Abstract：
BACKGROUND: No clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA.
METHODS: Two hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data.
RESULTS: Within the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)-38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing.
CONCLUSIONS: MTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention.
METHODS: Two hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data.
RESULTS: Within the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)-38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing.
CONCLUSIONS: MTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention.
摘要：
背景：没有临床研究检查三氧化二矿聚集体（MTA）闭塞水平对牙髓再治疗结果的影响。这项回顾性研究检查了三个队列的治疗结果，这些队列比较了过度充盈，冲洗灌装,以及使用MTA进行正行再处理后的欠充填。
方法：纳入了二百五十例患者，其中264颗牙齿被诊断为先前治疗过的根管和根尖周炎，在私人牙髓治疗中接受了治疗。所有牙齿均接受MTA闭塞，并相对于主要根尖孔测量最终填充水平的程度。经过6个月的随访，所有未愈合的病例均通过手术治疗。经过24到72个月的审查，评估术前病变大小和MTA闭塞程度的影响.使用Stata17软件(StataCorpLLC，学院站,TX)用于评估数据。
结果：在三个队列中，108颗过度填充的牙齿中有99颗（91.7％），103个冲洗填充物中有90个(87.4%)，53颗填充不足的牙齿中有10颗（18.9％）在48个月时愈合并成功进行了治疗，无需手术。当包括手术结果时，合并治愈比例为93.2％。发现术前病变大小是再治疗无法愈合的重要预测因素。基线时病灶大小增加1mm导致手术风险增加11%(95%CI1.04,1.18)-38%(95%CI1.22,1.58)。与过量填充和冲洗填充相比，充盈不足与需要手术的患者增加约3倍相关,其特点是延迟愈合.
结论：MTA封堵术是一种可行的再治疗选择，适用于未愈合的牙髓治疗。MTA过量填充或冲洗填充物不会对愈合结果产生不利影响。然而,MTA充盈不足增加了不愈合和手术干预的机会。
方法：纳入了二百五十例患者，其中264颗牙齿被诊断为先前治疗过的根管和根尖周炎，在私人牙髓治疗中接受了治疗。所有牙齿均接受MTA闭塞，并相对于主要根尖孔测量最终填充水平的程度。经过6个月的随访，所有未愈合的病例均通过手术治疗。经过24到72个月的审查，评估术前病变大小和MTA闭塞程度的影响.使用Stata17软件(StataCorpLLC，学院站,TX)用于评估数据。
结果：在三个队列中，108颗过度填充的牙齿中有99颗（91.7％），103个冲洗填充物中有90个(87.4%)，53颗填充不足的牙齿中有10颗（18.9％）在48个月时愈合并成功进行了治疗，无需手术。当包括手术结果时，合并治愈比例为93.2％。发现术前病变大小是再治疗无法愈合的重要预测因素。基线时病灶大小增加1mm导致手术风险增加11%(95%CI1.04,1.18)-38%(95%CI1.22,1.58)。与过量填充和冲洗填充相比，充盈不足与需要手术的患者增加约3倍相关,其特点是延迟愈合.
结论：MTA封堵术是一种可行的再治疗选择，适用于未愈合的牙髓治疗。MTA过量填充或冲洗填充物不会对愈合结果产生不利影响。然而,MTA充盈不足增加了不愈合和手术干预的机会。
