Endodontic Retreatment Versus Dental Implants of Teeth With An Uncertain Endodontic Prognosis 3-Year Results From A Randomised Controlled Tria

 

RIHMKJLQEM AKH]RKFFEM AFLHLAIF ]RLIF

 =21



Jirak Espksltk, Ihhi ]ruffehque-Erlcsskh, Jirak ]iffirlak

Ehmkmkhtla retreitjeht versus mehtif ljpfihts kg teet` wlt` ih uhaertilh ehmkmkhtla prknhksls? 1-yeir resufts grkj i rihmkjlsem akhtrkffem trlif Cey wkrms 

mealslkh jiclhn, mehtif ljpfiht, ehmkmkh ehmkmkhtlas, tlas, retreitjeht 

Turpkse? ]k isaertilh w`et`er lh t`e presehae kg i prevlkusfy ehmkmkhtlaiffy treitem tkkt` wlt` perliplaif pit`kfkny ihm/kr syjptkjs ihm ih uhaertilh prknhksls, lt ls better tk ehmkmkhtlaiffy retreit lt kr tk repfiae t`e tkkt` wlt` i slhnfe-ljpfiht-suppkrtem arkwh. Jiterlifs ihm jet`kms?  ]wehty pitlehts requlrlhn t`e treitjeht kg i prevlkusfy ehmkmkhtlaiffy treitem tkkt`, wlt` perliplaif pit`kfkny ihm/kr syjptkjs kg ehmkmkhtla krlnlh ihm ih uhaertilh prknhksls, is oumnem by t`e rearultlhn lhvestlnitkr, were rihmkjfy iffkaitem tk ehmkmkhtla retreitjeht (Ehmk nrkup, 94 pitlehts) kr tkkt` extriatlkh ihm repfiaejeht wlt` ih ljpfiht-suppkrtem arkwh (Ljpfiht nrkup, 94 pitlehts) iaakrmlhn tk i piriffef-nrkup meslnh it i slhnfe aehtre. Titlehts were gkffkwem tk 1 yeirs igter akjpfetlkh kg t`e treitjeht. Kutakje jeisures were? gilfure kg t`e prkaemure, akjpflaitlkhs, jirnlhif bkhe fevef a`ihnes it bkt` teet` ihm ljpfihts, ehmkmkhtla rimlknrip`la suaaess (teet` khfy), hujber kg pitlehts“ vlslts ihm miys tk akjpfete t`e treitjeht, pitlehts“ a`ilr tlje, aksts, iest`etlas issessem uslhn t`e plhc iest`etla sakre (TEQ) gkr t`e skgt tlssues ihm t`e w`lte iest`etla sakre (^EQ) gkr t`e tkkt`/arkwh reakrmem by lhmepehmeht issesskrs. Resufts?  Hk pitleht mrkppem kut. Khe ehmkmkhtlaiffy retreitem tkkt` griaturem ihm ihkt`er `im i arkwh fkksehlhn. ]`ere were hk stitlstlaiffy slnhl﬉aiht mlggerehaes gkr treitjeht gilfure kr akjpflaitlkhs (mlggerehae lh prkpkrtlkhs : 4.943 93 Ljpfiht : 7.94 ¹ 4.>=3 jeih mlggerehae : 4.5>3 3 T (t   test) : 4.947). Lt tkkc slnhl﬉aihtfy jkre miys tk akjpfete t`e ljpfiht re`iblfltitlkh (Ehmk : 79 ¹ 92.3 Ljpfiht : 95.4=3 jeih mlggerehae : ‑914.=43 7.153 T  (t   test) 6 4.449) but fess pitlehts“ a`ilr tlje (Ehmk : 72 miys.



Ljpfiht lhstiffitlkh tea`hlque

Qefg-tipplhn ayflhmrlaif tltihluj ljpfihts (JN-Lh`ex, Jkzk-Nriu/]laire) wlt` akhlaif ipex, lhterhif akhheatlkh ihm RBJ (Reskrbibfe Bfist Jemli) surgiae were usem. Kperitkrs were gree tk a`kkse ljpfiht fehnt`s (0.4, 94.4, 99.5, 91.4 ihm 95.4 jj) ihm mlijeters (1.14, 1.>5, =.25 ihm 5.44 jj) iaakrmlhn tk aflhlaif lhmlaitlkhs ihm t`elr pregerehaes. Ljjemlite pkst-extriatlve ljpfihts kr ljpfihts w`la` were nrigtem it lhsertlkh were pfiaem uhmer i >-miy ihtlblktla prkp`yfixls renljeh is prevlkusfy mesarlbem, w`ereis iff kt`er ljpfihts were pfiaem igter i slhnfe imjlhlstritlkh kg 2 n ijkxlalfflh (kr 744 jn aflhmijyalh) 9 `kur prlkr tk pfiaejeht. Mrlffs wlt` lhareislhn mlijeters were usem tk prepire t`e ljpfiht slte is sunnestem by t`e jihugiaturer. Ljpfihts were pfiaem wlt` t`elr jkst akrkhif pkrtlkh flus` tk t`e arestif fevef, wlt` t`e exaeptlkh kg pkst-extriatlve ljpfihts t`it were pfiaem ibkut 2 jj befkw t`e `ln`est arestif peic. Jktkrs were set wlt` i tkrque kg 15 Haj ihm

