歯周病後疼痛の発生率と重症度に対する歯牙因子と処置ミスの影響：プロスペクティブ臨床研究

Influence of Tooth Factors and Procedural Errors on the Incidence and Severity of Post-Endodontic Pain: A Prospective Clinical Study.

• Lavanya Bamini
• Anand Sherwood
• Ana Arias
• Savadamoorthi Kamatchi Subramani
• Puridi Bhargavi

抄録

この前向き研究の目的は、術後疼痛（PP）の発生率に役割を果たす歯に関連する因子を評価し、手続き上のエラーがPPの発生に影響を与えるかどうかを判断することであった。根管治療のために紹介された合計442人の患者が包括基準を満たし、この前向き研究に含まれた。すべての根管治療で同じプロトコールを使用した。患者、歯、治療に関連する因子、および手順エラーの発生を登録した。PPの発生率と強度は、治療後7日後と15日後の24時間と48時間に電話インタビューと対面で評価した。ロジスティック回帰分析と順序回帰分析を用いて、PPの発生率と強度における患者、歯、治療関連因子の役割を評価した。術前因子と術中因子は、異なる時間間隔でPPの発生率に異なる影響を与えた。手技ミスの存在はPPの発生に有意な影響を与えなかった。術前疼痛の存在と治療中の追加麻酔の必要性は治療後24時間および48時間後のPP発生率の高さと関連していた；治療7日後のPP発生には先端拡大の程度が重要な役割を果たしていた；対側の歯がないことによる過剰な咬合負荷は15日後までのPP維持に関連する唯一の因子であった。結論として、術前疼痛の存在、治療中の追加麻酔の必要性、先端拡大の程度、対合歯がないことによる過大な咬合負荷がPPの発生率の増加に関係していた。

The objective of this prospective study was to assess tooth-related factors that play a role in the incidence of postoperative pain (PP) and determining if procedural errors influence PP occurrence. A total of 442 patients referred for root canal treatment met the inclusion criteria and were included in this prospective study. The same protocol was used in all root canal treatments. Patient, tooth, treatment related factors and the occurrence of procedural errors were registered. Incidence and intensity of PP was assessed at 24 and 48 h by telephonic interview and in person seven and 15 days after treatment. A logistic and ordinal regression analysis was used to assess the role of patient, tooth and treatment related factors in the incidence and intensity of PP, respectively. Preoperative and intraoperative factors differently affected the incidence of PP at the different time intervals. The presence of procedural errors did not significantly influence PP occurrence. The presence of preoperative pain and the need of additional anesthesia during treatment were associated with higher incidence of PP 24 and 48 h after treatment; the extent of apical enlargement played a significant role in the presence of PP after seven days of treatment; and the excessive occlusal load induced by the absence of a contralateral tooth was the only factor related to the maintenance of PP up to 15 days. In conclusion, the presence of preoperative pain, the need of additional anesthesia during treatment, the extent of apical enlargement and the excessive occlusal load induced by the absence of a contralateral tooth were related to a higher incidence of PP.