下颌前磨牙变异根管的显微临床诊治

目的用根管显微技术对根管治疗失败的下颌前磨牙进行再处理。方法收集下颌前磨牙可疑因根管变异导致根管治疗失败的病例38例共41颗牙,其中下颌第一前磨牙19颗。利用根管显微镜对每颗患牙进行根管变异的诊断,并在镜下对各根管进行镍钛机动预备、热牙胶垂直加压充填。根管治疗术后定期复查2年。结果初次治疗时诊断为单根管的35颗患牙,在根管显微镜下无一例为单根管,28颗为双根管,7颗为三根管;初次治疗时诊断为双根管的6颗患牙,有2颗为双根管,4颗为三根管,即41颗再处理患牙有30颗(73.17%)为双根管,有11颗为三根管(26.83%),根管遗漏率达95.12%(39/41)。除一例再处理的患牙在寻找根管的过程中出现侧穿需要MTA修补外,其余患牙均能进行根管定位和完成根管治疗。经复查无一例患牙出现治疗失败。结论根管显微技术能提高对变异根管的识别率,为提高根管再处理成功率提供保障。     

下颌前磨牙变异根管的显微临床诊治一例

下颌前磨牙变异的根管解剖形态存在许多变异，传统方法对这些变异根管的诊治非常困难。显微根管技术在临床的广泛应用为根管变异的困难病例提供了先进的设备和方法。我们介绍1例下颌前磨牙变异根管的显微临床诊治病例。     

下颌前磨牙的根管形态

牙医师充分了解牙齿根管的形态是牙髓治疗成功的先决条件。鉴于以往文献中报导的下颌第一、第二前磨牙两个或更多根管的发生率的变异很大,作者对400个下颌第一前磨牙和400个下颌第二前磨牙的根管解剖进行了详细的研究。拔下的牙齿经固定,脱钙,染色和透明后在解剖显微镜下进行检查。记录根管的数目和类型,侧支根管,根尖孔相交叉吻合的     

下颌第一前磨牙的根管形态

作者用106颗人下颌第一前磨牙。先在牙唇面牙釉骨质界到解剖根尖用超厚锯盘磨槽,再从釉骨质界至解剖根尖垂直于牙长轴连续切3mm厚切片,在5.25％次氯酸钠液中去根管有机物1天,缓冲磷酸盐     

下颌第二前磨牙3根管的显微根管治疗

下颌前磨牙根管形态复杂,变异较大,可能存在多根管,在治疗中极易遗漏。牙科手术显微镜可提供良好的光源及放大效果,使术者有可能在直视情况下对多根管下颌前磨牙进行有效的治疗。该文报道1例下颌前磨牙3根管的显微根管治疗。     

下颌第二前磨牙3根管1例

患者女,18岁,因右侧下颌后牙劈裂半年要求修复就诊.检杏:35牙龈正常,颊面及咬合面牙体缺损,累及髓腔:无叩痛,电测无活力.X线片示35大面积缺损累及髓腔,根尖周未见明显低密度阴影(图1).诊断:35残冠、牙髓坏死.治疗计划:35根管治疗后行桩核冠修复.处理:35常规根管预备,以#15K锉为诊断丝拍摄X线片,疑遗漏近中颊侧第3根管(图2).显微下使用#15C锉寻找到近中颊侧第3根管,经X线片证实(图3).     

下颌第二前磨牙三根管一例

下颌第二前磨牙多为单根管,三根管极少见.中山大学孙逸仙纪念医院口腔科收治了一例下颌第二前磨牙三根管病例,现报告如下.     

下颌第二前磨牙3根管1例

病人男,25岁。2006-11于外院诊治,因25慢性牙髓炎给予开髓、封入三聚甲醛失活剂。复诊时转至我院。临床检查:25远中玻璃离子充填物已松动,面开髓入口处见暂封材料完整,叩诊无不适,牙龈色、形、质正常。X线片示25远充填物继发龋,开髓入口处有封料,髓室近中壁磨损,牙根呈方形,根管影像复杂模糊,隐约可见3根管;牙周膜清晰,根尖周骨密度未见降低。给予常规去除封药,揭除髓室顶,拔髓,测量操作长度,拍摄初尖锉X线片,Pro-taper手用器械预备3根管,摄主尖锉X线片,并于根管显微镜下拍摄髓底(图1)。由髓底图可见:髓底呈平台状,3根管口均较偏舌侧,…     

下颌第一前磨牙根管的形态分析

目的:采用锥形束CT(CBCT)探讨双侧下颌第一前磨牙根管的解剖形态。方法:选取97例双侧下颌第一前磨牙的CBCT扫描数据,使用NNT软件分析下颌第一前磨牙的根管数目、形态、根面沟、根管分叉和双侧根管对称性。结果:下颌第一前磨牙根管Vertucci分类,发生率分别为Ⅰ型83.5%,Ⅲ型3.6%,Ⅴ型8.8%,C形4.1%。多根管类型的根面沟发生率为75%,明显高于单根管的3.7%,并且56.3%、31.3%的多根管类型分别在根中1/3、根尖1/3分叉。93.8%的下颌第一前磨牙根管双侧对称,其中,单根管对称率为95.2%,高于多根管的66.7%。结论:下颌第一前磨牙根管解剖结构复杂,CBCT可为根管系统提供准确的依据。     

