Factores Prequirúrgicos Determinantes del Pronóstico Dental en Microcirugía Endodóntica a Diferentes Intervalos de Tiempo
Autores
García Guerrero, Claudia Carmiña
Director
Niño Barrera, Javier Laureano (Thesis advisor)
Tipo de contenido
Trabajo de grado - Maestría
Idioma del documento
EspañolFecha de publicación
2016-10-17
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Resumen
Objetivo: Analizar mediante la observación clínica, radiográfica y tomográfica, la asociación de los factores prequirúrgicos con el resultado del tratamiento Microcirugía Endodóntica, para dientes con enfermedad periapical post-tratamiento, en una cohorte prospectiva de pacientes evaluados desde uno hasta cinco años. Métodos: Estudio de cohorte de incepción tipo concurrente, que incluyó, de manera consecutiva, dientes permanentes con Enfermedad Periapical Posendodoncia (EPP), tratados con ME. Variable Dependiente: categorías de “Éxito y Fracaso”, según criterios; clínicos, radiográficos y tomográficos. Variables Independientes: Un factor de exposición, Altura de la cresta ósea (AC). Otras covariables: sexo, edad, tipo y localización del diente, tamaño de la lesión, integridad de la tabla ósea vestibular, calidad de la obturación endodóntica, presencia de signos y síntomas clínicos fueron analizadas en función del resultado. Análisis estadístico. Se estimó el grado de variabilidad inter-observador, para la lectura de la variable respuesta. Dos modelos; regresión lineal (ML) y regresión logística ajustado (MLog), con 95% de confianza determinaron la asociación factores prequirúrgicos y resultado posquirúrgico. Un análisis de probabilidad estableció la oportunidad de fracasar acorde con situaciones clínicas simuladas. Un Modelo Proporcional de Cox, estableció la relación entre los factores prequirúrgicos y el riesgo de fracaso posterior a ME en función del tiempo. Resultados: 125 dientes con EPP, sometidos a ME, un 88.8% fueron considerados exitosos. Las covariables sexo, categoría Hombre (OR: 9.09; IC95%0.02- 0.52; P=0.05) y “calidad de la obturación” categoría inadecuada (OR: 9.1; IC95%1.42- 59.10; P=0.020), resultaron ser estadísticamente significativas. El factor AC, no representó asociación con el fracaso de la ME (OR: 0.38; IC95%0.08-1.83; P=0.23). Para el Modelo proporcional de Cox se confirmó la asociación Hombre – Fracaso. Conclusión: El procedimiento de ME fue exitoso. El factor de exposición AC, no representó un riesgo en el resultado del procedimiento. Ser Hombre y presentar una Obturación endodóntica inadecuada fueron predictores del fracaso.
Abstract. Aim: To analyze, through clinical, radiographic and tomographic observation, the association of preoperative factors with the result of the Endodontic Microsurgery treatment, for teeth with post-treatment periapical disease, in a prospective cohort of patients evaluated from one to five years. Methods: Concurrent type inception cohort study, which included, consecutively, permanent teeth with Periapical Posendodontic Disease (PPD), treated with ME. Dependent Variable: "Success and Failure" categories, according to criteria; Clinical, radiographic and tomographic. Independent variables: An exposure factor, Bone crest height level (CL). Other covariates: sex, age, tooth type and location, lesion size, the buccal bone table, quality of endodontic obturation, presence of clinical signs and symptoms were analyzed according to the outcome. Analysis. The degree of inter-observer variability was estimated for reading the response variable. Two models; Linear regression (ML) and adjusted logistic regression (MLog), with 95% confidence determined the association between pre-surgical factors and postoperative outcome. A probability analysis established the opportunity to fail according to simulated clinical situations. A Cox Proportional Model established the relationship between preoperative factors and the failure as function of the time. Results: 125 teeth with PPD, submitted to ME, 88.8% were considered successful. The covariates of the male category (OR: 9.09, IC95% 0.02- 0.52, P = 0.05) and "quality of obturation" category (OR: 9.1, 95% CI 1.42- 59.10, P = 0.020) were found to be statistically significant. The AC factor was not associated with the failure of the ME (OR: 0.38; 95% CI 0.08-1.83; P = 0.23). For the Cox proportional model the Man - Failure association was confirmed. Conclusion: The ME procedure was successful. The AC exposure factor did not represent a risk in the outcome of the procedure. The factors “Man” and “inadequate endodontic obturation” were predictors of failure.
Abstract. Aim: To analyze, through clinical, radiographic and tomographic observation, the association of preoperative factors with the result of the Endodontic Microsurgery treatment, for teeth with post-treatment periapical disease, in a prospective cohort of patients evaluated from one to five years. Methods: Concurrent type inception cohort study, which included, consecutively, permanent teeth with Periapical Posendodontic Disease (PPD), treated with ME. Dependent Variable: "Success and Failure" categories, according to criteria; Clinical, radiographic and tomographic. Independent variables: An exposure factor, Bone crest height level (CL). Other covariates: sex, age, tooth type and location, lesion size, the buccal bone table, quality of endodontic obturation, presence of clinical signs and symptoms were analyzed according to the outcome. Analysis. The degree of inter-observer variability was estimated for reading the response variable. Two models; Linear regression (ML) and adjusted logistic regression (MLog), with 95% confidence determined the association between pre-surgical factors and postoperative outcome. A probability analysis established the opportunity to fail according to simulated clinical situations. A Cox Proportional Model established the relationship between preoperative factors and the failure as function of the time. Results: 125 teeth with PPD, submitted to ME, 88.8% were considered successful. The covariates of the male category (OR: 9.09, IC95% 0.02- 0.52, P = 0.05) and "quality of obturation" category (OR: 9.1, 95% CI 1.42- 59.10, P = 0.020) were found to be statistically significant. The AC factor was not associated with the failure of the ME (OR: 0.38; 95% CI 0.08-1.83; P = 0.23). For the Cox proportional model the Man - Failure association was confirmed. Conclusion: The ME procedure was successful. The AC exposure factor did not represent a risk in the outcome of the procedure. The factors “Man” and “inadequate endodontic obturation” were predictors of failure.