显微根管联合牙周组织再生术治疗牙髓牙周并发畸形根面沟的疗效观察

目的 探究显微根管联合牙周组织再生术治疗牙髓牙周并发畸形根面沟的临床疗效.方法 选取2017年1月到2019年6月我院收治的32例牙髓牙周并发畸形根面沟患者,采用显微根管联合牙周组织再生术综合治疗,术后随访1年,评价手术前后牙石指数(CI)、龈沟出血指数(SBI)、松动度(TM)、探诊深度(PD)、附着水平(AL),并...     

牙周牙髓联合病变患牙显微根尖手术一例

牙周牙髓联合病变（endodontic-periodontal lesions）是指同一个牙并存着牙周和牙髓病变,且互相融合连通。显微根尖手术是实现疑难牙髓根尖周病患牙保存的重要手段。牙周牙髓联合病变患牙根尖手术远期预后较牙周健康患牙差,牙周炎症控制与组织再生是影响其远期成功率的关键因素。对于牙周牙髓联合病变患牙,临床医生需要根据病因和骨缺损类型,选择正确的手术时机与方式,尽可能提高患牙手术成功率。     

畸形根面沟伴发牙体牙髓牙周疾病的临床治疗效果观察

目的 通过对比伴发不同临床症状的畸形根面沟病例在治疗前后的临床检查指标及影像学资料,评估其治疗效果。方法 选取2021年至2023年期间就诊的畸形根面沟的病例7例,年龄在9~49周岁,经CBCT诊断并分型,根据不同临床症状采取对症的牙髓治疗、牙周治疗以及根面沟的处理,记录术前、术后3个月、6个月和12个月的龈沟出血指数（sulcus bleeding index,SBI)、菌斑指数（plaque index,PLI)、牙周探诊深度（probing depth,PD)和牙齿松动度（tooth mobility,TM）等临床检查指标,并通过临床检查指标和X线片来观察临床治疗效果。结果 术后3个月、6个月、12个月较术前相比,SBI、PLI、PD和TM均有降低（P＜0.05);其中术后12个月与术后3个月相比其SBI、PLI、PD和TM均有明显降低（P＜0.05);而术后6个月较术后3个月以及术后12个月较术后6个月相比,各项指标虽有降低但无统计学意义（P＞0.05);术后3个月、6个月和12个月的根尖周病损愈合成功率分别为71.43%、85.71%和85.71%。结论 针对伴发不同临床症状的畸形根面沟疾病,试行个性化的治疗方案有一定治疗效果。     

GTR联合根尖手术治疗牙周牙髓联合病变伴重度牙槽骨缺损上颌磨牙1例

牙周牙髓联合病变涉及牙髓和牙周组织,其诊疗难度较大,预后一般不佳。本文报道1例牙周源性的牙周牙髓联合病变伴重度牙槽骨缺损的上颌第一磨牙,经根管治疗术、牙周基础治疗、引导性组织再生术(guided tissue regeneration,GTR)和同期根尖手术联合治疗,达到意向性保留患牙的目的。     

牙周—牙髓联合病损的研究进展

牙周－牙髓联合病损在临床上经常遇到,而临床医生对其病因、诊断、治疗及预后进行判断觉得非常困难。牙髓病和牙周病的治疗有何相到关系？如何治疗牙周－牙髓联合损害？牙髓治疗对牙周组织再生愈合的有何影响？本文将简略介绍这些方面新的研究结果和动态。     

