- 學位論文
探討影響乳牙根管治療預後因子之研究
Investigating the prognosis factors of endodontic treatment for primary teeth
摘要
研究背景：西元2012年，針對台灣地區兒童及青少年的口腔狀況調查結果顯示，12歲的學童其恆牙齲齒經驗指數平均值為2.50顆，比起世界衛生組織訂定的西元2025年的目標1.00顆還有很大的差距，而且數值還在全球70%的國家之後，顯示台灣兒童齲齒率仍偏高。 研究目的：乳牙根管治療後的牙齒會有齒質上的變化，咬到硬的食物容易造成牙齒裂掉，或因清潔不佳，造成二次齲齒或填補物掉落，需要再次治療。本研究的目的是想評估影響乳牙根管治療失敗的因素與乳牙的牙套是否可以降低失敗風險發生的機率。 研究方法：使用病歷回溯的方式，收案對象是年齡為9歲以下，於2016年8月到2019年7月在高雄榮總牙科有施作乳臼齒根管治療的病患。記錄病患年齡、性別、根管治療牙位、根管治療完成日開始，直至因病理性因素需要重新根管治療完成，與是否有施作牙套和接受根管治療的治療模式、病患身體狀況、是否有身心障礙和轉診等情形。使用描述性統計、獨立樣本t檢定、卡方檢定、變異數分析、邏輯迴歸、存活曲線和存活率分析來討論各變項對根管治療成功率的影響。 研究結果：總共有964顆接受根管治療的乳臼齒，女生有137人,佔 43.49%和男生178人,佔56.51%。平均每人根管治療顆數有3.08±2.26顆。乳牙根管治療病患中，病患年齡大部分在4-6歲，而5歲佔最多。有製作牙套的牙齒顆數為756顆(78.42%)，無製作牙套的牙齒顆數為208顆(21.58%)。重新根管治療的牙齒顆數有44顆，其中製作牙套756顆中重新治療20顆(2.65%)，無製作牙套208顆中重新治療24顆(11.54%)。根管治療後無製作牙套重新治療的比例較高。使用cox迴歸模式分析，發現病患治療時的年齡、根管治療後有無製作牙套、是否有系統性疾病與存活率有關。年齡的HRR(Hazard ratio rate)是1.35(95% CI=1.07~1.70)，P value=0.012。年齡愈高，需要重新治療的機會較高。是否製作牙套的HRR為10.94(95% CI=4.45~26.90)，P value<0.001。沒有製作牙套，根管治療失敗的風險比較高。是否有系統性疾病的HRR為0.27(95% CI=0.12~0.58)，P value=0.001。有系統性疾病的患者，根管治療的預後較不好。而病患性別、治療模式、是否有身心障礙、是否經由轉診來就診與根管治療存活率無顯著相關(P >0.05)。 結論：在治療乳牙齲齒時，需要多方面考量病患的條件和狀況，不能單純只考慮蛀牙的深度，因為病患年齡、治療計畫、身體狀況等都會影響治療的成果。在較高風險，如有系統性疾病的孩童可以縮短定期牙科回診的時間，早期診斷早期治療，在治療計畫上也可以更完善。而乳牙牙套可以改善乳牙接受牙髓治療後的成功率，可以應用此結果在臨床上，讓家長願意讓小孩接受更完善的治療。
並列摘要
Background: A 2012 survey aimed to evaluate oral health in Taiwanese children and adolescents shows that the DMFT index of permanent teeth for children aged 12 is 2.50, which is far beyond the target 1.00 in 2025 set up by the World Health Organization. There is still a large gap to make progress and to reach the ideal. In addition, the result of Taiwan is also behind 70% of the countries through the whole world, indicating that the high dental caries rate among Taiwanese children. Objective: The deciduous teeth after root canal treatment (RCT) will have biomechanical and physiological changes. It will cause to the tooth more susceptible to crack, secondary dental caries, or dislodged of dental filling when biting hard food, or due to poor cleaning, which needs to be retreated. The purpose of this study was to evaluate the factors affected the failure rate of RCT in deciduous teeth, and determined whether dental prosthesis (SSC) could be benefit to reduce the failure rate. Material and methods: By means of retrospective medical records, the patients under the age of 9 and had history of RCT over primary molars from August 2016 to July 2019 in Kaohsiung Veterans General Hospital were included. The following information had been recorded: the patient's age, gender, the tooth position received RCT, the initial and final date of RCT and RCT retreatment due to pathological factors, whether crowns have been applied, the mode of treatment, patient’s physical condition, physical and mental disability and referral. Descriptive statistics, independent sample t test, chi-square test, variance analysis, logistic regression, Kaplan-Meier method and survival analysis were used to analysis the effects of various variables on the success rate of RCT. Results: A total of 964 primary molars were treated with RCT. There were 137 girls, accounting for 43.49% and 178 boys, accounting for 56.51%. The average number of teeth with RCT per person was 3.08 ± 2.26. Among the patients’ deciduous teeth treated with RCT, mostly their age were between 4-6 years old, and 5 years old accounted for the majority. The number of teeth with crowns was 756 (78.42%) compared to the 208 (21.58%) teeth without crowns. There were 44 teeth with RCT retreated, of which 20 (2.65%) were among 756 crowns, and 24 (11.54%) were re-treated without 208 crowns. Using Cox regression model, it was found that the patient's age during treatment, with or without crowns after RCT, and the patient’s systemic diseases were related to survival rate. The HRR (Hazard ratio rate) of age was 1.35 (95% CI=1.07~1.70), and P value = 0.012. The older patients had higher retreatment rate. The HRR correlated to with or without crowns was 10.94 (95% CI=4.45~26.90), and P value < 0.001. Without crowns, the risk of RCT failure is relatively high. The HRR of patient’s systemic diseases was 0.27 (95% CI=0.12~0.58), and P value = 0.001. In patients with systemic disease, the prognosis of RCT is relatively poor. There was no significant correlation with survival rate (P>0.05) between patient’s gender, tooth position, treatment intervention, physical and mental disability, and referral for RCT. Conclusion: During approaching deciduous tooth caries, the general condition of the patient must be considered in many aspects. It is impossible to simply consider only the depth of tooth decay. That’s because the patient's age, treatment plan, and physical condition will all affect the outcome of the treatment. At higher risks, for example, children with systemic diseases should arrange more frequently for regular dental visits. Early diagnosis and early intervention can make the treatment more effective and perfect. The crowns can improve the success rate of deciduous teeth after RCT. This result can be used in daily practice to communicate and encourage parents willing to cooperate for more comprehensive treatment.