下颌切牙双根管的显微根管治疗

目的评价显微根管治疗术处理下颌切牙双根管的临床疗效。方法选取143颗需进行根管治疗的下颌切牙（下颌中切牙68颗,下颌侧切牙75颗）,拍摄术前X线正位投照片和偏位投照片。对单根管患牙采用常规根管治疗;对疑为双根管的患牙先常规探查根管,再在牙科手术显微镜下探查并疏通根管,机用镍钛器械预备根管,垂直加压充填技术充填根管。记录根管类型,不同X线投照角度、使用和未使用牙科手术显微镜时多根管的发现率,根据术前、术中及术后X线片评价根管预备和充填效果。结果采用显微根管治疗,下颌中切牙、侧切牙双根管的发现率分别为26.47%、29.33%,X线偏位投照片双根管的发现率高于正位投照片;使用牙科手术显微镜后,多根管的发现率高于未使用时;在牙科手术显微镜下进行根管预备,无根管堵塞、偏移、台阶、器械分离等并发症发生;134颗患牙适充,9颗有糊剂或牙胶超充,无欠充。结论显微根管治疗是处理双根管下颌切牙的有效方法,在牙科手术显微镜下以机用镍钛器械预备根管,垂直加压充填技术充填根管可取得良好的治疗效果。     

不同投照角度X线片诊断下颌第一前磨牙多根管的临床分析

目的探讨不同投照角度X线片在诊断下颌第一前磨牙多根管中的作用。方法选取需行根管治疗的88颗下颌第一前磨牙为研究对象。每颗患牙均拍摄术前X线正位、偏位投照片判断是否为多根管牙;K型锉探查和定位根管口,冠下法预备根管,冷侧压法充填根管,充填时记录根管形态及数量,并拍摄根管充填术后X线正位和偏位投照片,对根管进行分型。结果88颗下颌第一前磨牙中,术前X线片诊断多根管31颗,临床发现多根管30颗。术前X线诊断为多根管的31颗牙,临床治疗中3颗未定位到多根管;而术前诊断为单根管的2颗牙,在临床治疗中发现为多根管。术前正位X线片诊断多根管牙13颗,术前偏位X线片诊断多根管牙25颗,其中7颗牙的术前正位和偏位X线片均表现为多根管影像。下颌第一前磨牙多根管的临床发现率为34.09%（30/88）,其中Ⅳ、Ⅴ型根管为21颗,占多根管牙的70.00%。结论不同投照角度X线片有助于提高下颌第一前磨牙多根管的临床发现率。     

不同角度根尖片对诊断下颌第一前磨牙多根管的作用

目的探讨联合应用平行和偏移投照根尖片在诊断下颌第一前磨牙多根管中的作用。方法选择临床上需要进行根管治疗的130人的132颗下颌第一前磨牙为研究对象,每颗患牙术前均需拍摄平行和偏移投照X线片,初步判断是否为多根管牙;术中配合使用根管显微镜用K锉探寻根管口及根管,使用手用镍钛锉进行根管预备,侧方加压技术充填根管。结果132颗下颌第一前磨牙中,术前平行和偏移投照x线片共初步诊断多根管牙41颗;平行投照诊断多根管牙16颗,偏移投照诊断多根管牙37颗,其中有12颗患牙2种投照方法均表现为多根管影像。两种投照方法诊断的下颌第一前磨牙多根管与在临床治疗中发现的多根管数一致,发现率为31．06％。结论平行和偏移投照X线片联合应用有助于提高下颌第一前磨牙多根管的发现率,从而减少临床遗漏根管的发生。     

