根尖周炎与局部边缘性牙槽骨丧失关系的回顾性研究

doi:10.13591/j.cnki.kqyx.2026.08.001

摘要/Abstract

摘要：

目的基于锥形束CT(CBCT)探讨根尖周炎(apical periodontitis,AP)与局部边缘性牙槽骨丧失(alveolar bone loss,ABL)之间的关系。方法采用同体对侧配对设计,纳入48例患者,共60对配对牙。将存在明确根尖周炎,即CBCT根尖周指数(periapical index,PAI)≥3的牙齿纳入根尖周炎组,其对侧根尖周正常牙(PAI≤1)纳入对照组。基于CBCT测量ABL并计算ABL比例(ABL%)。Wilcoxon符号秩检验、McNemar检验和Stuart-Maxwell检验用于组间比较;多因素线性混合效应模型(linear mixed-effects model,LMM)评估CBCT-PAI评分与骨丧失程度之间的趋势关联。结果根尖周炎组的平均ABL及ABL比例显著高于对照组。AP对骨丧失的影响在前牙和磨牙区更为显著。在校正牙型等因素后证实,AP是平均ABL及ABL比例加重的独立相关因素。在根尖周炎牙中,CBCT-PAI评分每增加1分,平均ABL增加0.64 mm,ABL比例平均增加5.07%。结论根尖周炎与局部边缘性牙槽骨丧失程度增加显著相关。

关键词: 根尖周炎, 牙槽骨丧失, 同体配对研究, 根尖周指数, 牙髓-牙周关系

Abstract:

Objective To investigate the association between apical periodontitis(AP) and local marginal alveolar bone loss(ABL) based on cone beam computed tomography(CBCT). Methods This study adopted an intra-subject contralateral paired design. A total of 48 patients with 60 pairs of matched teeth were included. Teeth with definite apical periodontitis, defined as a CBCT-periapical index(CBCT-PAI) score ≥3, were assigned to the AP group, while the contralateral teeth with normal periapical status(PAI≤1) served as the control group. ABL was measured on CBCT images, and the alveolar bone loss percentage(ABL%) was calculated. Group comparisons were performed using the Wilcoxon signed-rank test, McNemar test, and Stuart-Maxwell test. Multivariable linear mixed-effects models(LMMs) were used to evaluate the trend association between CBCT-PAI scores and the extent of bone loss. Results The AP group showed significantly greater mean ABL and ABL percentage than the control group. The impact of AP on alveolar bone loss is more significant in the anterior teeth and molars. After adjustment for tooth type and other relevant factors, AP remained an independent factor associated with increased mean ABL and ABL percentage. Among AP teeth, each 1-point increase in CBCT-PAI score was associated with a 0.64 mm increase in mean ABL and a 5.07% increase in ABL percentage. Conclusion Apical periodontitis is significantly associated with increased local marginal ABL.

Key words: apical periodontitis, alveolar bone loss, intra-subject paired study, periapical index, endodontic-periodontal relationship

中图分类号:

R781.4

孙旭, 李瑾, 沈达, 王学. 根尖周炎与局部边缘性牙槽骨丧失关系的回顾性研究[J]. 口腔医学, 2026, 46(8): 561-566.

SUN Xu, LI Jin, SHEN Da, WANG Xue. Relationship between apical periodontitis and local marginal alveolar bone loss: A retrospective study[J]. Stomatology, 2026, 46(8): 561-566.

