Abstract：
BACKGROUND: Historical reports of unpredictable outcomes associated with vital pulpal therapies, particularly direct pulp capping (DPC), have contributed to clinicians\' skepticism of the procedure. Contemporary reports highlight more predictable outcomes of vital pulpal therapies, inclusive of DPC. There is a dearth of reported patient-centered outcomes of these procedures.
METHODS: Insurance claims were used in an observational, retrospective cohort study to evaluate outcomes of DPC performed on permanent teeth. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Log-rank tests were used to evaluate unadjusted differences in survival. Cox proportional hazard regression was used to evaluate the adjusted hazard of adverse event occurrence.
RESULTS: The analytic cohort included 4,136 teeth from 3,716 patients. DPC procedures were identified in public-payer (85.5%) and private-payer (13.4%) insurance claims databases. After DPC, procedure survival rate was 83% and tooth survival rate was 93% during a mean follow-up time of 52 months. Molar tooth type, same-day permanent restoration placement, and amalgam restoration type were significant positive predictors of procedure (DPC) survival. Age was not a statistically significant predictor of procedure survival after controlling for tooth type, gender, time to restoration, and restoration type. Nonmolar tooth type and younger age were significant positive predictors of tooth survival after DPC. Failures were most likely to occur within the first year.
CONCLUSIONS: DPC has favorable patient-centered outcomes and contributes to long-term tooth survival.
CONCLUSIONS: The favorable patient-centered outcomes of DPC bolster calls to consider cost-effectiveness and access to care for endodontic procedures.
METHODS: Insurance claims were used in an observational, retrospective cohort study to evaluate outcomes of DPC performed on permanent teeth. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Log-rank tests were used to evaluate unadjusted differences in survival. Cox proportional hazard regression was used to evaluate the adjusted hazard of adverse event occurrence.
RESULTS: The analytic cohort included 4,136 teeth from 3,716 patients. DPC procedures were identified in public-payer (85.5%) and private-payer (13.4%) insurance claims databases. After DPC, procedure survival rate was 83% and tooth survival rate was 93% during a mean follow-up time of 52 months. Molar tooth type, same-day permanent restoration placement, and amalgam restoration type were significant positive predictors of procedure (DPC) survival. Age was not a statistically significant predictor of procedure survival after controlling for tooth type, gender, time to restoration, and restoration type. Nonmolar tooth type and younger age were significant positive predictors of tooth survival after DPC. Failures were most likely to occur within the first year.
CONCLUSIONS: DPC has favorable patient-centered outcomes and contributes to long-term tooth survival.
CONCLUSIONS: The favorable patient-centered outcomes of DPC bolster calls to consider cost-effectiveness and access to care for endodontic procedures.
摘要：
背景：与重要牙髓治疗相关的不可预测结果的历史报道，特别是直接盖浆(DPC)，导致临床医生对该程序持怀疑态度。当代报告强调了重要牙髓治疗的更可预测的结果，包括DPC。这些程序缺乏以患者为中心的报告结果。
方法：保险索赔被用于观察，回顾性队列研究，以评估对恒牙进行DPC的结果。统计分析包括Kaplan-Meier生存估计和Cox比例风险回归。使用对数秩检验来评估未调整的生存差异。Cox比例风险回归用于评估不良事件发生的校正风险。
结果：分析队列包括3,716例患者的4,136颗牙齿。在公共付款人（85.5％）和私人付款人（13.4％）保险索赔数据库中确定了DPC程序。在DPC之后,在平均52个月的随访时间内，手术生存率为83％，牙齿生存率为93％。磨牙类型,当天永久修复安置，和汞合金恢复类型是手术（DPC）生存的显着阳性预测因子。在控制牙齿类型后，年龄不是手术生存的统计学显著预测指标，性别,恢复的时间，和恢复类型。非磨牙牙齿类型和年龄较小是DPC后牙齿存活的显着阳性预测因子。失败最有可能发生在第一年内。
结论：DPC具有良好的以患者为中心的结果，并有助于牙齿的长期存活。
结论：DPC支持以患者为中心的良好结果要求考虑成本效益和牙髓手术的获得。
方法：保险索赔被用于观察，回顾性队列研究，以评估对恒牙进行DPC的结果。统计分析包括Kaplan-Meier生存估计和Cox比例风险回归。使用对数秩检验来评估未调整的生存差异。Cox比例风险回归用于评估不良事件发生的校正风险。
结果：分析队列包括3,716例患者的4,136颗牙齿。在公共付款人（85.5％）和私人付款人（13.4％）保险索赔数据库中确定了DPC程序。在DPC之后,在平均52个月的随访时间内，手术生存率为83％，牙齿生存率为93％。磨牙类型,当天永久修复安置，和汞合金恢复类型是手术（DPC）生存的显着阳性预测因子。在控制牙齿类型后，年龄不是手术生存的统计学显著预测指标，性别,恢复的时间，和恢复类型。非磨牙牙齿类型和年龄较小是DPC后牙齿存活的显着阳性预测因子。失败最有可能发生在第一年内。
结论：DPC具有良好的以患者为中心的结果，并有助于牙齿的长期存活。
结论：DPC支持以患者为中心的良好结果要求考虑成本效益和牙髓手术的获得。
