钙化根管临床治疗的研究进展
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摘要
根管治疗术是目前治疗牙髓疾病、根尖周病最常用、最有效的方法,但钙化根管常由于根管不通、疏通困难等发生治疗失败。临床上根据根管探查和影像学检查进行钙化根管的诊断与评估,结合显微超声等器械和化学试剂进行根管疏通,可提高根管治疗成功率。本文将就钙化根管的分类、发生机制、术前评估及预备方法等治疗相关研究进行综述。
Root canal therapy (RCT) is the most commonly used and effective method to treat dental pulp disease and periapical disease. However,the treatments of calcified root canals often fail because of the omission of the root canals and the difficulties of dredging. Clinical diagnosis and evaluation based on root canal exploration and radiology can increase the success rate of root canal therapies. Additionally,root canal dredging that makes use of specialized instruments can also promote the success rate,such as ultrasonic microscope and chemical reagents. This article will review the research progress on the classification,mechanism,preoperative evaluation and pathway establishment of the calcified root canal.
Root canal therapy (RCT) is the most commonly used and effective method to treat dental pulp disease and periapical disease. However,the treatments of calcified root canals often fail because of the omission of the root canals and the difficulties of dredging. Clinical diagnosis and evaluation based on root canal exploration and radiology can increase the success rate of root canal therapies. Additionally,root canal dredging that makes use of specialized instruments can also promote the success rate,such as ultrasonic microscope and chemical reagents. This article will review the research progress on the classification,mechanism,preoperative evaluation and pathway establishment of the calcified root canal.
引文
[1]Siddiqui SH.Management of pulp canal obliteration using the Modified-Tip instrument technique[J].Int J Health Sci,2014,8(4):426-428.
[2]Mc Cabe PS,Dummer PM.Pulp canal obliteration:an endodontic diagnosis and treatment challenge[J].Int Endod J,2012,45(2):177-197.
[3]Gautam S,Galgali SR,Sheethal HS,et al.Pulpal changes associated with advanced periodontal disease:A histopathological study[J].J Oral Maxillofac Pathol,2017,21(1):58-63.
[4]Nanjannawar GS,Vagarali H,Nanjannawar LG,et al.Pulp stonean endodontic challenge:successful retrieval of exceptionally long pulp stones measuring 14 and 9.5 mm from the palatal roots of maxillary molars[J].J Contemp Dent Pract,2012,13(5):719-722.
[5]曾劲峰,张伟,蒋宏伟,等.髓石中Nanobacteria细菌的分离、培养与鉴定[J].中华口腔医学杂志,2006,41(8):498-501.
[6]李祥伟,李亚华,姜艳华,等.离体牙钙化根管的扫描电镜观察[J].现代口腔医学杂志,2008,22(6):644-646.
[7]Hargreaves K,Berman L.Cohen's pathways of the pulp[M].11th ed.St.Louis,Missouri:Elsevier,2016:564-566.
[8]Fonseca GM,Fonseca MM.Calcific metamorphosis with pathological root resorption in permanent teeth:Morphohistometric evaluation of two cases[J].Int J Morphol,2015,33(2):712-718.
[9]Ajmera K,Mulay S.Multimodality esthetic management-A case report[J].Int J Sci Res,2013,4(1):1176-1180.
[10]Khabbaz MG,Serefoglou MH.The application of the buccal object rule for the determination of calcified root canals[J].Int Endod J,1996,29(4):284-287.
[11]Ee J,Fayad MI,Johnson BR.Comparison of endodontic diagnosis and treatment planning decisions using cone-beam volumetric tomography versus periapical radiography[J].J Endod,2014,40(7):910-916.
[12]Shetty H,Sontakke S,Karjodkar F,et al.A Cone Beam Computed Tomography(CBCT)evaluation of MB2 canals in endodontically treated permanent maxillary molars.A retrospective study in Indian population[J].J Clin Exp Dent,2017,9(1):e51-e55.
[13]Rosen E,Taschieri S,Del Fabbro M,et al.The diagnostic efficacy of cone-beam computed tomography in endodontics:a systematic review and analysis by a Hierarchical model of efficacy[J].J Endod,2015,41(7):1008-1014.
[14]徐琼,刘建伟,凌均棨.手术显微镜配合超声技术处理钙化根管的临床疗效[J].中华口腔医学研究杂志:电子版,2011,05(1):31-34.
