根管治療と歯内マイクロサージェリーによる先端歯周炎の治療成績と予後因子-レトロスペクティブ・コホート研究

Outcomes and prognostic factors of apical periodontitis by root canal treatment and endodontic microsurgery-a retrospective cohort study.

抄録

背景:

本研究の目的は、歯根端部歯周炎に対する根管治療（RCT）と歯内マイクロサージェリー（EMS）の治療成績と予後因子を分析し、初回RCTと非外科的再治療（再RCT）の治療成績と予後因子を比較することであった。

BACKGROUND: The aim of this study was to analyze the outcome and prognostic factors of root canal treatment (RCT) and endodontic microsurgery (EMS) in the treatment of apical periodontitis (AP), respectively, and to compare the outcome and prognostic factors between initial RCT and nonsurgical retreatment (re-RCT) for AP.

方法は以下の通りです。:

2016年1月から2019年12月まで、北京大学第三病院の口臭科からAP患者を募集した。データはカルテレビューにより収集した。治療結果の単変量解析は、全RCT群、初回RCT群、再RCT群、EMS群でそれぞれ行った。多変量ロジスティック回帰は、3つのRCT群でそれぞれ実施したが、EMS群では実施しなかった。

METHODS: Patients with AP were recruited from the Stomatology Department of Peking University Third Hospital from January 2016 to December 2019. Data were collected by medical records review. Univariate analysis of treatment outcome was performed for the total RCT group, initial RCT group, re-RCT group and EMS group, respectively. Multivariate logistic regression was performed for the three RCT groups, respectively, but not for the EMS group.

結果:

APに対する治療の成功率は全体で73.8％であった。RCTの成功率は229例で70.7％、EMSの成功率は34例で94.1％であった。RCTの失敗率は，高齢者［オッズ比（OR）＝1.025，P＝0.013］，不完全骨折の歯（OR＝7.082，P＝0.013），歯冠根比が大きい歯（OR＝1.198，P＝0.029），一般歯科医が治療した歯（OR＝2.16，P＝0.042），無資格で治療した歯（OR＝2.841，P＝0.002）で有意に高かった．初回RCTで治療した166歯のうち、成功率は68.1％であった。歯冠根の比率が大きいこと（OR = 1.333, P=0.004）が治療のリスクファクターとして確認された。再度のRCTで治療した63本の歯の成功率は77.8％であった。非適格な治療を受けた歯では成功率が低かった（OR = 5.291, P=0.018）。EMSに関しては、単変量解析の結果、いずれの変数も結果に有意に関連していなかった。

RESULTS: The overall success of treatment for AP was 73.8%. The success rate of RCT in 229 cases was 70.7%, while that of EMS in 34 cases was 94.1%. The failure of RCT was significantly higher for elderly patients [odds ratio (OR) =1.025, P=0.013], teeth with incomplete fracture (OR =7.082, P=0.013), teeth with a greater crown root ratio (OR =1.198, P=0.029), teeth treated by a general dentist (OR =2.16, P=0.042) and teeth with unqualified treatment (OR =2.841, P=0.002). Of the 166 teeth treated by initial RCT, the success was 68.1%. A greater crown root ratio (OR =1.333, P=0.004) was identified as a risk factor for treatment. Of the 63 teeth treated by re-RCT, the success was 77.8%. A lower success was observed in teeth with unqualified treatment (OR =5.291, P=0.018). With regard to EMS, the univariate analysis showed that none of the variables were significantly related to the outcome.

結論:

RCTによるAP治療では，年齢，歯の不完全破折，歯冠根比，医師の分類，無資格治療が転帰に強く影響した．初回RCTでは、歯冠根比が転帰の有意な予測因子であり、再RCTでは、非適格治療が統計的に有意な強い因子であった。APの初回RCTと再RCTの成功率には有意な差は見られなかった。

CONCLUSIONS: For AP treated by RCT, age, incomplete tooth fracture, crown root ratio, doctor classification and unqualified treatment had a strong impact on determining outcome. For initial RCT, crown root ratio was a significant outcome predictor, while for re-RCT, unqualified treatment was a strong statistically significant factor. No significant difference was found between the success of initial RCT and re-RCT for AP.