根管治疗后牙根纵裂与牙体修复相关性的回顾性研究

A retrospective study on the correlation between vertical root fracture and crown restoration after root canal treatment

目的:分析根管治疗后牙根纵裂与牙体修复间的相关性,探讨根管治疗后牙根纵裂发生的影响因素。方法:回顾性收集2010年01月至2022年07月就诊于郑州大学口腔医院,曾接受根管治疗现存在持续性症状及体征患牙的临床资料,纳入可能影响根管治疗后牙根纵裂的临床指标行单因素分析,将有统计学意义的指标经共线性诊断后采用多因素Logistic回归进行统计学分析,P<0.05具有统计学意义。结果:在614个根管治疗后存在症状及体征的患牙中,158个诊断为牙根纵裂,发生率25.7%,其中采用冠修复的患牙共104个,包括69个全冠(43.7%)、35个桩(核)冠(22.2%),且67个采用二氧化锆全瓷材料;在桩(核)冠修复中多为纤维桩(62.9%),其次是铸造桩(34.3%),桩长多达根中1/3(57.1%)。多因素Logistic回归结果显示牙冠修复方式、修复材料、修复体存在形式、桩的应用、患牙咬合关系不良、邻牙缺失、牙周条件不良、窦道、牙周探诊深度(P<0.001)与根管治疗后牙根纵裂的发生相关。结论:二氧化锆全瓷材料的全冠修复、桩的应用及咬合不良因素等是根管治疗后牙根纵裂发生的危险因素,且为多因素长期综合作用所致。

AIM:This study was conducted to analyze the association between vertical root fracture(VRF)and crown restoration after root canal treatment(RCT),as well as to investigate the related factors contributing to VRF of endodontically treated teeth(ETT)METHODS:A retrospective study was conducted to collect the clinical data of ETT with persistent symptoms and signs at Zhengzhou University Stomatological Hospital from January 2010 to July 2022.Single-factor analysis was conducted on clinical indicators that could potentially influence the occurrence of VRF of ETT.After the multicollinearity diagnosis,the significant indicators were applied in a multivariate logistic regression analysis to certify the relevant factors that may contribute to the development of VRF of ETT.P<0.05 was considered statistical significance.RESULTS:614 teeth were included in the study,158 were diagnosed with VRF of ETT(25.7%),of which 104 were restored with crown restoration including 69 full crowns(43.7%),35 post(core)crowns(22.2%),and 67 zirconia ceramic crowns.Of the post-core crowns,the post was mostly fibrous post(62.9%),followed by cast post(34.3%).Among them,the length of the post was more than 1/3 of the root accounted for 57.1%.The results of multifactorial logistic regression showed that crown restorative method,restorative material,restorative form,application of post,malocclusion of the affected teeth,adjacent tooth loss,poor periodontal condition,sinus tract exist,and deep probing depth(PD)were significantly associated with the occurrence of VRF of ETT(P<0.001).CONCLUSION:Full crown restoration of zirconia ceramic with malocclusion,the application of posts are risk factors for VRF of ETT.The VRF of ETT is the result of multifactorial long-term cumulative effects.