显微根尖手术联合MTA治疗难治性慢性根尖周炎的研究

目的:研究在显微根尖手术治疗难治性慢性根尖周炎时应用MTA的可行性、特点、成功率及相关影响因素。方法:分析2013年1月~2015年12月间本院牙体牙髓科完成的显微根尖外科手术106例计146颗难治性慢性根尖周炎患牙的临床资料,其中上颌前牙75例、下颌前牙13例、上颌前磨牙6例、下颌前磨牙4例、上颌磨牙4例、下颌磨牙4例。手术包括根尖切除、根尖倒预备、根尖倒充填主要步骤,术后1年回访,通过临床症状和放射学检查评估疗效,并对预后影响因素进行卡方检验分析。结果:显微根尖外科手术联合MTA应用的1年成功率达95.9％(140/146),根据患者性别、年龄、牙位、根尖病灶范围分别统计手术疗效,组间差异均无统计学意义。失败5例6颗患牙,主要原因为根折及合并重度牙周炎。结论:在治疗难治性慢性根尖周炎时采用显微根尖手术联合MTA应用可取得满意效果;显微根尖手术是治疗慢性根尖周炎的有效手段。     

自固化磷酸钙根管充填材料治疗成人根端开放恒牙的疗效评价

目的 评价自固化磷酸钙根管充填材料治疗成人根端开放伴根尖周病恒牙的临床疗效。方法 选择39颗成人根端开放伴慢性根尖周炎的患牙,在完成根管预备和消毒后,将自固化磷酸钙根管封闭剂充填于根管内,至根尖完全封闭后进行永久根充,治疗后每隔3个月复查1次,随访1年进行疗效评价,将患者年龄、根尖发育程度与预后进行统计学分析。结果 39颗患牙治疗后随访1年,总有效率为87.2%,患者年龄大,患牙病变持续时间长、根尖发育程度差,则根尖达到生理性封闭越困难。结论 自固化磷酸钙可以作为根尖诱导技术的一种可选材料,用于治疗成人根端开放伴慢性根尖周炎的恒牙有一定疗效,但远期疗效有待进一步观察。     

根尖刮治术治疗难治性根尖周炎的临床观察

目的探讨根尖刮治术对难治性根尖周炎的治疗效果。方法难治性根尖周炎患者40例患牙47颗,完成根管治疗后,即刻行根尖刮治术,术后3、6、12个月复查,摄根尖片,进行疗效评价。结果随访1年,39颗患牙临床症状消失,无任何不适,根尖片显示患牙根尖周有新骨形成或原有根尖周透射影缩小;5颗患牙临床症状明显改善,咀嚼时偶感不适,根尖片显示患牙根尖周有新骨形成或原有根尖周透射影缩小;总有效率为93.6%。2颗患牙术后症状无减轻,经患者同意后拔除。1颗患牙术后6个月复发,患者出现咀嚼痛,颊侧牙龈出现瘘管,根尖片示根尖周透射影与术前比较没有变化。结论完善根管治疗后即刻行根尖刮治术,可有效治疗难治性根尖周炎。     

MTA应用于显微根尖手术治疗慢性根尖周炎的效果观察

目的 观察三氧化矿物凝聚体(mineral trioxide aggregate,MTA)应用于显微根尖手术治疗慢性根尖周炎的效果.方法 无法行常规根管再治疗的慢性根尖周炎患者64例91颗患牙,随机分为观察组和对照组.观察组患者32例48颗,行显微根尖手术,应用MTA进行倒充填治疗.对照组患者32例43颗,行传统外科根尖手术联合银汞合金充填治疗.术后每隔3个月定期复诊,随访12个月,通过临床和X线检查评估根尖周病损愈合情况,进行疗效判定.结果 观察组痊愈27颗,改善17颗,成功率91.67%(44/48);对照组痊愈19颗,改善12颗,成功率72.09%(31/43).观察组治疗成功率明显高于对照组(x2=5.997,P=0.014).结论 MTA应用于显微根尖手术治疗慢性根尖周炎效果满意.     

