上颌第一恒磨牙根管治疗128例临床体会

目的评估上颌第一恒磨牙根管治疗的临床技术特点及近期临床效果。方法选取128例牙髓炎或根尖周炎患者的上颌第一恒磨牙为实验对象,每个患牙均摄术前平行和偏移投照根尖X线片,采用逐步后退法常规进行根管预备,标准牙胶尖侧向加压充填。结果128病例中,适充91例(71.09%),欠充32例(占25.00%),超充5例(3.91%)。128例128个患牙中,存在MB2的患牙为24个(18.75%)。结论常规根管治疗技术治疗上颌第一恒磨牙可以取得较好的临床效果。平行和偏移投照根尖片有助于寻找和确诊MB2根管的存在。     

上颌第一恒磨牙近中颊根3个根管1例

<正>1病例报告患者,男,30岁,于2007年11月来我科就诊。主诉:左上后牙咀嚼痛1个月。检查:26(牙合)面见银汞充填体,叩(+),不松,颊侧偏远中牙龈见瘘管,无脓液溢出。X线示     

上颌第一恒磨牙近中颊根三根管1例

上颌磨牙近中颊根虽多为单根，但根管解剖复杂，其双根管发生率很高，但三根管较少见。现报告上颌第一磨牙近中颊根三根管并进行去髓术的一个病例。     

上颌第一磨牙5根管1例

上颌第一磨牙以3-4根管多见,腭侧双根管的病例较为罕见。笔者在未用根管娃微镜等特殊仪器的情况下探查发现上颌磨牙5个根管1例,报道如下,以期为临床工作提供参考。     

上颌第一恒磨牙的根管观察及临床意义

上颌第一恒磨牙萌出早,且承担着主要的咀嚼功能,其龋病发生率仅次于下颌第一、二恒磨牙［１］,常需作牙髓治疗。而上颌第一恒磨牙根管系统较为复杂,尤其是近中颊根,近年国内外对其双管发生率的报道相差甚大：Ｈｏｗａｒｄ等的临床研究为７１２％［２］;张萃贤等的...     

上颌第一磨牙近颊第二根管的临床治疗

目的 探讨上颌第一磨牙近烦第二根管（second mesiobuccal canal，MB2）的特征及临床治疗方法。方法 选取患牙髓炎或根尖用炎的上颌第一磨牙95颗，拍摄术前X线片，术中采用小号K锉配合15％EDTA溶液探查根管，记录根管数目、形态和类型；采用机动镍钛器械Hero642进行根管预备，侧向加压充填技术充填根管。结果上颌第一磨牙MB2的发现率为81．1％，扩通的MB2占72．6％，多数MB2根管细小弯曲，需用小号锉配合使用EDTA进行疏通，机动镍钛器械预备根管无明显并发症。结论上颌第一磨牙MB2的发生率高，多数根管细小弯曲，小号K锉配合EDTA疏通根管，机动镍钛器械预备可获得良好的治疗效果。     

上颌第二磨牙根管数目的临床研究

目的观察临床治疗中上颌第二磨牙根管数目。方法临床需要根管治疗的上颌第二磨牙166颗,拍X线片,术中配合使用根管显微镜、超声根管锉、小号K锉及17％EDTA溶液,探查并扩通根管,确定根管数目。用镍钛锉进行根管预备,侧方加压技术充填根管。结果166颗上颌第二磨牙中：单根管牙为2颗（1．2％）;双根管牙（颊根根管、腭根根管）5颗（3．0％）;3根管牙（近中颊根根管、远中颊根根管、腭根根管）为117颗（70．5％）;四根管牙为42颗（25．3％）,其中近中颊根第2根管（MB2）发生率23．5％。结论上颌第二磨牙根管变异较大,临床治疗中应多加注意。     