[15]Whitworth JM.实用根管治疗学[M].吕红兵,闫福华,译.北京:人民军医出版社,2006:74-85.
[16]黄定明,周学东.根管治疗难度分析的要点[J].中华口腔医学杂志,2006,41(9):532-534.
[17]Witherspoon DE,Small JC,Regan JD.Missed canal systems are the most likely basis for endodontic retreatment of molars[J].Tex Dent J,2013,130(2):127-139.
[18]Sitbon Y,Attathom T,St-Georges AJ.Minimal intervention dentistry II:part 1.Contribution of the operating microscope to dentistry[J].Br Dent J,2014,216(3):125-130.
[19]Zou WL,Guo LY,Hong X,et al.CBCT-aided microscopic and ultrasonic treatment for calcified root canals[C].IADR,2014.
[20]Ala9am T,Tinaz AC,Gen9 O,et al.Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics[J].Aust Endod J,2008,34(3):106-109.
[21]Kumar R.Report of a rare case:a maxillary first molar with seven canals confirmed with cone-beam computed tomography[J].Iran Endod J,2014,9(2):153-157.
[22]Anil KJ,Bhedasgoankar SY,Dilip BS.Periodontal microsurgery:a case report[J].J Indian Soc Periodontol,2013,17(6):790-792.
[23]Biswas M,Mazumdar D,Neyogi A.Non surgical perforation repair by mineral trioxide aggregate under dental operating microscope[J].J Conserv Dent,2011,14(1):83-85.
[24]Ball RL,Barbizam JV,Cohenca N.Intraoperative endodontic applications of cone-beam computed tomography[J].J Endod,2013,39(4):548-557.
[25]Schafer KG.Treatment of calcified root canals[J].Ont Dent,1996,73(10):21-23.
[26]Krasner P,Rankow HJ.Anatomy of the pulp-chamber floor[J].JEndod,2004,30(1):5-16.
[27]樊明文.牙体牙髓病学[M].4版.北京:人民卫生出版社,2012:281.
[28]蔡华雄,程慧琳,宋洁文,等.C型先锋锉和乙二胺四乙酸分次疏通磨牙弯曲钙化根管的临床研究[J].中华口腔医学研究杂志:电子版,2010,4(1):43-49.
[29]Schfer E,Lohmann D.Efficiency of rotary nickel-titanium FlexMaster instruments compared with stainless steel hand K-FlexofilePart 1.Shaping ability in simulated curved canals[J].Int Endod J,2002,35(6):505-513.
[30]赵隽隽,周卓君,韩俊力,等.Mtwo镍钛器械在钙化阻塞根管治疗中的应用[J].上海口腔医学,2016,25(2):204-207.
[31]Kiefner P,Connert T,EIAyouti A,et al.Treatment of calcified root canals in elderly people:a clinical study about the accessibility,the time needed and the outcome with a three-year follow-up[J].Gerodontology,2017,34(2):164-170.
[32]田慧颖,冯超,赵晶,等.应用显微超声技术进行根管再治疗的临床评价[J].华西口腔医学杂志,2008,26(5):509-512.
[33]Wu D,Shi W,Wu J,et al.The clinical treatment of complicated root canal therapy with the aid of a dental operating microscope[J].Int Dent J,2011,61(5):261-266.
[34]Van der Velden U,Koster TJ,Feilzer AJ,et al.In vitro evaluation of temperature changes in the root canal induced by ultrasonic scalers[J].Int J Dent Hyg,2015,13(2):132-137.
[35]Aydemir S,Cimilli H,Mumcu G,et al.Crack formation on resected root surfaces subjected to conventional,ultrasonic,and laser root-end cavity preparation[J].Photomed Laser Surg,2014,32(6):351-355.
[36]Sayin TC,Serper A,Cehreli ZC,et al.The effect of EDTA,EGTA,EDTAC,and tetracycline-HCl with and without subsequent Na OCl treatment on the microhardness of root canal dentin[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endodontics,2007,104(3):418-424.
[37]Calt S,Serper A.Time-dependent effects of EDTA on dentin structures[J].J Endod,2002,28(1):17-19.
[38]Walton RE.Current concepts of canal preparation[J].Dent Clin North Am,1992,36(2):309-326.
