锥形束CT结合显微超声技术处理钙化根管的效果评价

目的 评价锥形束CT(CBCT)结合显微超声技术处理钙化根管治疗效果.并探讨其临床应用价值.方法 选择2009年12月至2011年6月中山大学附属口腔医院诊治的钙化根管患牙,采用CBCT扫描,处理所得数据,获得牙体和根管的三维立体图像以及任意平面图像.确定根管形态、根管钙化段的位置、钙化长度等,在牙科显微镜引导下使用超声器械疏通根管,统计成功率.结果 CBCT从多个角度完整清晰地显示根管形态及走向、钙化部位、钙化部分的长度及变化趋势:36例钙化根管中,成功疏通的根管有34例,成功率为94.4%;另有2例为根管全段钙化.所有患者顺利完成根管治疗,术前诊断与术中判断完全一致,准确率为100%.结论 CBCT可直观准确地反映钙化根管的位置,根管形态及走向,为根管治疗提供可靠信息.CBCT结合显微超声技术是处理钙化根管行之有效的方法.     

锥形束CT在牛牙症诊断及治疗中的导航作用

牛牙症(taurodontism)是一类特有的牙体畸形,是在牙齿的发育过程中,釉牙骨质界水平向正常收缩发生障碍,并且牙髓腔在垂直方向上伸展,导致髓室底和根分叉向根方移位[1]。牛牙症在人群发病率较低,常发生于磨牙及前磨牙,Darwazeh[2]等报道高达26.7%的牛牙症患牙存在不同程度的髓石及根管钙化,伴随其特殊的髓腔形态给根管治疗造成很大的困难[3]。本文通过报道CBCT影像学分析技术辅助诊断治疗上颌第一磨牙牛牙症一例,进一步说明CBCT的应用价值。     

锥形束CT结合显微超声技术诊治老年钙化根管的研究

目的 评价锥形束CT结合显微超声技术诊治老年钙化根管的临床效果,为老年人钙化根管治疗提供参考.方法 选择我院60例老年患者,经常规根管治疗不能疏通的108根钙化根管作为研究对象,应用CBCT技术检查判断根管口的位置、根管走向及位置,再应用显微超声技术去除髓腔内及根管中、上段钙化组织,探查并疏通根管,统计根管疏通成功率.结果 108根钙化根管中,95根根管成功疏通,成功率87.9％;根颈1/3钙化根管疏通率为98.5％,根中1/3钙化根管疏通率80.0％,根尖1/3钙化根管疏通率53.8％.结论 锥形束CT与显微超声技术联合使用对疏通钙化根管具有明显效果.     

锥形束CT辅助诊断和治疗Ⅱ型牙内陷根尖周炎一例

牙内陷是一种解剖特征多样的牙体畸形,给诊断和治疗带来了很大的挑战。Ⅱ型牙内陷内陷程度较大,牙根解剖形态复杂,而锥形束CT能够更准确地分析复杂的根管系统,从而为诊断和治疗提供帮助。本文报道了一例Ⅱ型牙内陷根尖周炎患牙在锥形束CT指导下使用牙科显微镜和超声设备进行根管治疗取得良好效果的病例。     

锥形束CT结合显微超声技术在下颌第一磨牙近中三根管治疗中的应用研究

目的 评估锥形束CT （CBCT）结合显微超声技术定位疏通下颌第一磨牙近中三根管的能力,并依照Pomeranz的分类标准描述其分型特征。方法 从年龄在14~60岁的患者中选择75颗需要根管治疗的下颌第一磨牙。髓腔预备和主根管定位后,所有牙齿均在直视下用牙髓探针探查近中中央根管（MMC）（第一阶段）,然后在显微超声技术的帮助下探查寻找（第二阶段）,最后CBCT结合使用显微超声技术选择性去除牙本质领和钙化物后探查MMC（第三阶段）。结果 MMC的疏通率在各阶段分别为4.0%、18.7%、22.7%;第二阶段较第一阶段显著增加,差异显著（P<0.05）;第三阶段较第二阶段有所增加,但差异无统计学意义。根据Pomeranz的分类,“融合”解剖型,“歧状”解剖型,“独立”解剖型所占比例分别为52.9%、35.3%、11.8%。结论 CBCT结合显微超声技术的应用会增加临床医生探查疏通MMC的能力。     

锥形束CT在口腔医学中的应用

与传统的CT相比,锥形束CT具有空间分辨率高、放射剂量低和扫描速度快等优点,为口腔医学解决了许多疑难问题,该文就锥形束CT目前在口腔医学中的应用作一综述.     