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参考文献 21

[1]	Jivoinovici R, Suciu I, Dimitriu B, et al. Endo-periodontal lesion: Endodontic approach[J]. J Med Life, 2014, 7(4):542-544. pmid: 25713618
[2]	Bakhsh A, Joseph S, Mannocci F, et al. Apical periodontitis microbiome association with salivary and serum inflammatory burden[J]. Int Endodontic J, 2025, 58(3): 504-515. doi: 10.1111/iej.v58.3
[3]	Jansson L, Ehnevid H, Lindskog S, et al. Relationship between periapical and periodontal status: A clinical retrospective study[J]. J Clin Periodontol, 1993, 20(2): 117-123. pmid: 8436630
[4]	Ehnevid H, Jansson L, Lindskog S, et al. Periodontal healing in teeth with periapical lesions: A clinical retrospective study[J]. J Clin Periodontol, 1993, 20(4): 254-258. doi: 10.1111/j.1600-051x.1993.tb00354.x pmid: 8473535
[5]	Jansson L, Ehnevid H, Lindskog S, et al. The influence of endodontic infection on progression of marginal bone loss in periodonti-tis[J]. J Clin Periodontol, 1995, 22(10): 729-734. pmid: 8682918
[6]	Stassen IGK, Hommez GMG, De Bruyn H, et al. The relation between apical periodontitis and root-filled teeth in patients with periodontal treatment need[J]. Int Endodontic J, 2006, 39(4): 299-308. doi: 10.1111/iej.2006.39.issue-4
[7]	Timmerman MF, Vander Weijden GA. Bone level around endodontically treated teeth in periodontitis patients[J]. J Clin Periodontol, 2006, 33(9): 620-625. pmid: 16856903
[8]	Jansson L. Relationship between apical periodontitis and marginal bone loss at individual level from a general population[J]. Int Dent J, 2015, 65(2): 71-76. doi: 10.1111/idj.12143 pmid: 25412991
[9]	Ruiz XF, Duran-Sindreu F, Shemesh H, et al. Development of periapical lesions in endodontically treated teeth with and without periodontal involvement: A retrospective cohort study[J]. J Endod, 2017, 43(8): 1246-1249. doi: 10.1016/j.joen.2017.03.037
[10]	El Ouarti I, Chala S, Sakout M, et al. Prevalence and risk factors of apical periodontitis in endodontically treated teeth: Cross-sectional study in an adult moroccan subpopulation[J]. BMC Oral Health, 2021, 21(1): 124. doi: 10.1186/s12903-021-01491-6 pmid: 33731077
[11]	Sǎlceanu M, Dascǎlu C, Melian AC, et al. Assessment of periodontitis risk factors in endodontically treated teeth: A cross-sectional study[J]. Diagnostics, 2024, 14(17): 1972. doi: 10.3390/diagnostics14171972
[12]	Estrela C, Bueno MR, Azevedo BC, et al. A new periapical index based on cone beam computed tomography[J]. J Endod, 2008, 34(11): 1325-1331. doi: S0099-2399(08)00733-4 pmid: 18928840
[13]	Mackiewicz E, Bonsmann T, Kaczor-Wiankowska K, et al. Volumetric assessment of apical periodontitis using cone-beam computed tomography: A systematic review[J]. Int J Environ Res Public Health, 2023, 20(4): 2940. doi: 10.3390/ijerph20042940
[14]	Mahasneh SA, Al-Hadidi A, Kadim Wahab F, et al. A cone beam CT study on the correlation between crestal bone loss and periapical disease[J]. J Clin Med, 2023, 12(6):2423. doi: 10.3390/jcm12062423
[15]	Patil BA, Shakeel S. Evaluation of endo perio lesions using cone beam computed tomography (CBCT): A cross sectional study[J]. Int J Periodontics Restorative Dent, 2023, 43(7): s235-s243.
[16]	Sǎlceanu M, Melian A, Dascǎlu C, et al. Endo-periodontal lesions in endodontically treated teeth with periapical pathology[J]. Diagnostics (Basel), 2025, 15(13):1663.
[17]	Chen B, Zhu Y, Lin M, et al. Expert consensus on the diagnosis and therapy of endo-periodontal lesions[J]. Int J Oral Sci, 2024, 16(1):55. doi: 10.1038/s41368-024-00320-0 pmid: 39217161
[18]	Ruetters M KimTS, Krisam J, et al. Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients: A retrospective pilot study[J]. Clin Oral Investig, 2021, 25(4): 2373-2380. doi: 10.1007/s00784-020-03560-6
[19]	Gill S, Tabiyar K, Balachandran R, et al. Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: A systematic review and meta-analysis[J]. Clin Oral Investig, 2023, 27(11): 6371-6382. doi: 10.1007/s00784-023-05286-7
[20]	Fan YQ, Sun F, Zhu QY, et al. Effects of different treatment sequences on the efficacy of combined periodontal-endodontic lesions: A systematic review and meta-analysis[J]. Int Dent J, 2026, 76(1): 104021. doi: 10.1016/j.identj.2025.104021
[21]	Al-Sibassi A, Niazi SA, Clarke P, et al. Management of the endodontic-periodontal lesion[J]. Br Dent J, 2025, 238(7): 536-544. doi: 10.1038/s41415-025-8327-x

