学部学生が行った根管充填の品質と治療結果に関連する要因。2～5年後の追跡調査を行った

Quality of Root Canal Fillings Performed by Undergraduate Students and the Related Factors on the Treatment Outcome: A 2- to 5-Year Follow-Up.

抄録

目的:

2012年から2015年の間に学部生が行った根管充填の品質をX線写真で評価し、根の種類、術前の周囲の状態、修復治療の種類との相関関係が治療成績に及ぼす影響を調査する。

Objective: To evaluate radiographically the quality of root canal fillings performed by undergraduate students between 2012 and 2015, and to investigate the impact of their quality in correlation with root type, preoperative periapical status, and type of restorative treatment on the treatment outcome.

調査方法:

2012年から2015年にかけて、テッサロニキ・アリストテレス大学の学部生が歯内療法科の診療所で67件の非外科的根管治療を行った。244本の歯（349根）が基準を満たし、2016年から2017年にかけて臨床的およびX線的に再検査を行い、結果を "成功 "または "失敗 "に分類した。根管充填物は、先端部の拡張と密度の観点からX線写真で評価した。両方のパラメータが許容できると評価された場合、根管充填は許容可能と分類された。統計解析は，一般化推定方程式を用いて行った．一対比較は，逐次ボンフェローニ法で行った．検査者内および検査者間の一致は，クラス内相関係数とCohen's kappaによって確認した．統計的有意水準はP<0.05とした。

Methods: Six hundred seventy-seven non-surgical root canal treatments were performed by undergraduate students from the Aristotle University of Thessaloniki at the endodontic department clinics between 2012 and 2015. Two hundred forty-four teeth (349 roots) fulfilled the criteria and were clinically and radiographically re-examined between 2016 and 2017, and the outcome was classified as "success" or "failure." Root canal fillings were radiographically evaluated in terms of apical extension and density. The root filling was classified as acceptable when both parameters were rated as acceptable. Statistical analysis was performed using generalized estimating equations. Pairwise comparisons were performed by the sequential Bonferroni method. Intra-examiner and inter-examiner agreements were checked by the intraclass correlation coefficient and Cohen's kappa. The statistical significance level was set at P<0.05.

結果:

根管充填物が認められた歯根の割合は40.4％であった。前歯部（53％，P＜0.05），小臼歯部（43％，P＞0.05）に比べ，大臼歯部は最も低い割合（30.7％）であった。根管充填物の品質と，根の種類，術前の歯周病の状態，冠修復物の種類，および治療結果との相関関係を調べた結果，根や歯周病の存在，冠との関係で根管充填物の品質が受け入れられない場合，成功率が最も低くなった（それぞれ47.2％，40.3％，52.3％）。一方，根管充填物の品質が許容範囲内であれば，他の変数にかかわらず90％近い成功率が得られることがわかった。

Results: The percentage of the roots with acceptable root canal fillings was 40.4%. The molar roots demonstrated the lowest rate (30.7%) compared with the anterior (53%, P<0.05) and premolar teeth (43%, P>0.05). The results of the correlation of the quality of the root canal fillings with the root type, preoperative periapical status, type of coronal restoration, and the treatment outcome showed that the unacceptable quality of root canal filling in relation to root or presence of periapical lesion or crown revealed the lowest success rates (47.2%, 40.3%, and 52.3%, respectively). In contrast, results showed that roots with canal fillings of acceptable quality demonstrated success rates close to 90%, regardless of the other variables.

結論:

本研究の制限内では、テッサロニキ・アリストテレス大学歯内療法科の学部の診療所で行われたX線写真上許容できる根管充填の割合は40.4％と低かった。結果、成功率の高さと許容できる品質の根管充填との間には強い関連性があることがわかった。

Conclusion: Within the limitations of the present study, the percentage of radiographically acceptable root canal fillings performed in the undergraduate clinic of the Department of Endodontology at Aristotle University of Thessaloniki was low (40.4%). Results showed that there was a strong association of higher success rates with root fillings of acceptable quality.