Influence of different endodontic treatment protocols on tooth survival: A retrospective cohort study with multistate analysis and group balancing

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal Pub Date : 2025-06-13 DOI:10.1111/iej.14271

Ahmed Elmaasarawi, Mohamed Mekhemar, Andreas Bartols

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引用次数: 0

Abstract

Aim

This study aimed to assess how three different treatment protocols affect the survival of teeth and the survival of teeth without further interventions after root canal treatment (RCT), while also considering additional factors that could potentially influence the treatment outcome.

Methodology

Data were collected from an outpatient clinic database from July 1999 to January 2024 and 14 233 treated teeth could be included in a retrospective cohort study. Treatment protocols incorporated hand files (Protocol 1), multiple-file rotary NiTi systems added with passive ultrasonic irrigation (PUI), citric acid and occasionally chlorhexidine (Protocol 2) and reciprocating instruments added with PUI, EDTA, warm vertical compaction and calcium silicate-based sealer (Protocol 3). Survival analysis coupled with Cox proportional hazard regression and Kaplan–Meier curves took into account several variables including treatment, patient demographics and experience of the treatment provider. Confounding was addressed by entropy balancing and gradient boosted logistic regression. Multistate analysis was conducted to evaluate the influence of treatment protocols on the transition between various intervention states.

Results

Survival analysis revealed that Protocol 3 significantly enhanced survival rates and survival rates without further interventions by 30%–40% compared to both other protocols. Additionally, higher patient age was identified as a negative predictor of treatment outcomes. Supportive periodontal treatments were a positive predictor. Factors such as tooth type, vitality, number of visits, experienced treatment provider, calcium silicate-based sealer and patient gender did not significantly affect outcomes in the adjusted models. Multistate analysis confirmed that Protocol 3 was associated with significantly reduced incidences of retreatment and extraction.

Conclusion

Protocol 3 significantly enhanced survival and survival without further interventions compared to both other protocols. Patient age and supportive periodontal treatments were significant predictors of outcomes throughout all calculated models.

Abstract Image

查看原文本刊更多论文

不同根管治疗方案对牙齿存活的影响：一项多状态分析和组平衡的回顾性队列研究。

目的：本研究旨在评估三种不同的治疗方案如何影响根管治疗后牙齿的存活和无需进一步干预的牙齿存活（RCT），同时考虑可能影响治疗结果的其他因素。方法：从1999年7月至2024年1月的门诊数据库中收集数据，将14233颗治疗过的牙齿纳入回顾性队列研究。治疗方案包括手锉（方案1）、多锉旋转NiTi系统，外加被动超声灌洗（PUI）、柠檬酸和偶尔的氯己定（方案2），以及往复式仪器，外加PUI、EDTA、热垂直压实和硅酸钙基封口剂（方案3）。生存分析结合Cox比例风险回归和Kaplan-Meier曲线考虑了几个变量，包括治疗、患者人口统计学和治疗提供者的经验。通过熵平衡和梯度增强逻辑回归来解决混淆问题。采用多状态分析来评价治疗方案对不同干预状态间转换的影响。结果：生存分析显示，与其他两种方案相比，方案3显著提高了生存率和无进一步干预的生存率，提高了30%-40%。此外，较高的患者年龄被确定为治疗结果的负面预测因子。支持性牙周治疗是积极的预测因子。在调整后的模型中，牙齿类型、活力、就诊次数、经验丰富的治疗提供者、硅酸钙基封口剂和患者性别等因素对结果没有显著影响。多状态分析证实，议定书3与显著减少再处理和提取的发生率有关。结论：与其他两种方案相比，方案3显著提高了生存率和无需进一步干预的生存率。患者年龄和支持牙周治疗是所有计算模型结果的重要预测因素。

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

International endodontic journal 医学-牙科与口腔外科

CiteScore

10.20

自引率

28.00%

发文量

195

审稿时长

4-8 weeks

期刊介绍： The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted. The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.