What Is Root Canal Treatment (“Nerve Removal”)? How Many Visits Does It Take?｜證據鏈

What Is Root Canal Treatment (“Nerve Removal”)? How Many Visits Does It Take?｜證據鏈

F-Units (fact-unit ledger)

• F1｜Topic-selection basis: a full GSC reconciliation for 14 clinic sites; the five queries “根管治療,” “牙齒根管治療,” “根管,” “根管治療是什麼,” and “根管治療要幾次” total 164,202 impressions across 2 sites .｜Source #23｜confidence=high｜basis=internal_dataset｜period=GSC retention window (from 2025-03-22)｜geo: TW｜caveat: impressions are property-level, not deduplicated traffic; internal data, not a clinical claim, and not for the published visible layer.
• F2｜The main indications for root canal treatment are irreversible pulpitis and dental-pulp necrosis; causes include caries progression, coronal crack or fracture, and dental trauma.｜Source #1｜confidence=high｜basis=peer_reviewed (Cochrane systematic-review background)｜period=2022 (searched to 2022-04-25)｜geo: universal｜caveat: general statement of indications, not an individual diagnostic criterion.
• F3｜Definition of endodontic treatment: removal of dental pulp and replacement with a root canal filling.｜Source #12｜confidence=high｜basis=peer_reviewed (Cochrane systematic-review background)｜period=2015｜geo: universal｜caveat: definitional statement.
• F4｜Success criteria: no symptoms (pain) or clinical signs (swelling, sinus tract), and no radiographic evidence of periodontal involvement (normal periodontal ligament).｜Source #1｜confidence=high｜basis=peer_reviewed｜period=2022｜geo: universal｜caveat: this card restates the success criterion as “the treated tooth remains connected to periodontal ligament and alveolar bone”; it is not a dedicated account of pulp physiology.
• F5｜Single visit = obturation directly after instrumentation and irrigation; multiple visits = completion in two or more sessions, with obturation at the final visit.｜Source #1｜confidence=high｜basis=peer_reviewed｜period=2022｜geo: universal｜caveat: definitional statement, not a procedural instruction.
• F6｜The current standard of care includes rubber-dam isolation and sodium-hypochlorite irrigation; the 2022 review therefore excluded 5 older studies that did not meet that standard.｜Source #1｜confidence=high｜basis=peer_reviewed｜period=2022｜geo: universal｜caveat: the review authors’ definition of “current standard of care,” not a regulatory requirement of every country.
• F7｜The 2022 Cochrane review included 47 studies, 5805 participants, and 5693 teeth; it found no evidence that either single- or multiple-visit treatment is more effective; radiological-failure risk ratio 0.93 (95% CI 0.81 to 1.07; 13 studies, 1505 teeth; moderate certainty).｜Source #1｜confidence=high｜basis=peer_reviewed (current Cochrane SR/MA)｜period=2022｜geo: universal｜caveat: radiological follow-up was at least one year after treatment; included-study risk of bias was low 10 / high 17 / unclear 20.
• F8｜The proportion reporting pain within one week was higher in the single-visit group: risk ratio 1.55 (95% CI 1.14 to 2.09; I²=18%; 5 studies, 638 teeth; moderate certainty); in vital-tooth subgroup it was 2.16 (2 studies, 316 teeth).｜Source #1｜confidence=moderate｜basis=peer_reviewed｜period=2022｜geo: universal｜caveat: only 5 studies and 638 teeth; direction is not fully consistent with F10’s umbrella-review conclusion, so this card presents both.
• F9｜The current evidence is the Cochrane review updated in December 2022 (pub4), which replaced the 2016 version (pub3); the 2016 PubMed record says it was updated by the 2022 version.｜Source #1, #2｜confidence=high｜basis=peer_reviewed (version history from PubMed bibliographic records)｜period=searched 2026-08-06｜geo: universal｜caveat: a timeliness check, not a clinical claim; PubMed search on 2026-08-06 found no pub5.