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

 

 =2<



 

=14 

Espksltk et if

Ehmkmkhtla retreitjeht versus mehtif ljpfihts

reslstihae tk ljpfiht lhsertlkh wis reakrmem is up tk kr jkre t`ih 15 Haj. Reslmuif nips betweeh betwee h t`e ljpfiht surgiae ihm t`e bkhe wiffs were ﬉ffem wlt` i nrihufir bkhe substltute (JN-Kstekmrlve) ihm reskrbibfe birrlers (JN-Renuirme). Lh t`e aise kg trihsarestif slhus efevitlkh prkaemures, t`e wkrclhn fehnt` wis set 9 jj s`krter t`ih t`e `eln`t kg

wlt` kt`er ljpfihts/teet`. Lhvestlnitkrs were gree tk meflver prkvlslkhif guff iaryfla arkwhs begkre t`e me﬉hltlve jetif-aerijla kr guff-aerijla arkwhs, w`la` akufm be elt`er aejehtem kr sarew-retilhem. Mr ]iffirlak usem stihmirm JN-LH@EP @ex prepiribfe tltihluj ibutjehts gkr arkwhs, w`la` were prkvlslkhiffy aejehtem wlt` ]ejp-Bkhm (Cerr, Krihne, AI, UQI).

t`e reslmuif ifvekfir arest. Igter ljpfiht slte prepiritlkh, expihmlhn-akhmehslhn kstektkjes (Qlhus Flgt Kstektkjes, Qifvlh Mehtif Qpealiftles, A`irfktte, HA, UQI) were usem tk griature t`e slhus flkkr bkhe. Tksslbfe kaaurrehae kg jixlffiry slhus eplt`efluj pergkritlkh wis evifuitem wlt` t`e Wifsifvi jihkeuvre ljjemlitefy igter slhus flkkr griature. Lh aise kg reslmuif bkhe `eln`t lhgerlkr kr equif tk 2 jj fess t`ih t`e fehnt` kg t`e pfihhem ljpfiht, bkhe nrigtlhn wis ivklmem ihm akffineh spkhne (Tiriskrb Akhe, Reskrbi Jemlaif, Hurejbern, Nerjihy) wis lhsertem uslhn t`e kstektkje is i pfunner pfunner.. Qfln`t efevitlkh kg t`e slhus eplt`efluj wis ia`levem seakhmiry tk t`e `ymriufla pressure areitem by t`e akffineh spkhne. Glhiffy, Glhiffy, t`e ljpfiht wis pfiaem is prevlkusfy mesarlbem. Kperitkrs were gree tk a`kkse betweeh i subjernem kr i hkh-subjernem tea`hlque. Lg i subjernem tea`hlque wis usem, t`e wkuhm wis akjpfetefy afksem kver t`e ljpfiht3 `kwever, lh t`e aise kg pkst-extriatlve ljpfihts t`e wkuhm wis fegt pirtliffy kpeh, ihm afksem wlt` i akhheatlve tlssue nrigt kr i reskrbibfe birrler (JN-Renuirme). Ljpfihts akufm be fkimem ljjemlitefy, eirfy kr akhvehtlkhiffy, lh kaafuslkh kr lhgrikaafuslkh it t`e mlsaretlkh

It meflvery kg me﬉hltlve arkwhs/akjpfetlkh kg t`e restkritlve prkaemures gkr teet`, aflhlaif platures ihm stihmirmlsem perliplaif rimlknrip`s kg t`e stumy ljpfihts ihm teet` were jime, ihm ljpfihts were jihuiffy testem gkr stiblflty. Titlehts were reaiffem every 7 jkht`s gkr jilhtehihae gkr t`e ehtlre stumy perlkm. Lhvestlnitkrs akufm mealme tk reaiff pitlehts jkre grequehtfy (every 1 tk = jkht`s) lg heaessiry.

kg t`e kperitkr. Igter ljpfiht pfiaejeht, biseflhe perliplaif perl iplaif rimlknrip`s kg t`e ljpfihts were ticeh. Titlehts were presarlbem lbuprkgeh =44 jn (kr piriaetijkf 9 n gkr pitlehts wlt` stkjia` prkbfejs kr iffernla tk lbuprkgeh) but pitlehts were lhstruatem hkt tk tice t`ej lh ibsehae kg pilh. ]`ey were ifsk presarlbem 4.92% a`fkr`exlmlhe jkut`wis` gkr 9 jlhute twlae i miy gkr 2 weecs. ^lt`lh 9 weec iff pitlehts were reaiffem ihm a`eacem, ihm krif `ynlehe lhstruatlkhs relhgkraem. Qutures were rejkvem > tk 94 miys igter ljpfiht pfiaejeht.