不同投照角度X线根尖片诊断下颌前牙、前磨牙多根管的临床评价

目的 探讨不同角度X线投照技术对发现下颌前牙、前磨牙多根管及提高其临床治疗率的作用。方法 选取临床上需要进行下颌前牙、前磨牙根管治疗的患者214例，共247颗患牙。每颗患牙均需拍摄术前X线正、偏位投照片及诊断丝X线正、偏位投照片。依据两种X线影像特点（根管位置和走向不在牙根中心、较粗大的根管在根管上1／3、中1／3突然消失或模糊）判断是否为可疑多根管。采用冠向下法预备，冷侧压法根管充填后将根管分为Ⅰ～Ⅴ型并与X线结果对应。结果 在87颗X线诊断的多根管患牙中，临床证实多根管为60．92％；26．44％为扁根管。诊断丝X线偏位投照片的多根管X线诊断灵敏度为93．0％，4例术后发现有遗漏根管。247颗下颌前牙、前磨牙临床治疗多根管57颗，多根管临床治疗率分别为：中切牙9．43％、侧切牙38．33％、尖牙15．90％、第一前磨牙加．38％、第二前磨牙2．63％。结论 不同角度的术前及诊断丝X线根尖片有助于临床医师发现下颌前牙、前磨牙多根管，其中以诊断丝X线偏位投照发现的多根管最多。     

下颌前磨牙C形根管的诊断和治疗

目的：探讨下颌前磨牙C形根管的发现率及其诊治方法。方法：选取需要根管治疗的下颌前磨牙300个,拍摄术前正位和偏位X线牙片。多根管牙插诊断丝摄片。结合C形根管的诊断标准,诊断为C形根管的忠牙,记录髓室底形态和X线影像类型。所有患牙使用镍钛机动根管器械预备,侧方加压法充填根管。根据术前、术中和术后x线片评价根管预备和充填效果。结果：第一和第二前磨牙C形根管的发现率依次为5．56％和2．50％。髓室底以C2型多见,X线影像以尖部融合型多见。治疗中无根管堵塞等并发症的发生。根管充填效果,13例C形根管中有5例超充,8例恰充。结论：髓腔探察和插诊断丝拍片是诊断下颌前磨牙C形根管的有效方法。     

下颌第一前磨牙根管的临床显微观察

目的比较肉眼和根管显微镜探查对下颌第一前磨牙多根管的发现情况，为推广根管显微镜的临床应用提供参考依据。方法选取80颗需要根管治疗的下颌第一前磨牙，开髓后先行肉眼探查：插诊断丝拍正位、偏位X线片，结合髓底图和X线片对根管数目做出判断。再采用根管显微镜，观察并记录各牙的根管数目、类型。比较2种方法对下颌第一前磨牙多根管的发现情况。结果肉眼探查结合插针拍片法和根管显微镜探查多根管发现率分别为12．5％和30．0％，准确率分别为38．46％和92．31％，发现率和准确率的差异均有统计学意义（P〈0．001）。结论根管显微镜探查法能够较为准确地判断下颁第一前磨牙的根管数目和类型。     

下颌第二磨牙C形根管的临床诊断和治疗

目的：探讨下颌第二磨牙C形根管的临床诊断和治疗。方法：选择需进行治疗的下颌第二磨牙104个,通过术前拍摄X线片和术中根管显微镜下髓腔探查,按照AL-Fouzan术前X线诊断标准和Melton分类标准分别诊断是否为C形根管。采用手用Protaper进行根管预备,热牙胶垂直加压技术充填根管。记录C形根管口的类型,统计两种方法诊断的成功率。根据治疗前、中、后的X线评价根管预备和充填的效果,3～6个月后复查。结果：下颌第二磨牙C形根管术前X线片和根管显微镜的诊断率分别为72.1%和90.7%,所有患牙均无根管内并发症发生,治疗效果好。结论：术前X线片和根管显微镜相结合大大提高了下颌第二磨牙C形根的诊断率,镍钛器械预备根管和热牙胶垂直加压技术充填根管可获得良好的治疗效果。     