引导组织再生术治疗牙周牙髓联合病变的观察

目的观察应用Bio-Oss骨胶原与Bio-Gide胶原膜联合进行引导组织再生术,对牙周牙髓联合病变治疗后3年疗效。方法对16例患者20颗牙周牙髓联合病变患牙,先行根管治疗,牙周基础治疗后4周,联合使用Bio-Oss骨胶原与Bio-Gide胶原膜进行引导组织再生术,术后定期维护。术前和术后6、12、18、24、30、36个月,观测记录临床牙周指标,包括探诊深度（probing depth,PD）、附着丧失（attachment loss,AL）、牙龈退缩（gingivalrecession,GR）,拍X线片,对所得数据进行统计学分析。结果患牙行引导组织再生术术前PD、AL、GR分别为（4.81±1.37）mm、（5.48±1.76）mm、（0.64±0.62）mm,术后36个月PD、AL、GR分别为（2.09±0.66）mm、（3.90±1.11）mm、（1.86±0.83）mm。术后6、12、18、24、30、36个月PD、AL均较术前减少,差异有统计学意义（P〈0.05）;术后6、12、18、24、30、36个月GR较术前有所增加,差异有统计学意义（P〈0.05）。X线片显示治疗后随时间的延长,患牙周围骨密度不断增高,骨形成量不断增加。结论 Bio-Oss骨胶原与Bio-Gide胶原膜联合进行引导组织再生术,治疗牙周牙髓联合病变可获得良好稳定的临床疗效。     

牙周-牙髓联合病损的研究进展

牙周-牙髓联合病损在临床上经常遇到,而临床医生对其病因、诊断、治疗及预后进行判断觉得非常困难.牙髓病和牙周病的治疗有何相互关系?如何治疗牙周-牙髓联合损害?牙髓治疗对牙周组织再生愈合有何影响?本文将简略介绍这些方面新的研究结果和动态.     

根管治疗术在牙周牙髓联合病变治疗中的应用

目的：探讨根管治疗术在牙周牙髓联合病变治疗中的重要性。方法：对235例356个牙周病引起牙周牙髓联合病变的患牙进行分级并分成2组,实验组采用根管治疗术和牙周系统治疗的联合治疗,对照组只采用牙周系统治疗。观察治疗后1年的临床疗效。结果：治疗1年后,实验组临床疗效好于对照组,有显著性差异（P〈0．01）。结论：根管治疗术的应用在牙周病引起的牙周牙髓联合病变的治疗中具有重要意义。     

牙髓牙周联合病变综合治疗的临床疗效

目的探讨牙髓牙周联合病变综合治疗的临床疗效。方法选择牙髓牙周联合病变120例182颗患牙,采用牙髓牙周综合治疗,观察疗效。结果经2年随访,182颗患牙综合治疗的有效率为84．62％。结论对牙髓牙周联合病变采用综合治疗,可以取得良好的临床疗效。     

牙周牙髓联合病变治疗探讨

目的:探讨慢性牙周炎及其引起的牙髓根尖周病变治疗方法.方法:将118位病人的166个患牙进行牙髓活力测试、评价.根据临床症状进行牙周基础治疗和根管治疗术,随访6个月,观察疗效.结果:前磨牙冷诊阳性率77.55%,电活力阳性率85.71%,开髓后发现有67.34%牙髓部分或全部坏死;磨牙冷诊阳性率75.22%,电活力阳性率72.57%,开髓后发现有56.63%牙髓部分或全部坏死.根管治疗术6个月后复查所有患牙症状明显改善,咬合功能基本恢复正常,松动度、探诊深度都有明显改善(P<0.05).结论:牙髓状态应根据病史和症状进行综合判断.慢性牙周炎引起的牙髓刺激症状经过牙周基础治疗以及脱敏或楔形缺损充填治疗症状明显减轻者,可不做牙髓处理.经上述治疗后症状仍未消失,应行根管治疗术.如有牙髓坏死,并由此加重骨破坏者,应尽早进行根管治疗术.     

Malformations in maxillary incisors: case report of radicular palatal groove

Abstract – This report describes malformations of anterior teeth and a case of a palatal radicular groove in an upper lateral incisor with periodontal complications. The patient was first diagnosed with an endodontic problem. Endodontic treatment alone failed to resolve the pain. Therefore, after the palatal groove had been properly diagnosed, a palatal flap procedure was carried out including removal of the granulation tissue and careful scaling and root planing of the area with the groove. No odontoplasty was done. Endodontic therapy of the tooth was completed and periapical healing was evident. The treatment effectively reduced the gingival probing depth and led to an asymptomatic tooth.     

