国际口腔医学杂志

国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (2): 166-171.doi: 10.7518/gjkq.2023029

• 论著 • 上一篇    下一篇

288例前牙显微根尖手术临床资料的回顾性分析

梁芷瑩(),赵苑汐,朱嘉妮,苏勤()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院牙体牙髓病科 成都 610041
  • 收稿日期:2022-07-20 修回日期:2022-11-02 出版日期:2023-03-01 发布日期:2023-03-14
  • 通讯作者: 苏勤
  • 作者简介:梁芷瑩，医师，硕士，Email：812263017@qq.com
  • 基金资助:
    四川大学华西口腔医院探索与研发项目(LCYJ2019-6);成都市重大科技应用示范项目(2021-YF09-00078-SN)

Retrospective analysis of clinical data of 288 cases of endodontic microsurgery on anterior teeth

Liang Zhiying(),Zhao Yuanxi,Zhu Jiani,Su Qin.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-07-20 Revised:2022-11-02 Online:2023-03-01 Published:2023-03-14
  • Contact: Qin. Su
  • Supported by:
    Research and Develop Program, West China Hospital of Stomatology, Sichuan University(LCYJ2019-6);Chengdu Key Application Projects of Science and Technology(2021-YF09-00078-SN)

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摘要：

目的 通过对前牙显微根尖手术病例的临床资料进行回顾性分析，从疾病发生发展角度为预防前牙难治性根尖周炎的发生提供参考。 方法 收集前牙显微根尖手术288例患者517颗患牙的临床病历及影像学资料，分析其临床资料特点。 结果 女性患者多于男性，20~29岁年龄段的男女患者是主要的就诊人群。外伤患牙占比最高（58.41%），其次是龋坏患牙（32.49%）和慢性磨损患牙（6.58%），解剖结构异常患牙占比最少（2.51%）。患牙初始牙体硬组织疾病的构成比在不同性别间的差异具有统计学意义（P<0.05）。手术患牙中仅行初次根管治疗者，恰填占比最高，为48.93%，欠填和超填占比分别为38.24%和12.83%；根管再治疗患牙中，欠填占比为23.47%，超填为33.67%。根管再治疗后欠填、超填占比与初次根管治疗相比差异有统计学意义（P<0.05）。术中探查发现，即使是X线片、锥形束CT检查为恰填的患牙也存在根尖充填不严密现象。通过X线片、锥形束CT和术中探查评价根管充填质量的结果存在差异，且有统计学意义（P<0.05）。 结论 前牙显微根尖手术患者以有牙外伤史的年轻人居多，难治性根尖周炎多为根管治疗欠填、超填、遗漏根管、根尖封闭不密合等充填质量不佳的患牙，提示临床工作中应重视外伤牙的规范治疗，提高根管治疗的质量， 以防止前牙难治性根尖周炎的发生。

关键词: 显微根尖手术, 前牙, 难治性根尖周炎, 回顾性分析

Abstract:

Objective This study aims to analyze the clinical data of endodontic microsurgery on the anterior teeth for preventing the occurrence of refractory apical periodontitis. Methods The medical records and radiographic examination data of 288 patients (517 teeth) who received endodontic microsurgery on the anterior teeth in the hospital were collected and analyzed. Results The participants included more female patients than male patients, and the main age group was 20-29 years. Traumatic teeth accounted for the highest proportion (58.41%), followed by carious teeth (32.49%) and chronic abrasion teeth (6.58%). Anatomical abnormal teeth had the lowest proportion (2.51%). The constituent ratio of initial tooth hard tissue diseases had statistical difference between gender (P<0.05). About half of the teeth treated with first time root canal treatment had proper obturation (48.93%), with underfilling and overfilling rates of 38.24% and 12.83%, respectively. For the teeth with root canal retreatment, underfilling was 23.47% and overfilling was 33.67%. Statistical difference was found between the first time root canal treatment and the root canal retreatment in obturation quality at underfilling and overfilling (P<0.05). Although the radiographic examination showed that the teeth had right obturation, apical leakage was found by endodontic microsurgery exploration. The results of the evaluation of root canal filling quality by X-ray, cone beam computed tomography (CBCT), and surgical exploration had statistical difference (P<0.05). Conclusion Most patients who underwent endodontic microsurgery on anterior teeth were young people with traumatic tooth history. Teeth with refractory apical periodontitis mostly had underfilling, overfil-ling, missing root canals, and poorly apical sealing during the root canal treatment. Treatment of traumatic teeth should be standardized in clinical work, and the quality of root canal treatment should be improved to prevent the occurrence of refractory apical periodontitis on anterior teeth.

Key words: endodontic microsurgery, anterior teeth, refractory apical periodontitis, retrospective study

中图分类号: 

  • R 781.05

表 1

前牙显微根尖手术患牙在不同性别和年龄患者中的分布 (n/%)"

患者年龄段/岁男性女性χ2值P值
≤1932/14.1637/12.7110.2000.037
20~2997/42.92123/42.27
30~3939/17.2677/26.46a
40~4925/11.0616/5.50a
≥5033/14.6038/13.06
合计226/100291/100

表 2

不同性别、年龄组中患牙初始治疗病因的分布 (n/%)"

分组因素牙外伤龋坏慢性磨损解剖结构异常不同性别合计χ2值P值
不同年龄段合计302/100168/10034/10013/100
性别男140/61.9559/26.1123/10.184/1.77226/10014.7020.002
女162/55.67109/39.46a11/3.78a9/3.09291/100
年龄段/岁≤1952/17.2213/7.74b0/0.00bc4/30.77bcd*0.000
20~29160/52.9849/29.17b8/23.53b3/23.08
30~3950/16.5658/34.52b4/11.764/30.77
40~4916/5.3014/8.3310/29.41bc1/7.69
≥5024/7.9534/20.24b12/35.29b1/7.69

表 3

X线片检查评价初次根管治疗与根管再治疗患牙的根管充填质量"

根管充填质量初次根管治疗根管再治疗χ2值P值
合计374/10098/100
恰填183/48.9342/42.8625.0660.000
欠填143/38.2423/23.47a
超填48/12.8333/33.67a

表 4

X线片、CBCT和术中探查评价根管充填质量"

根管充填质量X线片CBCT术中探查χ2值P值
良好362/72.98364/73.39112/22.58ab344.2260.000
不佳134/27.02132/26.61384/77.42ab

图1

X线片与术中探查所见根管充填情况左：X线片显示根管充填致密恰填；右：术中发现根尖仍有渗漏。"

《牙科医生用药小手册》（第2版）出版发行"

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