CBCT结合显微超声技术诊治老年疑难根管71例报告

目的：评价锥形束CT（ CBCT）结合显微超声技术诊断治疗老年疑难根管的临床效果。方法：选择71例老年患者的124个均因传统方法根管治疗失败的疑难根管作为研究对象,通过CBCT检查判断根管数目、根管口的位置、根管弯曲角度,应用显微超声技术去除钙化组织,探查并疏通根管,统计根管疏通成功率。结果：124个疑难根管中,成功疏通根管108个（其中包含寻及11个遗漏根管）,成功率87．1％,牙位和钙化位置对疏通率有影响;两个根管发现根裂,建议拔除。结论：CBCT与显微超声技术联合使用,为临床诊治老年疑难根管提供了有效的方法。     

锥形束CT在牙内陷诊断中的应用

目的:探讨牙内陷的锥形束CT影像特征。方法:收集同济大学附属口腔医院就诊的40例患者其49枚牙内陷患牙的锥形束CT影像资料,对其影像特征进行分析归纳。结果:40例患者中共发现49枚牙内陷患牙,按Oehlers分型其中Ⅰ型35枚、Ⅱ型13枚、Ⅲ型1枚;发生于上颌侧切牙46枚,上颌切牙2枚,上颌尖牙1枚。49枚患牙的内陷畸形均发生于所涉及患牙的舌侧;47枚牙有1个凹陷,2枚牙有两个凹陷;3例患牙并发根尖周炎。CBCT图像显示:患牙在内陷层面,Oehlers分型为Ⅰ型的35枚和Ⅱ型13枚,在矢状面、冠状面均可见盲管征;OehlersⅢ型见双轨征;上述3型在横断面均见圆环征;大部分凹陷壁的密度与牙釉质的密度一致。结论:锥形束CT能准确诊断牙内陷,并为指导临床治疗提供可靠的影像学依据。     

锥形束CT诊断颌面部异物1例

<正>张口受限为颌面外科的常见疾患,但颌面部异物引起张口受限多为个案报道[1-3]。准确定位异物位置及其形状大小,是外科手术取出异物,保证手术成功的关键。锥形束CT(cone beam computed tomography,CBCT)因其独特的三维成像特点,可以精确定位,更好地引导外科手术的顺利进行[4-6]。现对我院收治的1例颌面部异物引起的张口受限患者的临床资料进行报道,并结合文献回顾对CBCT在颌面异物诊断中的应用价值进行讨论。     

口腔手术显微镜联合锥形束CT辅助治疗上颌第一前磨牙遗漏远颊根管1例报告

遗漏根管是根管治疗失败的常见原因,避免根管遗漏对提高根管治疗成功率至关重要。上颌第一前磨牙根管解剖形态变异较大,多为颊腭双根管或单根管,极少存在三根管[1]。研究表明,汉族人上颌第一前磨牙三根管的发生率为0.2%~1.8%[2-4]。如何识别可能存在的遗漏第三根管是上颌第一前磨牙根管治疗过程中的难点。本文报道了1例口腔手术显微镜联合锥形束CT(CBCT)辅助治疗上颌第一前磨牙根管治疗中远颊根管遗漏的病例,以期为临床治疗提供参考。     

Endodontic management of a double-type IIIB dens invaginatus in a vital maxillary central incisor aided by CBCT: A case report

Type IIIB dens invaginatus presents with diagnostic and treatment related challenges when in need of endodontic management as a consequence of its complex anatomy, especially when presented in a vital tooth with a periapical lesion. Apical periodontitis associated with two type IIIB invaginations in a central maxillary incisor of a 10-year-old patient was diagnosed. A cone-beam computed tomography (CBCT) scan provided essential diagnostic information and steered the treatment plan. The two invaginations were separate, with no communication between them and the pulp. The pulp appeared vital and non-inflamed. Endodontic treatment of the invaginations was carried out without intervention in the pulp. A 4-month follow-up periapical radiograph showed significant shrinkage of the lesion and a 2-year follow-up CBCT scan confirmed its complete healing. The pulp remains vital, responding normally to sensitivity tests. This outcome indicates that preserving the pulp's vitality is achievable through timely diagnosis.     

