Outcomes of apexification in immature traumatised necrotic teeth and risk factors for premature tooth loss: A 20-year longitudinal study

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Dental Traumatology Pub Date : 2024-06-05 DOI:10.1111/edt.12973

Alina Wikström, Malin Brundin, Afrah Mohmud, Maria Anderson, Georgios Tsilingaridis

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Abstract

Background/Aim

To evaluate the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA-apical plug) and to identify major factors affecting the survival of these teeth.

Materials and Methods

Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time-point for tooth loss, and overall survival time in years. Kaplan–Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI).

Results

The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA-apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3–5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1–2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3–5, and 5.6 times higher in avulsions.

Conclusions

Calcium hydroxide apexification, avulsion, and postoperative PAI 3–5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss.

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未成熟外伤坏死牙的先端修复结果和牙齿过早脱落的风险因素：一项为期 20 年的纵向研究。

背景/目的：评估使用两种根管治疗技术（氢氧化钙根尖化技术和 MTA 根尖封闭技术）对牙髓坏死和根尖牙周炎的未成熟外伤切牙进行根管治疗后的长期存活率，并确定影响这些牙齿存活率的主要因素：在 2003 年 1 月至 2022 年 12 月期间，对 2400 名儿童和青少年的记录进行了筛查，以确定是否存在对未成熟切牙的外伤，在这些未成熟切牙中使用了两种根管治疗技术，并与使用传统根管治疗技术的成熟牙齿对照组进行了比较。研究的变量包括年龄、性别、根尖强化技术、是否存在牙槽骨和硬组织损伤、术前牙根发育阶段（RDS）、术前和术后根尖周指数（PAI）、牙齿脱落的时间点以及以年为单位的总存活时间。采用 Kaplan-Meier 估计法以图形显示生存函数，并采用 Cox 比例危险模型计算危险比（HR，95% CI）：结果：氢氧化钙顶点成形术的中位生存时间为10年，MTA-顶点成形术为16.1年，除侵入和撕脱外的松动损伤为15.5年，侵入为12.5年，撕脱为6.8年。对牙齿存活率有明显负面影响的变量是氢氧化钙顶点化、撕脱和术后 PAI 3-5。MTA顶点化、震荡、半脱位、侧脱位、挤压、内陷、硬组织损伤、术前RDS和PAI评分以及术后PAI 1-2等变量均无明显关系。经过调整后，氢氧化钙先端缺损导致牙齿过早脱落的风险高出13.5倍，PAI 3-5高出约2至4倍，而撕脱则高出5.6倍：结论：氢氧化钙尖化、撕脱和术后 PAI 3-5 是对牙齿过早脱落风险有显著负面影响的预后变量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dental Traumatology 医学-牙科与口腔外科

CiteScore

6.40

自引率

32.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Dental Traumatology is an international journal that aims to convey scientific and clinical progress in all areas related to adult and pediatric dental traumatology. This includes the following topics: - Epidemiology, Social Aspects, Education, Diagnostics - Esthetics / Prosthetics/ Restorative - Evidence Based Traumatology & Study Design - Oral & Maxillofacial Surgery/Transplant/Implant - Pediatrics and Orthodontics - Prevention and Sports Dentistry - Endodontics and Periodontal Aspects The journal"s aim is to promote communication among clinicians, educators, researchers, and others interested in the field of dental traumatology.