下颌第二前磨牙三根管1例

<正>患者,男,45岁,汉族,因右下后牙有龋洞、反复有咬合不适2年来就诊。患者2年前自觉右下后牙有龋洞,无明显不适症状。偶有发生对温度刺激敏感,口服消炎药(具体不详)可缓解,轻度咬合痛,一直未就诊。本次为了得到彻底的治疗来我院就诊。检查:45远中邻面洞,探(-),叩(+),冷(-),无松动,牙龈正常。46面银汞不良修复体,边缘有微渗漏,周边牙体组织变黑,探(-),叩(+),冷     

3个根管的下颌第一前磨牙的根管治疗1例

3个根管的下颌第一前磨牙极其罕见,本文报道1例3个根管的下颌第一前磨牙的根管治疗,并着重探讨了根管探查和预备的要点。     

The root and root canal morphology of the human mandibular first premolar: a literature review

The purpose of this study was to undertake a comprehensive literature review of the root and root canal morphology of the mandibular first premolar. Published studies citing the anatomy and morphology of mandibular premolars report data for over 6,700 teeth. These studies were divided into anatomical studies reporting number of roots, number of canals, and apical morphology. Variations because of sex and ethnic background have also been reported, along with case reports of anomalies. Approximately 98% of the teeth in these studies were single-rooted. The incidence of two roots was 1.8%. Three roots when reported were found in 0.2% of the teeth studied. Four roots were rare and were found in less than 0.1% of the teeth studied. Studies of the internal canal morphology revealed that a single canal was present in 75.8% of the teeth. Two or more canals were found in 24.2% of the teeth studied. A single apical foramen was found in 78.9% of the teeth, whereas 21.1% had two or more apical foramina. The role of genetics and racial variation may result in differences of incidence of root number and canal number in human populations. The dental literature is not unique in studying ethnicity and sex variations. Higher incidences of teeth with additional canals and roots have been reported in Chinese, Australian, and sub-Sahara African populations. Physical anthropology studies seem to show the lowest incidence in Western Eurasian, Japanese and American Arctic populations. The root and root canal morphology of this tooth can be complex and requires careful evaluation prior to root canal therapy.     

下颌第二前磨牙牛牙症伴C型根管的显微治疗一例

牛牙症、C型根管在下颌第二前磨牙的发生率均极低.本文报道1例罕见下颌第二前磨牙牛牙症伴C型根管病例,展示锥形束CT影像学分析和显微根管技术在该病例诊治中的联合应用,为该特殊类型根管的临床治疗提供新思路.     

Diagnosis and root canal treatment of a mandibular second premolar with three root canals

AIM: To present a case of a mandibular second premolar with three root canals. SUMMARY: An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. A review of the literature reveals a low incidence of all types of premolars with three root canals. Diagnostic means such as preoperative radiographs and examination of the pulp chamber floor aid the location of root canal orifices. The diagnostic and therapeutic problems concerning premolars with unusual anatomy are described on the basis of a clinical example. A case report describes the successful treatment of a mandibular second premolar with three root canals. KEY LEARNING POINTS: Clinicians should be aware of unusual root canal anatomy in mandibular premolars. Radiographs exposed at two different horizontal angles and their careful interpretation facilitate the search of additional root canals. The use of magnification and additional lighting are recommended for the clinical examination of the pulpal floor.     

下颌第一前磨牙的根面沟对牙根和根管X线影像影响的离体研究

目的：观察下颌第一前磨牙的根面沟(分叉痕迹)的发生特点，以及对X线片判断牙根和根管形态的影响。方法：69个离体的下颌第一前磨牙中的15个牙有明显根面沟，先对牙齿进行近远中向及颊舌向X线照像。然后打开髓腔，用^#15扩大针插入根管到根尖孔，再模拟临床颊向目标法拍X线片(Buccal object rule，与常规拍片成30～40度夹角)。结果：15个下颌第一前磨牙的根面沟均可在近远中向及颊向目标法X线片上出现影像，这些影像易被误诊断为多根、多根管或其他异常表型。结论：由于下颌第一前磨牙相对高的根面沟发生率(22％)，可造成对X线片牙根或根管形态判断的困难。     

Dens invaginatus in first mandibular premolar

Abstract A case of dens invaginatus in a mandibular first premolar with periapical lesion is presented in which it was possible to perform non-surgical endodontic therapy. Dens invaginatus is a developmental malformation of teeth which results from abnormal morphodifferentation. Due to their abnormal anatomical configuration, invaginated teeth present technical difficulties in their clinical management. The treatment modalities available to the clinician include: endodontic therapy, endodontic surgery, combined treatment, or extraction. In this case the treatment of choice, selected according to clinical and radiographic considerations, was endodontic therapy of the main root canal.     

