根管治疗术远期疗效的影响因素

根管治疗术（root canal therapy,RCT）是治疗牙髓病、根尖周病的主要方法.影响根管治疗术远期疗效的因素较多,而RCT前根尖周状态和根充位置是两大主要因素.     

根管治疗后三年疗效评价及影响因素分析

目的评价根管治疗的疗效及其影响因素。方法回访检查根管治疗后3年患牙的临床状况和根尖周X线片表现,对根管治疗的疗效及可能的影响因素进行分析。结果695颗患牙根管治疗后3年的治愈率为75．1％,有咀嚼功能的占96．0％。单因素分析发现,前牙、活髓牙、术前根尖周组织正常、适充及牙体修复完好的患牙治愈率较高;回归分析表明,无根尖周病变、适充及牙体修复完好的患牙比术前有根尖周病变、欠充及根充物暴露的患牙治愈率分别高2倍、3倍和1．6倍。结论患牙有无根尖周病变、根管充填质量和牙体修复的完好程度均可对根管治疗的疗效产生影响。     

根管治疗远期疗效的影响因素

随着牙髓治疗技术的发展，很多学者对影响根管治疗远期疗效的因素进行研究。本文通过回顾近20年来的文献，认为根管治疗前根尖状态、根管尖部充填质量及根管治疗后冠修复情况是影响根管治疗远期疗效的重要因素；根管治疗前的牙髓状态、根管预备方法和充填技术、根管充填材料及根管治疗中出现的问题对远期疗效有一定的影响；而病人的年龄、性别，牙位和治疗次数对远期疗效的影响不大。     

老年人根管治疗疗效相关因素分析

目的 研究老年人根管治疗疗效及其影响因素。方法 对56例65岁以上老年人在根管治疗后2年以上的126颗牙齿进行检查，按治疗年限分三组，2～3年组，4～5年组以及6年以上组，应用根尖周指数(Periapical-index)评定X线片并综合临床检查，对其疗效进行评价。结果 老年人根管治疗成功率为72．2％；三组间根管治疗成功率无显著性差异。恰填根管治疗的成功率(82.2％)比欠填和超填的的成功率(47．2%)要高；恰填病例中，冠方修复体质量好的患牙比质量差的患牙根尖周炎发病率低(25．7％和58.4％)；去除欠填和超填病例后，桩冠修复患牙的根管治疗成功率为58.8％，而未做桩冠修复的患牙成功率为87．5％。结论 根充质量、冠方修复体质量、桩冠修复是影响老年人根管治疗疗效的主要因素。     

根管治疗疗效评价及其影响因素

根管治疗是治疗牙髓病和根尖周病最常用的方法,但其远期疗效尚不确定,文献报道的成功率为40%~97%[1]。评价根管治疗的疗效并发现治疗中可能存在的问题和缺陷,将有利于找到有效的针对性解决方案,进一步提高根管治疗成功率。下面从根管治疗疗效评价的方法和标准,疗效评价的研究方     

感染根管一次性根管治疗的短期疗效分析

目的观察分析感染根管一次性根管治疗的术后反应和短期治愈情况，评价一次性根管治疗的临床可行性。方法临床诊断为牙髓坏死和急、慢性根尖周炎的患牙在一次治疗内完成根管预备和根管充填，共100例，与42例两次疗程（疗程间氢氧化钙根管封药）完成根管治疗的类似患牙进行临床效果比较分析。临床观察的主要指标有患者自评的疼痛率、临床评定的疼痛率、术后6个月X线片和临床评定的治愈率。结果患者术后自评疼痛率一次组为60．0％，两次组为57．1％，差异无统计学意义（P〉0．05）；术后1周临床评定疼痛率一次组为43．0％，两次组为52．4％，差异无统计学意义（P〉0．05）。两次疗程的第二次治疗增加了第二次激惹疼痛的机会。术后6个月一次组治愈率为67．9％，两次组为61．5％，差异无统计学意义（P〉0．05）。结论感染根管一次性根管治疗在术后疼痛和近期治愈率上与两次疗程相同，但疼痛期较短，具有临床可行性。     

