目的:有意再植(IR)被认为是保留根尖周炎牙齿的可行治疗选择。这项研究旨在比较有或没有牙周受累的牙齿IR的治疗结果,并探讨相关因素的影响。
方法:共纳入157颗牙齿,这些牙齿在2012年9月至2022年11月期间有IR病史,随访时间超过1年。样本包括100颗单纯性根尖周炎的牙齿和57颗牙周牙髓联合病变(CPEL)的牙齿。临床和影像学标准用于评估治疗结果,包括功能保留和拔除。卡方分析和Fisher精确检验用于比较结果与临床或人口统计学变量之间的双变量关联。使用Kaplan-Meier分析来评估有意重新种植的牙齿的累积存活率。
结果:1年总累积生存率为93.0%,5年的76.7%,10年的56.2%。在100颗单纯性根尖周炎的牙齿中,生存率为93.0%,86.7%,和78.8%在同一时间点。相比之下,57颗CPEL牙齿的存活率为93.0%,65.0%,36.9%,分别。导致拔牙的主要术后并发症是牙周受累(51.9%),牙齿骨折(18.5%),外部根部吸收(18.5%),和持续性根尖周炎(11.1%)。CPEL牙齿的结果受窦道和牙冠修复的存在显着影响。相比之下,未发现无牙周受累的牙齿的显著预后因素.
结论:CPEL患者的长期预后明显比单纯根尖周炎患者差。拔牙的主要原因是牙周受累。定期进行牙周维护和适当的牙冠修复可能有助于改善CPEL牙齿的预后。
OBJECTIVE: Intentional replantation (IR) is considered as a viable treatment option to preserve the teeth with apical periodontitis. This study aimed to compare the treatment outcomes of IR in teeth with or without periodontal involvement, and to investigate the influence of related factors.
METHODS: A total of 157 teeth with a documented history of IR between September 2012 and November 2022 and a follow-up duration of more than 1 year were included. The samples included 100 teeth with simple apical periodontitis and 57 teeth with combined periodontal-endodontic lesions (CPEL). Clinical and radiographic criteria were used to evaluate treatment outcomes including functional retention and extraction. Chi-square analyses and Fisher\'s exact tests were used to compare bivariate associations between outcomes and clinical or demographic variables. Kaplan-Meier analyses were used to evaluate the cumulative survival rate of the intentionally replanted teeth.
RESULTS: The overall cumulative survival rates were 93.0% at 1 year, 76.7% at 5 years, and 56.2% at 10 years. Among the 100 teeth with simple apical periodontitis, the survival rates were 93.0%, 86.7%, and 78.8% at the same time points. In contrast, 57 teeth with CPEL exhibited survival rates of 93.0%, 65.0%, and 36.9%, respectively. The primary postoperative complications that led to extraction were periodontal involvement (51.9%), tooth fracture (18.5%), external root resorption (18.5%), and persistent apical periodontitis (11.1%). The outcomes of teeth with CPEL were significantly affected by the presence of a sinus tract and crown restoration. In contrast, no significant prognostic factors were identified for teeth without periodontal involvement.
CONCLUSIONS: The long-term prognosis of teeth with CPEL is significantly worse than those with simple apical periodontitis. The main reason of extraction was periodontal involvement. Regular periodontal maintenance and appropriate crown restoration may help to improve the prognosis for teeth with CPEL.