偏移投照技术与显微治疗诊治遗漏根管的疗效分析

Effectiveness analysis of augulated periapical radiography and micro-endodontics in the detection and treatment of missing root canals

目的分析根管治疗术后偏移投照技术与显微根管治疗的应用对遗漏根管的发现与治疗的临床疗效。方法选择需行初次牙髓治疗的下颌前牙、下颌前磨牙、下颌第一、二磨牙及上颌第一、二磨牙共360颗(分别为49、68、62、50、85、46颗)。常规拍摄术前正位根尖片,并于根治后拍摄正位及20°～30°偏位根尖片,通过对比分析,对可疑遗漏根管的患牙,在显微镜下寻找及治疗遗漏根管。结果经显微治疗,360颗患牙中25颗(6.9%)确诊为遗漏根管,各牙位依次为3、5、5、4、6、2颗,其中23颗患牙发现并成功充填遗漏根管,2颗根管可找到但不完全通畅;正位发现8颗(2.2%),偏位发现23颗(6.4%),术后偏移投照发现率明显高于正位(P<0.05)。结论根治术后偏移投照技术与显微根管治疗对遗漏根管的发现与治疗有较大的帮助。

Objective To analyze the clinical effectiveness of augulated periapical radiography and micro-endodontics in the detection and treatment of missing root canals after endodontic treatment.Methods Three hundred and sixty nonendodontically treated teeth,including 49 mandibular anterior teeth,68 mandibular premolars,62 mandibular first molars,50 mandibular second molars,85 maxillary first molars and 46 maxillary second molars,were selected.Before the endodontic treatment,conventional periapical radiographs were taken at the routine angle.After root canal obturation,both routine and 20-30 degree horizontally angulated periapical radiographs were taken.The suspected teeth were explored and treated under dental operating microscope.Results Among the 360 teeth,25 teeth（6.9%） were found to have missing root canals after endodontic treatment by using routine and augulated periapical radiographs and micro-endodontics（3,5,5,4,6 and 2 respectively）.The 23 missing root canals were identified and filled successfully and 2 canals can not achieve the full length.Periapical radiographs showed the missing canals in 8 of the 25 teeth,and the angulated radiographs showed the missing canals in 23 of the 25 teeth.Significant difference was found between the two periapical radiographs（P0.05）.Conclusions The augulated periapical radiography after endodontic treatment and micro-endodontics will assist the clinician in the detection and treatment of missing root canals.