上颌第二恒磨牙近中颊根第二根管的离体牙研究

目的研究上颌第二恒磨牙近中颊根第二根管（MB2）的发生情况,为提高上颌第二恒磨牙根管治疗的成功率提供解剖学基础。方法于山东地区收集离体上颌第二恒磨牙118颗,采用斜方型开髓洞型开髓,利用小号C型锉探查并疏通根管,记录MB2的发现率及扩通率;拍摄X线牙片,记录近中颊根的根管数目、形态和类型;在根管显微镜下观察并应用数显卡尺测量近中颊根主根管和MB2根管口之间的距离,确定根管口的位置;记录近中颊根的根尖孔数目,并测量解剖根尖孔至解剖根尖的距离。结果118颗上颌第二恒磨牙中,有58颗发现MB2,发现率为49.15%;其中48颗牙齿的MB2被扩通,扩通率为82.76%。108颗3根牙中,近中颊根的根管形态为Ⅰ型者有50颗,占46.30%;Ⅱ型及Ⅲ型者分别为14和34颗,占12.96%和31.48%。近中颊根主根管口与MB2根管口的平均距离为1.26 mm;近中颊根解剖根尖孔至解剖根尖的距离平均值为1.13 mm。结论山东地区上颌第二恒磨牙MB2的发现率较高,临床治疗中采用改良的斜方型开髓孔有利于发现MB2,用X线片确定工作长度时需要结合临床综合判断根尖孔的位置。     

手术显微镜对上颌第一恒磨牙近舌根管寻找定位的临床评价

目的 :评价手术显微镜在上颌第一恒磨牙近中颊根的近舌根管 (MB2根管 )定位中的作用。方法 :选取上颌第一恒磨牙牙髓病或尖周病患牙 52个 ,采用肉眼观察或手术显微镜下观察来寻找、定位上颌第一恒磨牙MB2根管口 ,运用统计学分析将两者对MB2根管的发现率进行比较。结果 :肉眼观察组 30例中有1 5例发现MB2根管。手术显微镜组 2 2例中有 1 7例发现MB2根管 ,手术显微镜组对MB2根管的发现率显著高于肉眼组 (P <0 .0 5)。结论 :手术显微镜的应用有助于寻找、发现MB2根管 ,从而有效改善上颌第一恒磨牙根管治疗的成功率     

上颌第一恒磨牙根管弯曲度初探

目的:分析上颌第一恒磨牙根管弯曲发生情况、弯曲位置、弯曲方向及弯曲程度。方法:收集南京地区80例上颌第一恒磨牙,在根管中分别插入15#~20#扩大针,拍摄近远中向和颊舌向X线片,用Photoshop6.0软件测量分析根管弯曲位置、弯曲方向和弯曲角度。结果:1)上颌第一磨牙腭侧根管通畅、较直。2)远中颊侧根管在近远中方向有80%,颊舌方向有45%出现大于5°的明显弯曲,弯曲位置多位于根中1/3,且近远中向的弯曲明显大于颊舌向(P<0.05)。3)上颌第一恒磨牙近中颊根颊侧根管在近远中方向、颊舌方向分别有82.5%、77.5%出现大于5°的明显弯曲。两个方向上的弯曲程度无明显差异(P>0.05)。4)本研究中有35%的标本探通了近颊根舌侧根管,其在近远中向、颊舌向出现明显弯曲的比例达91%、83%。结论:上颌第一恒磨牙四个根管在近远中方向、颊舌方向均有不同程度的弯曲,其第二弯曲出现的情况也各不相同。     

上颌第一磨牙根管系统的研究

目的 观察上颌第一磨牙的根管系统。方法 制备50个上颌第一磨牙透明牙标本,显露根管系统的空间构型,在体视显微镜下观察并记录根管系统的形态,结合应用加以统计。结果 ①上颌第一磨牙近中颊根单根管率为66%,其中Ⅰ型占38%,双根管率为34%,远中颊根Ⅰ型占74%,腭根Ⅰ型占94%。②根管侧支、根尖分歧、根尖分叉多见于近颊根,在近颊根的发生率为40%, 远颊根的发生率为24%,腭根的发生率为6%,发生部位多见于根尖1/3。结论 上颌第一磨牙近颊根的根管系统最为复杂,根管变异较远颊根多,腭根变异最少。     