云南地区人群下颌第一前磨牙、第二前磨牙和第一恒磨牙根管解剖形态的锥形束CT分析

目的利用锥形束CT（CBCT）分析云南地区人群下颌第一前磨牙、第二前磨牙和第一恒磨牙根管解剖形态,为临床根管治疗提供理论依据和参考。 方法根据年龄（20 ~ 29岁、30 ~ 39岁、40 ~ 49岁、50 ~ 59岁）分层抽取2017年1月至2018年1月在昆明医科大学附属口腔医院放射科进行CBCT检查的患者的数据资料各100例。400例患者中有324例CBCT数据资料符合标准,其中男166例、女158例,年龄20 ~ 29岁82例、30 ~ 39岁82例、40 ~ 49岁82例、50 ~ 59岁78例。统计分析下颌第一前磨牙、第二前磨牙和第一恒磨牙的根管数目、根管长度和根管弯曲度,并对不同年龄段根管长度、下颌第一磨牙牙尖到根分叉距离及根尖孔到下颌神经管距离数据进行单因素方差分析,对不同性别下颌第一磨牙牙尖到根分叉距离及根尖孔到下颌神经管距离数据进行独立样本t检验。 结果通过对324例患者CBCT影像资料的分析得出,下颌前磨牙基本为单根管（647/648颗）,仅见1例右下第一前磨牙双根管。下颌前磨牙弯曲度以一级弯曲（5° ~ 10°）和二级弯曲（10° ~ 25°）为主,前磨牙根管长度大多处于正常范围（15 ~ 25 mm）,下颌第一恒磨牙弯曲度近远中根均以二级弯曲（10° ~ 25°）为主,下颌第一恒磨牙牙尖到根分叉的距离随年龄增长变短（F_左侧=11.16,P_左侧<0.001;F_右侧=11.51,P_右侧<0.001）,男女性别差异无统计学意义（t_左侧=1.31,P_左侧=0.19;t_右侧=0.51,P_右侧=0.61）;下颌第一恒磨牙根尖孔到下颌神经管的距离随年龄增长变长（F_左侧=7.03,P_左侧<0.001;F_右侧=12.25,P_右侧<0.001）,男女性别差异无统计学意义（t_左侧=-0.64,P_左侧=0.52;t_右侧=-0.11,P_右侧=0.91）。 结论本研究中云南地区人群下颌前磨牙根管解剖形态相对简单;下颌第一恒磨牙根管解剖形态复杂,云南地区人群下颌前磨牙、第一恒磨牙根管解剖系统与其他地区相比有所差异,但增龄性变化无区别,CBCT可为临床根管治疗提供依据。     

Anomalous mandibular premolars: a mandibular first premolar with three roots and a mandibular second premolar with a C‐shaped canal system

Aim To describe unusual variations in the root morphology and root canal systems of mandibular first and second premolar teeth extracted for orthodontic reasons. Summary Normally mandibular first and second premolar teeth have single roots with single canals. A 15‐year‐old patient presented for orthodontic treatment and two mandibular premolar teeth were examined post‐extraction. The mandibular first premolar exhibited three distinct, separate roots and the mandibular second premolar exhibited a C‐shaped root canal system. The coronal morphology of each of the mandibular premolars revealed dimensions and anatomy within normal limits. The incidence of a three‐rooted mandibular first premolar is approximately 0.2%. Key learning points ? Thorough clinical and radiographic interpretation is important in recognizing anomalous root and root canal systems. ? The most common forms of root and canal systems and its aberrations must be understood to realize variations from normal do occur. ? Successful root canal treatment requires an accurate diagnosis of the root canal system using all available aids. ? Value of microcomputed tomography in the study of anatomy ex vivo and cone‐beam tomography in clinical endodontics of complex premolar cases is increasing.     

下颌第二磨牙根管系统的临床诊断和治疗

目的:探讨下颌第二磨牙根管系统的特征及临床诊断和治疗方法。方法:选取患牙髓炎或根尖周炎的下颌第二磨牙 127个,拍摄术前X线片,探查根管,确定根管形态和类型;采用机用镍钛器械Hero642预备根管,热牙胶垂直加压技术充填根管。根据治疗前后的X线片评价根管预备和充填效果。结果:下颌第二磨牙独立 3个根管的发生率为 54. 3%, 独立 2个根管和单一根管的发生率为 11. 0%和 3. 1%,C形根管的发生率为 31. 5%,以Ⅰ、Ⅱ型居多。所有患牙均无根管内并发症发生,治疗效果佳。结论:下颌第二磨牙根管系统以独立的 3个根管为主,其次为C形根管,根管探查结合X线片可诊断C形根管;机用镍钛器械预备根管热牙胶垂直加压技术充填根管可获得良好的治疗效果。