根管治疗失败原因的临床分析

目的：探讨根管治疗失败的原因。方法：按纳入标准选取206名患者，分析根管治疗失败患牙215颗，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：失败病例中慢性根尖周炎患牙最多，占67．9％，其次是无根尖暗影、但因欠充要求再治疗的患牙，以及存在冠渗漏的患牙；X线片显示84．2％的患牙欠充，多数后牙根管锥度欠佳；遗漏根管多见于上颌第一磨牙和前磨牙；18．1％的患牙存在台阶、根管偏移等并发症。结论：因预备和充填不当等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，遗漏根管、冠部渗漏等也可造成治疗失败。

Clinical analysis of failure factors in root canal therapy

Objective:To analyze the failure factors in root canal therapy(RCT)by analysis of the failed cases.Methods:215 teeth of 206 patients were analyzed according to former treatment records,clinical examination,pretreatment radiographs,and root canal exploration during endodontic retreatment.Results:67.9% of failed teeth showed apical radiolucency,12.6% showed under-filled canal material without apical radiolucent area,and 8.4% involved coronal leakage.When examined with X ray,84.2% of teeth indicated under-filling,and most canals of premolars and molars had poor taper.Most missed root canals were found in maxillary first molars and premolars.18.1% of teeth had complications such as ledge and apical transportation.Conclusions:The factors associated with RCT failure involve cleaning,obturation and poor seal of root canal system resulted from inadequate shaping.Coronal leakage and missed canals also contribute to the endodontic treatment failure.