C-shaped root canal configuration in maxillary first molars

AIM: This clinical report presents the endodontic treatment of two maxillary first molars and the anatomical study of two additional maxillary first molars with a C-shaped distally located root canal system. This configuration is not a common finding. SUMMARY: According to the endodontic literature, the C-shaped root canal is most frequently seen in the mandibular second molar. The occurrence of C-shapes in maxillary first molars, however, has only been described in a limited number of case reports. We observed this configuration in two out of 2175 root-filled maxillary first molars treated at the Department of Endodontology, Ghent University Hospital, during the last 10 years. In order to study and visualize this particular aberration, cross-sections in two additional two-rooted maxillary first molars were made. From these cross sections it can be concluded that the C-shaped canal configuration is the result of a fusion of the distobuccal and the palatal roots.     

显微CT法研究上颌第一磨牙根管系统解剖形态

目的 使用显微CT研究上颌第一磨牙根管系统解剖形态.方法 随机收集33颗上颌第一磨牙,使用显微CT扫描后重建根管系统.观察并记录各牙根根管形态和分支根管的发生数目、位置.记录各根管口位置并测量根管口间的距离和所成角度.在距离根尖1、2和3mm处进行虚拟切割,记录断面上分支根管暴露情况.结果 上颌第一磨牙近颊根第二根管发生率为75.76%.近颊根发生分支根管为71.64%;近颊根分支根管发生率为72.73%.91.04%的分支根管发生于根尖1/3段,近颊根距根尖3mm处截面分支根管暴露率为12.12%.近颊根第一、第二根管口间的距离为(1.60±0.41)mm.结论 上颌第一磨牙根管系统解剖形态复杂,近颊根根管形态存在较大解剖变异.     

Root canal anatomy of maxillary first and second permanent molars

AIM: The aim of this investigation was to study the root canal anatomy of maxillary first and second molar teeth from an Irish population sample using a clearing technique. METHODOLOGY: Eighty-three extracted permanent maxillary right first molars and 40 permanent right maxillary second molars were included in this investigation. The specimens were demineralized and then cleared using methyl salicylate. The following observations were made: number of roots, prevalence of fusion, types of root canals using Vertucci's classification, presence and position of lateral canals, presence and position of transverse anastomoses, number and position of apical foramina and the frequency of occurrence of apical deltas. RESULTS: Eleven per cent of maxillary first molars and 43% of maxillary second molars had fused roots. A total of 78% of mesiobuccal roots in maxillary first and 58% in maxillary second molars had two canals. Sixty-two per cent of maxillary first and 50% of maxillary second molars had two apical foramina. There was a significant inverse relationship between age and the occurrence of two canals and between age and the occurrence of transverse anastomoses in both tooth morphotypes (P < or = 0.05). CONCLUSIONS: It is concluded that a significant proportion of the first and second molar specimens studied had two canals in the mesiobuccal root (78% and 58%, respectively) and that the occurrence of two canals and transverse anastomoses decreased significantly with increasing age.     

上颌第一磨牙根管弯曲度的实验研究

目的:分析上颌第一磨牙根管弯曲位置、方向及弯曲度。方法:收集80个上颌第一磨牙,在根管中分别插入15#-20#扩大针,拍摄近远中向和颊舌向X线片,用Photoshop6.0软件测量根管弯曲位置、方向和弯曲度。结果:上颌第一磨牙腭侧根管通畅、较直。远中颊侧根管80%在近远中方向、45%在颊舌方向有>5°的明显弯曲,弯曲位置多位于根中1/3,且近远中向弯曲度明显大于颊舌向(P<0.05)。近中颊根颊侧根管在近远中方向、颊舌方向分别有82.5%、77.5%出现>5°的明显弯曲。两个方向上的弯曲度无明显差异(P>0.05)。35%的标本探通了近颊根舌侧根管,其在近远中向、颊舌向出现明显弯曲的比例达91%和83%。结论:上颌第一磨牙四个根管在近远中向、颊舌方向均有不同程度的弯曲,其第二弯曲出现的情况也各不相同。     