变量	根尖周炎组	对照组	检验方法	P
近中ABL/mm	3.90±1.71	3.46±1.50	Wilcoxon检验	<0.001^***
远中ABL/mm	3.86±1.69	3.48±1.60	Wilcoxon检验	0.002^**
平均ABL/mm	3.88±1.68	3.47±1.53	Wilcoxon检验	<0.001^***
ABL比例/%	28.85±12.50	25.52±11.39	Wilcoxon检验	<0.001^***
ABL分级/n(%)			Stuart-Maxwell检验	0.052
轻	9(15.0)	14(23.3)
中	28(46.7)	29(48.3)
重	23(38.3)	17(28.3)
存在角形骨缺损/n(%)	19(31.7)	20(33.3)	McNemar检验	>0.999
存在根分叉受累/n(%)	5(17.2)	6(20.7)	McNemar检验	>0.999

牙型	变量	根尖周炎组	对照组	P
前牙	平均ABL/mm	3.15±1.37	2.63±1.33	0.011^*
	ABL比例/%	22.74±9.48	18.95±9.77	0.006^**
	ABL分级/n(%)			0.062
	轻	5(29.4)	10(58.8)
	中	9(52.9)	4(23.5)
	重	3(17.6)	3(17.6)
前磨牙	平均ABL/mm	4.00±2.07	3.36±1.63	0.060
	ABL比例/%	28.80±14.96	24.34±11.26	0.132
	ABL分级/n(%)			0.607
	轻	3(21.4)	3(21.4)
	中	6(42.9)	8(57.1)
	重	5(35.7)	3(21.4)
磨牙	平均ABL/mm	4.26±1.56	4.01±1.41	0.040^*
	ABL比例/%	32.46±11.74	29.94±10.62	0.009^**
	ABL分级/n(%)			0.264
	轻	1(3.4)	1(3.4)
	中	13(44.8)	17(58.6)
	重	15(51.7)	11(37.9)

结局变量	影响因素	β(95% CI)	P
平均ABL/mm	根尖周炎	0.30(0.00,0.61)	0.050
	根长	0.29(0.02,0.55)	0.035^*
	根管治疗史	0.14(-0.29,0.58)	0.521
	桩核修复史	-0.58(-1.17,0.01)	0.053
	存在冠部修复体	0.31(-0.07,0.69)	0.110
	牙型(Ref:前牙)
	前磨牙	0.17(-0.38,0.73)	0.540
	磨牙	0.75(0.23,1.26)	0.005^**
ABL比例/%	根尖周炎	2.24(0.01,4.47)	0.049^*
	根管治疗史	0.94(-2.27,4.14)	0.563
	桩核修复史	-4.11(-8.35,0.12)	0.057
	存在冠部修复体	2.26(-0.53,5.05)	0.110
	牙型(Ref:前牙)
	前磨牙	1.40(-2.70,5.51)	0.500
	磨牙	5.29(1.65,8.92)	0.005^**

研究对象	结局变量	β(95% CI)	P
全部牙齿	平均ABL/mm	0.11(0.05,0.18)	0.001
(n=120)	ABL比例/%	0.92(0.44,1.40)	<0.001
仅根尖周炎牙齿	平均ABL/mm	0.64(0.26,1.03)	0.002
(n=60)	ABL比例/%	5.07(2.10,8.04)	0.001