• Gkr teet`, gilfure wis w`eh i tkkt` wis extriatem kr lg lt wis hk fkhner ibfe tk pergkrj lts jistlaitkry guhatlkh. ]kkt` extriatlkh akufm be mue tk ihy reiskh, sua` is ehmkmkhtla ibsaess, rkkt griature kr perlkmkhtif reiskhs.



  Trkst`etla prkaemures

Iff ljpfihts/teet` were tk be restkrem is slhnfe uhlts ihm hkt spflhtem uhmer prkst`etla reakhstruatlkhs

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

  Kutakje jeisures



]`ls stumy testem t`e huff `ypkt`esls t`it t`ere were hk mlggerehaes lh aflhlaif kutakjes betweeh t`e twk prkaemures inilhst t`e ifterhitlve `ypkt`esls kg i mlggerehae. ]`e prljiry kutakje jeisure wis gilfure kg t`e prkaemure? • Gkr mehtif ljpfihts gilfure wis me﬉hem is ljpfiht jkblflty, ljpfiht griature ihm/kr ihy lhgeatlkh mlatitlhn ljpfiht rejkvif. ]`e stiblflty kg eia` lhmlvlmuif ljpfiht wis jeisurem jihuiffy wlt` i tkrque kg 24 Haj it meflvery kg t`e ﬉hif restkritlkh ihm fiter kh uslhn t`e `ihmfes kg twk jetiffla lhstrujehts.

Qeakhmiry kutakje jeisures were? • Ihy blkfknlaif kr blkjea`ihlaif akjpflaitlkh it ljpfihts kr teet` t`it kaaurrem murlhn t`e ehtlre kbservitlkh perlkm. Tkstkperitlve pilh wis akhslmerem i akjpflaitlkh lg stlff preseht lh i spkhtihekus gkrj 9 weec igter treitjeht. Exijpfes kg akjpflaitlkhs ire? herve lhoury, ﬉stufis, perlljpfihtltls, perliplaif rimlkfuaehay, ibsaesses, airles, griature kg t`e jetif sarews, arkwh fkksehlhn, rkkt griature ihm griature kg aerijla.

 

Espksltk et if

Ehmkmkhtla retreitjeht versus mehtif ljpfihts

• Jirnlhif bkhe fevef a`ihnes it bkt` ljpfihts ihm teet`. Mlnltif perliplaif rimlknrip`s kg bkt` teet` ihm ljpfihts were jime wlt` t`e piriffeflhn tea`hlque uslhn akjjeraliffy ivilfibfe ﬉fj `kfmers (Rlhh PAT3 Mehtspfy Rlhh, Efnlh, LF, UQI) ihm, gkr teet` khfy, wlt` lhmlvlmuif stehts jime kg `irm slflakhe usem gkr blte renlstritlkh

ljpfihts) ihm tk jihine pksslbfe akjpflaitlkhs murlhn t`e gkffkw-up (rkutlhe jilhtehihae ippklhtjehts were hkt iaakuhtem gkr). • Miys requlrem tk akjpfete t`e prkaemure. ]`e hujber kg miys heaessiry grkj t`e stirt tk t`e ehm kg t`e t`eripy (ehm kg t`e ehmkmkhtla t`eripy lhafumlhn pksslbfe reakhstruatlkh kg

tk stihmirmlse repksltlkhlhn kg t`e ﬉fj `kfmer. Rimlknrip`s were tk be ticeh oust igter ljpfiht pfiaejeht/ehmkmkhtla retreitjeht, it meflvery kg me﬉hltlve ljpfiht-suppkrtem arkwhs, ihm 9 ihm 1 yeirs igter akjpfetlkh kg t`e treitjeht. Lh aise kg ih uhreimibfe rimlknrip`, t`e rimlknrip` wis tk be ticeh inilh. Jirnlhif bkhe fevefs were jeisurem uslhn t`e LjineO (Hitlkhif Lhstltutes kg @eift`, UQI) skgtwire. ]`e skgtwire wis aiflbritem gkr every slhnfe ljine uslhn t`e chkwh fehnt` kr mlijeter kg mehtif ljpfihts. Gkr teet`, t`e ljines were aiflbritem wlt` t`e chkwh mljehslkhs kg t`e iatlve irei kg Mlnkri Kptlje (Qkremex, ]uusufi, Glhfihm) kr mljehslkhs kg t`e iatlve irei kg t`e RWN sehskr (RWN 7944 Mlnltif Rimlknrip`y Qystej, Airestreij @eift`, Rka`ester, H\, UQI). Jeisurejehts kg t`e jeslif ihm mlstif bkhe arest fevef imoiaeht tk eia` tkkt`/ljpfiht were jime tk t`e heirest 4.49 jj. ]`e regerehae pklhts gkr t`e flheir jeisurejehts were t`e AEO gkr teet`, w`eh vlslbfe, kr t`e emne kg restkritlkhs ihm t`e akrkhif jirnlh kg t`e akffir gkr t`e ljpfihts, ihm t`e jkst akrkhif pklht kg bkhe-tk-ljpfiht/tkkt` akhtiat. Bkhe fevefs were jeisurem it bkt` je-

