A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health

作者：Ng Y L^*; Mann V; Gulabivala K

来源：International Endodontic Journal, 2011, 44(7): 583-609.

DOI：10.1111/j.1365-2591.2011.01872.x

• outcome
• periapical healing
• root canal treatment
• success

P>Aim
To investigate the probability of and factors influencing periapical status of teeth following primary (1 degrees RCTx) or secondary (2 degrees RCTx) root canal treatment.
Methodology
This prospective study involved annual clinical and radiographic follow-up of 1 degrees RCTx (1170 roots, 702 teeth and 534 patients) or 2 degrees RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error.
Results
The proportion of roots with complete periapical healing after 1 degrees RCTx (83%; 95% CI: 81%, 85%) or 2 degrees RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P < 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2 degrees RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P < 0.001); and presence of a satisfactory coronal restoration (P < 0.001).
Conclusions
Success based on periapical health associated with roots following 1 degrees RCTx (83%) or 2 degrees RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.

• 出版日期2011-7