[39]Zehnder MS,Connert T,Weiger R,et al.Guided endodontics:accuracy of a novel method for guided access cavity preparation and root canal location[J].Int Endod J,2016,49(10):966-972.
[40]Van der Meer WJ,Vissink A,Ng YL,et al.3D Computer aided treatment planning in endodontics[J].J Dent,2016,45:67-72.
[41]Krastl G,Zehnder MS,Connert T,et al.Guided Endodontics:a novel treatment approach for teeth with pulp canal calcification and apical pathology[J].Dent Traumatol,2016,32(3):240-246.
[42]Shi X,Zhao S,Wang W,et al.Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology[J].Aust Endod J,2018,44(1):66-70.
[43]封琼,王一舟,黄雨婷,等.精准微创根管治疗---3D导板指引下的钙化根管疏通术[J].口腔医学研究,2017,33(4):427-431.
[2]Mc Cabe PS,Dummer PM.Pulp canal obliteration:an endodontic diagnosis and treatment challenge[J].Int Endod J,2012,45(2):177-197.
[3]Gautam S,Galgali SR,Sheethal HS,et al.Pulpal changes associated with advanced periodontal disease:A histopathological study[J].J Oral Maxillofac Pathol,2017,21(1):58-63.
[4]Nanjannawar GS,Vagarali H,Nanjannawar LG,et al.Pulp stonean endodontic challenge:successful retrieval of exceptionally long pulp stones measuring 14 and 9.5 mm from the palatal roots of maxillary molars[J].J Contemp Dent Pract,2012,13(5):719-722.
[5]曾劲峰,张伟,蒋宏伟,等.髓石中Nanobacteria细菌的分离、培养与鉴定[J].中华口腔医学杂志,2006,41(8):498-501.
[6]李祥伟,李亚华,姜艳华,等.离体牙钙化根管的扫描电镜观察[J].现代口腔医学杂志,2008,22(6):644-646.
[7]Hargreaves K,Berman L.Cohen's pathways of the pulp[M].11th ed.St.Louis,Missouri:Elsevier,2016:564-566.
[8]Fonseca GM,Fonseca MM.Calcific metamorphosis with pathological root resorption in permanent teeth:Morphohistometric evaluation of two cases[J].Int J Morphol,2015,33(2):712-718.
[9]Ajmera K,Mulay S.Multimodality esthetic management-A case report[J].Int J Sci Res,2013,4(1):1176-1180.
[10]Khabbaz MG,Serefoglou MH.The application of the buccal object rule for the determination of calcified root canals[J].Int Endod J,1996,29(4):284-287.
[11]Ee J,Fayad MI,Johnson BR.Comparison of endodontic diagnosis and treatment planning decisions using cone-beam volumetric tomography versus periapical radiography[J].J Endod,2014,40(7):910-916.
[12]Shetty H,Sontakke S,Karjodkar F,et al.A Cone Beam Computed Tomography(CBCT)evaluation of MB2 canals in endodontically treated permanent maxillary molars.A retrospective study in Indian population[J].J Clin Exp Dent,2017,9(1):e51-e55.
[13]Rosen E,Taschieri S,Del Fabbro M,et al.The diagnostic efficacy of cone-beam computed tomography in endodontics:a systematic review and analysis by a Hierarchical model of efficacy[J].J Endod,2015,41(7):1008-1014.
[14]徐琼,刘建伟,凌均棨.手术显微镜配合超声技术处理钙化根管的临床疗效[J].中华口腔医学研究杂志:电子版,2011,05(1):31-34.
[15]Whitworth JM.实用根管治疗学[M].吕红兵,闫福华,译.北京:人民军医出版社,2006:74-85.
[16]黄定明,周学东.根管治疗难度分析的要点[J].中华口腔医学杂志,2006,41(9):532-534.
[17]Witherspoon DE,Small JC,Regan JD.Missed canal systems are the most likely basis for endodontic retreatment of molars[J].Tex Dent J,2013,130(2):127-139.
[18]Sitbon Y,Attathom T,St-Georges AJ.Minimal intervention dentistry II:part 1.Contribution of the operating microscope to dentistry[J].Br Dent J,2014,216(3):125-130.
[19]Zou WL,Guo LY,Hong X,et al.CBCT-aided microscopic and ultrasonic treatment for calcified root canals[C].IADR,2014.
