一次法与多次法根管治疗术的临床疗效对比观察和影响因素分析

Observation of clinical outcomes of single-visit versus multiple-visit endodontic therapy and analysis of relavant factors

目的比较一次法和多次法根管治疗成功率、术后疼痛率和椅旁总操作时间,分析影响根管治疗疗效的因素。方法选择2015年9月~2018年12月接受初次根管治疗的176例患者的202颗患牙,随机分配进行一次或多次治疗,记录医生椅旁总操作时间。术后随访记录疼痛情况,依据临床检查和X线片评判治疗效果。结果一次法和多次法根管治疗的成功率分别为83.9%和85.3%,术后一周疼痛率分别为24%和14%,差异无统计学意义(P>0.05)。经logistic回归分析显示牙髓状态及根尖周有无病变是与根管治疗效果有显著相关性的因素。一次法和多次法根管治疗的椅旁总操作时间分别为72.33 min和86.98 min,经多元方差分析结果显示,一次法根管治疗和单根管减少了椅旁操作时间。结论牙髓状态和根尖周情况对初次根管治疗的成功率有着较明显的影响。一次法与多次法根管治疗效果无明显差异,但一次法根管治疗可明显缩短椅旁操作时间,值得在临床推广使用。

Objective To compare the success rate,prevalence of postoperative pain and total chairside time of single-visit and multiple-visit endodontic treatments,and evaluate the relationship between the treatment outcome and relevant factors.Methods 176 patients with 202 teeth received initial endodontic treatment between September 2015 and March 2019 were included in the study.Patients were randomly assigned to single-visit or multiple-visit treatments.The total chairside time and postoperative pain were recorded.The outcome was examined clinically and radiographically.Results The success rate of single and multiple root canal treatment was 83.9% and 85.3%,respectively,and the pain rate was 24% and 14% one week after the operation(P>0.05).Logistic regression analysis showed that pulp status and periapical lesions were the factors significantly correlated with the effect of root canal treatment.The average chairside time of single-visit and multiple-visit treatments were 72.33 min and 86.98 min respectively.Results in the final model of multi-way ANCOVA showed the chairside time was reduced by single-visit treatment and treatment on a single-canal tooth.Conclusions Pulp vitality and apical periodontitis may be prognostic factors for outcome of initial endodontic treatment.There was no significant difference in the effect of single root canal therapy and multiple root canal therapy.The total chairside time for single-visit treatment was shorter than multiple-visit treatment,which is worth popularizing in clinical.