应用口腔手术显微镜探查和疏通下颌磨牙近中中央根管的临床研究

Detection and Negotiation the Middle Mesial Canals in Mandibular Molars by Microscope

目的:评价口腔手术显微镜用于下颌磨牙探查和疏通近中中央根管的临床效果。方法:采集门诊患者126人,下颌磨牙139颗。由3位高年资医生分别在常规肉眼下和口腔手术显微镜下进行下颌磨牙近中中央根管的探查和疏通,比较两者成功率。对下颌磨牙近中中央根管口进行定位测量,并采用偏移投照方法描记该根管走行特点。结果:在显微镜帮助下,所有下颌磨牙近中中央根管的探查和疏通成功率分别提高了11.5%和10.1%。下颌第一磨牙和第二磨牙近中中央根管的疏通率,分别由5.0%增加到15.0%,3.4%增加到了13.6%;而它们的探查成功率分别提高了12.5%和10.2%。所有近中中央根管口均位于髓底发育沟,46.2%靠近近中舌根管口,30.8%在两根管口中间,23.1%靠近近中颊根管口。所有疏通的近中中央根管有45%与近中舌侧根管融合,未发现独立根尖孔类型。结论:在口腔手术显微镜的帮助下,探查和疏通下颌磨牙近中中央根管的数量均有显著提高。

Objective：To evaluate the clinical effect of using dental operating microscope to detect and negotiate the middle mesial canals in mandibular molars.Methods：One hundred and thirty-nine mandibular molars from 126 patients were recruited.The detection and negotiation of middle mesial canals in mandibular molars were performed by three senior endodontists by naked eye or with the aid of dental operating microscope.The location of middle mesial canal orifices was recorded and the pathway of the canals was characterized by periapical angulated projection of X ray.Results：With the aid of microscope,the total number of detected and negotiated middle mesial canals increased by 11.5% and 10.1% respectively compared with naked eye.The number of negotiated middle mesial canals increased from 5.0%to15.0%in the first molars,and from 3.4%to 13.6%in the second molars.The number of detected middle mesial canals in the first and second molars increased by 12.5% and 10.2% under microscope.All of the detected middle mesial canal orifices were located in the mesial subpulpal groove,closer to the mesiolingual canal（46.2%）,in the middle of the groove（30.8%）,or closer to the mesiobuccal canal（23.1%）.There was 45% of the negotiated confluenting with the mesiolingual canal and there was no middle mesial canals with an independent apical foramen.Conclusion：With the aid of dental operating microscope,the percentages of detected and negotiated middle mesial canals in mandibular molars were increased significantly.