493颗根管再治疗患牙的临床分析

Clinical analysis of 493 nonsurgical root canal retreatments

目的研究影响根管治疗效果的常见因素,以提高根管治疗成功率。方法收集405例根管再治疗患者共493颗患牙,包括前牙115颗,前磨牙91颗,磨牙287颗。记录患牙的临床表现、X线片表现、冠修复或充填情况、根管再治疗情况等,分析临床上影响根管治疗效果的问题,总结引起治疗失败的原因。结果患牙中,根管欠填464颗(94.1%)、超填8颗(1.6%),遗漏根管138颗(28.0%),存在钙化根管134颗(27.2%),根管偏移202颗(41.0%),根管内异物27颗(5.5%),髓腔或根管穿孔15颗(3.0%),冠方修复不完善340颗(69.0%),有根尖暗影356颗(72.2%),有症状的患牙307颗(62.7%)。磨牙遗漏根管、根管偏移的比例较前磨牙和前牙高。470颗患牙能够顺利完成根管再治疗,23颗患牙因根管异物无法取出、根管超填、根管偏移严重、治疗中根尖区侧穿、髓腔穿孔较大等问题经根管再治疗后症状不缓解而拔除。结论引起根管治疗失败的常见因素主要是根管欠填、冠方修复不完善、根管偏移、遗漏根管,大多数患牙采用规范的根管治疗技术进行根管再治疗可以取得较好的临床治疗效果。

Objective Clinical data of 493 endodontic failure cases were analyzed,to evaluate the factors affecting the effect of root canal treatment.Methods Four hundred and ninety three endodontic retreatment teeth of 405 patients were analyzed,clinical examination,pretreatment and posttreatment radiographs,and effect after clinical management were recorded,to determine the faults that contribute to the endodontic treatment failure.Results A total of 115 anterior teeth,91 premolars,and 287 molars were included,72.2% of failed teeth showed apical radiolucency,94.1% showed under-filled canal,1.6% with over-filled canals,the rate of missing canals,calcified canals,ledge and transportation,foreign body in canals,perforation in pulp cavity or root were 28.0%,27.2%,41.0%,5.5%,3.0%,respectively.Among of them,307 teeth were symptomatic,340 had poor coronal restoration.Endodontic retreatments of 470 teeth were conducted favorably,and 23 teeth were pulled out during to endodontic failure.Conclusion The study indicated that factors that associated with endodontic failure involve in inadequate canal cleaning and shaping,under-filling canal,poor coronal restoration and complex root canal anatomy,the treatment outcome can improve when modern and normalized root canal therapy technique is applied.