刻意再植术治疗难治性根尖周炎的预后及相关因素分析

目的：评价刻意再植术治疗难治性根尖周炎的疗效以及影响再植预后的相关因素。方法：回顾分析2001年因难治性根尖周炎,临床建议拔除患者5例7个患牙,经即刻拔除再植术＋根管充填治疗5年后的临床资料。其中,5例患者均为45岁以上,年龄最大56岁,女性3例,5个患牙,3个磨牙,2个前磨牙;男性2例,前磨牙和磨牙各1个。上述患牙均在局麻下拔除术、牙齿离体后30min内完成根尖周变性组织湿法刮除术、根管充填术、牙体缺损即刻解剖性外形修复术,再植复位术。结果：术后5年复查,所有患牙均存留,牙龈附着正常,牙体活动度在Ⅰ度内,咀嚼功能良好,X光检查均达到牙周膜或骨性愈合。结论：根尖生物膜与难治性根尖周炎的发生密切相关,牙齿再植术能有效地清除病灶区的整个生物膜,彻底根治生物膜引起的难治性和慢性感染,为临床降低医源性牙齿缺失提供了一种新途径。     

iRoot BP Plus结合热牙胶垂直加压充填术治疗慢性根尖周炎伴根尖未闭合者的疗效

目的 探讨iRoot BP Plus结合热牙胶垂直加压充填术治疗慢性根尖周炎伴根尖未闭合者的疗效及对龈沟液炎性因子水平的影响。方法 选择2019年8月至2020年12月我院收治的慢性根尖周炎伴根尖未闭合患者116例,随机分为研究组和对照组,各58人。对照组接受iRoot BP Plus根尖屏障术治疗,研究组在对照组基础上结合热牙胶垂直加压充填术治疗。比较两组6个月和12个月时的临床疗效、两组手术操作时间、术后疼痛持续时间、治疗平均时间、治疗平均周期、血清炎症因子水平变化及患牙保留率情况。结果 6个月复查时,研究组X线检查成功率为91.38%,临床指标成功率为93.10%,高于对照组的84.48%和82.76%(P>0.05）;12个月复查时,研究组X线检查成功率为94.83%显著高于对照组的77.59%,临床指标成功率为93.10%,高于对照组的70.69%(P<0.05）;研究组术后疼痛持续时间、治疗平均次数及治疗平均周期均低于对照组(P<0.05）。研究组治疗后IL-1β及IL-6水平低于对照组(P<0.05）。研究组患牙保留率为92.65%,高于对照组的80.82%(P=0.010）。结论 iRoot BP Plus结合热牙胶垂直加压充填术治疗慢性根尖周炎伴根尖未闭合患者的临床疗效确切,可有效减少患者的平均治疗次数和周期,降低患者龈沟液中炎症因子水平,提高患牙保留率,长期疗效较好,值得推广。     

MTA和Vitapex糊剂治疗成人慢性根尖周炎伴根尖孔闭合不全的疗效比较

目的：比较三氧化物多聚体（mineral trioxide aggregate,MTA）和Vitapex糊剂应用于成人慢性根尖周炎伴根尖闭合不全恒牙的临床疗效。方法：选取成人慢性根尖周炎伴根尖孔闭合不全的恒牙共38颗,随机分为2组,实验组在根管显微镜下用MTA严密封闭根尖开放部位,硬固后根管行热牙胶充填;对照组用Vitapex糊剂行根尖诱导成形,在根尖部有硬组织形成后行根管充填。两组术后均定期复查,评价临床效果及X线片结果。结果：经过2年的复查,实验组所有病例在治疗后均无临床不适症状,X线片显示患牙11颗根尖阴影完全消失,8颗明显缩小,1颗无变化,有效率95%。对照组2颗磨牙因冠根折拔除,8颗根尖有硬组织形成,8颗根尖无硬组织形成,有效率为44.4%,两者差异有统计学意义。结论：MTA治疗成人根尖孔未闭合恒牙是一种较理想的根尖诱导成形材料,短期临床疗效好,长期效果有待于进一步观察。     