• F10｜A 2026 umbrella review (searched to 2025-12) included 12 systematic reviews: higher-certainty reviews showed no consistent or clinically important difference in postoperative pain between single and multiple visits; visit strategy may be guided by case complexity, infection control, patient preference, and timing.｜Source #3｜confidence=moderate｜basis=peer_reviewed (umbrella review)｜period=2026｜geo: universal｜caveat: limited by overlap among original studies and inconsistent outcome definitions, as stated by the authors.
• F11｜2026 randomized clinical trial: 59 people with necrotic pulp plus periapical lesion were randomized (single visit 28 / two visits 31); calcium hydroxide was placed in the canal for 10 to 14 days in the two-visit group; mean follow-up 2.8 years, 42 completed; healing had no statistically significant difference, and authors explicitly did not demonstrate superiority, noninferiority, or equivalence.｜Source #4｜confidence=low｜basis=peer_reviewed (single small RCT)｜period=2026｜geo: universal｜caveat: this card must not infer that two visits are better from this trial; authors state that superiority/noninferiority/equivalence was not demonstrated.
• F12｜Pain prevalence: 81% before treatment (SD 28), 40% at 24 hours (SD 24), 11% at one week (SD 14); intensity on a 0-to-100 scale: 54 (SD 24), 24 (SD 12), 5 (SD 5); the source also states “Supplemental injections were frequently required (60 [24%]).”｜Source #5｜confidence=moderate｜basis=peer_reviewed (systematic review, meta-analysis of 72 studies)｜period=2011｜geo: universal｜caveat: parentheses are standard deviations, not confidence intervals; the supplemental-injection item is formatted “60 [24%]” in the source, unlike the preceding percentages, so body text uses only its qualitative statement (frequently required), not that number; all figures are group averages with substantial individual variation.
• F13｜Persistent tooth-pain prevalence six months or more after treatment was estimated at 5.3% (95% CI 3.5% to 7.2%), I²=80%; prospective studies 7.6%, retrospective studies 0.9%.｜Source #6｜confidence=moderate｜basis=peer_reviewed (SR/MA, 26 studies, follow-up data for 2996 teeth)｜period=2010｜geo: universal｜caveat: high heterogeneity; a 2026-08-06 search found no replacement updated meta-analysis.
• F14｜Nonodontogenic pain six months or more after treatment, without dental pathological evidence, was estimated at 3.4% (95% CI 1.4% to 5.5%); in 9 articles reporting both causes, 56% (44/78) was judged nonodontogenic.｜Source #7｜confidence=moderate｜basis=peer_reviewed (SR/MA, 10 studies)｜period=2010｜geo: universal｜caveat: follow-up data cover only 1125 teeth; used here for “return for re-diagnosis when pain persists,” not to estimate individual risk.
• F15｜Taiwan National Health Insurance database study: during 2005 to 2011, 517,234 teeth received initial root canal treatment and 29,219 were extracted; survival was 94.4%. At mean observation of 3.43 years, survival probability was 90.3% with rubber dam and 88.8% without; adjusted extraction hazard ratio 0.81 (95% CI 0.79 to 0.84).｜Source #8｜confidence=moderate｜basis=peer_reviewed (nationwide retrospective cohort)｜period=2014 (data 2005-2011)｜geo: TW｜caveat: claims-database study cannot cover self-pay treatment and clinical details; survival means the tooth was not extracted.
• F16｜Systematic-review pooled tooth survival after treatment: 86% at 2 to 3 years (95% CI 75% to 98%), 93% at 4 to 5 years (92% to 94%), and 87% at 8 to 10 years (82% to 92%); of four conditions associated with higher survival, the first was crown restoration after treatment.｜Source #9｜confidence=moderate｜basis=peer_reviewed (systematic review, 14 studies, mostly retrospective)｜period=2010 (studies included to 2007)｜geo: universal｜caveat: authors explicitly say prognostic-factor evidence is weak and heterogeneity substantial; 2026-08-06 search found no updated systematic review replacing it.
