55 - 根管治疗效果：跨时代的概述 – 第55集

欢迎收听EndoVoices，由美国牙髓病学协会为您呈现。在这个节目中，我们推动牙髓病学的艺术与科学发展，并携手当今顶尖专家，促进最高标准的患者护理。

Welcome to EndoVoices, brought to you by the American Association of Endodontists, the show where we are advancing the art and science of endodontics and promoting the highest standards of patient care with today's top experts in the field.

现在有请我们的主持人，医生。

Now here's your host, Doctor.

马库斯·D.

Marcus D.

约翰逊。

Johnson.

那么，你知道，医生。

So, you know, Doctor.

伯恩斯，我们正在AAE 2023现场。

Burns, we're here hanging out at AAE twenty twenty three.

很多人都在关注我们，这太棒了。

A lot of people checking us out, which is fantastic.

这一切都是为了提升专业水平和教育。

It's all about elevation of profession, education.

非常高兴你能来。

It's very nice to have you on.

你一直是我最喜欢的人之一，所以很高兴见到你……

You've always been one of my favorite people, so it's nice to see your...

你现在提升到了这个高度，而且昨天的演讲非常精彩。

This elevation right now to this point and had a fantastic presentation yesterday.

所以，为你点赞。

So kudos to that.

非常感谢。

Thanks so much.

你感觉怎么样？

How are you feeling?

还好吗？

Good?

我感觉很好。

I'm feeling good.

你应该的。

You should.

你知道吗？

You know?

我准备好放松一下了。

I'm ready to relax.

哎呀，天哪。

Oh, man.

我想今晚是什么活动？

I think tonight is what?

庆祝芝加哥，庆祝芝加哥？

Chicago celebrate celebrate Chicago?

在邮局那边。

At the post office.

我很期待。

I'm looking forward to it.

这是你应得的。

You earned it.

你知道吗，你现在算是正式成为董事会成员了。

You know, you're now a newly sort of, cemented board member.

是的。

Yes.

我是在追随你的脚步。

Following in your footsteps.

哦，哇。

Oh, wow.

我只是想花点时间。

I just wanna take the time.

我的意思是，

I mean,

你说过要一边往上走一边拉别人一把。

you talk about lift as you climb.

你真是身体力行。

You embody it.

你说得对。

You got the saying.

就是这样。

That's it.

上帝保佑。

God is good.

你真是身体力行。

You embody it.

我很高兴能追随你的脚步。

I'm happy to follow in your footsteps.

我很感激能有这个机会。

I'm grateful for the opportunity.

而且，我是说，你通过这个播客真的提升了我们整个行业。

And, I mean, you've really lifted our profession up through this podcast.

我们这个专科，还有所有想成为内分泌科医生的人，都特别棒。

Our specialty, all the all the prospective Endo's Good.

她这是在夸我呢。

She's gassing me up.

我听过马库斯医生的播客。

Listened to Doctor.

就是马库斯医生做的那个播客。

Marcus's podcast.

所以我才知道这些内分泌方面的话题，真的特别棒。

That's how I know about the Endo topics and it's amazing.

而且内容很通俗易懂。

It's accessible.

做得很好。

It's good.

你知道的，这种形式和内容都很接地气，当然像你这样做了很多非常出色的研究。

You know, it's one of the digestible format and the content, you know, of course, like yourself are really just doing some fantastic research.

所以我真的很感谢你。

And so I really appreciate you.

这就是我们想讨论的，就是围绕结果来展开讨论，或者，我猜，也许是研究结果时遇到的障碍。

And that's what we wanted to kinda just discuss, just frame a discussion around outcomes or, I guess, maybe barriers to really studying outcomes.

你围绕这个展开了一场很好的对话，我们可以稍微聊聊你的背景，如果你愿意的话。

And you you framed a really nice, conversation around that, and we can kinda just get into maybe a little bit of your background, you know, if you like.

我觉得很明显你是搞教育的。

You know, I think that it's evident that you're in education.

你这里还有住院医生来支持你。

You have some residents here to support you.

你差不多是纽约大学的全职教员，在那里做得很不错，还拿到了NIH的资助，而且真的……

You're at pretty much full time faculty at New York University, doing some good stuff there, getting some NIH grants under your belt and really have...

我觉得你被认可了，你还获得了基金会颁发的教育者奖。

I think you're recognized as the, you got to receive the Educator Award as well from the foundation.

是的。

Yes.

2019年。

2019.

2019年。

2019.

所以，你知道，这真的很高兴看到。

So, you know, it's very nice to see.

如果你还有什么想跟我们分享的，关于你进入牙髓病学的经历，尽管说吧。

And if there's anything else you kinda just wanna, you know, enlighten us a little bit about your journey into endodontics.

