Abstract：Objective: To investigate the least absolute shrinkage and selection operator (LASSO) regression for treatment failure in refractory periapical periodontitis based on radiographic characteristics. Methods: Prospectively,134 patients with refractory periapical periodontitis who had failed anterior root canal treatment and were admitted to our hospital from January 2017 to January 2021 were selected as study subjects,all of whom underwent micro-apical surgery to observe the effect of refractory periapical periodontitis treatment,and were divided into a success group and a failure group according to the result.The general information,excised apical segment specimens,apical X-ray films and CBCT data of the two groups of patients were collected.A LASSO-Logistic regression model was used to screen the influencing factors of treatment failure in refractory apical periodontitis,and a decision curve was plotted to evaluate the prediction of treatment failure in refractory apical periodontitis based on radiological indicators. Results: Among the 134 patients,2 were lost to follow-up,and 132 patients were finally included in the study.40 patients (30.30%) with refractory apical periodontitis who failed to be treated were classified as failure group,and the remaining 92 patients (69.70%) were classified as successful group after successful treatment.There were significant differences in Enterococcus faecalis infection,lateral wall perforation,tooth position,non-filled root canal volume,root canal filling density,and root apical filling volume between the two groups (P<0.05); the LASSO regression algorithm screened out four significant correlation indicators with non-zero coefficients,including enterococcus faecalis infection,tooth position,apical canal filling density,and apical filling volume.Further multivariate Logistic regression analysis showed that:enterococcus faecalis infection (OR=52.328,95%CI6.765~404.743),underfilling of the root apex (OR=6.242,95%CI1.738~22.423),and the affected teeth were mandibular teeth (OR=20.709,95%CI4.063~105.552) and uneven filling density of the apical canal (OR=11.374,95%CI1.933~66.913) were the risk factors for treatment failure of refractory apical periodontitis (all P<0.05) ; decision curve analysis showed that additional clinical benefit was provided when the radiographic features predicted treatment failure in refractory periapical periodontitis (0.1~0.53). Conclusion: Enterococcus faecalis infection,tooth location,apical filling density,and apical filling volume are risk factors for treatment failure in refractory periapical periodontitis.Inflammation treatment failure has high application value.
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2022, Vol. 28 
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