【作者】 孙书昱； 刘阗； 刘溦； 林桂珍；

【机构】 广东省口腔医院综合科；

【摘要】 目的:对临床需要再治疗的下颌第二恒磨牙C形根管病例进行分析,探讨此类根管治疗失败的常见原因。方法:收集已行根管治疗的下颌第二恒磨牙C形根管再治疗病例73例,根据Melton分类记录髓室底C形根管形态并对再治疗原因进行分类分析。结果:73例再治疗下颌第二恒磨牙C形根管病例中C1形27例(36.99%),C2形41例(56.16%),C3形5例(6.85%);C1形再治疗病例中髓室底穿孔1例(3.7%),X线片显示根管欠填病例27例(100%),治疗中发现遗漏根管11例(40.74%),根管内折断器械导致治疗失败1例(3.7%),未行完善的冠修复导致治疗失败4例(14.81%);C2形再治疗病例中X线片显示根管欠填病例38例(92.68%),治疗中发现遗漏根管23例(56.1%),未行完善的冠修复导致治疗失败6例(14.63%);C3形再治疗病例中X线片显示根管欠填病例5例;通过根管再治疗后患牙均无不适症状,X线片示根管再治疗后充填良好,治疗中无根管侧穿等并发症发生。结论:下颌第二恒磨牙C1、C2形态根管治疗失败比例较高,此类患牙除了根管欠填外,遗漏较小的近舌根管临床也较常见,因此针对C形根管改进根管清理、充填技术以及熟悉下颌第二恒磨牙C形根管解剖形态对于保证治疗效果是非常重要的。更多还原

【Abstract】 Aim:To analyze the reasons that may led to the endodontic treatment failure of C-shaped mandibular second molars.Method:A total of 73 mandibular second molars in 73 patients who underwent nonsurgical endodontic retreatment that possessed a C-shaped canal system were collected for this study,the C-shaped orifices on the pulp chamber floor were recorded based on Melton’ s classification,and the analysis were proceed according to the reasons of endodontic treatment failures in the presence of different type of C-shaped orifices.Results:Among 73 mandibular second C-shaped molars,27 had continuous C-shaped canal(type CD,41 had MB-D canal and an ML canal(type C2),5 had M canal and a D canal or MB、ML and a D canal(type C3);In teeth classified as type C1,one tooth was found perforation in pulp chamber floor,27 teeth were showed underfilling canals,missing canals in 11 teeth,separated instrument in one tooth and 4 teeth showed poor quality of coronal restoration;In teeth classified as type C2,38 teeth were showed underfilling canals,missing canals in 23 teeth,6 teeth showed poor quality of coronal restoration;In teeth classified as type C3,5 teeth were showed underfilling canals.No pain、perforation and other complications occur during and after nonsurgical retreatment alone. Conclusions:the results suggested that high endodontic treatment failure rates of type C1 and C2 configurations in mandibular second molars,the common causes are underfilling canals and missing mesiolingual canals,so effective means to prepare and fill the C-shaped canals and equipped with the knowledge of the internal anatomy of C-shaped lower second molar are necessary to hence the chance of endodontic success.更多还原