上颌第一恒磨牙变异根管的诊治

Clinical Analysis of Aberrant Canals in Maxillary First Molars: A Case Report

目的 探讨上颌第一恒磨牙变异根管在根管治疗中的诊断及治疗对策。方法 1例上颌第一恒磨牙的再治疗病例,清理髓腔后在手术显微镜下超声器械小心钻磨髓室底,牙髓探针仔细探查,在近中侧发现第二个腭侧根管口,近颊根近舌根管与近颊根管融合,常规逐步后退法预备探查到的4个根管,冷牙胶侧方加压技术充填根管。结果 术后10个月复查,患者无主观症状,患牙能正常行使功能,X线片显示根尖无病变,临床检查患牙无异常表现。结论 术前X线片对于上颌第一恒磨牙变异根管的诊断及发生部位的确定有较大帮助,治疗中完全去除髓室顶、仔细探查髓室底和显微超声技术的应用有助于寻找、发现并疏通遗漏根管。

Objective To study the diagnosis and treatment of the atypical root canal in maxillary first molars. Methods A retreated maxillary first molar with two distinct palatal roots was evaluated. Routine endodontic access to cavity were prepared, and during examination with an operating microscope the canals of the left first maxillary molar were determined as follows: one oval canal in the mesiobuccal root, one canal in the distobuccal root, two canals in the palatal roots(mesial and distal palatal roots). These canals were instrumented and medicated, then they were filled by lateral condensation technique. Results Ten months after treatment,the patient was asymptomatic and able to function equally well on both sides, and radiograph demonstrated normal root and bone image over time. Conclusion It should be assumed that the maxillary first molar may have more than traditionally expected three canals because its anatomical variation can occur at any time. The location of extra canals should be identified at high magnification under the microscope, and careful radiographic examination of the tooth should be done in order to identify possibly missed canals.