歯冠修復物および根管充填物の品質が根尖周囲の状態に及ぼす影響：臨床的およびX線学的評価

Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation.

抄録

はじめに:

この研究の目的は、ブラジル人患者のコホートにおいて、臨床的およびX線写真的に評価した、歯周病状態と歯冠修復物および根管充填物の品質との間の関係を評価することである。

INTRODUCTION: The purpose of this study was to evaluate the relationship between periapical status and the quality of coronal restoration and of root canal filling, assessed both clinically and radiographically, in a cohort of Brazilian patients.

方法:

歯内療法を受けた 337 例 523 歯について、術後 2-10 年目に臨床的および X 線写真的な再検査を行った。修復物および根管充填の質は Tronstad らによる修正基準に従って分類された。記述的分析には，Mann-Whitney検定とFriedman検定を使用した．相関は、単純ロジスティック回帰分析および多変量ロジスティック回帰分析を用いて分析した。

METHODS: A total of 523 teeth from 337 patients submitted to endodontic treatment were clinically and radiographically reexamined 2-10 years postoperatively. Restoration and root canal filling quality were classified according to modified criteria from Tronstad et al. Periapical status was evaluated according to periapical index scores. Mann-Whitney and Friedman tests were used to conduct the descriptive analysis. Correlations were analyzed by using simple and multivariate logistic regression analysis.

結果:

臨床的に評価した歯冠修復物が適切な場合と不適切な場合の歯根端歯周炎の発生率に有意差は認められなかった（12.8%対19.4%）が、X線写真による修復物の質の評価では有意差が認められた（11.6%対28.7%、P < 0.001）．根管充填が不十分な歯では，修復が十分であってもなくても，根尖性歯周炎の発生率は根管充填が十分であっても，修復が十分でなくても有意に高かった（それぞれ38.6%と48.4%、6.5%と14.6%、P < 0.0001 ）．

RESULTS: No significant difference was observed between the rates of apical periodontitis for adequate or inadequate coronal restorations assessed clinically (12.8% versus 19.4%), whereas these rates were significantly different when the restoration quality was assessed radiographically (11.6% versus 28.7%, P < .001). The rates of apical periodontitis in teeth with inadequate root canal filling, with or without adequate restoration, were significantly higher than in teeth with adequate canal filling, with or without adequate restoration (38.6% and 48.4% versus 6.5% and 14.6%, respectively; P < .0001).

結論:

X線写真または臨床評価のどちらか一方だけを用いても、修復物の質が術後の周囲環境の状態と相関しているかどうかを確認するための信頼できる方法ではない。根管充填の質の低さは歯内療法失敗の予後決定因子であり、一方、歯冠修復の質は歯内療法の結果にあまり影響を及ぼさないことがわかった。

CONCLUSIONS: Using either a radiographic or clinical assessment alone was not a reliable method to ascertain whether restoration quality could be correlated with postoperative periapical status. Poor root canal filling quality was a prognostic determinant of endodontic treatment failure, whereas coronal restoration quality had a lesser impact on the outcome of the endodontic treatment.