Clinical detection of the minor mesiobuccal canal of maxillary first molars

One hundred extracted maxillary first molars from a South East Asian population were sectioned at a level below the roof of the pulp chamber. The detection of the minor mesiobuccal canal was determined on the pulpal floor using a size 08 file. When the canal was not detected by this technique, its presence or absence was then determined by sectioning the mesiobuccal root transversely, and the position of the extra canal was explored from the cut end. It was found that by modifying the outline of the access cavity, and by widening and deepening the groove running palatally from the major mesiobuccal canal up to a depth of 0.5 mm and a distance of 2.0 mm, the visibility of the extra mesiobuccal canal orifice was greatly improved. This study showed that more than 50% of maxillary first molars had a minor mesiobuccal canal, and 19% of these canals could not be detected clinically.     

上颌第一磨牙根管治疗术后5年疗效分析

目的:评价上颌第一磨牙根管治疗疗效及其影响因素.方法:回顾170颗诊断为牙髓炎、需行根管治疗的上颌第一磨牙,其中牙科手术显微镜下探查根管、Protaper机用镍钛器械根管预备、热牙胶垂直加压充填根管100颗;肉眼探查根管、Protaper机用镍钛器械根管预备、侧压法充填根管70颗.170颗牙术后行冠或桩冠修复.根据治疗前、后临床检查及X线片,综合充填长度和充填密度两方面,对根管充填质量和根管治疗疗效进行评价.采用Reversion 3.0.2软件包对数据进行统计学分析.结果:热牙胶垂直加压和侧压法充填根管在充填长度方面优良率分别达到93％、91.4％,两者无显著差异;热牙胶垂直加压充填在充填密度方面优良率达到96％,优于冷牙胶侧压法的84.3％,两者差异显著:2种方法的综合根管充填质量优良率分别达到91％、75.7％,差异显著.肉眼近颊第二根管(MB2)发现率为31.4％,根管显微镜下MB2发现率为55％,两者差异显著.热牙胶垂直加压和侧压法充填根管治疗术后5年临床成功率分别达到98％、81.4％,两者差异显著;术后5年热牙胶垂直加压法根管充填无论充填长度还是充填密度均无变化,稳定性好,维持高质量的根管充填,RCT优良率维持在91％;而侧压法根管充填长度无变化,但RCT优良率由75.7％下降为68.6％.术后5年无1例冠折.结论:上颌第一磨牙根管形态复杂,根管显微镜有助于发现MB2.机用镍钛器械预备根管,热牙胶垂直加压充填上颌第一磨牙,无论充填长度还是充填密度,均可获得良好效果,上颌第一磨牙根管治疗术后应常规行冠或桩冠修复.     

Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics

The aim of this study was to investigate whether the use of operating microscope in combination with ultrasonics increased the rate of second mesiobuccal (MB2) canal detection in permanent maxillary first molar teeth. A hundred extracted human maxillary first molars were assessed. After location of the main canals, the MB2 canal was sought in all teeth first without microscopy, then with the aid of the operating microscope and finally with the combined use of the operating microscope and ultrasonics. With these techniques, the MB2 canal was detected in 62%, 67% and 74% of the teeth, respectively. The combination of the operating microscope and ultrasonics detected significantly more MB2 canals than when no microscopy was utilized (P < 0.05). Sectioning of the roots disclosed the presence of the MB2 canal in 82% of the teeth. Twenty‐nine per cent of the teeth had a separate MB2 canal orifice and separate apical foramina. The results of this study suggested that the combined use of the operating microscope and ultrasonics increased the detection of MB2 canals in maxillary first permanent molars.