当然。

Sure.

让我想想。

Let's see.

嗯，我牙科学校毕业后就直接进入了牙髓病学领域。

Well, I went straight to Endo after dental school.

我去了宾夕法尼亚大学，很荣幸能接受那里一些顶尖专家的培训，专科项目结束后就立刻进入了全职学术界。

I went to the University of Pennsylvania and was happy to be trained by some of the best there, and entered full time academia immediately after, coming out of my specialty program.

其中一件促成这件事的事情是，纽约大学实际上允许兼职私人执业。

And one of the things that enabled that was that NYU actually allows for the part time private practice.

所以，能够继续在私人诊所工作，使得全职投入学术界对我来说变得可行。

And so being able to still be in a private practice setting, made committing to full time academia something that was gonna be feasible for me.

而且一直都很棒。

And it's been great.

我的意思是，我认为，学术界的支柱是学术研究、教学和服务。

I mean, I think, you know, the pillars of academia are scholarship, teaching, and service.

对。

And Yes.

确实如此。

Indeed.

能够同时做到这三件事，真的是一种荣幸。

Able to, like, do all three of those, I mean, it's really an honor.

所以我觉得，对我来说，学术界是完美的选择。

So I think for me, academia is a perfect fit.

不是。

No.

确实如此。

It really is.

而且你在这方面做得很好，对服务的承诺也是。

And you embody that quite well and commitment to service, of course.

不过，我们还是回到讨论上来吧。

So, you know, let's kinda get back into the discussion, though.

我……

I...

知道，我刚刚请了一位很棒的嘉宾，约翰·考米，特别感谢他专程飞过来参加那次对话，他现在正准备离开。

Know, I just had on a fantastic guest, John caught me, and big shout out to him for actually flying in just to kinda have that conversation that he's actually headed out.

但我们刚才在聊牙髓学的传承。

But we were just looking at kind of the legacy of Endodontics.

如果从牙髓学1.0开始，也许可以看看那五个机械方面的成果。

And if we were to start out with Endodontics one point o, maybe looking at, I guess, the the five mechanical sort of, you know, outcomes.

其实不完全是结果，而是牙髓治疗的机械性操作方式。

Not really outcomes, but just the the mechanical sort of approach to endodontics.

我们引入了

And we bring

攻击

Attack

到现在我们讨论的是牙髓治疗3.0。

to And now we're talking about endodontics three point o.

我们实际上是在做微创，或者我喜欢称之为微介入牙髓治疗。

We're actually in minimally invasive or like I like to say, minimally engaging endodontics.

好的。

Okay.

我们看到现在住院医师们有一些很棒的病例。

And we're seeing that residents now are having some amazing cases.

而且，尽管我们还没有一个标准化的方案，我们确实把很多这样的技术引入到了这些干预措施中，应该说是这样。

And really, even though we don't have a necessary standardized protocol, we're introducing a lot of this technology into, these interventions we should say.

我们看到了一些令人印象深刻的成果，但从成功率和存活率的角度来看，这真的改变了结果吗？

And we're seeing some impressive outcomes, but is it really changing the outcomes that we see from a success and survival standpoint?

所以，就是想请你来聊聊你的看法，然后也谈谈你的研究和你昨天讲的内容。

And so it just kinda, you know, want to bring you in and kinda hear your thoughts about that and then talk a little bit about your research and what you presented on yesterday.

好的。

Sure.

是的，成果确实是个大话题。

I mean, yeah, outcomes is a big topic.

确实是个大话题。

It's a huge topic.

而且，是的，我们在X光片上看到的和我们在生物学上能实现的是有区别的。

And, yeah, there is a difference between what we see in the radiograph and what we're able to achieve biologically.

你知道，我昨天在演讲中提到，有一些大人物研究了成果，真正改变了我们的专业，让我们能够评估我们的成果。

You know, I mentioned in my presentation yesterday, there are some really big names that have studied outcomes and really changed our profession and enabled us to evaluate our outcomes.

我们可以从最基础的开始说起。

I mean, we could just start, you know, from the the basic range trope.

我们应该问问住院医生们，看他们是否还记得那些。

We should ask some the residents if they remember those.

那些数值是多少？

What were the values on those?

术前有病变和术前没有病变。

Pre op lesion versus no pre op lesion.

你们还记得吗？

You guys remember that?

没关系。

It's okay.

但基本上，我们看到大约有10%的差异，整体上，当我们比较术前和术后时。

But essentially, we see there's about a 10% difference, you know, across the board when we have the pre op versus post op.

我是说术前有病变和没有病变。

I mean pre op lesion versus no lesion.

