根管治疗术后即刻桩核预备并冠修复的临床观察

Clinical study on root canal preparation immediately after root canal treatment

目的观察根管充填术后即刻进行桩核预备的临床疗效。方法选取我院2011年10月1日~2013年9月30日门诊93例患者106颗完成根管治疗术后需行根管桩核预备＋全冠修复的牙齿（如残根、残冠）,分成对照组和实验组两组治疗。实验组采用根管治疗术后即刻进行桩道预备＋烤瓷冠牙体预备;对照组按常规于治疗后一周进行桩道预备并烤瓷冠修复。随访6个月~2年。复诊时检查牙齿有无叩痛,有无松动,牙龈健康状况,烤瓷冠龈缘密合程度,并X线片检查根尖周及牙周膜状况。制定评价标准,做出临床效果评价。结果经2年的随访,对照组中于修复前出现1例颊舌向劈裂,4例牙冠部分折裂;术后1年3例有牙周炎症状;术后2年4例出现根尖周炎,1例发现有桩核轻度松动,均计为失败病例,共13例,成功率76.36%。实验组术前无牙折现象,2例术后2年出现根尖周炎症状。1例于术后1年有牙周炎症状。均计为失败病例,共3例。成功率达94.12%。实验组的成功率显著高于对照组（P〈0.05）。结论即刻预备优于术后1周进行桩核预备的常规方法,有利于根尖的封闭,减少桩核预备的常见并发症,为保存患牙争取了机会。

Objective To observe the effects of root canal preparation for post-core immediately after root canal obturation. Methods A total of 106 cases of mutilated coronal tooth structure, after endodontic therapy, indicated for postcore and crown, collected from dental outpatients in our hospital during 1st Oct 2011-30 th Sep 2013, were randomly divided into the control group and the experimental group. The experimental group were prepared for post space 7 days after root obturation, and then the teeth were prepared for retention of crowns; while in control group, post space was made 7 days after obturation. The two groups were observed in intervals of every half a year after treatment to examine the integrity, masticatory function and retention. Meteyards were established to evaluate its clinical effects. Results During follow-up visiting patients half a year to 2 years, in control group, there was 1 patient with splitting along bucclingual direction and 4 patients with fracture of coronal structure before preparation; after restoration there were 3 patients with periodontitis in the 1st year, 4 patients with periodical periodontitis, and 1 patient with loosening of post in the 2nd year, all of which were failure cases. In experimental group, before preparation there were no fracture case;after restoration there were 2 patients with periodical periodontitis in the 2nd year and 1 patient with periodontitis in1 year. All the 3 cases counted as failure cases. The total successful rate in control group was 76.36%, and 94.12% in experimental group. The successful rate in the experimental group was significantly higher than the control group（P〈0.05）. Conclusion Root canal preparation for post-core immediately after obturation is more successful than the usual way with better apical sealing,less complication and frequency of teeth fracture.