t`e arkwh kr meflvery kg t`e me﬉hltlve arkwh gkr ljpfihts). • A`ilr tlje. ]`e hujber kg jlhutes speht by t`e pitleht kh t`e a`ilr tk akjpfete t`e treitjeht (ehm kg t`e ehmkmkhtla t`eripy lhafumlhn pksslbfe reakhstruatlkh kg t`e arkwh kr meflvery kg t`e me﬉hltlve arkwh gkr ljpfihts) ihm tk skfve ihy pksslbfe akjpflaitlkhs (rkutlhe jilhtehihae ippklhtjehts were hkt iaakuhtem gkr). • ]reitjeht aksts. ]`e guff tktif akst kg eia` prkaemure up tk meflvery kg ﬉hif restkritlkhs aifaufitem iaakrmlhn t`e priatlae kg﬉alif prlae flst (hkt t`e iatuif akst pilm by t`e pitleht) kg t`e lhmlvlmuif mehtif priatlae. ]`e tktif aksts requlrem tk ﬉x pksslbfe akjpflaitlkhs up tk 1 yeirs igter akjpfetlkh kg t`e treitjeht were ifsk tk be immem. • Iest`etla evifuitlkh kg t`e vestlbufir ihm kaafusif aflhlaif platures, lhafumlhn t`e twk imoiaeht teet`, ticeh it t`e ehm kg t`e treitjeht, 9 ihm 1 yeirs igter treitjeht akjpfetlkh, ihm pergkrjem kh i akjputer sareeh by ih lhmepehmeht aflhlalih. ]`e iest`etla evifuitlkh wis mkhe gkffkwlhn bkt` t`e plhc iest`etla sakre (TEQ) 7 ihm t`e w`lte iest`etla sakre (^EQ)>. Lh brleg, wlt` t`e TEQ sakre seveh virlibfes were evifuitem?

slif ihm mlstif slmes ihm iverinem. • Ehmkmkhtla rimlknrip`la suaaess (gkr teet` khfy) wis issessem by ih lhmepehmeht issesskr w`k akjpirem t`e pkstkperitlve rimlknrip`s wlt` t`kse kbtilhem it 9 ihm 1 yeirs igter akjpfetlkh kg t`e treitjeht. Rimlknrip`s were vlsuiflsem lh pilrs (t`e biseflhe ihm t`e gkffkw-up rimlknrip`s kg t`e sije tkkt`) kh i akjputer sareeh. ]`e rimlknrip`la a`ihnes were repkrtem lh t`e gkffkwlhn wiy? akjpfete `eiflhn (hk vlslbfe perliplaif rimlkfuaehay)3 ljprkvejeht (remuatlkh kg t`e perliplaif feslkh)3 ihm hk a`ihnes/wkrsehlhn (rimlkfuaehay rejilhem uhifterem kr lhareisem kver tlje). • Hujber kg aflhlaif sesslkhs requlrem tk akjpfete t`e treitjeht (meflvery kg t`e ﬉hif arkwh gkr

jeslif piplffi, mlstif piplffi, skgt tlssue fevef, skgt tlssue akhtkur, ifvekfir prkaess me﬉alehales, skgt tlssue akfkur ihm texture. I 4-9-2 sakrlhn systej wis usem, 4 belhn t`e fkwest ihm 2 belhn t`e `ln`est vifue, wlt` i jixljuj ia`levibfe sakre kg 9= per mehtif uhlt. ^lt` t`e ^EQ sakre, ﬉ve virlibfes were evifuitem? tkkt` gkrj, tkkt` vkfuje/kutflhe, akfkur (`ue/vifue), surgiae texture, ihm trihsfuaehay. I 4-9-2 sakrlhn systej wis usem, 4 belhn t`e fkwest ihm 2 belhn t`e `ln`est vifue, wlt` i jixljuj ia`levibfe sakre kg 94 per mehtif uhlt. It t`e aehtre t`ere wis i fkaif bflhmem kutakje issesskr (Mr Ihhi Wiaaireffi) w`k reakrmem t`e gkffkwlhn kutakje jeisures? ljpfiht stiblflty stiblflty,, hujber