意向性牙再植术治疗上颌侧切牙畸形舌侧沟1例

本病例为上颌侧切牙畸形舌侧沟致牙周牙髓联合病损病例,唇腭根面的凹陷、腭侧窄而深牙周袋、根管系统的峡部、破坏严重的唇腭骨板和迁延不愈的瘘道等,给控制根管内外感染保留该牙提出了严重挑战。本病例采用显微根管治疗技术、意向性牙再植术以及纳米生物活性材料,实现了对该患牙的感染控制、患牙保留以及牙周新附着的形成。     

The palatal radicular groove. Two case reports

Two cases of the rare anomaly, the palatal radicular groove, affecting maxillary lateral incisors, are reported and discussed. Both were considered to be untreatable. Horizontal sections of one of these cases demonstrated a canal configuration not previously reported.     

Bilateral buccal radicular groove in maxillary incisors: case report

AIM: To present the rare localization of a radicular groove on the buccal aspect of a tooth and to discuss the pathology and management of the concomitant endo-periodontal defect. SUMMARY: Bilateral buccal radicular grooves were found on the maxillary central incisors of a 60-year-old female Caucasian. One groove was associated with deep local pocketing resulting in pulp necrosis and the formation of a periodontal-endodontic lesion. After endodontic treatment of the affected tooth, periodontal surgery was performed during which an apicoectomy was carried out on the root-filled tooth. Both the buccal grooves were removed by grinding, the roots were planed with curettes and a guided-tissue regeneration technique applied using amelogenin (Emdogain, Biora, Sweden). Following a period of 2 years, re-examination showed excellent healing with the complete elimination of the periodontal pocket on both incisors and significant radiographic evidence of bone regeneration. KEY LEARNING POINTS: Deep radicular grooves can predispose to pulp necrosis and the establishment of combined periodontal-endodontic lesions. Evaluation of clinical signs and appropriate diagnostic tests are of paramount importance in order to prevent incorrect diagnosis and treatment. Endodontists must be capable of performing advanced periodontal regeneration techniques during endodontic surgery.     

Intentional Replantation with a 2-segment Restoration Method to Treat Severe Palatogingival Grooves in the Maxillary Lateral Incisor: A Report of 3 Cases

The palatogingival groove is a developmental anomaly that typically starts near the cingulum of the maxillary incisors and extends along the roots at varying lengths and depths. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. There are various therapeutic options available for these cases; however, the prognosis is unfavorable. Here, we report the successful surgical treatment of 3 cases of maxillary lateral incisors with severe palatogingival grooves using intentional replantation with a 2-segment restoration method. The teeth were gently extracted, resulting in minimal damage to the periodontal ligament. Under a dental operating microscope, 3 mm of the root end was resected. The palatogingival groove was removed, and root-end preparation was performed with a #700 fissure bur. The groove cavity was connected with root-end cavity to form a class II cavity. The cavity was then filled using a 2-segment restoration method (ie, dividing the cavity into 2 parts by the cementoenamel junction, the coronal portion was filled with a flowable composite while the radicular portion, including the root-end cavity, was filled with bioceramics). The tooth was then replanted into its alveolar bone and splinted with a flexible splint for 7 days. The sinus tract was closed at the 1-week postoperative visit. During subsequent recalls, the teeth showed almost complete periapical healing. In summary, intentional replantation with a 2-segment restoration method is a viable treatment modality for single-rooted teeth with a severe palatogingival groove that extends to the root apex.     

Prognostic factors for clinical outcomes in endodontic microsurgery: a retrospective study

Introduction

This retrospective study examined the potential prognostic factors on the outcome after endodontic microsurgery and compared the predictors of isolated endodontic lesion with those of both isolated endodontic lesions and endodontic-periodontal lesions.

Methods

The data were collected from patients with a history of endodontic microsurgery performed between August 2004 and December 2008 and at least 1 year before being evaluated. Surgical procedures were performed by the endodontic faculty and residents. After surgery, an operation record form was made with the preoperative, intraoperative, and postoperative factors from the clinical and radiographic measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome (ie, success vs failure).

