牙髓治疗失败的原因分析

目的:通过对临床上牙髓治疗失败需再治疗的病例进行分析,探讨牙髓治疗失败的原因。方法:选取牙髓治疗失败患牙236个,根据初次治疗情况、临床检查、术前X线片以及术中对患牙根管系统的探查等,判断原治疗失败的原因。结果:83.7%的干髓术患牙存在根尖周病变;塑化治疗失败的患牙中,以无根尖周病变但发生牙折最多见,占57.1%,其次为塑化不全造成根尖周炎或残髓炎;根管治疗失败的患牙,58.5%存在根尖周病变,85.1%的患牙欠充且根管形态欠佳,14.9%的患牙存在台阶、根管偏移等并发症。结论:干髓术疗效差,多数失败患牙存在根尖周炎;塑化治疗失败的原因多为牙折或塑化不全;因预备和充填不完善等因素造成的根管清理不彻底、封闭不严密,使根管系统再感染是根管治疗失败的主要原因。

Clinical analysis of factors associated with endodontic treatment failure

AIM:To analyze the factors of endodontic treatment failure.METHODS:236 failed treated teeth were analyzed according to the initial treatment records, clinical examination, pretreatment radiographs, and root canal exploration during endodontic retreatment.RESULTS:83.7% of mummified teeth showed apical lesion. 57.1% of failed resinified teeth resulted from fracture,and incomplete resinifying was the next.For failure teeth with root canal therapy, 58.5% had apical lesion, 85.1% indicated under-filling, and most canals had poor taper and flow characteristics. 14.9% had complications such as ledge and transportation.Root canals were omitted in some premolars and maxillary first molars.CONCLUSION:Most mummified teeth had poor result. The main cause of failure of resinfying therapy involved teeth fracture and inadequate resinfying operation. The factors associated with root canal therapy failure involve poor seal of root canal system resulted from inadequate shaping, cleaning and obturation. Coronal leakage and missed canals also contribute to the root canal treatment failure.