Der Einfluss verschiedener Parameter auf das Überleben von endodontischen Maßnahmen an Milchzähnen

Introduction: The aim of this study was to examine the influence of various parameters on the cumulative survival of primary teeth following endodontic treatment. Method: Using medical files, data from patients in a dental school who have received endodontic treatments on one or more teeth between 2001 and 2010 were surveyed. Various parameters which affect the success or failure of endodontic therapy were recorded. The survival time was analyzed using the Kaplan Meier estimator, and the log-rank test was applied for group comparisons. The significance level was set at α = 0.05. Teeth which at the time of the last dental findings were still in situ or naturally exfoliated were recorded as a "success" (census). Teeth which had been prematurely extracted were recorded as a "failure". Results: Data was collected from 218 child patients (341 teeth). The average age of the patients at the beginning of the treatment was 5.4 years. Of the total of 341 teeth, 232 (68 %) were still in situ at the end of the observation period, 40 (11.7 %) were naturally exfoliated and 69 (20.2 %) teeth had been prematurely extracted. An average survival time of 62 months (95 % confidence interval 55.5-68.4) was found for all endodontic treatments capable of being assessed. Vital teeth showed a significantly higher average survival time (39.8 months) compared to non-vital teeth (20.1 months, p=0.01). Teeth which tested negative to percussion showed a significantly higher (p=0.01) survival time of 24.7 months compared to teeth which positively tested to percussion (19.2 months). The survival time of teeth that showed only a cavity on x-rays was 67.1 months and was significantly higher (p=0.01) than those had a radiographically interradicular osteitis. A significantly higher average survival time (p=0.01) was exhibited by teeth with indirect pulp capping compared to pulpotomized (37.1 months) and pulpectomized (28.3 months) teeth. Treatment of patients under general anesthesia showed significantly better results (p <0.01) than treatment of patients with normal compliance. The survival time of teeth treated with a compomer filling after the endodontic treatment was significantly higher than that of teeth with a GIC filling (p <0.01). Teeth with a zinc oxide filling had a significantly poorer survival time than teeth with a composite (p <0.01) or compomer filling (p <0.01). Teeth of patients below the mean age (5.4 years) showed a significantly higher mean survival time (66.4 months) compared to patients above the mean age (56.2 months). A significantly higher (p <0.01) mean survival time (66.7 months) was found in patients with a DMFT index below the mean value of 0.54 compared to patients whose DMFT index was above the mean value (33.8 months). Regarding the type of tooth, no significant difference was observed between primary anterior teeth, canines or molars. There was no significant difference in the survival time of symptom-free primary teeth compared to those with symptoms and medical history in general, as well in patients with normal compared to abnormal patient history. The different states of the tooth prior to treatment (e.g. fistula, abscess, infiltration, and trauma) showed no significant difference in the survival time. Dental treatment by specialists in pediatric dentistry showed no significant difference when compared with non-specialists. Regarding the root filling material used in the pulpectomy, no significant difference between calcium hydroxide paste and calcium hydroxide-iodoform paste was observed. The dmft-index was not shown to be a significant factor. Conclusion: Certain parameters (including pulp vitality, X-ray findings), as well as dental factors (e.g. choice of adequate endodontic treatment, choice of proper filling material) were identified as factors with significant influence on the survival time of endodontically treated primary teeth.