Results

Of 907 cases, 491 were retained at follow-up. At the 0.05 level of significance, age, sex (female), tooth position (anterior), root-filling length (adequate), lesion type (endodontic lesion), root-end filling material (mineral trioxide aggregate and Super EBA; Harry J. Bosworth, Skokie, IL), and restoration at follow-up appeared to have a positive effect on the outcome. On the other hand, with an isolated endodontic lesion, the tooth position (anterior), root-filling length (adequate), and restoration at follow-up were significant factors at the 95% confidence level.

Conclusions

Under the control of the significant variables in logistic regression, the potential prognostic factors on the outcome were sex, tooth position, lesion type, and root-end filling material. On the other hand, the tooth position was a pure predictor of an endodontic lesion affecting the clinical outcome.     

Radicular cyst affecting a root-filled human tooth: a long-term post-treatment follow-up

Apical periodontitis is caused primarily by microorganisms residing in the root canals of affected teeth. Nevertheless, there is convincing evidence implicating other independent factors that adversely affect the outcome of conventional root canal therapy. In this paper, morphological evidence is presented in support of die potential role of two endogenous factors that may interfere with post-endodontic healing of the periapex. The specimens consisted of a surgical biopsy of an asymptomatic peri-apical lesion which persisted for a follow-up period of 44 months. The biopsy was processed for correlated light and electron microscopy. The lesion was characterized by the presence of a large central lumen lined by a stratified squamous epithelium. The most striking feature of the lesion was the presence of vast numbers of cholesterol crystals which congregated in the connective tissue surrounding the cyst cavity. Extensive light and electron microscopic investigation of the apical part of the root canal and the lesion foiled to reveal the presence of microorganisms. These findings strongly suggest that intrinsic factors like the accumulation of certain tissue break-down products such as cholesterol crystals, and the cystic condition of the lesion itself, can adversely affect the healing process of the periapex following root canal therapy. Consequently, such apical lesions can remain refractory to conventional endodontic therapy for long periods of time.     

Successful treatment of a radicular groove by intentional replantation and Emdogain® therapy

Abstract –  Radicular groove is an anatomical malformation often predisposing to a severe periodontal defect. Treatment of such an anomaly presents a clinical challenge to the operator. Presented is a case of successful treatment of a radicular groove associated with a maxillary lateral incisor in a 15-year-old girl. A combination of endodontic, intentional replantation and Emdogain® therapy was used. At 1-year follow-up, the patient was comfortable and active healing was evident.     

Targeted Endodontic Microsurgery: A Novel Approach to Anatomically Challenging Scenarios Using 3-dimensional–printed Guides and Trephine Burs—A Report of 3 Cases

Endodontic microsurgery (EMS) techniques have increased success rates over traditional approaches. Despite surgical advances, anatomically challenging scenarios can preclude EMS in certain cases. The aim of this article was to introduce targeted EMS, which uses 3-dimensional–printed surgical guides (3DSGs) and trephine burs to achieve single-step osteotomy, root-end resection, and biopsy in complex cases. In each of 3 cases, a 3DSG with a trephine port was printed using computer-aided design/computer-aided manufacturing implant planning software. The osteotomy site, angulation, and depth of preparation were defined preoperatively to avoid sensitive anatomic structures. The 3DSG was inserted at the target site to achieve precise osteotomy and root-end resection during surgery. A hollow trephine rotated within the 3DSG port produced single-step osteotomy, root-end resection, and biopsy. Root-end preparation and fill were accomplished, and tissues were sutured in place. Targeted EMS potentiated successful surgical treatment in 3 anatomically challenging scenarios: (1) a palatal approach to the palatal root of a maxillary second molar, (2) a facial approach to a fused distofacial-palatal root of a maxillary first molar, and (3) a mandibular second premolar in close proximity to the mental foramen. Trephine burs guided by 3DSGs produce efficient targeted osteotomies with a predictable site, angulation, and depth of preparation. Apical surgery in challenging anatomic cases such as the palatal root of the maxillary second molar, fused molar roots, and root ends in approximation to the mental nerve are possible with targeted EMS.     

The Post–endodontic Adhesive Interface: Theoretical Perspectives and Potential Flaws

Introduction

The aim of this review was to analyze the potential of successful bonds of endodontic posts to radicular dentin as well as the limitations of the post–endodontic adhesive interface.