根管治疗的三个关键点——根充密码ABC

2018-04-03 田洪琰 中国医学论坛报今日口腔

根管治疗术是非常重要的保存患牙的方法,不论你出身于口腔哪个专业,根管治疗术都属必备技能;可以说这一治疗是非常“内外咸宜,修(复)(牙)体必备”了。对于这样一个“口腔医师必备技能”,大家是否真的能够做好呢?怎样才能把握住这一技能的关键呢?


作者:田洪琰   北京大学口腔医院门诊部 

根管治疗术是非常重要的保存患牙的方法,不论你出身于口腔哪个专业,根管治疗术都属必备技能;可以说这一治疗是非常“内外咸宜,修(复)(牙)体必备”了。对于这样一个“口腔医师必备技能”,大家是否真的能够做好呢?怎样才能把握住这一技能的关键呢?

根管治疗的三个关键点

有些医生会把注意力集中在技术复杂的“根管预备成形”上,而忽略了“根管充填”这一关键环节。这样的想法十分不科学且危险,须知根管治疗的基本理念来自于外科清创术,彻底清创后需要关闭死腔、缝合恢复。不符合要求的“根管充填”就好比是做完腹腔手术没有分层缝合或者拉拢过紧过松等,想象一下,这个虚拟的病人从手术台上站起来时肚皮晃晃荡荡的样子——是不是跟超填/欠填参差不齐的术后X线片很像?其实根管充填暗含着三大关键点,只要解开这个密码,你可以解锁各种充填姿势(冷测压或热牙胶),完全没有再害怕的。这三个关键点可以用“ABC”来概括,A:根尖档(Apical stop);B:回拉阻力(tug-Back);C:加压充填(Compaction)。

根尖档(Apical stop)

高质量的根管预备形成坚实的根尖档(apical stop)和合适的锥度(taper)。Apical Stop 像一个口小底大的漏斗,“底托”的形状可以限制根充材料溢出,避免超充对根尖周组织造成刺激(图1)。根尖档的结构还提供了一个物理止点,有利于加压充填形成严密的根管封闭。锥度则提供了盥洗和充填的操作空间。

图1 根尖档(apical stop)示意图

回拉阻力(tug-Back)

主牙胶尖试尖(cone fit)时不仅要达到工作长度,并要有明显的回拉阻力(tug-back)。牙胶尖有一定弹性,要“卡”在Apical stop的位置上。太松卡不住,要么充填过程中被带出,要么加压时因为空隙大“打滑”被挤出根尖孔而超充。想象一下上一次吃煮鸡蛋被噎住的感觉,这种“不上不下不能动”的感觉类似“清晰”的回拉阻力。

图2 回拉阻力(tug-Back)示意图

加压充填(Compaction

牙胶尖或牙胶需要加压充填(compaction),从而获得三维封闭效果。侧方加压可有效的整合根管内空间,如擀面杖一般,将辅牙胶尖压成均匀一体的充填物封闭根尖。热牙胶连续波技术,则是先加热牙胶使之变软,再加压使软化牙胶充满根尖区根管的各个缝隙,然后将多余牙胶烫断带出。无论冷热,根管封闭剂都随着加压进入副根管和侧方根管,封闭管壁牙本质小管。

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    2018-04-04 营养医师

    之前做根管治疗.不到一年牙齿就裂了...

    0

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    2018-04-04 1dd8c52fm63(暂无匿称)

    学习学习.了解了解

    0

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    2018-04-04 张新亮1853311252142e2fm

    好文献学习了

    0

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    2018-04-04 changjiu

    学习一下谢谢

    0

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    2018-04-04 飛歌

    厉害了我的哥

    0

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    2018-04-04 秀红

    学习了

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    2018-04-04 121832a9m88暂无昵称

    学习了

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