所以当我们谈论那些生物预测因子以及不同的干预措施和技术时，我们通过这些范围综述或系统综述看到了什么？

And so when we're talking about those sort of, biological predictors and the different interventions in technology, what is it that we're kinda seeing through these scoping reviews or then these systematic reviews?

我们真的在做荟萃分析吗？

Are we really in meta analysis?

所以我想深入探讨这个问题，但我想先设定一下讨论的框架，因为我觉得在牙髓病学领域，很长一段时间我们都在认真研究我们的治疗效果，并且对此持批判态度。

So I wanna get into that, but I I wanna I wanna frame the discussion because I think for a long time in endodontics, we were we were really studying our outcomes, and we were critical about it.

而且我觉得当我们……

And I think that when we...

当种植牙出现后，我们真的必须把自己定位为种植牙的一个值得考虑的替代方案，所以我们不得不改变我们的说法。

When the implants came along and we really had to position ourselves as a considered alternative to that, we had to change our narrative.

而且，你知道，我觉得弗里德曼确实带头帮助我们清晰地表达我们的治疗效果，这样我们就能成为种植牙的替代选择。

And, know, I think Friedman really led the charge in helping us, articulate our outcomes so that we could be an alternative option to implants.

这就是我们关于成功与存活的那场讨论的由来。

And that's where we had this whole discussion about success versus survival.

没错。

Exactly.

而且我觉得这对我们的专业来说是一个巨大的贡献，能够以这种方式清晰地阐述以患者为中心和以临床医生为中心的治疗效果之间的区别。

And I think that's been a great service to our specialty to be able to articulate the difference between patient centered outcomes and clinician centered outcomes in that way.

但我觉得在我们讨论的过程中，我们忽略了以生物学为导向的结果。

But I think as we had that conversation, we lost sight of the biologically focused outcomes.

必须关注生物学。

It has to be focused on the biology.

而且随着技术飞速发展，我觉得文献还没来得及跟上，因为你需要时间来评估结果，最短一年，理想情况下要四年。

And with the advancements of technology progressing so rapidly that, I think the literature hasn't had the time to keep up because you have to have time to evaluate outcomes minimum one year, ideally up to four years.

所以存在一个时间差。

And so there's this time lag.

所以当我们在技术上不断进步时，我们却没能从生物学角度进行评估。

And so as we're trying to progress technologically, we haven't been able to evaluate biologically.

所以我想说，如果我们转变方向，重新审视一些以生物学为导向的结果，我们必须回顾过去，才能展望未来。

So I would say that if we pivot and we look back to some of the biologically focused focused outcomes, you've got to look at where we've been so that we can look at where we could be going.

你知道，我觉得，经典的例子是……

You know, I think that, you know, the classic is...

我认为最经典的是1990年的Schroger。

What I think is the classic is Schroger in 1990.

哦，是的。

Oh, yeah.

所以，你知道，那项研究真的很有意思，因为如果你看它的方法，参与者是牙科本科生。

And so, you know, that study is really interesting because if you look at the methods, it's undergraduate dental students.

用的是手工锉。

It's hand filing.

但我认为那项研究的关键在于，他们在充填之前获得了阴性的细菌培养结果。

But I think the key thing in that study was that they had negative bacterial culture prior to obturation.

虽然在系统评价层面，阴性细菌培养可能并不意味着在统计学上会有更高的成功率。

Although at a systematic review level, maybe that negative bacterial culture doesn't mean that you're going to have improved success at a statistical level.

但要达到那个结果，意味着你在消毒上投入了大量时间。

But to achieve that means that you put a lot of time into disinfection.

那确实……

That has...

无菌技术必须放在首位。

Aseptic technique has to be at the forefront.

而且你看他们的方法，从术前擦拭管子，到擦橡皮障，再到用那种抑菌的临时填充材料，每一步都很讲究。

And if you look at the methods, I mean, the aseptic technique from preoperatively wiping down the tubes to wiping down the rubber dam to having a temporary, you know, stealing material that was bacteriostatic.

我觉得正是这些努力，才让他们取得了那样的成功。

All of those efforts, I think, built up to allow them to achieve success that they saw.

所以你看那项研究，术前没有根尖周病变的病例，成功率超过百分之九十六，而有术前根尖周病变的，成功率是百分之八十六。

So if you look at that study cases with no preoperative periapical lesion had success rates over ninety six percent compared to those that had preoperative periapical lesions success rates at eighty six percent.

对。

Yes.

这是Sungquist和Wing，Sjogren的Sungquist和Wing。

This the Sungquist and Wing, Sjogren's Sungquist and Wing.

对。

Yes.

对。

Yes.

所以这就是我……

And so that's that's like how I...

这就是我的……

That's my...