One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report

Aim  To describe a case in which a mandibular right second premolar with a necrotic pulp, sinus tract, periradicular radiolucency and an immature apex underwent revascularization via a single treatment approach.
Summary  Revascularization procedures have the potential to heal a partially necrotic pulp, which can be beneficial for the continued root development of immature teeth. However, it is not clear which revascularization protocols are the most effective. This case report details the outcome of a successful revascularization procedure on tooth 45 (FDI) in a 12-year-old patient, eliminating the associated periapical pathosis within 19 months. The tooth was treated using coronal root irrigation with 6% NaOCl and 2% chlorhexidine without instrumentation in a single visit. The successful outcome of this case report suggests that this conservative revascularization treatment approach can preserve the vitality of the dental pulp stem cells and create a suitable environment for pulp regeneration, resulting in the completion of root maturation.   Key learning points

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  The noninstrumentation procedure using 6% NaOCl and 2% chlorhexidine coronal irrigation may help preserve the remaining vital dental pulp stem cells believed to be critical for pulp revascularization.
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  A single visit pulp revascularization protocol can be a favourable treatment option for an immature permanent tooth with a partially necrotic pulp.

     

Vasculitis of dental pulp associated with cryoglobulinemia in hepatitis C virus patients: case report

Introduction

This report presents a case of impacted lower third molar extracted for surgical reasons in patient with uncontrolled hepatitis C. After decalcification, dental pulp vasculature and its tissue quality were investigated.

Methods

Serial sections of 4-μm thickness along the midline buccolingually for the demineralized specimen were obtained, mounted on a glass slide, stained with hematoxylin-eosin, covered, and viewed under the light microscope.

Results

The histologic investigation of the pulp tissue revealed thickening, stenosis, and occlusion of the vessel wall, ectopic calcification of the pulp tissue in close association with pulpal blood vessels, interrupted and vacuolated odontoblastic layer in the coronal pulp chamber, with an inflammatory cell infiltrate throughout the pulpal tissue.

Conclusions

Cryoglobulinemia associated with uncontrolled hepatitis C virus infection in patients endangers the dental pulp vasculature and alters its normal tissue architecture.     

数字化根管定位导板应用于完全钙化根管的临床报道1例

髓腔完全钙化的牙齿需要行根管治疗时,精确定位并疏通钙化根管、避免侧穿是困扰临床医生的一大难题.随着锥形束CT、口内扫描和3D打印技术的逐步成熟,数字化根管定位导板技术可以通过计算机辅助设计定位到狭窄的根管通路,最大程度地保存牙体组织,提高根管治疗的安全性和成功率,该文报道1例将数字化根管定位导板应用于髓腔完全钙化的前牙...     

Guided Endodontics: Use of a Sleeveless Guide System on an Upper Premolar with Pulp Canal Obliteration and Apical Periodontitis

Guided endodontics has been used for the treatment of anterior teeth with a successful outcome. This approach is not only limited to anterior teeth because it can also be used for the treatment of premolars and molars. However, in such cases, space may be a limitation because a long bur has to be used in addition to the guide being placed on top of the teeth. The aim of this case report was to present a novel guided endodontics technique using a sleeveless 3-dimensional–printed guide. This design can reduce vertical space, allowing an open view of the tooth and irrigation during drilling. A 46-year-old female patient consulted the endodontic department with intermittent pain around tooth #5. Tooth #5 presented pain upon percussion and responded negative to a cold test. The initial periapical radiograph revealed an apical radiolucency with pulp canal obliteration. Clinically, there was no sinus tract. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. Guided endodontic treatment was performed with a sleeveless 3-dimensional–printed guide and long neck carbide bur with a head diameter of 1 mm to drill a minimally invasive access cavity up to the root canal. A completely healed apical area of tooth #5 was visible after 1 year on periapical radiographs. This technique seems to be a promising alternative in comparison with the conventional guided endodontic guide design for the negotiation of pulp canal obliteration in cases in which vertical space is limited.