根管治疗术一次法疗效观察

本人自1992年以来，对268例采用根管治疗术一次法患者较长期随访观察，疗效满意。     

根管治疗处理牙髓治疗牙髓治疗失败牙的疗效观察

根管治疗是牙髓根尖周病的治疗方法之一 ,进行根管治疗需要精湛的技术和先进的设备[1] 。发达国家对牙髓根尖周病主要采用根管治疗术。目前我国仍多种治疗方法并存 ,牙髓治疗失败率较高。本文就近年收集的 16 2例牙髓治疗失败患牙进行病因分析、再处理及临床疗效观察。1　材料和方法1.1　病例选择选择 1996～ 1998年间中山医科大学口腔医学院牙体牙髓科就诊的 148例、16 2颗牙髓治疗失败患牙 (纵折除外 )。出现下述任何一项即为牙髓治疗失败 :①治疗后 6～ 2 4个月出现骨质破坏或骨质破坏区扩大 ;②瘘管未消失 ;③治疗6个月后仍诉疼痛和肿胀…     

根管治疗术治疗根尖周病的远期疗效观察

目的：观察根管治疗术治疗根尖周病的远期疗效。方法：对急，慢性根尖周病患者行根管治疗术后，随机追踪7－10年，观察其远期疗效。结果：经临床检查及X线片共复查77个牙，107个牙根，痊愈195个牙根，痊愈率为88．79％。年龄在50岁以下者的疗效明显高于50岁以上者（P＜0．005），而性别，牙位，根充程度，尖周有无病变对根管治疗术的远期疗效无明显影响。结论：证明了根管治疗术仍是治疗根尖周病的最理想的治疗方法。     

三种根管充填材料在根管治疗术的临床疗效

自 2 0 0 0 - 0 3— 2 0 0 1- 0 3月采用 3种不同的根充材料对 30 9例患者 32 5个恒牙进行根管充填 ,并追踪观察 ,得出注射用根管糊剂在充填弯曲、侧枝根管等方面明显优于根管糊剂充填材料。1　临床资料和方法1.1　病例选择和分组在口腔内科门诊随机选择牙髓坏死和急、慢性根尖周炎拟做根管治疗术的 30 9例患者、32 5个患牙 ,患者无全身性疾病。随机分为 3组 :比塔派克斯糊剂组 10 9例共 113个牙 ,其中男 64例 ,女 4 5例 ,年龄 14～ 72岁。瑞邦齿泰组 10 2例共 10 7个牙。男 4 8例 ,女 5 4例 ,年龄 17～ 69岁。根管糊剂充填剂组 98例共 10 5…     

Factors influencing the long-term results of endodontic treatment: a review of the literature

The purpose of this review of the literature is to examine the factors and their influence on the outcome of endodontic treatments, and also to attempt to have an authors' consensus concerning the impact of these factors on long-term results. The documentary research was conducted using the meta-analysis principles of critical reading of the literature. Two groups of factors can be identified regarding the outcome of endodontic treatments: those which influence the success of the procedure and those which do not significantly affect the success rate. Agreement is obtained in all studies on two major factors, the preoperative periapical status and the apical limit of the obturation, which appear to strongly influence the success of endodontic therapy. This review highlights the methodological problems of retrospective studies and points out the need for consensus regarding the evaluation criteria of root canal therapy.     

初次根管治疗愈合率和影响因素分析

目的评价进行初次根管治疗的患牙的愈合率,分析影响初次根管治疗愈合的因素。方法选取2005年1月-2007年12月接受初次根管治疗的296例患者的371颗患牙,采用冠向下技术进行根管治疗,随访2年。依据临床检查和X线片评判治疗效果,并分析牙根数目、牙髓活力、根管充填情况、根尖周病变对治疗效果的影响。结果296例患者（371颗牙）中143例患者（176颗牙）参与了回访。复诊病例中有152颗（86.36%）患牙评定为愈合（无临床症状、无根尖周病变）;24颗为病变,其中12颗被拔除,12颗进行再治疗。活髓牙的根管治疗愈合率（95.38%）明显高于死髓牙（81.08%）,根尖周无病变患牙的愈合率（95.24%）明显高于有病变的患牙（73.24%）;单根牙的愈合率与多根牙无明显差异,不同根管充填情况（适充或充填不完善）患牙的愈合率也无明显差异（P>0.05）。结论牙髓和根尖周状况对初次根管治疗的成功率有着较明显的影响。     