我们一路走来的情况。

Where we've been.

我觉得每个人脑子里都有那些数字，百分之九十七的成功率，还是真的……

And I think that everybody has those numbers in their head, ninety seven percent success or is it really...

你知道，但具体是什么情况？

You know, but in what case?

具体是哪种情况。对，没错。

In which Exactly.

而且我们还要考虑那些我们真的无法控制的基础预测因素。

And also when we consider, know, those, those baseline predictors that we really can't control for.

比如，这颗牙出问题多久了？

Like, how long has the tooth act?

那个病变存在多久了？

How long has that lesion been present?

你看，这里有个窦道，你可能不知道它存在多久了，但我们必须把这个考虑进去。

If you look, there's a sinus track, and you may not know how long that's been there, but we have to take that into consideration.

而且，真正影响最终结果的，不一定非得是病灶的大小，而是像你提到的，比如充填物或修复体的长度这些因素。

And not so much as it necessarily the size of the lesion that really influences the, you know, final outcome, but like you suggested, considerations like the length of the filling, restoration.

我觉得我们越来越看到，文献中这些预测因素在决定某些病例的存活率方面仍然是一致的。

I think we're kind of seeing that those predictive factors are still consistent through the literature in terms of determining how successful are the survival of certain cases.

我觉得有时候这让我们挺害怕的，因为你知道，术前根尖周病变的存在，很多时候，冠部修复，这些都不是我们牙髓科医生能控制的。

And I think that sometimes that's scary for us because, you know, presence of preoperative periapical lesion, a lot of times, coronal restoration, that's outside of our control as endodontists.

我觉得我们看到了越来越多的修复性牙髓治疗。

I think we're seeing a lot of more restorative endodontics.

没错。

Exactly.

这点值得强调。

Want to highlight that.

把控制权拿回来。

Take back into our control.

但是有些

But some

这些因素，就像Ray和Troop在1995年展示的那样，关于冠部修复，在我们重新审视之前，那些我们无法控制的因素会影响我们的结果。

of these factors, as Ray and Troop showed in 1995 with the coronal restorations before we, you know, kind of recarnished that, those factors outside of our control influence our outcomes.

我觉得这确实很难应对，但我们必须承认它们。

And I think that can be, hard to contend with, but we have to acknowledge them.

然后我觉得我们必须为我们的患者和转诊医生设定期望。

And then I think that we have to then set expectations for both our patients and our referring docs.

我觉得如果期望设定得当，大家都会理解的。

And I think if you properly set expectations, then everybody appreciates that.

嗯，期望被理解，但我觉得这更多是……

Well, the expectations, they're appreciated, but I think it's more or less...

就拿激光来说，或者像声波冲洗，比如GentleWave之类的。

Let's just take for instance lasers, or maybe some sort of, you know, sonic irrigation like a gentle wave.

就像你提到的，我们确实可以有一个标准化的技术协议，但也许可以标准化一下，比如在放置牙胶尖之前，人们到底如何消毒牙胶尖。

Really having a standardized protocol like you kind of alluded to, we can kind of have a standardized protocol for the technology, but maybe standardizing how does someone actually disinfect their gutta percha before they seat the cone.

他们每次拿东西的时候会换手套吗，比如拍片子或者别的什么……

Are they changing their gloves each time they take it, you know, an image or think...

就是这些小细节。

Little things like that.

所以真的要从根本上理解，我们之所以在这里，就是因为要考虑到生物学方面或者说生物学原理。

So really understanding that at the basic level that we really should be accounting for the biological aspect or the biological principles as to even why we're here at this this moment.

我觉得你说得对，说实话，根管治疗或者任何牙髓治疗，真的很难做到标准化。

And I think what you're saying is, honestly, root canal therapy, any endodontic procedure, it's not really standardizable.

它是可以标准化的。

It is a standardizable.

你知道，这取决于生物学的实际情况和牙齿的解剖结构。

You know, it's dictated by the biologic reality and the anatomy of the tooth.

所以这些都不好对付，但我们可以有一些基本原则。

And so all of that's tricky to contend with, but we can have basic principles.

对。

Yes.

而且，你知道，我昨天在讲座中提到，去年我在AAE会议上听了Shannon Patel的演讲。

And, you know, I mentioned yesterday in my lecture that I watched Shannon Patel speak last year at the AAE meeting.

他谈到了如何提高你的临床效果。

And he talked about how to improve your clinical outcomes.

他回顾了我们过去的情况。

And he took a look at where we've been.

而且，你知道，他的工作真正了不起的地方在于，他做的是基于实践的研究。

And, you know, what's really great about his work is that he does practice based research.

所以他研究的是他自己私人诊所里的病例。

And so he studies the cases in his own private practice.