根管外科手术的临床疗效观察

目的 :观察根管外科手术在慢性根尖周炎治疗中的临床疗效。方法 :对 40例 42个难治性慢性根尖周炎患牙 ,分别采用根尖刮治术、根尖切除术和根尖倒充填术进行治疗 ,术后随诊观察 ,比较疗效。结果 :根尖手术成功率为 90 .47%。根尖刮治术、根尖切除术和根尖倒充填术的成功率分别为 85 .71%、90 .91%、10 0 % ,经 χ2检验三者无显著差异。结论 :根管外科手术在难治性慢性根尖周炎治疗中 ,具有满意的疗效。     

Vitapex治疗成年患者根尖发育不全伴窦型慢性根尖炎的临床研究

目的观察Vitapex治疗成年患者根尖发育不全伴窦型慢性根尖周炎患牙的临床疗效。方法选择成年患者根尖发育不全并发窦型慢性根尖周炎患牙32颗,用Vitapex糊剂行根尖诱导术,定期复查,在确认根尖有硬组织形成,行永久性充填。结果根尖发育完成5例,占15.6%;根尖形成钙化桥24例,占75%;失败3例,占9.4%。总有效率90.6%。结论Vi-tapex治疗成年患者根尖未完全发育伴窦型慢性根尖周炎患牙有良好的临床疗效,值得临床推广。     

iRoot BP Plus材料结合显微根尖手术治疗难治性根尖周炎的疗效观察

目的 探讨iRoot BP Plus材料结合显微根尖手术治疗难治性根尖周炎的疗效.方法 选择2018年6月至2019年6月我院收治的难治性根尖周炎患者96例(101颗患牙),随机分为A组34颗患牙、B组33颗患牙、C组34颗患牙.所有患者均行显微根尖手术治疗,A、B、C组分别使用三氧化矿物凝聚体、银汞合金和iRoot ...     

1例意向性牙再植治疗下颌磨牙难治性根尖周炎

[摘要] 目的 观察意向性牙再植治疗下颌磨牙难治性根尖周炎的临床疗效。方法 将诊断为难治性根尖周炎的下颌第二磨牙(47)拔出后,彻底去除根尖和牙槽窝内的炎症组织,即刻回植入牙槽窝内并固定。 结果 术后2周再植47牙龈红肿症状减轻,窦道闭合。术后4周无不适症状,3个月牙齿基本稳定。术后6个月复查,患牙临床检查正常,根尖区被新骨充填。结论 对于不利于行根尖手术,或由于经济原因不接受种植的难治性根尖周炎,意向性牙再植是一种有效的治疗方法。     

老年人根管治疗失败患牙的牙再植术

目的：探讨老年人根管治疗失败病例的牙再植术的临床效果。方法：对56颗经临床常规根管治疗无治愈希望的根尖周炎患牙，行即刻原位牙再植术。结果：经5-10年观察，根尖周炎根管治疗失败后，采用牙再植术治疗的临床成功率为87．50％；再植5年以内、5-10年、10年以上患牙的成功率无显著差异（P〉0．05）。结论：对老年人根管治疗失败患牙开展牙再植术，可以挽救许多治疗无希望的患牙。     

A recall program for the outcome of conventional root canal treatment performed in a teaching hospital

Abstract

Objectives: This study investigated the long-term survival and the prognostic factors of endodontic treatments performed in a dental teaching hospital. The aim was to calculate the probabilities of success or failure according to the follow-up extent and to assess the time allowed for a complete periapical healing. Materials and methods. A cohort of 185 teeth were re-examined 1–4 years after treatment. The outcome was assessed on the basis of radiographic and clinical criteria as success, uncertain or failure. A survival analysis using the Cox model was used (i) to explore tooth survival and periapical healing over the time and (ii) to highlight the predictive factors of treatment outcome. Results. After 2 years, the appearance of an apical periodontitis remained lower than 3.5%, whereas only 22.8% of periapical healed cases were notified. The prognosis factors are: (i) for teeth with initial healthy periapical conditions, coronal leakage (p = 0.002) with the higher risk of failure (RR = 19.77), absence of correspondence filling length/shaping = 0.026), type of teeth (p = 0.041) and (ii) for teeth with apical periodontitis, number of root canals (p = 0.000,91), correspondence filling length/shaping length (p = 0.017) and over-filling (p = 0.09). New periapical lesions or tooth loss were recorded after 2 years. Half of the successful cases of periapical healing were observed during the follow-up from 2–4 years. Conclusions. This longitudinal study shows that coronal leakage is responsible for late failure and that periapical healing is long to achieve. Therefore, endodontic treatments may require a follow-up of over 2 years.     

