冠状修復物の質と根管充填物の質が根管治療の成功に与える影響：系統的レビューとメタ分析

Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis.

抄録

はじめに:

根管の徹底的な清掃と形成は、根尖周囲の治癒に不可欠である。また、歯内療法を行った歯が機能し、歯冠漏出を防止するためには、歯内療法を行った歯を修復することが必要である。この研究では、根管治療の質と歯冠修復の質が治療成績に与える影響を比較した。

INTRODUCTION: Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes.

方法:

検索語 "coronal restoration", "root canal", "periapical status", "quality "を用いて文献検索を実施した。根充と歯冠修復の品質、またはその両方が根管治療の成功に及ぼす影響を評価した論文を選択した。9 件の論文が同定され，3 名の研究者によってレビューが行われた．データはあらかじめ設定された基準に基づいて収集された．根管治療が十分であった歯（AE），根管治療が不十分であった歯（IE），修復が十分であった歯（AR），修復が不十分であった歯（IR）のカテゴリーごとに根尖性歯周炎のない歯の割合が記録された．データはメタアナリシスによりオッズ比（OR）で解析した。

METHODS: Literature search was conducted using the search terms "coronal restoration," "root canal," "periapical status," and "quality." Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected. Nine articles were identified and were reviewed by 3 investigators. Data were collected based on predetermined criteria. Percentages of teeth without apical periodontitis were recorded for each category: adequate root canal treatment (AE), inadequate root canal treatment (IE), adequate restoration (AR), and inadequate restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs).

結果:

異質性を低減するために有意な共変量を調整した後、結果を組み合わせて、AR/AE対AR/IE（OR = 2.734; 95％信頼区間[CI]、2.61-2.88、P < .001）およびAR/AE対IR/AE（OR = 2.808; 95％ CI, 2.64-2.97; P < .001）の比較の共通ORのプール推定値が求められた。

RESULTS: After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61-2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001).

結論:

現在入手可能な最善のエビデンスに基づくと、根管治療と修復治療を適切に行うことで、根尖性歯周炎の治癒の確率は上昇する。十分な根管充填-不十分な歯冠修復と不十分な根管充填-不十分な歯冠修復では、より悪い臨床結果が予想されるが、これら2つの組み合わせの治癒のオッズに有意差はない。

CONCLUSIONS: On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these 2 combinations.