–0,37] za premer 1–5 mm in ?6 mm v primerjavi z odsotnostjo lezije), vrsta zoba (RO = 0,51 [0,27–0,97] in 0,45 [0,24 0,83] za ličnike in kočnike v primerjavi s sekalci in podočniki), občutljivost na periapikalno palpacijo (RO = 0,64 [0,43–0,94]) in dva kanala v korenini (RO = 0,67 [0,54–0,83]). Štirje dejavniki so bili medoperativni: nehomogena polnitev (RO = 0,18 [0,08 0,40]), dolžina polnitve (RO = 0,44 [0,26–0,75] in 0,62 [0,40–0,97] za hiperpolnitev in hipopolnitev v primerjavi z normopolnitvijo), uporaba polimerne polnilne paste (RO = 0,58 [0,39–0,87] v primerjavi z biokeramično polnilno pasto) in zdravljenje izvedeno v eni seji (RO = 0,40 [0,21–0,75] v primerjavi z večsejnim zdravljenjem). En dejavnik je bil pooperativen: poškodovana koronarna zapora (RO = 0,35 [0,21–0,56]). Zaključki Z neuspehom endodontskega zdravljenja so bili povezani ti napovedni dejavniki: (i) pretekla poškodba zoba, napredovali apikalni parodontitis (višja PAI vrednost, večji premer lezije, občutljivost na periapikalno palpacijo), zahtevnejša morfologija zoba (ličnik ali kočnik, dva kanala v korenini); (ii) enosejno zdravljenje, po dolžini in homogenosti nekakovostna polnitev kanalov ali uporaba polimerne polnilne paste; (iii) poškodovana koronarna zapora zoba.

• Language: Slovenian
• Keywords: apikalni parodontitis, endodontsko zdravljenje, izid zdravljenja, ocena izida zdravljenja
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2024
• PID: 20.500.12556/RUL-159403
• Publication date in RUL: 10.07.2024

Secondary language

• Language: English
• Title: Factors affecting the endodontic treatment outcome

Abstract

Aim To investigate the association of various pre-, intra-, and postoperative factors on root canal treatment outcome. Methodology In this cohort study, primary or secondary root canal treatment was performed by a single endodontist in a private practice over 13 years, and followed 1-4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) 䁤 2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 prognostic factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. Results 1259 teeth (2445 roots, 3149 canals) in 735 patients were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9%[95% confidence interval 77.7-82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success. Six were preoperative: injury history (OR=0.05[0.01-0.24]), root PAI (OR=0.29[0.20-0.42], 0.21[0.13-0.34], and 0.22[0.12-0.42] for PAI=3, 4, and 5, respectively, against PAI=1), lesion diameter (OR=0.30[0.21-0.43] and 0.24[0.16-0.37] for diameters of 1-5mm and 䁥6mm, respectively, against no lesion), tooth type (OR=0.51[0.27-0.97] and OR=0.45[0.24-0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR=0.64[0.43-0.94]), and two canals per root (OR=0.67[0.54-0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR=0.18[0.08-0.40]) or extending beyond or shorter than 2 mm from the apex (OR=0.44[0.26-0.75] and 0.62[0.40-0.97], respectively), resin sealer (OR=0.58[0.39-0.87] against bioceramic sealer), and single visit treatment (OR=0.40[0.21-0.75] against multiple visits). One factor was postoperative: defective coronal restoration (OR=0.35[0.21-0.56]). Conclusion The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomical conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.

• Keywords: outcome assessment, periapical periodontitis, root canal therapy, treatment outcome