下颌第二磨牙C形根管的特点和临床治疗

目的探讨下颌第二磨牙C形根管的发生率、临床诊断和治疗方法。方法通过对152例下颌第二磨牙拍摄术前X线片和术中根管探查,按照Melton标准诊断C形根管;采用机用镍钛器械Hero642进行根管预备,次氯酸钠超声冲洗,热牙胶垂直加压技术充填根管。记录C形根管的发生率及临床特点,根据治疗前、中、后的X线片评价根管预备和充填的效果。结果下颌第二磨牙C形根管的发生率为32.2%,79.6%的C形根管患牙X线片表现为锥形融合牙根,20.4%表现为近、远中独立牙根;所有患牙均无根管内并发症发生,治疗效果好。结论下颌第二磨牙C形根管主要存在于融合牙根,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、次氯酸钠超声冲洗和垂直加压技术充填根管可获得良好的治疗效果。     

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。     

偏移投照技术与显微治疗诊治遗漏根管的疗效分析

目的分析根管治疗术后偏移投照技术与显微根管治疗的应用对遗漏根管的发现与治疗的临床疗效。方法选择需行初次牙髓治疗的下颌前牙、下颌前磨牙、下颌第一、二磨牙及上颌第一、二磨牙共360颗(分别为49、68、62、50、85、46颗)。常规拍摄术前正位根尖片,并于根治后拍摄正位及20°～30°偏位根尖片,通过对比分析,对可疑遗漏根管的患牙,在显微镜下寻找及治疗遗漏根管。结果经显微治疗,360颗患牙中25颗(6.9%)确诊为遗漏根管,各牙位依次为3、5、5、4、6、2颗,其中23颗患牙发现并成功充填遗漏根管,2颗根管可找到但不完全通畅;正位发现8颗(2.2%),偏位发现23颗(6.4%),术后偏移投照发现率明显高于正位(P<0.05)。结论根治术后偏移投照技术与显微根管治疗对遗漏根管的发现与治疗有较大的帮助。     

塑化根管再治疗中显微超声技术的临床应用

目的探讨显微超声技术在塑化治疗后根管再治疗的临床应用。方法选取临床上已行根管塑化治疗但因各种原因需要进行根管再治疗的患者168例,前磨牙187颗（239个根管）,分成两组,分别运用常规手动K锉和显微超声技术去除根管内的塑化物后进行根管预备和充填,并记录根管再治疗的疗效和根管充填的效果。结果166个根管（69．45％）疏通获得成功,其中运用显微超声技术对上颌前磨牙根管再通畅成功率为83．82％,常规方法的下颌前磨牙的再通畅率为60．00％。统计结果显示这两种方法有着显著性差异。结论塑化治疗后的根管再治疗中运用显微超声技术能够取得比较好的临床效果。     

广东珠江三角洲地区人下颌第一前磨牙根管解剖形态的研究

目的通过普通x线片法、牙科手术显微镜下探查结合插诊断丝拍片法以及透明标本法,了解广东珠江三角洲地区人下颌第一前磨牙根管系统解剖特征。方法筛选出广东珠江三角洲地区人离体下颌第一前磨牙363颗为研究对象。将离体牙拍摄颊舌向、近远中向数字化x线片,初步判断根管数目。将离体牙开髓,采用牙科手术显微镜下观察法和离体牙透明标本法,观察并记录各牙齿的根管数目、类型。结果 不同研究方法所得结果不同。普通x线片法多根管发现率为7．71％;牙科手术显微镜下探查结合插诊断丝拍片法多根管发现率为33．33％;透明标本法显示多根管发生率为34．44％,其中双根管27．82％, 三根管5．79％,四根管0．83％。根管类型多样化,出现Vertuc-ci分类Ⅱ、Ⅲ、Ⅳ 、V及附加型(3-1)等。双根管的下颌第一前磨牙的髓底图特征为颊舌向直线,三、四根管下颌第一前磨牙的髓底图呈平台状。结论广东珠江三角洲地区人下颌第一前磨牙多根管出现率高,根管类型多样。牙科手术显微镜下探查法和插诊断丝拍片法结合,能够较为准确地判断下颌第一前磨牙的根管数目和类型。     