不过，我们真正需要的，我觉得没问题，是让实践页面成为一个更大的网络。

What we really need though, I I think it's fine, is the practice page be a larger network.

是的。

Yes.

而且，我们应该谈谈这个。

And and we we should talk about that.

而且他，你知道，他……

And he, know, he...

他……

What he...

我从那次讲座中学到的，以及他根据自己私人诊所数据发表的内容，就是也许我们在无菌技术方面忽略了基本原则。

My took away from that lecture and he's published on from his private practice data is that maybe we're losing sight of the fundamentals as it relates to an aseptic technique.

听完他的讲座，我在临床操作上做了很多小改变。

And I made so many small changes in the way that I practice clinically just walking out of his lecture.

我提到过，我在充填前会换手套，也让我的助手在充填前换手套，因为当你准备充填时，

And I talked about, you know, I changed my gloves before obturation, and I have my assistant change their gloves before obturation because you're ready to obturate.

你希望那是整个操作中最干净的时刻。

You want that to be the cleanest point in the procedure.

但实际上，你周围的一切都是脏的。

But actually, everything around you is dirty.

那么你能做些什么来清理这些，以免把细菌带入干净的环境呢？

So what can you do to clean that up so that you're not bringing bacteria into a clean environment?

我觉得就是一些很小的事情，也能带来很大的影响。

And just, like, really small things, I think, can make a big impact.

而且我觉得，虽然这项技术很有前景，因为它旨在……

And I think while the technology, is promising because it aims to...

它，你知道，它是朝着我们的生物学目标去的，但如果我们连无菌技术的基本功都没做好，那这项技术可能带来的成功，我们也实现不了。

It's, you know, it's aimed toward our biologic goals, we can't realize a success that that technology can potentially afford if we haven't if we haven't cleaned up on the fundamentals of aseptic technique.

我觉得这是个很好的观点。

I mean, I think that's a that's a great point.

但当我们真正开始评估病例时，如果说长期成功是四年，其实四年真的不算长，我们回到牙髓病学1.0时代，看那些研究，可能我们当时采用的是直线通路。

But when we really start to evaluate cases and if we're saying long term success is four years, which is really not, you know, four years, And we were going back to Endodontics 1.0 and looking at those studies where maybe we were employing, I guess, straight line access.

但没意识到这实际上如何影响或左右那颗牙齿的长期抗折性。

But not realizing how that is actually affecting or influencing the long term resistance to fracture of that tooth.

因为现在有了镍钛控制记忆锉的进步，我们发现直线通路其实，你知道，那只是一个概念。

Because now with the advancements of nickel titanium controlled memory files, see that straight line access is really, you know, that that was just a concept.

它绝对不是一条定律。

It was definitely not a law.

所以当我们考虑影响生物过程，然后想着保留牙颈部牙本质，再引入不同的评估方式，比如二维和三维的对比，我们真的需要有标准化的方案。

And so when we're thinking about affecting the biological processes and then looking to preserve periscervical dentin, and then we bring in different modalities of assessing that two d versus three d, we really need to have standardized protocols.

而且我觉得，术前评估的方案、随访的方案、治疗的方案，以及把这些新技术介绍给临床医生，这些都需要有标准。对吧？

And I think that's kind of I think protocols for evaluating preoperatively and also, protocols for follow-up and protocols for treatment and introducing these new technologies to these clinicians, right?

所以，这就是我和Kotomi医生交流后得到的体会。

And so, I mean, that's kind of what I was taking away from my conversation, with doctor Kotomi.

但我觉得你把它提升到了另一个层次，你说即使我们引入了这些新的干预措施，看了这些范围综述，不管是Ng还是你说的Lucy，长期来看，结果并没有太大变化。

But I think you brought it to another level in saying that even though we've brought in these new interventions and we're looking at these scoping reviews, whether it's Ng or I think you said Lucy, we really weren't seeing too much shift in what the outcomes were showing long term.

所以我觉得，批评研究和文献是很容易的。

So I think, you know, it's easy to be critical of the research and of the literature.

我得说，做研究真的很难。

I'll say it's it's really hard to do.

所以，做研究非常难。

And so It's very hard to do.

一旦你开始做研究，你就会少一些批评了。

Once you start doing it, I think you're a little less critical.

但是对Ng的研究或者Lucy的综述的批评，你知道，就是它包含了一些人们认为过时的研究。

But the criticism of of Ng's work or or Lucy's review, you know, is that it includes what people would consider, you know, outdated studies.

有些研究，你知道，甚至可以追溯到1922年发表的。

Studies, you know, published all the way back to 1922.

所以对这些系统综述的一些批评是，我们把过时的操作或者过时的……

And so some of the criticisms of these systematic reviews is that we're lumping in outdated procedures or out...