[20]Ala9am T,Tinaz AC,Gen9 O,et al.Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics[J].Aust Endod J,2008,34(3):106-109.
[21]Kumar R.Report of a rare case:a maxillary first molar with seven canals confirmed with cone-beam computed tomography[J].Iran Endod J,2014,9(2):153-157.
[22]Anil KJ,Bhedasgoankar SY,Dilip BS.Periodontal microsurgery:a case report[J].J Indian Soc Periodontol,2013,17(6):790-792.
[23]Biswas M,Mazumdar D,Neyogi A.Non surgical perforation repair by mineral trioxide aggregate under dental operating microscope[J].J Conserv Dent,2011,14(1):83-85.
[24]Ball RL,Barbizam JV,Cohenca N.Intraoperative endodontic applications of cone-beam computed tomography[J].J Endod,2013,39(4):548-557.
[25]Schafer KG.Treatment of calcified root canals[J].Ont Dent,1996,73(10):21-23.
[26]Krasner P,Rankow HJ.Anatomy of the pulp-chamber floor[J].JEndod,2004,30(1):5-16.
[27]樊明文.牙体牙髓病学[M].4版.北京:人民卫生出版社,2012:281.
[28]蔡华雄,程慧琳,宋洁文,等.C型先锋锉和乙二胺四乙酸分次疏通磨牙弯曲钙化根管的临床研究[J].中华口腔医学研究杂志:电子版,2010,4(1):43-49.
[29]Schfer E,Lohmann D.Efficiency of rotary nickel-titanium FlexMaster instruments compared with stainless steel hand K-FlexofilePart 1.Shaping ability in simulated curved canals[J].Int Endod J,2002,35(6):505-513.
[30]赵隽隽,周卓君,韩俊力,等.Mtwo镍钛器械在钙化阻塞根管治疗中的应用[J].上海口腔医学,2016,25(2):204-207.
[31]Kiefner P,Connert T,EIAyouti A,et al.Treatment of calcified root canals in elderly people:a clinical study about the accessibility,the time needed and the outcome with a three-year follow-up[J].Gerodontology,2017,34(2):164-170.
[32]田慧颖,冯超,赵晶,等.应用显微超声技术进行根管再治疗的临床评价[J].华西口腔医学杂志,2008,26(5):509-512.
[33]Wu D,Shi W,Wu J,et al.The clinical treatment of complicated root canal therapy with the aid of a dental operating microscope[J].Int Dent J,2011,61(5):261-266.
[34]Van der Velden U,Koster TJ,Feilzer AJ,et al.In vitro evaluation of temperature changes in the root canal induced by ultrasonic scalers[J].Int J Dent Hyg,2015,13(2):132-137.
[35]Aydemir S,Cimilli H,Mumcu G,et al.Crack formation on resected root surfaces subjected to conventional,ultrasonic,and laser root-end cavity preparation[J].Photomed Laser Surg,2014,32(6):351-355.
[36]Sayin TC,Serper A,Cehreli ZC,et al.The effect of EDTA,EGTA,EDTAC,and tetracycline-HCl with and without subsequent Na OCl treatment on the microhardness of root canal dentin[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endodontics,2007,104(3):418-424.
[37]Calt S,Serper A.Time-dependent effects of EDTA on dentin structures[J].J Endod,2002,28(1):17-19.
[38]Walton RE.Current concepts of canal preparation[J].Dent Clin North Am,1992,36(2):309-326.
[39]Zehnder MS,Connert T,Weiger R,et al.Guided endodontics:accuracy of a novel method for guided access cavity preparation and root canal location[J].Int Endod J,2016,49(10):966-972.
[40]Van der Meer WJ,Vissink A,Ng YL,et al.3D Computer aided treatment planning in endodontics[J].J Dent,2016,45:67-72.
[41]Krastl G,Zehnder MS,Connert T,et al.Guided Endodontics:a novel treatment approach for teeth with pulp canal calcification and apical pathology[J].Dent Traumatol,2016,32(3):240-246.
[42]Shi X,Zhao S,Wang W,et al.Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology[J].Aust Endod J,2018,44(1):66-70.
[43]封琼,王一舟,黄雨婷,等.精准微创根管治疗---3D导板指引下的钙化根管疏通术[J].口腔医学研究,2017,33(4):427-431.