根管治疗失败原因分析及预防对策研究

Study on failure cause and clinical measures of root canal treatment

目的分析导致根管治疗术失败的主要临床因素,为RCT更趋于完善,成功率得到进一步的提高提供临床参考。方法按研究病例的纳入标准,选择首次RCT失败患牙169颗为研究对象,运用该患牙就诊时临床检查情况与首次RCT前病历资料做对照,结合X线影像技术分析,综合判定RCT失败的主要临床因素,研究根尖周状态、根管充填位置、密实程度、冠渗漏等因素与可能导致RCT失败的关系。结果 169颗患牙中,首次治疗前根尖有病变患牙最多,141颗(83.43%);其次为根管充填位置欠佳,101颗(59.76%);冠渗漏79颗(46.75%);遗漏根管20颗(11.83%);牙纵折3颗(1.78%)。患牙有多种情况交叉发生现象。结论 RCT失败的主要原因依次为患牙治疗前根尖周严重病变的存在,根管充填欠佳,冠渗漏,遗漏根管。彻底去除感染源、杜绝继发性感染发生是RCT应遵循的两大原则。

Objective To increase the success rate of root canal treatment,analyze the clinical factors of root canal treatment failure.Methods In accordance with the inclusion criteria,select 169 failed teeth as study objects.Through x-ray analysis and comparing the current situations and the previous situations,determine the clinical factors of root canal treatment failure.Results In all the 169 teeth,the serious periapical lesions existed in 141 teeth（83.43%） before the first treatment,overfilling/underfilling 101（59.76%）,crown leakage 79（46.75%）,missing root canals 20（11.83%）,tooth longitudinal fracture3（1.78%）.Most teeth have two or more factors.Conclusions The factors of root canal treatment failure are as follows： the serious periapical lesion,overfilling/underfilling,crown leakage,missing root canals.To remove the infection sources completely and to prevent the secondary infection is the two principles that should be followed.