过时的方案混入了我们的结果评估中。

Outdated protocols into our outcomes assessment.

所以，你知道，在我们去年从NYU和IEJ发表的系统综述中，我们意识到了这一点，我们只想关注那些更现代时期发表的研究。

And so, you know, in the systematic review that we published out of NYU and IEJ last year, we were cognizant of that, and we wanted to look at only studies that were more published in the modern era.

所以我想在这里暂停一下。

And so I just wanna pause for it.

我们能不能把现代时期大致分类一下？

Can we kinda categorize modern era?

这样问很合理。

So that's fair.

所以我要说的是，你知道，Ng的研究涵盖了从……

So I'll say, you know, Ng's studies included everything from...

在她的系统综述里，从1922年到2002年的都有。

In her in her systematic review, anything from 1922 to 2002.

好的。

Okay.

当我们想要更新她的工作，补充内容的时候，我们只纳入了2003年到2020年底发表的研究。

And when we took on the task of wanting to update her work, right, add to it, we only included studies published 2003 through the end of twenty twenty.

但如果你看实际的治疗年份，是从1971年到2019年。

But when you actually look at the years of treatment, it's 1971 through 2019.

所以可能1971年听起来不那么现代。

So maybe 1971 doesn't feel so so modern.

确实。

Exactly.

确实是这样。

It really definitely does.

但是，你知道，这比1920年要现代多了。

But, you know, it's more modern than 1920.

对。

Yes.

确实。

It is.

确实。

It is.

但是我觉得你提到的那个范围综述，是多伦多的Azarpazhooh发表的，对吧？

But I think the the scoping review that you're talking about published by Azarpazhooh out of Toronto Yes.

去年在《牙髓病学杂志》上分三部分发表，他研究了1981年到2020年发表的研究。

In three parts in JOE last year, highlighted that he looked at studies published 1981 to 2020.

他发现实际上大多数研究是在八十年代发表的，而且是在学术牙科中心。

And he found that actually most of the studies are published in the nineteen eighties, in academic dental centers.

所以，你之前提到的那个学术牙科中心的部分。

And so this academic dental center piece you talked about a little bit earlier.

这缺乏普遍适用性。

That lacks generalizability.

所以如果我们能利用他的范围审查所显示的内容，建立核心结果集，然后招募更多的私人执业临床医生来跟踪他们的病例并提交数据，我认为我们的结果可以产生更具普遍适用性的结论。

And so if we can use what his scoping review showed and create core outcome sets and then recruit more, private practice clinicians to, know, track their cases and submit data, I think our outcomes can yield much more generalizable results.

而且我认为我们作为研究人员，真的可以努力利用我们的全职临床医生合作伙伴，创建具有普遍适用性且对专业有益的结果数据。

And I think we can really, like, take effort, as researchers to leverage our, you know, our full time clinician partners and create outcome data that's generalizable and and of benefit to the specialty.

我的意思是，这就是普遍性的挑战……

And I mean, that is the challenge of the general...

让这些研究具有如此普遍的适用性。

Having these studies be so generalizable.

普遍适用性。

Generalizable.

我们稍后回来，先听一段赞助商的广告。

We'll be right back with more after a quick word from our sponsor.

牙髓治疗实践合作伙伴团队很高兴在盐湖城与这么多朋友相聚。

The team at Endodontic Practice Partners loved connecting with so many of you in Salt Lake City.

在那里，EPP的医生

While there, EPP's Doctor.

特雷尔·普罗珀录制了一期特别的《牙髓之声》节目，分享了她几十年经验中的领导力心得。

Terrell Proper recorded a special episode of Endo Voices, sharing leadership lessons from her decades of experience.

这期节目将于6月19日上线，记得收听，获取见解、灵感，还有不少笑料。

That episode is available June 19, so be sure to tune in for insight, inspiration, and a few laughs.

你看到今年“为你最爱T恤投票”比赛中，住院医生们提交的那些超棒的牙髓主题设计了吗？

Have you seen the incredible Endo themed designs submitted by residents for this year's Root for Your Fave T shirt contest?

你可以在Instagram上查看入围作品，就在Endo Practice Partners的官方页面。

You can check out the finalists on Instagram on the Endo Practice Partners Instagram page.

获胜的T恤将在圣路易斯的APICES大会上发放，

The winning T shirt will be distributed at APICES in St.

前三名的设计将为他们的住院医生项目赢得资金，用于满足住院医生的需求。

Louis and the top three designs will win funding for their residency program to use for resident needs.