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

 

 =19



 

=12 

Espksltk et if

Ehmkmkhtla retreitjeht versus mehtif ljpfihts

kg pitleht“s vlslts ihm miys tk akjpfete t`e treitjeht, pitleht“s a`ilr tlje, ihm aksts. Akjpflaitlkhs were meift wlt` ihm repkrtem mlreatfy by Mr ]iffirlak. Khe lhmepehmeht aflhlalih (Mr ]ruffehque-Erlcsskh), hkt lhvkfvem lh t`e treitjeht kg t`e pitlehts, evifuitem ehmkmkhtla rimlknrip`la suaaess, iest`etlas ihm jirnlhif bkhe fevefs. Mue tk t`e hiture kg t`e stumy stumy,,

bkhe fevef a`ihnes, hujber kg pitlehts“ vlslts ihm miys tk akjpfete t`e treitjeht, pitlehts“ a`ilr tlje, aksts, ihm iest`etla sakres) betweeh nrkups were akjpirem by t  tests.  tests. Mlggerehaes kver tlje gkr jirnlhif bkhe fevefs were akjpirem uslhn pilrem t   tests. Lt wis pfihhem tk jice i subnrkup ihifysls tk akjpire t`e kutakje kg teet` wlt` slhnfe kr

kutakje issesskrs akufm hkt be bflhmem.

juftlpfe aihifs3 `kwever, t`ls wis hkt mkhe slhae t`e hujber kg lhafumem pitlehts wis tkk sjiff. Iff stitlstlaif akjpirlskhs were akhmuatem it t`e 4.45 fevef kg slnhl﬉aihae.

  Qtitlstlaif ihifysls



I sijpfe slze wis estljitem gkr i `ypkt`etlaif mlggerehae gkr ljpfiht/tkkt` gilfures grkj 9% tk 5%. I twk-nrkup akhtlhulty akrreatem a`l-squire test wlt` i 4.454 twk-slmem slnhl﬉aihae fevef wlff `ive 04% pkwer tk meteat i mlggerehae betweeh i prkpkrtlkh kg 4.454 ihm i prkpkrtlkh kg 4.494 (kmms ritlk kg 4.9

Jeih ine it ljpfiht lhsertlkh, y (rihne)

=0.7 (1

]eet` restkrem wlt` pkst, h

=

5

Qyjptkjitla teet`, h

I ff

<

0

Trkvkcem pilh

0

7

Qpkhtihekus pilh

9

9

G l st u f i

4

9

Ibsaess

4

4

=

7

]eet` wlt` i perliplaif kr fiterif rimlknrip`la feslkh, h

• Gilfures? Khe jixlffiry glrst jkfir griaturem betweeh ehmkmkhtla sesslkhs begkre t`e aihifs were meglhltlvefy kbturitem3 t`eregkre, t `eregkre, t`e mlggerehae lh prkpkrtlkhs kg gilfures betweeh nrkups wis hkt stitlstlaiffy slnhl﬉aiht (mlggerehae lh prkpkrtlkhs : 4.943

Lh t`e nip kg pkst-extriatlve ljpfihts

2

Bkt` lh t`e t`e nip nip ihm ihm buaaif buaaiffy fy kg kg pkst-ex pkst-extriatl triatlve ve ljpfi ljpfihts hts

2

Arestif sl slhus ef efevitlkh wl wlt`kut bk bkhe substltutes

1

Ljpfihts fkimem ljjemlitefy, h

2

Ljpfihts hkh-subjernem ihm mefiyem fkimem, h

2

Ljpfihts subjernem ihm mefiyem fkimem, h

7

QM, stihmirm mevlitlkh.

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

 

Espksltk et if

Ehmkmkhtla retreitjeht versus mehtif ljpfihts

 =15

 



]ibfe 1  Jirnlhif bkhe bkhe fevefs (jj) (jj) ihm a`ihnes it it 9 ihm 1 yeirs yeirs igter akjpfetlkh kg kg t`e t`eripy by stumy nrkup ]eet`

It akjpfetlkh kg t`e ehmkmkhtla retreitjeht/ljretreitjeht/ljpfiht pfiaejeht

L j p fi ht s

H

J i r n l hi f bkhe fevef (jeih ¹ QM)

H

J i r nl h i f bkhe fevef (jeih ¹ QM)

<

2.94 ¹ 4.77

94

4.45 ¹ 4.95

94

4.02 ¹ 4.=1

It ljpfiht fkimlhn

Jeih mlggerehae (QE)

¹ 4.>9

94

4.>7 ¹ 4.7>

9. ¹ 4 .7 =

9.77 (4.14)

9.42 tk 2.2<

6 4.449*

Jeih a`ihnes biseflhe tk 9 y

<

4.5> ¹ 4.5=

94

4 .> 2 ¹ 4 .7 <

‑4.9= (4.25 tk 4.=7 4.719

Jeih a`ihnes biseflhe tk 1 y

<

4.21 ¹ 4.02

94

4 .7 2 ¹ 4 .7 0

‑4.1< (4.1=)

‑9.92 tk 4.11 4.27>

T vifue

4.492*

4.49*



>.>0 ¹ 9.14

90.0< ¹ 2.52

Ljpfihts : 94 (jeih ¹ QM)

4.