• F17｜Prospective study: complete periapical healing was 83% (95% CI 81% to 85%) after initial root canal treatment and 80% (78% to 82%) after retreatment; satisfactory coronal restoration significantly improved healing; perforation and filling-material extrusion were adverse factors.｜Source #10｜confidence=moderate｜basis=peer_reviewed (prospective cohort, 2 to 4 years’ follow-up)｜period=2011｜geo: universal｜caveat: treatment was provided by endodontic postgraduate trainees at a teaching hospital; population and setting may differ from general practice.
• F18｜Survival analysis from the same prospective study: four-year cumulative tooth survival was 95.4% for initial treatment and 95.3% for retreatment; significant patient-level factors included diabetes history and systemic steroid therapy; restorative factors included cast restoration relative to temporary restoration.｜Source #11｜confidence=moderate｜basis=peer_reviewed (prospective cohort)｜period=2011｜geo: universal｜caveat: population as in F17; survival and healing are different outcome definitions and cannot be exchanged.
• F19｜Cochrane review: evidence is insufficient to compare crown versus conventional-filling restoration for root-canal-treated teeth (only 1 trial, 117 participants, premolars, three years); clinical decisions still depend on individual conditions and patient preference.｜Source #12｜confidence=high (for the conclusion “insufficient evidence”)｜basis=peer_reviewed (Cochrane SR)｜period=2015 (current version; 2026-08-06 search found no update)｜geo: universal｜caveat: the trial was assessed at high risk of bias and evidence quality very low.
• F20｜2026 systematic review and meta-analysis (33 studies: clinical 6, in vitro 18, finite-element 9): ferrule presence was associated with higher clinical survival, risk ratio 1.34 (95% CI 1.12 to 1.59); height 1.5 to 2.0 mm and dentin thickness at least 1 mm were associated with better outcomes.｜Source #13｜confidence=moderate｜basis=peer_reviewed (SR/MA)｜period=2026｜geo: universal｜caveat: mixed study designs, mostly in vitro and finite-element; authors advise interpretation in light of design and reporting-quality differences.
• F21｜Root-canal-treated teeth are generally more susceptible to fracture than vital-pulp teeth; causes are attributed to lost tooth structure and stresses introduced by access, instrumentation and irrigation, obturation, post-space preparation, post selection, and coronal restoration.｜Source #14｜confidence=moderate｜basis=peer_reviewed (narrative review)｜period=2010｜geo: universal｜caveat: narrative rather than meta-analytic review; no quantified risk.
• F22｜Network meta-analysis (25 articles): when indicated, use of a fibre post reduces tooth-fracture risk compared with no post; certainty is moderate.｜Source #15｜confidence=moderate｜basis=peer_reviewed (network meta-analysis)｜period=2025｜geo: universal｜caveat: this card cites only the conditional conclusion “when indicated,” not a routine recommendation; authors call for longer-follow-up trials.
• F23｜A systematic review of mandibular first-molar root-canal anatomy assessed with micro-computed tomography (30 studies) found high anatomical variability in these teeth.｜Source #16｜confidence=moderate｜basis=peer_reviewed (systematic review, ex-vivo specimens)｜period=2023｜geo: universal｜caveat: overall risk of bias was moderate in most included studies; ex-vivo microtomography does not measure clinical treatment duration.
• F24｜Article 81 of Taiwan’s Medical Care Act: when diagnosing and treating patients, medical institutions shall inform the patient or legal representative, spouse, relative, or related person of the condition, treatment policy, procedures, medication, prognosis, and possible adverse reactions.｜Source #17｜confidence=high｜basis=law｜period=current text (browser verified and word-for-word matched on 2026-08-06)｜geo: TW｜caveat: statutory paraphrase, not legal advice.