Morphological variations of mandibular first premolar on cone-beam computed tomography in a Saudi Arabian sub-population

In-depth knowledge of common and aberrant pulp morphology is essential for appropriate diagnosis and treatment planning prior to commencing root canal treatment. Radicular morphology of mandibular premolars has been extensively studied. Considerable variation in the number of canals and roots found in these teeth has been reported.AimThe purpose of this study is to investigate the root and root canal morphology of mandibular first premolar among Saudi Arabian subpopulation in Aseer using CBCT.MethodsCone-beam computed tomography images of Mandibular first premolar were taken from 166 patients which were referred to Armed Forces Hospitals Southern Region (AFHSR), Khamis Mushayt, Asir region Saudi Arabia. All the images were assessed by two Evaluators (An Endodontist and a Radiologist). Inter-examiner reliability was determined and was assessed by KAPPA value.ResultsThe mandibular first premolar (n = 216) distributed as 120 teeth in female and 96 teeth in male. Out of the 120 teeth examined in female groups one canal was seen in 95 (79.2%) teeth, two canals in 19 (15.8%) teeth and three canals in 6 (5%) teeth where as in the Male group out of 96 teeth, 52 (54.1%) teeth showed one canal, 32 (33.3%) teeth with two canals whereas 12 (12.5%) teeth showed presence of three canals.Chi-Square test for mandibular first premolars demonstrated the chance of second canal in the mandibular first premolar more in male than female and these differences was statistically significant (P ≤ 0.05).ConclusionEndodontic therapy of mandibular premolars is a challenge for clinician because of their frequent morphological and anatomical abnormalities. Proper knowledge about number of root canals and canal configuration is a key to success in Endodontic. There is a great variability in different population regarding the root canal configuration in mandibular pre-molars. However, most studies state the mandibular first premolar has one root canal. Also, the most prevalent type of root canal found was Type I vertucci.     

Root canal treatment of mandibular second premolar with four root canals: a case report

The importance of an accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment and has been emphasized throughout the literature. Root canal morphology of premolar teeth, either maxillary or mandibular, and the discrepancies between first and second premolars, have been investigated and reported. A case report is presented of the root canal treatment of a mandibular second premolar with four root canals. As far as the reviewed literature revealed, up to three root canals in mandibular premolars have been reported. No previous report of a similar case of four root canals in a mandibular premolar was found.     

A cone-beam computed tomography study of root canal morphology of maxillary and mandibular premolars in a Turkish population

Aim. The aim of this study was to evaluate the root canal number and configuration of maxillary and mandibular premolar teeth by gender, intervals for decades, tooth position and unilateral or bilateral occurrence in a Turkish population using Cone Beam Computed Tomography(CBCT) scanning. Methodology. CBCT images of 5496 maxillary and mandibular premolars from 849 patients were evaluated. The following was evaluated in all the images: numbers of roots and root canals, the morphology of the root canal configuration according to the Vertucci classification, male–female differences in the tooth position and male–female differences in unilateral or bilateral occurrence. The reliability data were analyzed with a chi-square test. Results. The most prevalent root canal frequency was the two canals (86.2%) and type IV (76.9%) configuration for maxillary first premolar, one canal (59.7%) and type I (54.5%) canal configuration for second premolar. The incidence of one canal was higher in females and the occurrence of two or three canals was more common in males. The incidence of one canal was higher on the left side of maxillary premolars and the incidence of two canals was higher on the right side. Most mandibular first (93.5%) and second (98.5%) premolars had one canal. In general, females had one root canal of the mandibular premolar, whereas males had two or three canals. The type I configuration was most common and the incidence was higher on the right side. There were some differences found in the frequency distribution of the number of root canals and configuration of maxillary and mandibular premolar teeth according to intervals for decades. Conclusion. CBCT scanning provides comprehensive information about the root canal morphology of maxillary and mandibular premolar teeth. These data may help clinicians in root canal treatment of premolar teeth.