恒磨牙根管治疗术后成功率的影响因素

Influence Factors of Success Rate after the Canal System of Maxillary Molar Surgery

目的探讨感染根管的类型、重度牙周炎、冠修复等在恒磨牙根管治疗的术后影响因素,为临床提高根管的成功率提供理论基础。方法整群选取2012年4—11月徐汇区牙病防治所口腔内科非根管再治疗的患者,共312例,336颗患牙。依据感染根管的类型将336颗恒磨牙分成两组是:活髓患牙组和死髓患牙(牙髓坏死和根尖周病患牙)组。分别对是否伴有重度牙周炎和是否冠修复进行统计学分析。结果 336颗恒磨牙根管治疗术后4年总成功率为89.58%,其中活髓牙根管治疗总成功率为93.93%,死髓牙成功率为83.33%。两者之间差异有统计学意义(χ~2=6.89,P<0.05)。活髓牙伴有重度牙周炎的成功率53.33%,不伴有重度牙周炎的成功率为97.80%,两者之间差异有统计学意义(χ~2=47.26,P<0.05)。死髓牙伴有重度牙周炎的成功率54.84%,死髓牙不伴有重度牙周炎的成功率为91.59%,两者之间差异有统计学意义(χ2=23.37,P<0.05)。活髓牙冠修复的成功率和不做冠修复两者之间差异有统计学意义(χ~2=10.22,P<0.05)。死髓牙冠修复和不做冠修复两者之间差异有统计学意义(χ~2=6.77,P<0.05)。结论根管术后影响因素除根管的充填质量有关外,还与患牙感染的类型、伴有牙周炎的程度及是否做冠修复等影响因素相关,根管治疗后需及时做冠修复。伴有重度牙周炎的患者,需要积极进行牙周治疗,从而提高根管治疗的成功率。

Objective To study the postoperative influence factors of type of infected root canal, severe periodontitis and crown restoration in the canal system of maxillary molar surgery and provide theoretical basis for improving the success rate of canal system in clinic. Methods Group selection 312 cases of patients（ 336 teeth） with non-canal system retreatment in our hospital from April to November 2012 were selected and divided into the vital pulp teeth group and dead dental pulp teeth group（dental pulp necrosis and periapical disease）, and whether the patients were with severe periodontitis or crown restoration was statistically analyzed. Results After operation, the total success rate of 4 years was 89.58%, and the success rate of vital pulp teeth and dead dental pulp teeth was respectively 93.93% and 83.33%, and the difference in the curative effect was obvious with statistical significance（χ^2=6.89,P〈0.05）, and the success rate of vital pulp teeth with severe periodontitis was 53.33% and the success rate of vital pulp teeth without severe periodontitis was 97.80%, and the difference between groups was statistically significant（χ^2=47.26, P〈0.05）, the success rate of death pulp teeth with severe periodontitis was54.84% and the success rate of death pulp teeth without severe periodontitis was 91.59%, and the difference between groups was statistically significant（χ^2=23.37, P〈0.05）m, and the difference in the success rate of death pulp crown restoration and no crown restoration between the two groups was statistically significant（χ^2=23.37,P〈0.05）, and the difference in the vital pulp crown restoration and no crown restoration between the two groups was statistically significant（χ^2=6.77, P〈0.05）. Conclusion The influence factors after canal system operation are related to the type of infected teeth, degree of periodontitis and whether to do the crown restoration or not in addition to the canal filling quality, and we should do the crown restoration for patients in time after the canal treatment, the patients with severe periodontitis need to adopt the active periodontal treatment thus improving the success rate of canal treatment.