9.>4 ¹ 4.70

9.=4 ¹ 4.>4

9.74 ¹ 4.52

9.24 ¹ 4.><

7.04 ¹ 2.1<

91.14 ¹ =.1>

Mlggerehae

4.5=

‑4.9=

4.4=

4.=4

4.91

4.<

4.41>*

4.>14

4.209

4.44=*

T

* Qtitlstlaiffy slnhl﬉aiht mlggerehae.

T  (t   test) : 4.209) betweeh treitjehts. ^`eh ihifyslhn t`e lhmlvlmuif TEQ sakre mkjilhs (]ibfe =), t`e mlggerehae wis stitlstlaiffy slnhl﬉aiht ihm jkre aflhlaiffy evlmeht gkr jeslif piplffi pipl ffi ihm ifvekfir prkaess me﬉alehales.

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  Mlsausslkh

]`ls trlif wis meslnhem tk lhvestlnite khe kg t`e jkst mlsaussem mlfejjis lh mehtlstry, w`et`er, lh t`e presehae kg ih ehmkmkhtlaiffy treitem tkkt` wlt` perslsteht pit`kfkny ihm wlt` ih uhaertilh prknhksls, lt ls better tk retreit lt ehmkmkhtlaiffy kr tk extriat ihm repfiae lt wlt` ih ljpfiht-suppkrtem arkwh. Khfy khe tkkt` (griature kg i jixlffiry ﬉rst jkfir murlhn t`e ehmkmkhtla retreitjeht) ihm khe arkwh tkkt` fkksehlhn were repkrtem 1 yeirs igter treitjeht akjpfetlkh. Hk mlggerehaes were kbservem gkr t`e hujber kg pitleht vlslts3 `kwever `kwever,, severif stitlstlaiffy ihm aflhlaiffy slnhl﬉aiht mlggerehaes were kbservem betweeh t`e twk prkaemures. ^`eh mlsausslhn t`ese mlggerehaes, lt ls ljpkrtiht tk ceep lh jlhm t`it t`e hujber kg pitlehts lhafumem wis very sjiff, sk neheriflzitlkh s`kufm be mkhe

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

very aireguffy ihm akhafuslkhs s`kufm be akhslmerem jkre is wkrclhn `ypkt`eses t`ih evlmehae-bisem trut`s. Renirmlhn t`e iest`etla kutakje, teet` mlm better t`ih ljpfihts wlt` respeat tk skgt tlssue (plhc) iest`etlas w`lfe t`e iest`etla kutakje kg t`e arkwhs (w`lte iest`etlas) wis sljlfir betweeh nrkups. ]`e firnest mlggerehaes kbservem it 1 yeirs igter t`eripy akjpfetlkh renirmem jeslif piplffi ihm ifvekfir prkaess me﬉alehales. Lg iest`etlas ls t`e pitleht“s prlkrlty, ehmkmkhtl ehmkmkhtlaa retreitjeht jln`t be t`e ﬉rst treitjeht a`klae. Ih ljpfiht aih stlff be pfiaem it i fiter stine lg heemem. Gewer miys were heemem tk akjpfete ehmkmkhtla retreitjeht ihm re`iblfltitlkh, w`ereis pitleht“s a`ilr-tlje wis ifjkst mkubfe. ]`ese giatkrs s`kufm be expfilhem tk pitlehts w`k aih mealme iaakrmlhn tk t`elr heems ihm premlspksltlkhs. Aksts, aifaufitem iaakrmlhn tk t`e kg﬉alif prlaes kg i prlvite priatlae, were `ln`er gkr ljpfiht re`iblfltitlkh re `iblfltitlkh but t`ls wis expeatem. ]`e aifaufitem aksts, `kwever, mk hkt refleat t`e iatuif akst pilm by pitlehts, w`k belhn lh i reseira` prktkakf is vkfuhteers, reaelvem akhslmeribfe mlsakuhts. ]`ese ﬉nures were jeiht tk nlve i rkun` estljite, refleatlhn t`e Ltiflih aflhlaif reiflty, ceeplhn lh jlhm

 

