多根管下颌第一前磨牙显微根管治疗的临床评价

Treatment of mandibular first premolar with multiple root canals using surgical microscope

目的 评价手术显微镜在多根管下颌第一前磨牙根管治疗中的作用.方法 选取临床上需行根管治疗的下颌第一前磨牙148例,拍摄术前X线正位和偏位投照片,对疑为多根管的患牙,先在肉眼下探查根管,再在显微镜下定位和疏通根管,ProTaper镍钛器械预备根管,垂直加压法充填根管.比较显微镜使用前后多根管的发现率,并根据治疗前后X线片评价根管预备和充填效果.结果 显微镜使用前后下颌第一前磨牙多根管发现率分别为12.2%和23.6%,两者之间差异有统计学意义（P〈0.01）.治疗中无并发症发生,根管预备及充填效果佳.结论 手术显微镜有助于定位和清理额外根管,提高下颌第一前磨牙根管治疗的成功率.

Objective To evaluate the efficacy of treatment of mandibular first premolar with multiple root canals using surgical microscope. Methods One hundred and forty eight mandibular first premolars requiring root canal treatment in vivo were included in the study. The preoperative radiographs were taken at a horizontal angle of 0, 20-30 degree from mesial or distal direction. Initial location and negotiation of extra canal was attempted with the naked eyes. Teeth in which extra canal was not located or not negotiated were further explored under operative microscope. All the root canals were prepared by ProTaper Ni-Ti rotary instruments and obturated with vertical condensation method. The frequency of extra canal detection was recorded with or without microscope, and the efficiency of preparation and obturation was analyzed with radiographs before, during and after operation. Results The frequency of extra canal detection in mandibular first premolars for the naked eyes and the microscope was 12,2% and 23,6%, respectively. When no magnification was used, significantly fewer extra canals were located based by Chi-square analysis at P〈0.01. Conclusion Surgical operative microscope can increase the number of root canal orifices located and enhance the long-term prognosis of root canal treatment of mandibular first premolars.