下颌切牙双根管的显微根管治疗

Clinical management of mandibular incisors with multiple root canals using dental operating microscope

目的评价显微根管治疗术处理下颌切牙双根管的临床疗效。方法选取143颗需进行根管治疗的下颌切牙(下颌中切牙68颗,下颌侧切牙75颗),拍摄术前X线正位投照片和偏位投照片。对单根管患牙采用常规根管治疗;对疑为双根管的患牙先常规探查根管,再在牙科手术显微镜下探查并疏通根管,机用镍钛器械预备根管,垂直加压充填技术充填根管。记录根管类型,不同X线投照角度、使用和未使用牙科手术显微镜时多根管的发现率,根据术前、术中及术后X线片评价根管预备和充填效果。结果采用显微根管治疗,下颌中切牙、侧切牙双根管的发现率分别为26.47%、29.33%,X线偏位投照片双根管的发现率高于正位投照片;使用牙科手术显微镜后,多根管的发现率高于未使用时;在牙科手术显微镜下进行根管预备,无根管堵塞、偏移、台阶、器械分离等并发症发生;134颗患牙适充,9颗有糊剂或牙胶超充,无欠充。结论显微根管治疗是处理双根管下颌切牙的有效方法,在牙科手术显微镜下以机用镍钛器械预备根管,垂直加压充填技术充填根管可取得良好的治疗效果。

Objective To evaluate the role of dental operating microscope in clinical treatment of lower incisors with multiple root canals. Methods 143 mandibular incisors in 128 patients were treated endodontically. Two kinds of preoperative radiographs were taken for each tooth, using straight projection and eccentric projection. The root canal morphology was recorded according to Vertucci＇s classification. Under dental operating microscope, the teeth with multiple root canals were shaped using Ni-Ti rotary instruments Hero 642, cleaned using sodium hypochlorite, and obturated with vertical condensation technique. The following information was recorded： The number of teeth that were found to have multiple canals in two kinds of preoperative radiographs, and when using and without using mi- croscope. The efficiency of preparation and obturation was analyzed with radiographs before, during and after opera- tion. Results The mandibular central incisor with one canal was 73.53% and multiple canals was 26.47% in treated teeth. The mandibular lateral incisor with one canal was 70.67% and multiple canals was 29.33% in treated teeth. By eccentric projection radiograph and treatment using microscope, more teeth with multiple canals were found. No complication was found during root canal preparation. 135 teeth were well filled and 9 showed slight over-filling. Conclusion With dental operating microscope, the mandibular incisors with multiple root canals could be treated well in combination with rotary instrumentation and vertical condensation technique.