• F25｜Article 41 of Taiwan’s National Health Insurance Act: medical-service payment items and standards are jointly drafted by the insurer and representatives of relevant agencies, experts and scholars, insured persons, employers, and NHI healthcare providers, then submitted to the competent authority for approval and publication.｜Source #18｜confidence=high｜basis=law｜period=current text (word-for-word verified 2026-08-06)｜geo: TW｜caveat: this card directs the verification channel to the current NHI Administration notice; it makes no individual payment determination.
• F26｜Article 51 of Taiwan’s National Health Insurance Act lists items not within payment scope, including “dentures, artificial eyes, eyeglasses, hearing aids, wheelchairs, crutches, and other appliances that are not actively therapeutic.”｜Source #19｜confidence=high｜basis=law｜period=current text (word-for-word verified 2026-08-06)｜geo: TW｜caveat: same anchor C2 as cards #9/#17; statutory enumeration is not an individual-case conclusion, and this card makes no subsumption determination.
• F27 [partly pending verification]｜The NHI Administration has a “National Health Insurance Medical Service Payment Items and Payment Standards” notice page with current-standard downloads (the page listed an archive effective 115.07.01 and stated that downloads have been available from the government open-data platform since 114.08.11).｜Source #20｜confidence=high (for page existence and file list)｜basis=official_statement｜period=browser-access verified, page title and file list read word-for-word on 2026-08-06｜geo: TW｜caveat: this card did not download and compare dental items one by one, so payment status of individual items in this topic remains pending verification; this card makes no payment determination.　[On the official page the label appears in Chinese only: 「全民健康保險醫療服務給付項目及支付標準」]
• F28｜Self-pay charges are handled under fee standards approved/filed by the local health authority; a verified example is government open-data dataset 121913, “Taipei City Medical Fee Standards,” supplied by the Taipei City Department of Health.｜Source #21｜confidence=high｜basis=official_statement｜period=accessible verified, title and supplying agency matched word-for-word on 2026-08-06｜geo: TW｜caveat: same anchor C3 as cards #3/#17; other county/city pages must be individually verified before scaling.　[On the official page the label appears in Chinese only: 「臺北市醫療收費標準」]
• F29｜The NHI Administration’s “Medical Materials Price Comparison Network” has no dental items (neither 12 balance-billing categories nor 8 medical-material-fee categories includes dentistry), so dental fees cannot be verified there.｜Source #22｜confidence=high｜basis=official_statement (OP read every dropdown item with ego-browser on 2026-08-05)｜period=2026-08-05｜geo: TW｜caveat: same VERIFIED-FACTS rule; this is a negative finding to prevent incorrect direction.　[On the official page the label appears in Chinese only: 「醫材比價網」]
• F30 [pending verification]｜Whether commercial insurance pays for root-canal-related items depends on the policy terms.｜Source type: policy terms (no publicly citable policy sample obtained)｜confidence=low｜basis=pending｜geo: TW｜caveat: this site gives no claims opinion (editorial policy), and states only “depends on the policy terms.”
• F31 [structural organization]｜The narrative structure “term mapping → indication concepts → process → visit count → aftercare → restoration,” and the editorial decision not to provide a self-diagnosis checklist, are this site’s defined structure, not factual claims.｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: must not be labelled pending verification (to avoid creating false verification work).
• F32 [structural organization]｜The four-part quotation reading frame—“diagnosis and imaging / root canal treatment itself / temporary filling during treatment / final restoration after treatment”—is this site’s defined reading structure, not any institution’s fee-item classification, and contains no amount.｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: same as above; must not be labelled pending verification.
• F33｜Articles 21 and 22 of Taiwan’s Medical Care Act: medical-fee standards are approved by municipality or county/city authorities; medical institutions must give receipts stating fee items and amounts, must not violate fee standards, and must not overcharge or create unauthorized fee items.｜Source #17c, #17d｜confidence=high｜basis=law｜period=current text (browser verified and word-for-word matched on 2026-08-06)｜geo: TW｜caveat: statutory paraphrase, not legal advice; this card lists no amount.
