根管显微镜对上颌第一磨牙遗漏近颊第二根管再治疗效果分析

Retreatment of the second mesiobuccal canal in the maxillary first molar by root canal microscope

目的探讨使用根管显微镜对上颌第一磨牙遗漏近颊第二根管的治疗效果。方法选取2017年12月~2018年12月在我院实行根管再治疗的上颌第一磨牙60例患者为研究对象,按照X线片的特点,牙冠和髓底的形态特点判定是否有上颌第一磨牙近颊第二根管(MB2)的存在。使用斜方形开髓入口,探查工具为小号K锉,必要时可以借助根管手术显微镜定位MB2根管。镍钛机使用根管锉冠向下法预备根管,1%NaClO对根管系统进行冲洗,冷牙胶侧方加压和热牙胶垂直加压充填根管。记录近颊根的根管分型、MB2根管畅通情况及VAS评分情况。结果再治疗内共出现MB2根管52例,疏通43例(82.7%)。近颊根双根管比较常见的是2-1型和2-2型。治疗中无任何器械折断和管壁侧穿的情况。治疗后患者VAS评分[(2.6±0.8)分]较治疗前患者VAS评分[(4.6±1.5)分]明显降低,差异有统计学意义(t=3.1673,P<0.05)。结论上颌第一磨牙MB2有着较高的发生率,并且有着弯曲、隐蔽和狭窄等情况,增加了治疗难度,临床医生有意识的寻找并结合显微镜下的可视化操作可以提升MB2根管的发展及成功率。

Objective To investigate the effect of root canal microscopy on the second mesiobuccal canal in the maxillary first molar. Methods Sixty patients who underwent root canal retreatment for maxillary first molars in our hospital from December 2017 to December 2018 were selected as subjects. According to the morphological characteristics of crown and pulp base in X-ray films, whether there was second mesiobuccal canal(MB2) in maxillary first molar was determined. A beveled open-dental pulp entrance was used, and the probing tool was a small K file. The MB2 root canal could be positioned with a root canal surgery microscope if necessary. The nickel-titanium machine was used to prepare the root canal by the root canal file crown-down method. 1% NaClO flushed the root canal system. The root canal was filled with the cold side rubber side pressure and the hot tooth vertical pressure. The root canal classification of the proximal mesiobuccal root and the situation of MB2 root canal flow and VAS scores were recorded. Results A total of 52 cases of MB2 root canal were found in the re-treatment and 43 cases(82.7%) were dredged. The mesiobuccal double root canals were more commonly type 2-1 and type 2-2. There were no fractures of the instrument and side wall penetration during the treatment. After treatment, the VAS score (2.6±0.8) was significantly lower than that before treatment (4.6±1.5), and the difference was statistically significant(t=3.1673, P<0.05). Conclusion The MB2 in the maxillary first molar has a high incidence, and the curvature, concealment and stenosis increase the difficulty of treatment. The clinician's conscious search and combination of visualization operations under the microscope can improve the development and success rate of MB2 root canals.