現代の歯内療法的再治療：臨床治療所見に基づく分析

Contemporary endodontic retreatments: an analysis based on clinical treatment findings.

抄録

現代の非外科的歯内療法による再治療に関連するX線写真的および臨床的因子を明らかにするために、前向きin vivo調査を実施した。適切な治療計画を決定するため、約1,100本の歯内療法治療失敗歯をスクリーニングした。拡大鏡を用いて、337例の連続した再治療症例を評価し、治療を行った。再治療症例の大部分は複数の要因が関与していた。85％の症例に歯周囲放射融解が認められた。65％の症例は、X線写真上の咬合状態が不良であった。51％の症例で関連痛が認められた。42％の歯に未処置の管腔があった。レントゲン写真で非対称なオブリチュレーションを認めた症例の89%で、追加的な管腔が発見され、治療されたことは統計的に有意であった（カイ二乗、p<または=0.05）。再治療した歯の13%に歯冠漏出が認められた。歯数、充填材料、オーバーフィル、外科的再充填の既往も記録した。臨床的成功率を向上させる可能性のある提言がなされた。

A prospective in vivo investigation was conducted to determine radiographic and clinical factors associated with contemporary nonsurgical endodontic retreatments. Approximately 1,100 failing endodontically treated teeth were screened to determine an appropriate treatment plan. Using magnification, 337 consecutive retreatment cases were evaluated and treated. The vast majority of the retreated cases involved multiple factors. Eighty-five percent of the cases presented with periradicular radiolucencies. Sixty-five percent of the cases demonstrated poor radiographic obturation quality. Associated pain was noted 51% of the time. Forty-two percent of the teeth had untreated canal space. It was statistically significant (Chi-square, p < or = 0.05) that additional canal space was located and treated in 89% of the cases that had previous radiographic asymmetrical obturations. Evidence of coronal leakage was noted in 13% of the retreated teeth. Tooth number, obturation materials, overfills, and previous surgical retrofillings were also recorded. Recommendations were made that might improve the rate of clinical success.