中华口腔医学杂志
中華口腔醫學雜誌
중화구강의학잡지
Chinese Journal of Stomatology
2014年
7期
421-427
,共7页
王捍国%李丹%田宇%余擎
王捍國%李丹%田宇%餘擎
왕한국%리단%전우%여경
根尖周疾病%显微外科手术%回顾性研究%根尖外科
根尖週疾病%顯微外科手術%迴顧性研究%根尖外科
근첨주질병%현미외과수술%회고성연구%근첨외과
Periapical disease%Microsurgery%Retrospective studies%Apical surgery
目的 分析显微根尖外科手术的临床应用、成功率及其预后影响因素,以期为临床提供参考.方法 回顾性分析进行显微根尖外科手术,即显微镜下使用显微手术器械和超声工作尖进行切开翻瓣、去骨开窗、根尖切除、根管倒预备和三氧化矿物凝聚体倒充填、缝合的患者资料,术后1、3、6及12个月进行回访,通过临床和放射学检查确定疗效,并对预后影响因素进行统计学分析.结果 2010年7月至2012年12月期间完成显微根尖外科手术180例共计240颗患牙,其中上颌前牙132颗、下颌前牙22颗,上颌前磨牙31颗,下颌前磨牙18颗,上颌磨牙19颗,下颌磨牙18颗.术后1年随访152例207颗患牙,回访率为86.3％(207/240).显微根尖外科手术主要应用于根管(再)治疗术难以或者不能治疗的复杂、疑难根尖周病,包括根管治疗术失败、因修复体等原因不能进行根管治疗术、根尖周囊肿、根管钙化、根管内外分离器械、超填、根管粗大、根折、根尖手术失败、根尖穿孔及特殊根管系统共计11种类型.显微根尖外科手术的1年成功率达90.8％(188/207).根据患者性别、年龄、牙位、根尖周阴影类型、有无窦道以及临床应用类型分别统计手术疗效,组间差异均无统计学意义(P＞0.05),有无牙周炎组间差异有统计学意义(P＜0.05).失败18例19颗患牙,主要原因为合并重度牙周炎和根裂.结论 显微根尖外科手术是治疗复杂、疑难根尖周病的有效方法,病例选择和规范化操作是手术成功的关键.
目的 分析顯微根尖外科手術的臨床應用、成功率及其預後影響因素,以期為臨床提供參攷.方法 迴顧性分析進行顯微根尖外科手術,即顯微鏡下使用顯微手術器械和超聲工作尖進行切開翻瓣、去骨開窗、根尖切除、根管倒預備和三氧化礦物凝聚體倒充填、縫閤的患者資料,術後1、3、6及12箇月進行迴訪,通過臨床和放射學檢查確定療效,併對預後影響因素進行統計學分析.結果 2010年7月至2012年12月期間完成顯微根尖外科手術180例共計240顆患牙,其中上頜前牙132顆、下頜前牙22顆,上頜前磨牙31顆,下頜前磨牙18顆,上頜磨牙19顆,下頜磨牙18顆.術後1年隨訪152例207顆患牙,迴訪率為86.3％(207/240).顯微根尖外科手術主要應用于根管(再)治療術難以或者不能治療的複雜、疑難根尖週病,包括根管治療術失敗、因脩複體等原因不能進行根管治療術、根尖週囊腫、根管鈣化、根管內外分離器械、超填、根管粗大、根摺、根尖手術失敗、根尖穿孔及特殊根管繫統共計11種類型.顯微根尖外科手術的1年成功率達90.8％(188/207).根據患者性彆、年齡、牙位、根尖週陰影類型、有無竇道以及臨床應用類型分彆統計手術療效,組間差異均無統計學意義(P＞0.05),有無牙週炎組間差異有統計學意義(P＜0.05).失敗18例19顆患牙,主要原因為閤併重度牙週炎和根裂.結論 顯微根尖外科手術是治療複雜、疑難根尖週病的有效方法,病例選擇和規範化操作是手術成功的關鍵.
목적 분석현미근첨외과수술적림상응용、성공솔급기예후영향인소,이기위림상제공삼고.방법 회고성분석진행현미근첨외과수술,즉현미경하사용현미수술기계화초성공작첨진행절개번판、거골개창、근첨절제、근관도예비화삼양화광물응취체도충전、봉합적환자자료,술후1、3、6급12개월진행회방,통과림상화방사학검사학정료효,병대예후영향인소진행통계학분석.결과 2010년7월지2012년12월기간완성현미근첨외과수술180례공계240과환아,기중상합전아132과、하합전아22과,상합전마아31과,하합전마아18과,상합마아19과,하합마아18과.술후1년수방152례207과환아,회방솔위86.3％(207/240).현미근첨외과수술주요응용우근관(재)치료술난이혹자불능치료적복잡、의난근첨주병,포괄근관치료술실패、인수복체등원인불능진행근관치료술、근첨주낭종、근관개화、근관내외분리기계、초전、근관조대、근절、근첨수술실패、근첨천공급특수근관계통공계11충류형.현미근첨외과수술적1년성공솔체90.8％(188/207).근거환자성별、년령、아위、근첨주음영류형、유무두도이급림상응용류형분별통계수술료효,조간차이균무통계학의의(P＞0.05),유무아주염조간차이유통계학의의(P＜0.05).실패18례19과환아,주요원인위합병중도아주염화근렬.결론 현미근첨외과수술시치료복잡、의난근첨주병적유효방법,병례선택화규범화조작시수술성공적관건.
Objective To evaluate the outcome and the potential prognostic factors of apical microsurgery.Methods The teeth with persistent periapical diseases were treated by microsurgery using micro instruments,ultrasonic retrotips and mineral trioxide aggregate(MTA) under dental operate microscope.The procedure includes incision and flap retraction,osteotomy,apicoectomy,retro-preparation and retro-filling of root canal.Patients were recalled at 1,3,6,and 12-month intervals.The outcome was evaluated by clinical and radiographic examinations,and the potential prognostic factors were analyzed.Results One hundred and eighty cases(240 teeth),including 132 upper anterior teeth,22 lower anterior teeth,31 upper premolars,18 lower premolars,19 upper molars and 18 lower molars,were treated by microsurgery between July 2010 and December 2012.A total of 152 cases(207 teeth) were recalled.The application of the apical microsurgery included failure of previous endodontic treatment,periapical lesion with post,periapical cyst,calcified canals,separated instruments,overfilling,open apex,root facture,failure of previous apical surgery,apical fenestration,and special root canal system.The success rate was 90.8％ (188/207).Age,sex,tooth position,type of periapical radiolucency,fistula and clinical application type appeared to have a negative effect on the outcome.Endo-perio lesion was a significant factor.Eighteen cases (19 teeth) failed mainly because of periodontally involved lesion and vertical root fracture.Conclusions Apical microsurgery,which combines the magnification and illumination provided by the microscope with the proper use of micro instruments,can treat the teeth with persistent periapical diseases precisely and less traumatically with high success rate.Case selection and standardized operations play a key role for success.
