左上颌第二磨牙近颊三根管根管治疗1例并文献回顾

Root canal treatment of maxillary second molar with three mesial buccal root canals:a case report and literature review

目的探讨近颊根三根管的临床诊疗要点,为临床提供参考。方法在对患有牙髓炎的左上第二磨牙进行根管治疗的过程中,通过牙科显微镜下根管探查及锥形束CT(cone beamCT,CBCT)辅助影像学检查,明确了左上第二磨牙含有3个牙根、5个根管,其中近颊根有第三根管的存在。结合完善的根管预备、清理、消毒、充填和微创的嵌体修复,消除了患者的临床症状;治疗后随访并进行相关文献复习。结果1年及2年随访时患者均表示患牙无不适,可正常使用;X线片示充填完好,根尖周组织无异常。回顾相关文献结果表明,上颌第二磨牙近颊3根管发生率为0.11%~4.2%,单纯通过X线片很难发现额外根管,医师应通过CBCT、手术显微镜等检查进一步确定根管的数量与解剖形状;当上颌磨牙存在近颊3根管时,医师应避免过度预备,根管治疗过程中保留更多的健康牙体组织是预后良好的关键。结论对上颌第二磨牙近颊3根管进行根管治疗时,临床医师需充分考虑根管的解剖变异,借助CBCT检查,综合使用手术显微镜、超声及各种辅助器械来定位和治疗变异根管。

Objective To explore the key points of clinical diagnosis and treatment of three mesiobuccal root canals.Methods In the procedure of endodontic therapy for the upper left second molar with pulpitis,through root canal exploration under a dental microscope and cone beam CT(CBCT)-assisted imaging examination,it was confirmed that the left upper second molar contained 3 roots and 5 root canals,among which the third root canal existed in the mesiobuccal root.Combined with perfect root canal preparation,cleaning,disinfection,filling and minimally invasive inlay repair,the clinical symptoms were eliminated.The patients were followed up and the related literatures were reviewed.Results One-and two-year follow-ups showed that the tooth had no discomfort and could be used normally.X-ray revealed that the filling was complete,and the periapical tissue was normal.The results of the literature review showed that the incidence of three mesiobuccal root canals in maxillary second molars was 0.11%-4.2%.It is difficult to find additional root canals only by X-ray imaging.Dentists should further determine the number and anatomical shape of root canals by CBCT and operating microscopy.When there are three mesiobuccal root canals in maxillary molars,dentists should avoid overpreparation.Healthy tooth tissue is the key to good prognosis.Conclusion During root canal therapy,clinicians should consider the anatomical variation of the root canal,should always be alert to the existence of an extra root canal,and should use CBCT,operating microscopy,ultrasound and various auxiliary instruments to locate and treat the variant root canal.