目的:探讨牙髓显微手术在表现为大的或贯穿的病变的复杂病例中的临床效果。
方法:我们回顾性收集和分析术前,术中,和143例复杂病例接受牙髓显微手术的随访数据。根据牙齿存活率和手术成功率评估临床结果。Cox回归分析用于评估生存率并确定相关危险因素。此外,术后不同时期的成功率进行了比较,通过二元逻辑回归分析确定了导致手术失败的潜在因素.
结果:总生存率和成功率分别为93.0%和91.7%,分别。Cox回归模型确定了影响牙齿存活的四个危险因素,包括四颗牙齿的根尖切除术(HR=35.488;P=0.0002),术前X光片观察到开放的顶点(HR=6.300;P=0.025),引导组织再生技术的性能(HR=8.846;P=0.028),和pal手术入路(HR=8.685;P=0.030)。成功率显示术后早期(从0.5年到2年;P=5.8124e-30)的初始增加,其次是稳定(2至9年;P=0.298)。当根尖切除术累及四颗牙齿时,手术成功率显着下降(OR=109.412;P=0.002)。
结论:牙髓显微手术在复杂病例中显示出令人满意的结果,两年后保持稳定的成功率。然而,当根尖切除术涉及四颗牙齿时,牙齿的存活率和手术成功率会受到很大影响。如引导组织再生等因素,一个开放的顶点,并且腭外科方法与拔牙风险增加相关。
结论:尽管在复杂病例中取得了可接受的结果,四颗牙齿的根尖切除术会对牙髓显微手术产生不利影响。
OBJECTIVE: To investigate the clinical outcomes of endodontic microsurgery in complicated cases presenting with large or through-and-through lesions.
METHODS: We retrospectively collected and analyzed preoperative, intraoperative, and follow-up data from 143 complicated cases that underwent endodontic microsurgery. Clinical outcomes were assessed in terms of tooth survival and surgery success. Cox regression analysis was used to evaluate the survival rate and identify associated risk factors. Additionally, the success rate was compared across different postoperative periods, and potential factors contributing to surgical failure were identified through binary logistic regression.
RESULTS: The overall survival and success rates were 93.0% and 91.7%, respectively. The Cox regression model identified four risk factors affecting tooth survival, including
apicoectomy of four teeth (HR = 35.488; P = 0.0002), an open apex observed on preoperative radiographs (HR = 6.300; P = 0.025), the performance of guided tissue regeneration technique (HR = 8.846; P = 0.028), and a palatal surgical approach (HR = 8.685; P = 0.030). The success rate demonstrated an initial increase in the early postoperative period (from 0.5 to 2 years; P = 5.8124e-30), followed by stabilization (from 2 to 9 years; P = 0.298). Surgery success rate significantly declined when
apicoectomy involved four teeth (OR = 109.412; P = 0.002).
CONCLUSIONS: Endodontic microsurgery demonstrates satisfactory outcomes in complicated cases, maintaining a stable success rate after two years. However, tooth survival and surgery success are significantly compromised when
apicoectomy involves four teeth. Factors such as guided tissue regeneration, an open apex, and the palatal surgical approach are associated with an increased risk of tooth extraction.
CONCLUSIONS: Despite achieving acceptable outcomes in complicated cases, endodontic microsurgery is adversely affected by the
apicoectomy of four teeth.