钙化根管的临床研究及病例报告

发布时间：2018-06-02 15:32

本文选题：根管治疗 + 牙髓钙化　；参考：《山东大学》2017年硕士论文

【摘要】：背景:根管治疗是牙髓病和根尖周病最有效和保留患牙时间最长的治疗方法。在根管治疗中,常会遇到钙化不通的根管,其治疗难度大,治疗时间长,治疗次数多,耗费材料、器械多,较为棘手。牙髓钙化的发生率很高,可出现在任何牙上。根管及根管口的钙化是导致根管遗漏的重要原因,而根管遗漏则是根管治疗失败的常见原因之一。研究表明,钙化根管治疗的失败率可达25-80%。近年来,随着口腔新材料、新器械的研发及新技术的应用,对钙化根管的医治成功率有较大提高,使从前难以保留的患牙最大程度上得以保存。目的:通过对临床钙化根管治疗的研究,分析钙化根管的形成原因,探讨其治疗的常用方法及操作要点,观察治疗的效果,积累临床经验,为更好地开展钙化根管的临床诊疗提供参考和依据。方法:选择2015年3月至2017年2月就诊于山东大学口腔医院特诊科及城西分院的钙化根管治疗的患者248例共286颗患牙。记录患者就诊时间、姓名、性别、年龄、牙位、诊断、处置。统计前牙、前磨牙、磨牙钙化不通根管的病例数,有无治疗史,钙化情况及其治疗结果。结果:1.在本研究中,248例根管钙化的患者,男性患者占37.9%,女性患者占62.1%,女性总体多于男性;根管钙化可出现在各个年龄段上,临床治疗钙化根管的年龄峰值位于青、中年;根管钙化的形成也与增龄性变化有关。2.在本研究中,286颗根管钙化的患牙,根据牙位和原因分组,龋病、牙周病、外伤、慢性磨损、再治疗、隐裂等原因均可造成患牙的根管钙化,男性和女性无明显的性别差异。龋病(多为深龋露髓)和再治疗(包括根管再治疗和不良充填体再治疗)的患牙发生根管钙化的比率远高于其它几种原因,其中因龋患牙占37.76%,再治疗患牙占45.1%,而靠近龋损的根管的钙化严重于其它根管;因外伤造成根管钙化的多见于前牙,尤其是上前牙;隐裂或劈裂造成根管钙化多见于磨牙;慢性磨损导致的根管钙化可以发生在各个牙位上,慢性磨损包括因咬合关系不当而造成的牙齿重度磨耗和因不当的刷牙方式导致的重度楔状缺损。就牙位而言,磨牙发生根管钙化的比率高于前牙、前磨牙,占总体的73.43%。3.在本研究中,248例患者286颗根管钙化的患牙中,治疗失败者大部分为磨牙,再治疗的患牙治疗失败的可能性更高,治疗的疏通率为94.06%,成功率为89.86%,治疗失败率为10.14%。结论:钙化根管的治疗是临床常见的复杂根管治疗,其形成原因是多方面的,可能与外伤、慢性磨损、龋病、根尖周病、牙周病、牙齿发育异常、不当的治疗史、增龄性变化等有关,因此治疗过程繁复困难。钙化根管的治疗需制定全面的治疗计划,多种材料器械联合应用,C型先锋锉、镍钛K锉、机用镍钛器械、超声工作仪,EDTA凝胶及NaClO、H202冲洗液,电子根测仪配合X线片、CBCT,以及必要时Micro-CT、显微镜的运用,掌握根管的解剖尤其是解剖变异情况,谨慎细心,规范操作,逐步疏通钙化物,最大程度地防止根尖偏移、根管侧穿、器械分离、台阶形成等,使患牙得以保存。
[Abstract]:Background: root canal therapy is the most effective treatment for dental pulp disease and periapical periodontitis. In root canal therapy, the root canal often meets calcified root canal. It is difficult to treat, with long treatment time, more times, more materials, more instruments, and more difficult. The incidence of dental pulp calcification is very high and can appear on any tooth. The calcification of the canal and root canal is an important cause of leakage of root canal, and the omission of root canal is one of the common reasons for the failure of root canal therapy. The study shows that the failure rate of the calcified root canal treatment can reach 25-80%. in recent years. With the development of new oral materials, new instruments and new techniques, the success rate of calcified root canal treatment is greatly improved. Objective: to preserve the most difficult teeth which were previously difficult to retain. Objective: through the study of the clinical calcified root canal therapy, the causes of the formation of calcified root canal were analyzed, the common methods and operation points of the treatment were discussed, the effect of the treatment was observed and the clinical experience was accumulated, so as to provide reference and basis for the better clinical diagnosis and treatment of calcified root canal. Methods: from March 2015 to February 2017, 248 patients with 286 teeth were treated at the special diagnosis Department of the Shandong University oral hospital and the calcified root canal in the West Branch of Chengxi Branch. The patient's time, name, sex, age, tooth position, diagnosis and disposal were recorded. The number of cases of anterior teeth, premolar and calcified root canal were counted, there was no history of treatment and calcification. Results: 1. in this study, in this study, 248 cases of root canal calcification, male and female accounted for 37.9%, women accounted for 62.1%, and women were more than men; root canal calcification could occur at all ages. The peak age of clinical treatment of calcified root canal was in green and middle age; the formation of root canal calcification was related to.2. in this study. In the case of 286 teeth with calcified root canal, caries, periodontitis, periodontitis, trauma, chronic wear, retreatment, and cleft can cause root canal calcification of the affected teeth. There is no significant gender difference between men and women. Caries (mostly deep caries) and retreatment (including root canal retreatment and retreatment of bad filling body) The ratio of rooting tube calcification is much higher than other reasons, of which 37.76% of dental caries are caused by decayed teeth and 45.1% of the affected teeth, and the calcification of the root canal near the caries is more serious than the other root canals; the root canal calcification is often seen in the anterior teeth, especially the anterior teeth; the root canal calcification is often found in the molar; the root canal calcification is often found in the molar; the root canal caused by chronic abrasion is the root cause. Tube calcification can occur on the various teeth. Chronic wear includes severe tooth wear caused by improper occlusion and severe wedge-shaped defects caused by improper brushing. The ratio of root canal calcification in molar teeth is higher than that of anterior teeth, premolar, and the total 73.43%.3. in this study, 286 root canals in 248 patients. In calcified teeth, most of the losers are the molars, and the treatment failure is more likely, the rate of dredging is 94.06%, the rate of success is 89.86%, the rate of failure is 10.14%. conclusion: the treatment of calcified root canal is a common complex root canal treatment in clinical, and the cause is many aspects, it may be associated with trauma, chronic wear and tear. Caries, periapical disease, periodontitis, abnormal tooth development, improper history of treatment, aging changes, and so on. Therefore, the treatment process is difficult. The treatment of calcified root canal needs comprehensive treatment plan, combined application of various materials and instruments, C avant-garde file, nickel titanium K file, mechanical nickel titanium instrument, ultrasonic instrument, EDTA gel and NaClO, H202 flushing fluid In conjunction with X-ray, CBCT, and the use of Micro-CT and microscope, the electronic root measuring apparatus mastered the anatomy of the root canal, especially the anatomic variation, carefully and carefully, standardized operation, gradually dredged the calcification, prevented the root excursion, the root canal side piercing, the instrument separation, the step formation and so on, so that the affected teeth could be preserved.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

【参考文献】