国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (3): 308-316.doi: 10.7518/gjkq.2026027

• 专家笔谈 • 上一篇    

根管再治疗的病例评估与临床决策

田俊(),韦曦,刘红艳()   

  1. 中山大学光华口腔医学院·附属口腔医院牙体牙髓病科 广东省口腔医学重点实验室 广州 510055
  • 收稿日期:2025-10-21 修回日期:2025-11-20 出版日期:2026-05-01 发布日期:2026-04-24
  • 通讯作者: 刘红艳
  • 作者简介:田俊，中山大学—美国宾夕法尼亚大学联合培养博士，副主任医师，硕士研究生导师。担任广东省口腔医学会牙体牙髓病学专业委员会青年委员，入选广州市青年人才托举项目以及中山大学附属口腔医院青年人才高质量发展计划A类拔尖人才培养项目。主要从事间充质干细胞及其胞外囊泡免疫调控与牙髓组织修复再生机制的研究。先后主持国家级及省部级项目5项；以第一或共同第一作者发表被科学引文索引（science citation index，SCI）数据库收录论文11篇，所刊载期刊包括Autophagy、Bioactive Materials、Advanced Healthcare Materials、International Endodontic Journal等；获批国家发明专利2项。|田俊，副主任医师，博士，Email：tianjun2@mail2.sysu.edu.cn|韦曦，教授、主任医师、博士研究生导师，中山大学附属口腔医院牙体牙髓病科主任，中华口腔医学会牙体牙髓病学专业委员会副主任委员，广东省口腔医学会牙体牙髓病学专业委员会主任委员。主要从事牙体牙髓疾病的临床防治及研究。发表学术论文200余篇，其中被SCI数据库收录的第一或通信作者论文70余篇；主编、副主编专著7部，参编教材专著8部；主持国家自然科学基金7项；获省部级科技进步奖7项，省级教学成果一等奖3项。|刘红艳，中山大学医学博士，中山大学附属口腔医院牙体牙髓病科副主任医师、硕士研究生导师，广东省口腔医学会牙体牙髓病学专业委员会委员、广东省口腔医学会口腔医院感染控制与管理专业委员会常务委员，荷兰阿姆斯特丹牙科研究中心访问学者。主要从事牙髓根尖周病的病因学机制的研究。主持国家及省部级科研项目5项；发表相关论文30余篇；参编学术专著及教材5部；作为主要完成人获得广东省科学奖技术一等奖和二等奖、中山大学校级教学成果一等奖。

Case assessment and clinical decision-making in endodontic retreatment

Jun Tian(),Xi Wei,Hongyan Liu()   

  1. Dept. of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
  • Received:2025-10-21 Revised:2025-11-20 Online:2026-05-01 Published:2026-04-24
  • Contact: Hongyan Liu

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摘要：

根管治疗是牙髓根尖周病的有效治疗手段。由于存在根管系统解剖结构复杂、根管治疗技术敏感性高等因素，因此部分患牙在术后仍会出现根尖周病变迁延不愈、愈后复发或新发病变的情况，常需进行根管再治疗。根管再治疗病例存在冠部修复体、根管充填材料和既往根管治疗并发症等不利因素，其病因判断和治疗难度显著增加。为此，本文系统梳理了以“3D”理念为核心的临床决策流程，即判定是否失败（Decide if fai-lure）、风险‒效益评估（Decide to treat）及治疗方案选择（Decide treatment type）三大关键环节，并基于患牙、患者及医生的三维评估框架，对治疗方案的科学选择进行深入探讨。

关键词: 根管再治疗, 临床决策, 牙髓病学, 治疗结果

Abstract:

Root canal therapy is an effective treatment for pulp and periapical diseases. However, some teeth may exhibit persistent periapical lesions, disease recurrence, or new lesions after treatment because of the complex anatomy of the root canal and technique-sensitive procedure, thus often requiring retreatment. Retreatment is challenging because of coronal restoration, root filling materials, and complications from previous treatments. This article presents a “3D” clinical decision-making framework comprising “Decide if failure,” “Decide to treat,” and “Decide treatment type” for the evaluation of the teeth, patients, and clinicians to ensure appropriate treatment selection.

Key words: root canal retreatment, decision-making, endodontology, treatment outcome

中图分类号: 

  • R781.05

图 1

评估患牙是否为“疾病”状态"

图 2

根管再治疗的临床决策路径"

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