开髓洞型对患牙根管治疗术后抗折性能影响的研究进展

Research progress on fracture resistance of endodontically treated teeth with different endodontic access cavities

根管治疗术是目前治疗牙髓根尖周疾病最常用且有效的手段之一。根管治疗过程会导致牙体组织损失,可能会降低患牙的抗折性。开髓洞型的设计与冠部牙体组织的磨除量密切相关。如何在保证根管治疗的有效开展下进行微创开髓,减少冠部牙体组织损失,以提高术后患牙的抗折性能,是本领域的研究热点。与强调直线入路的传统开髓洞型相比,以保守开髓洞型为代表的微创开髓洞型能否增强患牙的抗折性存在争议。本文从不同开髓洞型设计要点、根管治疗术后患牙抗折性能的研究现状入手,对相关研究进行文献回顾和综述。综合研究结果,可以认为微创开髓洞型减少了冠部牙体组织损失量,降低了应力集中;但过分微创的开髓洞型未能实现患牙抗折性能的提升,可能是因为微创设计破坏了直线通路所致。本文为微创开髓洞型在根管治疗中的应用提供了新思路,设计新的微创开髓洞型以兼顾冠部牙体组织的保存与直线通路的建立,或许是未来的研究方向。

Root canal therapy is one of the most common and effective methods for treating pulp and periapical diseases. The loss of dental tissue during treatment may reduce the fracture resistance of endodontically treated teeth. The design of endodontic access cavities is closely related to the preservation of crown dental tissue. Performing minimally invasive access under the condition of ensuring the effect of root canal therapy to reduce the loss of dental tissue and improve the fracture resistance of endodontically treated teeth has become a research hotspot. Whether minimally invasive access, which is represented by conservative endodontic cavities, can enhance the fracture resistance of endodontically treated teeth compared with the traditional endodontic cavity with linear approach is controversial. This review intends to start with the design points of endodontic access cavities and the status of the research on the fracture resistance of endodontically treated teeth with different endodontic access cavities. We reviewed correlational studies to provide fresh ideas for the application of minimally invasive access in root canal therapy. Studies confirmed that minimally invasive access can reduce the loss of crown dental tissue and stress concentration. However, an excessively minimally invasive access cannot improve the fracture resistance of endodontically treated teeth likely because the minimally invasive design disrupts the linear approach. Designing a new minimally invasive access to account for the preservation of crown dental tissue and the establishment of linear approach may be a future research direction.