Espksltk et if

Ehmkmkhtla retreitjeht versus mehtif ljpfihts

t`it sehslbfe virlitlkhs betweeh prlvite priatlaes mk exlst. Renirmlhn perl-ljpfiht jirnlhif bkhe fevefs, hk mlggerehaes lh bkhe fkss betweeh teet` ihm ljpfihts were kbservem3 `kwever, t`e jet`kms usem tk estljite bkhe fevefs it teet` were fess reflibfe t`ih t`kse gkr ljpfihts, ljpfylhn t`it t`e rimlknrip`la

mealslkhs, 94 aehtres puffem biac grkj t`e stumy. Lh immltlkh, khe kg t`e twk aehtres w`k prkvlmem t`e 9-yeir miti mlm hkt prkvlme 1-yeir miti. ]`ls bimfy iggeatem t`e krlnlhif sijpfe slze. Bkhe fevef issessjeht it teet` wis akjpfex ihm pksslbfy hkt guffy reflibfe. ]`ls wis mue tk t`ree jilh giatkrs? l) t`e mlg﬉aufty tk lmehtlgy t`e regerehae pklht it teet`

akjpirlskh kg bkhe fevefs betweeh teet` ihm ljpfihts s`kufm be lhterpretem wlt` aiutlkh. ]`e rimlknrip`la `eiflhn kg ehmkmkhtla feslkhs kbvlkusfy ippflem tk ehmkmkhtlaiffy retreitem teet` khfy. It biseflhe khfy gkur kut kg 94 teet` `im vlslbfe rimlkfuaeht feslkhs. Kg t`ese teet`, 1 yeirs igter akjpfetlkh kg t`e t`eripy, khe wis fkst mue tk griature, twk s`kwem akjpfete `eiflhn ihm khe `im i rimlknrip`la ljprkvejeht. Fkhner gkffkw-ups wlff be lhgkrjitlve, t`kun` ljprkvejeht kg rimlknrip`la slnhs ls expeatem rit`er t`ih meterlkritlkh. ]`ere ire hk kt`er RA]s testlhn sljlfir `ypkt`eses sk hk jeihlhnguf mlsausslkh wlt` respeat tk kt`er sljlfir stumles akufm be mkhe. ]`e preseht very prefljlhiry resufts suppkrt t`e hktlkh t`it t`ere jln`t be hk jiokr jemluj-terj mlggerehaes lh aflhlaif kutakjes by ehmkmkhtlaiffy retreitlhn kr extriatlhn ihm repfialhn prevlkusfy ehmkmkhtlaiffy treitem teet` wlt` perslstlhn pit`kfknles ihm i mublkus fkhn-terj prknhksls wlt` mehtif ljpfihts. @kwever, skgt tlssue iest`etlas, aksts ihm tlje heemem tk akjpfete t`e treitjeht were lh givkur kg ehmkmkhtla retreitjeht. Lg t`ese prefljlhiry resufts ire akh﬉rjem by firner trlifs, t`eh lt jln`t be pregeribfe tk stirt wlt` i fess lhvislve

(t`e AEO kr t`e jirnlh kg restkritlkhs)3 ll) t`e fiac kg chkwh mlstihaes tk aiflbrite t`e issessjehts3 lll) t`e use kg mlggereht equlpjeht tk tice perliplaif mlnltif rimlknrip`s. ]`ls stumy akufm be akhslmerem i typlaif exijpfe kg t`e prkbfejs flhcem tk aflhlaif reseira`. ]k akhmuat prkper aflhlaif reseira`, i skuhm questlkh, i metilfem ihm t`krkun`fy pfihhem reseira` prktkakf, i neherkus ihm hkt ‖pus`lhn‚ spkhskr, ihm uhblisem uhblisem kperitkrs nehulhefy lhterestem lh ihswerlhn t`e testem aflhlaif questlkh ire heemem. Lh jihy aises experlehaem kperitkrs ifreimy befleve t`ey chkw t`e best treitjeht kptlkh gkr t`elr pitlehts mesplte i fiac kg salehtl﬉a evlmehae ihm i firne hujber kg aflhlalihs wlt` kppkslhn vlews, ihm t`eregkre reoeat t`e lmei kg iffkaitlhn t`e treitjeht rihmkjfy. ^`eh beflegs ire sk strkhnfy `efm, lt ls mlg﬉auft tk pergkrj uhblisem reseira`. ]`e pksltlve slme ls t`it t`ls RA] ls t`e khfy khe pubfls`em sk gir t`it jices sua` i akjpirlskh. Lt ls `kpem, t`eregkre, t`it wlt` t`ls stumy is i preaemeht, kt`er reseira`ers akufm be stljufitem tk test sljlfir `ypkt`eses. Qua` stumles ire mlg﬉auft tk akhmuat gkr t`e reiskhs prevlkusfy jehtlkhem, but ire bimfy heemem tk uhmerstihm t`e akrreat ipprkia` w`eh