锥形束CT与根尖片在慢性牙周炎诊断中的应用比较

目的:研究CBCT在慢性牙周炎诊断中的价值。方法:通过拍摄20例慢性牙周炎患者的后牙区CBCT及根尖片,并对其进行临床牙周探针检查,比较纳入的276颗牙唇(颊)、舌(腭)、近中、远中牙槽骨缺损情况。结果:CBCT与临床探诊检查后牙区各位点牙槽骨缺损情况未见明显差异,而CBCT、临床探诊、根尖片检查后牙区近远中牙槽骨缺损可见明显差异(P＜0.05),其中根尖片所测结果小于CBCT及临床探诊,均有统计学意义(P＜0.05)。结论:在慢性牙周炎的诊断中CBCT检测较根尖片更加准确。     

Pulp Revascularization of Immature Dens Invaginatus with Periapical Periodontitis

IntroductionDens invaginatus is a rare developmental malformation of a tooth caused by the invagination of the tooth crown before biological mineralization occurs. The complex anatomy of these teeth makes nonsurgical endodontic treatment difficult and more so when there is presence of periapical periodontitis with open apex. The endodontic treatment of dens invaginatus is a challenge, especially in the case of periapical periodontitis with open apex. Pulp revascularization is a conservative endodontic treatment that has been introduced in recent years. Presented here is a variant approach for the treatment of immature dens invaginatus type II with periapical periodontitis, which combines filling of the invagination and pulp revascularization.MethodsAfter accessing the pulp chamber, the main canal and the invagination were explored. The root was thoroughly disinfected by irrigating and medication, invagination was filled, and the main canal was revascularized. Then the coronal sealing was made by glass ionomer cement and composite resin. Radiograph taken regularly and computed tomography scan were used to investigate the healing of the periapical lesion and development of the root.ResultsIn the subsequent follow-up, the periapical lesion was completely eliminated, the open apex was closed, and the wall of the root was thickened.ConclusionsFor type II immature dens invaginatus with large periapical lesion, conservative endodontic treatment should be considered before periapical surgery. With sufficient infection control, pulp revascularization can be an effective alternative method.     

Outcomes of endodontic therapy in general practice: a study by the Practitioners Engaged in Applied Research and Learning Network

BackgroundThe authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy.MethodsMembers in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion.ResultsP-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity.ConclusionsThese results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data.Clinical ImplicationsThe results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis.     

2种糊剂对慢性根尖炎患牙侧副根管封闭性的效果比较

目的:观察2 种根管充填糊剂充填慢性根尖炎侧副根管的治疗效果.方法:选择术后X 线片显示有侧副根管的慢性根尖炎病例54 例, 随机分为AH-plus 组和赛普敦组,每组27 例.开髓、揭顶、去除牙本质肩领,应用逐步后退法进行根管预备,氢氧化钙糊剂根管封药消毒,分别选用AH-plus 糊剂和赛普敦(SEPTODONT)美松根管充填糊剂, 热牙胶连续波垂直加压充填技术进行根管充填.比较根尖1/3侧副根管充填率、治疗一年后根管治疗成功率和感染控制率.结果:AH-plus 组根尖1/3 侧副根管充填率为62.96%,根管治疗成功率为88.89%,感染控制率为96.30%,分别高于赛普敦组的37.04%、66.67% 和74.07%,差异有统计学意义(P<0.05).结论:AH-plus 糊剂较赛普敦美松糊剂对侧副根管充填的疗效好.