EPP与各种规模的牙髓病医生合作，提供人员配备、薪资、IT、资质认证和运营方面的支持，让你能专注于提供优质的患者护理。

EPP partners with endodontists of all sizes, providing support in staffing, payroll, IT, credentialing, and operations so you can focus on delivering excellent patient care.

他们还帮助住院医生找到合适的诊所，让他们有信心开始职业生涯。

They also help residents find the right practice to start their careers with confidence.

更多信息请访问 endopracticepartners.com。

Visit endopracticepartners.com for more information.

牙髓病实践合作伙伴。

Endodontic Practice Partners.

支持牙髓病医生，赋能诊所，塑造职业生涯。

Supporting endodontists, empowering practices, shaping careers.

现在我们回到了芝加哥AAE二十三的现场。

And now we're back live on the floor at AAE twenty three in Chicago.

所以我想回到一个...

So I kinda want to go back to a...

你提到过...

You mentioned...

这里有点吵了。

It's kinda getting loud in here.

这

It's

有点失控了。

out of control.

我们刚才在讨论控制某些预测因素，比如修复体。

We were talking about controlling certain predictors like the restoration.

当然。

Sure.

所以我有点把自己看作是一个以修复为导向的牙髓病医生。

And so I kind of see myself as maybe a restorative based endodontist.

总是注意保留牙颈周围的牙本质，你知道，就是牙骨质界上下三毫米。

Always kind of being mindful of preserving periscervical dentin, you know, three millimeters above and below the C.

牙骨质界。

J.

而且真的努力做好隔离，采用正确的粘接技术，并且在完成根管充填后，放置一个核心，通常是双固化树脂核心。

And really trying to have good isolation, proper bonding techniques, and placing a a core, usually like a dual cure resin core, postoperatively after I complete my obturation.

而且我也在想，如果我们看看很多这样的病例，它们要么是……

And being mindful that I think if we look at a lot of these cases that were either...

有时候我们还得考虑拔牙，把拔牙也算作失败，而且这确实已经被写进文献里了。

And sometimes we have to look at extractions and and classifying extractions as also failures and how that's actually, you know, brought into the literature.

但是修复这些牙齿的时候，我们要意识到，我们看到的很多病例，时间长了之所以失败，不是因为生物学上的失败，而是因为结构上的失败。

But restoring these teeth with the idea that we're anticipating most of these cases that we see over time are failing not because of biological failures, but because of structural failures.

所以，我们怎么才能真正地去看这些文献，然后给我们一个很好的研究分类，比如吴的研究，我想你提到过，看看不同的结果，考虑术后修复，以及如何在整个领域里标准化这些，以便获得更好的研究结果，或者更好地防止那些阻碍研究结果的因素。

And so how are we able to really look at this literature and kind of gave us a a nice breakdown of studies from Wu, I think you're talking about and looking at various outcomes and factor in the postoperative, restoration and how to standardize that across the board for better study outcomes or better ways to prevent barriers for proper Study outcomes.

我不知道。

I don't know.

我一直对这个概念感兴趣，从研究的角度来看，就是牙冠修复，因为我觉得这常常是我们无法控制的。

I've been interested in this concept of the kernel restoration a research standpoint for some time because I think it's something that's oftentimes out of our control.

而且我觉得你在做的这项工作，在……

And I think the work that you're doing in...

你知道，在你的修复性牙髓治疗方法和微型……

You know, with your restorative endodontic approach and mini...

在颈部区域做微创治疗，确实能提高天然牙的长期存活率。

Minimally invasive at the at the cervical level is just going to improve, you know, long term survival of the natural dentition.

我觉得这样做很合适，也很棒。

And I think that it's appropriate, and I think that it's great.

但很难研究。

Hard to study.

因为涉及的变量太多了。

There's so many factors there.

但你说得对，如果我们想改进研究方法，至少要在根管治疗完成后使用哪种修复体上达成一致，这样就能减少变量，提高我们分析结果的能力。

But to your point, if we want to improve our outcomes methodology, if we can get on the same page at least about what type of restoration is being placed at the completion of this endodontic treatment that's going to be studied, then we've just reduced variation and improve our ability to analyze outcomes.

不管是不是每个参与这类研究的人都放置髓腔开口屏障，或者承诺做永久修复，对，就是这样。

And whether that's everybody places an intracanal orifice barrier, if they're gonna participate in this kind of research or commit to placement of a permanent restoration, Yeah.

如果我们能在这方面达成一致，那将会非常有帮助。

If we can get on the same page about that, I think that that will be extremely helpful.

那你说的达成一致，是不是暗示我们应该在本科教育层面推动一个范式转变，教学生在根管治疗完成时就进行牙齿修复的新技术？

And so when you talk about getting on the same page, are you hinting that maybe that's a paradigm shift we should see at the level of the the undergrad level, teaching new techniques to restore teeth at the time of completion?