ehmkmkhtla retreitjeht ipprkia` is ﬉rst treitjeht kptlkh, ceeplhn t`e ljpfiht treitjeht kptlkh is i resaue treitjeht lh aise kg gilfure kg t`e ehmkmkhtla retreitjeht. ]`e jilh fljltitlkhs kg t`e preseht trlif ire t`e lhsug﬉aleht sijpfe slze ihm t`e mlg﬉auftles tk prealsefy estljite bkhe fevefs it teet`. ]`e lhsug﬉aleht sijpfe slze aih khfy be skfvem by akhmuatlhn sljlfir trlifs wlt` jua` firner sijpfe slzes. @kwever, iaakrmlhn tk kur experlehae t`ls wlff hkt be ih eisy tisc. Ift`kun` t`e `kpe wis tk expfklt tk t`e jixljuj t`e kppkrtuhlty neherkusfy kggerem by t`e spkhskr tk akjpire ehmkmkhtla retreitjeht wlt` ljpfiht repfiaejeht ihm 92 aehtres eht`uslistlaiffy mealmem tk oklh t`e prktkakf, w`eh aflhlalihs were it t`e jkjeht kg rihmkjlzitlkh, w`la` fljltem t`elr

meiflhn wlt` teet` wlt` uhaertilh prknhkses. Qlhae lh t`e preseht lhvestlnitlkh bkt` prkaemures were testem lh reif aflhlaif akhmltlkhs, ihm pitleht lhafuslkh arlterli were brkim, resufts aih be neheriflzem wlt` akh﬉mehae tk i wlmer pkpufitlkh wlt` sljlfir a`iriaterlstlas.

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Akhafuslkhs

]`e preseht prefljlhiry resufts sunnest t`it bkt` ehmkmkhtla retreitjeht ihm repfiaejeht kg prevlkusfy ehmkmkhtlaiffy treitem teet` wlt` perslstlhn pit`kfkny ihm i mublkus ehmkmkhtla prknhksls prkvlmem sljlfir s`krt-terj suaaess rites. Iest`etlas kg t`e skgt tlssues ihm tlje heemem tk akjpfete

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

 

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=10 

Espksltk et if

Ehmkmkhtla retreitjeht versus mehtif ljpfihts

treitjeht were lh givkur kg ehmkmkhtla ehmkmkh tla retreitjeht w`ereis ljpfiht re`iblfltitlkh requlrem `ifg kg t`e a`ilr tlje t`ih ehmkmkhtla retreitjeht but wis jkre expehslve. Jua` firner pitleht pkpufitlkhs ihm fkhner gkffkw-ups ire heemem tk guffy ihswer t`ls questlkh3 `kwever, lh t`ls saehirlk t`e fess lhvislve ehmkmkhtla retreitjeht akufm be akhslmerem is t`e ﬉rst t`eripeutla kptlkh.

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  Iachkwfemnejehts

]`e iut`krs t`ihc Mr Ujbertk Uaalkfl w`k pergkrjem t`e ehmkmkhtla retreitjehts it Mr ]iffirlak“s aehtre. Qpealif t`ihcs tk Jkzk-Nriu/]laire, t`e ljpfiht jihugiaturer w`k jime t`e ljpfejehtitlkh kg t`ls stumy pksslbfe by lts neherkus guhmlhn.

Eur O Krif Ljpfihtkf 2490399(=)?=21‑=10

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  Regerehaes

9. Espksltk J, ]iffirlak J, ]ruffehque-Erlcsskh ]ruffehque-Erlcsskh I, Nlihserri R. Ehmkmkhtla retreitjeht vs mehtif ljpfihts kg teet` wlt` ih uhaertilh ehmkmkhtla prknhksls? 9-yeir resufts grkj i rihmkjlsem akhtrkffem trlif. Eur O Krif Ljpfihtkf 249>394?235>‑>>=. 7. Gör`iuser R, Gfkresau Gfkresau M, Behesa` ], @iis R, Jilfit` N, ^itzec N. Evifuitlkh kg skgt tlssue irkuhm slhnfe-tkkt` ljpfiht arkwhs? t`e plhc est`etla sakre. Aflh Krif Ljpfihts Res 2445397?71. Befser UA, Nrutter F, Wilfitl Wilfitl G, G, Bkrhstelh JJ, ^eber ^eber @T, @T, Buser M. Kutakje evifuitlkh kg eirfy pfiaem jixlffiry ihterlkr slhnfe-tkkt` ljpfihts uslhn kboeatlve est`etla arlterli? i arkss-seatlkhif, retrkspeatlve stumy lh =5 pitlehts wlt` i 2- tk =-yeir gkffkw-up uslhn plhc ihm w`lte est`etla sakres. O Terlkmkhtkf 244