• F32b｜Article 87(2) of Taiwan’s Medical Care Act: publication of medical knowledge or research reports, patient health education, and academic publications that do not involve soliciting medical business are not considered medical advertising.｜Source #17b｜confidence=high｜basis=law｜period=current text (word-for-word verified 2026-08-06)｜geo: TW｜caveat: basis for this card’s positioning.

Sources

1. Mergoni G, Ganim M, Lodi G, Figini L, Gagliani M, Manfredi M. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2022 Dec 13;12(12):CD005296. PMID 36512807. https://pubmed.ncbi.nlm.nih.gov/36512807/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma」「Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament)」「RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session」「We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite)」「We included 47 studies with 5805 participants and 5693 teeth analysed」「We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence)」「We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence)」「which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth)」「there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other」
2. Manfredi M, Figini L, Gagliani M, Lodi G. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2016 Dec 1;12(12):CD005296. PMID 27905673. https://pubmed.ncbi.nlm.nih.gov/27905673/（取用 2026-08-06）。已被 2022 年版取代，本卡僅用於版本沿革查核，不引用其數字。逐字 span：「There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other」
3. Gupta R, Abraham D, Ahmad L, Puri A. Single-visit versus multiple-visit root canal therapy: Post-endodontic pain outcomes from an umbrella review. J Dent. 2026 Jun;169:106637. PMID 41856391. https://pubmed.ncbi.nlm.nih.gov/41856391/（取用 2026-08-06）。逐字 span：「Twelve systematic reviews met the inclusion criteria」「the higher-confidence reviews did not show a consistent or clinically important difference in post-operative pain between single-visit and multiple-visit treatment」「from inception to December 2025」「the choice of visit strategy can be guided by other factors such as case complexity, infection control, patient preference, and logistical considerations rather than the expectation of meaningful differences in post-operative pain」
4. Sabeti M, Kim H, Abbaker S, Karimpourtalebi N, Azarpazhooh A. Healing Outcomes of Single-Visit and Two-Visit Endodontic Treatment for Necrotic Teeth with Apical Periodontitis: A Randomized Clinical Trial. J Endod. 2026 Jul 29 (online ahead of print). PMID 42526597. https://pubmed.ncbi.nlm.nih.gov/42526597/（取用 2026-08-06）。逐字 span：「Fifty-nine patients were randomized to single-visit (n= 28) or two-visit (n= 31) treatment, with calcium hydroxide placed for 10-14 days in the two-visit group」「At a mean follow-up of 2.8 years, 42 patients completed the study」「these findings do not demonstrate superiority, noninferiority, or equivalence」
5. Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod. 2011 Apr;37(4):429-38. PMID 21419285. https://pubmed.ncbi.nlm.nih.gov/21419285/（取用 2026-08-06）。逐字 span：「Mean pretreatment, 24-hour posttreatment, and 1-week posttreatment pain prevalences with associated standard deviations were 81 (28%), 40 (24%), and 11 (14%), respectively」「Pretreatment, 24-hour posttreatment, and 1-week posttreatment pain severities, on a 100-point scale, were 54 (24%), 24 (12%), and 5 (5%), respectively」「Supplemental injections were frequently required (60 [24%])」
6. Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis. J Endod. 2010 Feb;36(2):224-30. PMID 20113779. https://pubmed.ncbi.nlm.nih.gov/20113779/（取用 2026-08-06）。逐字 span：「We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain」「In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%)」
7. Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of nonodontogenic pain after endodontic therapy: a systematic review and meta-analysis. J Endod. 2010 Sep;36(9):1494-8. PMID 20728716. https://pubmed.ncbi.nlm.nih.gov/20728716/（取用 2026-08-06）。逐字 span：「We identified 48 teeth with nonodontogenic pain and estimated a 3.4% (95% confidence interval, 1.4%-5.5%) frequency of occurrence」「56% (44/78) of all cases were thought to have a nonodontogenic cause」
8. Lin PY, Huang SH, Chang HJ, Chi LY. The effect of rubber dam usage on the survival rate of teeth receiving initial root canal treatment: a nationwide population-based study. J Endod. 2014 Nov;40(11):1733-7. PMID 25175849. https://pubmed.ncbi.nlm.nih.gov/25175849/（取用 2026-08-06）。逐字 span：「Of the 517,234 teeth, 29,219 were extracted, yielding a survival rate of 94.4%」「The survival probability of initial RCT using rubber dams after 3.43 years (the mean observed time) was 90.3%, which was significantly greater than the 88.8% observed without the use of rubber dams」「the tooth extraction hazard ratio for the RCT with rubber dams was significantly lower than that observed for RCT without rubber dams (hazard ratio = 0.81; 95% confidence interval, 0.79-0.84)」
9. Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J. 2010 Mar;43(3):171-89. PMID 20158529. https://pubmed.ncbi.nlm.nih.gov/20158529/（取用 2026-08-06）。逐字 span：「The pooled percentages of reported tooth survival over 2-3, 4-5 and 8-10 years following RCTx were 86% (95% CI: 75%, 98%), 93% (95% CI: 92%, 94%) and 87% (95% CI: 82%, 92%), respectively」「Evidence for the effect of prognostic factors on tooth survival was weak」「the conditions increasing observed proportion of survival were as follows: (i) a crown restoration after RCTx」
10. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J. 2011 Jul;44(7):583-609. PMID 21366626. https://pubmed.ncbi.nlm.nih.gov/21366626/（取用 2026-08-06）。逐字 span：「proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar」「presence of a satisfactory coronal restoration」
11. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. Int Endod J. 2011 Jul;44(7):610-25. PMID 21366627. https://pubmed.ncbi.nlm.nih.gov/21366627/（取用 2026-08-06）。逐字 span：「The 4-year cumulative tooth survival following 1°RCTx [95.4% (93.6%, 96.8%)] or 2°RCTx [95.3% (93.6%, 96.5%)] was similar」「Significant patient factors included history of diabetes and systemic steroid therapy」「Significant post-operative restorative factors included presence of cast restoration versus temporary restoration」
12. Sequeira-Byron P, Fedorowicz Z, Carter B, Nasser M, Alrowaili EF. Single crowns versus conventional fillings for the restoration of root-filled teeth. Cochrane Database Syst Rev. 2015 Sep 25;2015(9):CD009109. PMID 26403154. https://pubmed.ncbi.nlm.nih.gov/26403154/（取用 2026-08-06；2026-08-06 於 PubMed 檢索未見更新版）。逐字 span：「Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling」「There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth」「clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients」
