MTA治疗成年患者根尖孔未闭合患牙的疗效评价

Clinical Management of Open Apices Teeth with Mineral Trioxide Aggregate(MTA) as Apical Barrier in Adults

目的评价无机三氧化聚合物(MTA)治疗成年患者根尖孔未闭合患牙的临床疗效。方法选取成年患者根尖孔未闭合的前牙及前磨牙共41颗,随机分为2组,试验组21颗牙,在完成根管预备和消毒后,在手术显微镜下将MTA充填于根尖孔及根管下段,厚约3—5mm,硬固后采用热牙胶完成根管中上段的充填;对照组20颗牙,采用氢氧化钙类根管糊剂Vitapex行根尖诱导成形术,定期复查,在根尖部有硬组织形成后完成根管治疗。记录患者就诊次数、治疗周期及治疗效果。结果试验组术后X线片显示15颗患牙适充,6颗牙超充约0.5—2mm,根管内充填物致密;平均就诊次数3.5次,平均治疗周期11.8d,复查时多数患牙窦道闭合,根尖周病变明显缩小或消失,无新的暗影出现;对照组11颗患牙诱导成功,根尖有硬组织形成,9颗牙无明显根尖屏障形成,平均就诊次数6次,平均治疗周期306.8d。结论与根尖诱导成形术比较,MTA治疗成年患者根尖孔未闭合患牙的周期短,疗效好。

Objective To evaluate the clinical effect of treatment of open apices teeth with mineral trioxide aggregate （MTA） compared with apexification using Vitapex in the adult. Methods The root canals of 41 anterior teeth and premolars with single canal and open apices in adults were cleaned and shaped, and then disinfected with calcium hydroxide. The apical root canals of 21 teeth in experimental group were filled with MTA to create a 3-5 mm apical barrier. The remainder of the canals was filled with AH plus and Obtura Ⅱ gutta-percha. The canals of 20 teeth in control were treated with Vitapex. The root canals were then filled with Obtura Ⅱ gutta-percha when the apical barrier could be detected. The visit times, period and result of the treatment were recorded for all cases. Results Good result was achieved in the most cases in the experimental group. The postoperative X-ray films showed that the canals of 15 teeth were obturated well. 6 teeth showed over-filling by 0.5-2 mm. The recalled patients declared their teeth to be asymptomatic except one. The recall radiographs indicated that the apical radiolucent areas of the teeth with pre-existing apical lesion decreased apparently or disappeared completely, except one tooth with large apical radiolucency. No new radiolucency was found around the roots. In the control group, the apexification of 11 teeth succeeded, and 9 failed. The average visit times was 3.5 in experimental group and 6.0 in control. The average period of the whole endodontic treatment was 11.8 days in experimental group and 306.8 in control. Conclusion MTA is more effective and quicker than apexification in treatment of teeth with open apices in adults.