牙髓治疗失败的原因分析

目的:通过对临床上牙髓治疗失败需再治疗的病例进行分析,探讨牙髓治疗失败的原因。方法:选取牙髓治疗失败患牙236个,根据初次治疗情况、临床检查、术前X线片以及术中对患牙根管系统的探查等,判断原治疗失败的原因。结果:83.7%的干髓术患牙存在根尖周病变;塑化治疗失败的患牙中,以无根尖周病变但发生牙折最多见,占57.1%,其次为塑化不全造成根尖周炎或残髓炎;根管治疗失败的患牙,58.5%存在根尖周病变,85.1%的患牙欠充且根管形态欠佳,14.9%的患牙存在台阶、根管偏移等并发症。结论:干髓术疗效差,多数失败患牙存在根尖周炎;塑化治疗失败的原因多为牙折或塑化不全;因预备和充填不完善等因素造成的根管清理不彻底、封闭不严密,使根管系统再感染是根管治疗失败的主要原因。     

Discuss the factors that affect the outcome of endodontic treatment

Factors affecting the outcome of endodontic treatment are discussed from the theoretical viewpoint (microbes, foreign bodies and epithelium) and from a clinical aspect (preoperative factors, intraoperative factors and miscellaneous factors). The following conditions favour endodontic success significantly: the absence of a periapical infection, a well‐condensed root filling, the root filling extending to 2 mm within the radiographic apex and not beyond, a satisfactory coronal restoration, use of a rubber dam during treatment and cases involving primary root canal treatment as opposed to retreatment. Other factors have the potential to affect success rates, but these have not yet been quantified. Although there is an array of potential factors that influence the outcome of endodontic treatment, success is most significantly dependent upon the elimination of root canal infection present when treatment starts and the prevention of contamination during treatment.     

Long-term prognosis of endodontically treated teeth: a retrospective analysis of preoperative factors in molars

Introduction

Long-term predictability of restored endodontically treated teeth is important for the decision of tooth retention versus extraction and implant placement. The purpose of this study was to validate the hypothesis that preoperative factors can predict the long-term prognosis of molars requiring endodontic and restorative treatment for future prognostic investigations.

Methods

A clinical database was searched for molar endodontic treatments with crown placement and a minimum of 4-year follow-up. Charts of 42 patients with 50 individual treatments were randomly selected. Information concerning crown lengthening; periodontal diagnosis; attachment loss; furcation involvement; mobility; and internal, external, or periradicular resorption was recorded. Radiographs from treatment initiation and follow-up were digitalized. The presence of apical periodontitis was evaluated. Available ferrule was calculated from bitewing radiographs using CAD software (AutoCAD; Autodesk, Cupertino, CA). The resulting data, age, sex, and times of restoration and follow-up were analyzed for correlation with the presence of apical radiolucency at follow-up and the following four possible outcome scenarios: “no event,” “nonsurgical retreatment,” “surgical retreatment,” or “extraction” using Spearman rank order correlation analysis.

Results

Patients’ ages ranged from 19 to 87 years, 22 were male and 20 female, and 48 teeth (96.0%) were retained at follow-up. Of those, 44 (88.0%) were without intervention (“no event”), and four (8.0%) underwent surgical or nonsurgical retreatment. Two teeth (4.0%) had been extracted. Significant positive correlations existed between “untoward events” (any form of retreatment or extraction) and “prognostic value according to periodontal status” (p = 0.047) and “attachment loss” (p = 0.042).

Conclusion

The only preoperative factors significant for the prognosis of restored endodontically treated molars were related to periodontal prognostic value and attachment loss. It can be concluded that it may be difficult to predict the prognosis of molars in need for endodontic treatment and restoration from prognostic factors not related to periodontal disease.     