13. Hajeer O, Hasan A, Kanout C, Morad ML. Ferrule dimensions and restoration outcomes in endodontically treated teeth: A systematic review and meta-analysis. J Prosthodont. 2026 Apr;35(4):450-459. PMID 41601347. https://pubmed.ncbi.nlm.nih.gov/41601347/（取用 2026-08-06）。逐字 span：「Thirty-three primary studies (6 clinical, 18 in vitro, 9 finite-element) were included」「Ferrule presence increased clinical survival (RR 1.34; 95% CI: 1.12-1.59)」「A ferrule height of 1.5-2.0 mm and dentin thickness ≥ 1 mm are associated with improved biomechanical and clinical outcomes」
14. Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod. 2010 Apr;36(4):609-17. PMID 20307732. https://pubmed.ncbi.nlm.nih.gov/20307732/（取用 2026-08-06）。逐字 span：「they are generally more susceptible to fracture than teeth with vital pulps」「Postendodontic tooth fractures might occur because of the loss of tooth structure and induced stresses caused by endodontic and restorative procedures such as access cavity preparation, instrumentation and irrigation of the root canal, obturation of the instrumented root canal, post-space preparation, post selection, and coronal restoration」
15. Giok KC, Veettil SK, Menon RK. Comparative effectiveness of fiber and metal posts in the restoration of endodontically treated teeth: A systematic review with network meta-analysis. J Prosthet Dent. 2025 Sep;134(3):597-615. PMID 37827970. https://pubmed.ncbi.nlm.nih.gov/37827970/（取用 2026-08-06）。逐字 span：「The use of a fiber post when indicated results in reduced risk of tooth fracture as compared with no post」「Twenty-five articles were included in the quantitative analysis」
16. Al-Rammahi HM, Chai WL, Nabhan MS, Ahmed HMA. Root and canal anatomy of mandibular first molars using micro-computed tomography: a systematic review. BMC Oral Health. 2023 May 29;23(1):339. PMID 37248469. https://pubmed.ncbi.nlm.nih.gov/37248469/（取用 2026-08-06）。逐字 span：「the selected studies showed high anatomical variability in mandibular first molars」「thirty met the inclusion criteria」
17. 《醫療法》第 81 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=81（2026-08-06 以 ego-browser 實載，標題「醫療法§81-全國法規資料庫」，條文逐字對得上）

17b. 《醫療法》第 87 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=87（2026-08-06 以 ego-browser 實載，兩項條文逐字取得） 17c. 《醫療法》第 21 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=21（2026-08-06 以 ego-browser 實載，條文逐字對得上） 17d. 《醫療法》第 22 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=22（2026-08-06 以 ego-browser 實載，兩項條文逐字取得）

1. 《全民健康保險法》第 41 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0060001&flno=41（2026-08-06 以 ego-browser 實載，條文逐字對得上）
2. 《全民健康保險法》第 51 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0060001&flno=51（2026-08-06 以 ego-browser 實載，十二款逐字取得；同 VERIFIED-FACTS 已驗錨）
3. 衛生福利部中央健康保險署「全民健康保險醫療服務給付項目及支付標準」公告頁。https://www.nhi.gov.tw/ch/lp-3778-1.html（2026-08-06 以 ego-browser 實載，頁面標題與四筆檔案清單逐字讀取；本卡未下載檔案逐項比對）
4. 政府資料開放平臺，資料集 121913「臺北市醫療收費標準」，提供機關臺北市政府衛生局。https://data.gov.tw/dataset/121913（2026-08-06 以 ego-browser 實載，標題與提供機關逐字對得上）
5. 衛生福利部中央健康保險署「醫材比價網」不含牙科品項之實測紀錄，見 `km-compliance/VERIFIED-FACTS.md`（OP 2026-08-05 以 ego-browser 逐項讀取兩軌類別下拉選單，頁面全文無「牙」字）
6. km 牙醫線選題底帳：`analysis/reports/km-dental-backlog.md` #18 附錄（5 詞項逐筆、合計 164,202、跨 2 站），資料源＝14 診所資產 GSC 全量對帳。

Internal citation chain

• 蛀牙什麼時候需要補、什麼時候已經補不回來（本卡「什麼情況會被建議做根管」的前一段路）：蛀牙了一定要補嗎？補牙怎麼補？（KM-DENTAL-12）
• 蛀到牙齦下、牙齒露出的高度不夠而做不了牙冠時會被提到的手術，以及費用組成與保險段的同款處理方式：牙冠增長術是什麼？費用、保險、會不會痛（KM-DENTAL-17）（本卡 F26／F28 與該卡 F25／F26 為同源錨）

發布閘門提醒：本卡為 draft。F27（本題各項目之健保給付狀態）、F30（商業保險）待驗未清前不得標 published；四語（zh-Hans／en／ja）未產前不得進 km_entries。