我

I

觉得这是个大方向，而且我并不是……

think that that is the big picture, and I'm not...

你知道，其实我并不认为自己是一个以修复为导向的牙髓病医生。

You know, I I actually don't consider myself a restoratively based endodontic.

我的意思是，我从牙科学校毕业后就直接进入了牙髓病住院医师培训，所以有些修复技能我还没有掌握。

I mean, went straight from dental school to to endo residency, and so some of those restorative skills I haven't built.

对。

Yes.

所以不一定非要承诺做永久修复，但可以承诺用髓腔开口屏障来保护你的治疗成果。

And so it doesn't have to be a commitment to that, but it can be a commitment to protecting your work with an intracanal orifice barrier.

而且，你知道，这取决于你的市场，也取决于转诊医生对修复的期望。

And, you know, depending on your market, depends on what the restorative desires of your referring doctor is.

所以我并不是要求所有人都做永久修复。

So I'm not taking all the way to everybody place permanent restorations.

但是，你知道，这些研究大多来自学术牙科中心，如果你知道那些……

But, you know, with these studies mostly coming out of academic dental centers, and if you are knowing that those...

那些工作会为结果研究做出贡献。

That work is gonna contribute to outcome studies.

然后，总的来说，你知道，作为研究者和教育者，我们可以决定在牙髓治疗结束时从修复角度采取什么措施，以便标准化那个变量，我觉得那会很好。

And then across the board, you know, as researchers and as educators, we can decide what we're going to do in terms of a restorative standpoint at the end of endodontic treatment so that we can standardize that variable, I think it would be great.

好的。

Okay.

我觉得这很合理。

I think that's fair.

当我们谈到不同的影像模式，二维和三维，以及可能增加三维技术的使用，以及我们如何评估这些病例的成功或存活率时，你有什么看法？

When we talk about, you know, imaging in the different modalities, two d versus three d, and maybe an increased use of the three d technology and how we evaluate the success or survival of these cases, you know, what are your thoughts on that?

然后把它和你演讲中强调的一些研究联系起来。

And then kinda tie that into some of the studies that you were highlighting through your presentation.

我觉得三维影像确实，你知道，真的推动了专业的发展。

I mean, I think three d imaging has, you know, really, you know, advances as a specialty.

而且实际上……

And actually...

所以我听了你的播客，我一直在听……

So I listen to your podcast and I was listening it to...

我通常在做家务的时候听。

I usually listen to it while I'm, like, doing household chores.

不错。

Nice.

我觉得我

And I think I

是在听你多任务处理。

was listening to you Multitask.

在打扫厨房的时候，你正在采访一位放射科医生，讨论CBCT成像的LAR原则。

While cleaning the kitchen, and you were you were you were interviewing, I think, was a a radiologist on the LAR principles of CBCT imaging.

哦，对。

Oh, yeah.

来自科罗拉多医疗的丽贝卡·米尔曼。

Rebecca Millman out of Colorado Medical

放射科医生。

Radiologist.

看那个播客的时候，我就想，哦，对。

Looking at that podcast, and I was oh, yeah.

我永远不会上这个播客。

I'm never gonna be on this podcast.

我觉得大家都知道我不会上。

I I think everybody knows I'm not.

如果你了解我，你就知道我不是很善于表达。

If you know me, you know I'm not very expressive.

所以当你邀请我的时候，我心想，对。

So I was like, when you asked me to do this, I was like, yeah.

绝对不行。

Absolutely not.

不。

No.

你可以……

You could...

这聊起来很轻松。

This is easy conversation.

所以，你知道，我已经用上了我兴奋的声音，现在我们就在这里了。

So, you know, I've got my excited voice on, and here we are.

好的。

Okay.

你做得

You're doing

很好。

fine.

不错。

Good.

这是整个会议中人数最多的一场。

Biggest crowd of the whole of the whole whole conference.

我可以告诉你，就是这样。

I'll tell you that much.

但我们谈的是……

But what we talk...

所以这就是为什么我在想她，因为你提到了CBCT成像。

And so that's why I'm I'm thinking about her because you bring up CBCT imaging.

但我觉得，你知道，这是一个很好的额外结果分析工具，可以加到我们的工作中。

But, I think that it's, you know, a great additional outcome analysis tool to add to our work.

我们知道CBCT成像比我们的二维放射成像更敏感。

We know that CBCT imaging is more sensitive than our two dimensional, radiographic imaging.

所以，你知道，我们看到的结果只会更低。

And so, you know, the outcomes we see are just gonna be lower.

如果我们对此敏感的话，对吧，嗯。

And if we're sensitive to that, right Mhmm.