根尖手术预后影响因素的研究进展

根尖手术作为根管治疗失败后的选择,对保存牙体组织具有重要的价值.一般来说,根尖手术的成功率多在90％以上,但任何影响组织愈合的身体状况或系统性疾病,如糖尿病、贫血和放射治疗术后等均会对手术预后产生影响.此外,患牙的位置、骨质缺损、病变与牙周袋贯通与否、术前根管治疗等,对手术预后也有着重要的影响.手术准备对手术预后亦具有最直接的影响,充分的手术准备包括术前检查、手术工具和手术材料的准备等.美学因素也是评价手术预后好坏的重要指标,要收到较好的美学效果,核心要点在于手术瓣膜的设计和软组织处理.有学者认为在上述众多因素中,根管倒充填材料和放大设备应该为主导因素,但各因素间的相互关系以及对预后影响的确切机制尚无定论,还有赖于进一步的研究.     

上颌第一磨牙根管治疗术后5年疗效分析

目的:评价上颌第一磨牙根管治疗疗效及其影响因素.方法:回顾170颗诊断为牙髓炎、需行根管治疗的上颌第一磨牙,其中牙科手术显微镜下探查根管、Protaper机用镍钛器械根管预备、热牙胶垂直加压充填根管100颗;肉眼探查根管、Protaper机用镍钛器械根管预备、侧压法充填根管70颗.170颗牙术后行冠或桩冠修复.根据治疗前、后临床检查及X线片,综合充填长度和充填密度两方面,对根管充填质量和根管治疗疗效进行评价.采用Reversion 3.0.2软件包对数据进行统计学分析.结果:热牙胶垂直加压和侧压法充填根管在充填长度方面优良率分别达到93％、91.4％,两者无显著差异;热牙胶垂直加压充填在充填密度方面优良率达到96％,优于冷牙胶侧压法的84.3％,两者差异显著:2种方法的综合根管充填质量优良率分别达到91％、75.7％,差异显著.肉眼近颊第二根管(MB2)发现率为31.4％,根管显微镜下MB2发现率为55％,两者差异显著.热牙胶垂直加压和侧压法充填根管治疗术后5年临床成功率分别达到98％、81.4％,两者差异显著;术后5年热牙胶垂直加压法根管充填无论充填长度还是充填密度均无变化,稳定性好,维持高质量的根管充填,RCT优良率维持在91％;而侧压法根管充填长度无变化,但RCT优良率由75.7％下降为68.6％.术后5年无1例冠折.结论:上颌第一磨牙根管形态复杂,根管显微镜有助于发现MB2.机用镍钛器械预备根管,热牙胶垂直加压充填上颌第一磨牙,无论充填长度还是充填密度,均可获得良好效果,上颌第一磨牙根管治疗术后应常规行冠或桩冠修复.     

Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment

The aim of this work was to identify the limitations of previously published systematic reviews evaluating the outcome of root canal treatment. Traditionally, periapical radiography has been used to assess the outcome of root canal treatment with the absence of a periapical radiolucency being considered a confirmation of a healthy periapex. However, a high percentage of cases confirmed as healthy by radiographs revealed apical periodontitis on cone beam computed tomography (CBCT) and by histology. In teeth, where reduced size of the existing radiolucency was diagnosed by radiographs and considered to represent periapical healing, enlargement of the lesion was frequently confirmed by CBCT. In clinical studies, two additional factors may have further contributed to the overestimation of successful outcomes after root canal treatment: (i) extractions and re-treatments were rarely recorded as failures; and (ii) the recall rate was often lower than 50%. The periapical index (PAI), frequently used for determination of success, was based on radiographic and histological findings in the periapical region of maxillary incisors. The validity of using PAI for all tooth positions might be questionable, as the thickness of the cortical bone and the position of the root tip in relation with the cortex vary with tooth position. In conclusion, the serious limitations of longitudinal clinical studies restrict the correct interpretation of root canal treatment outcomes. Systematic reviews reporting the success rates of root canal treatment without referring to these limitations may mislead readers. The outcomes of root canal treatment should be re-evaluated in long-term longitudinal studies using CBCT and stricter evaluation criteria.     

根管治疗过程中影响牙根纵裂的因素

牙根纵裂最常发生于根管治疗之后且临床症状不具有明显的特异性,常常症状不明显,早期诊断较为困难,常出现漏诊和误诊。本文从病因学的角度出发,针对根管治疗过程中的每个步骤,就牙根纵裂的影响因素作一综述,以供临床操作参考。