虫歯性歯髄露出のある成熟歯における歯髄切除または根管治療後の歯内療法後の疼痛。多施設共同無作為化比較試験

Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial.

• Mohammad Jafar Eghbal
• Ali Haeri
• Arash Shahravan
• Ali Kazemi
• Fariborz Moazami
• Mohammad Ali Mozayeni
• Eshaghali Saberi
• Mohammad Samiei
• Mehdi Vatanpour
• Alireza Akbarzade Baghban
• Mahta Fazlyab
• Ardavan Parhizkar
• Mahboobe Ahmadi
• Nazila Akbarian Rad
• Shima Bijari
• Delaram Bineshmarvasti
• Paria Davoudi
• Roya Dehghan
• Mandana Dehghani
• Habibollah Ebrahimi
• Nafiseh Emami
• Nafiseh Farajian
• Rahim Fereidooni
• Gelareh Ghobadi
• Mostafa Ghodrati
• Atefeh Gohari
• Azadeh Hashemi
• Mohammadreza Hosseini
• Elham Karami
• Nasir Kheirabadi
• Sepideh Kozegari
• Hadi Labaf Ghasemi
• Alireza Majidi
• Parastu Malekzadeh
• Vahid Mehrabi
• Mehrnush Mohammadi
• Leila Moradi Eslami
• Atefeh Noghani
• Negin Omatali
• Negar Pourhatami
• Behnam Rahbani Nobar
• Saeid Rahmani
• Parviz Shafaq
• Sara Soofiabadi
• Somaye Teimoori
• Farzaneh Vatandoost
• Saeed Asgary

抄録

この同等性のある無作為化臨床試験は、永久歯の成熟歯において、ミネラル三酸化物集合体（PMTA）またはカルシウム富化混合物（PCEM）を用いた根管治療（RCT）の術後疼痛を比較することを目的とした。7つの学術施設で、歯髄露出の多い550例を対象に、PMTA（188例）、PCEM（194例）、RCT（168例）のいずれかの群に無作為に割り付けた。術前の数値評価尺度（Numerical Rating Scale）による「痛みの強さ」（PI）と術後7日目までのPIを記録した。患者の人口統計学的情報、術前/術中/術後の要因/条件を記録/解析した。両群とも人口統計学的には同質であった。術前PIの平均値は同程度（=0.998）、術後10回の間隔で記録された合計PIの平均値は同程度（=0.939）、疼痛緩和の傾向と変化は全群で平行（=0.821）であった。術前の中等度・重度の疼痛の発生率は、RCT群で56.5％、PMTA群で55.7％、PCEM群で56.7％であったが、24時間後にはそれぞれ13.1％、10.6％、12.9％と大幅に減少していた（=0.578）。歯内療法の時間スパンは、RCT=69.73分、PMTA=35.37分、PCEM=33.62分と統計的に異なっていた（＜0.001）。術前疼痛が大きい患者、症状のある歯槽膿漏、PDL拡大がある患者では、より多くの疼痛があった(=0.002, 0.035, 0.023, resp.)が、その他の術前/術中/術後の要因/条件は同程度であった。MTA/CEMとRCTを用いたプルポトミーは、術後の疼痛緩和効果が同等で効果的であることを示している。

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA ( = 188), PCEM ( = 194), or RCT ( = 168) arms. Preoperative "Pain Intensity" (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (=0.939), and the trend/changes in pain relief were parallel (=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes ( < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

Copyright © 2020 Mohammad Jafar Eghbal et al.