ProTaper镍钛锉治疗重度弯曲根管1例

2019-05-15 安京涛 牙体牙髓牙周病学杂志

患者女,38岁。因右上后牙冷热刺激痛1月余伴夜间痛2d前来就诊。检查:16远中牙合面充填物脱落,叩(++),牙髓活力(-),松动Ⅰ°。X线片示:16根尖周未见异常,近颊根尖部偏远中弯曲,弯曲度>25°。诊断:16慢性牙髓炎急性发作。

根管治疗过程中,因根管解剖特点及器械力学性能的影响,弯曲根管预备易出现工作长度丧失、台阶、根尖堵塞、根尖敞开、侧壁穿孔、肘部形成、根管偏移、器械分离、治疗期间急性炎症等并发症,影响疗效。因此,狭窄、细小、弯曲根管预备过程中保持根管的初始形态,形成光滑而连续的锥度是根管治疗的重点,而切削、成形能力及根管清洁能力俱佳的根管预备器械选择在弯曲根管预备具有重要作用。Walia等证实镍钛根管器械可保持根管原有的形态,有效减少偏移的发生。本文报道1例ProTaper镍钛锉在重度弯曲根管治疗中的应用。
 
1.病例报告
 
患者女,38岁。因右上后牙冷热刺激痛1月余伴夜间痛2d前来就诊。检查:16远中牙合面充填物脱落,叩(++),牙髓活力(-),松动Ⅰ°。X线片示:16根尖周未见异常,近颊根尖部偏远中弯曲,弯曲度>25°。诊断:16慢性牙髓炎急性发作。
 
治疗计划:①16根管治疗术(RCT);②择日冠修复。治疗:16常规开髓,探查根管,因根管弯曲度大,首先以预弯的不锈钢K锉(#8或#10)探查根管的通畅性,尽量选用新锉,不求一次探至全长。①选用#10~#15K锉预弯后进行根管疏通;②用SX预备根管口;③根管弯曲上段采用根管马达预备,下段用#25K锉以逐步后退法预备完成。用根尖定位仪测量根管长度,MB=20.5mm,DB=21.0mm,P=21mm,25g/LNaClO反复冲洗根管;术中X片示主尖到位,近颊向远中弯曲,25g/LNaClO+超声荡洗+170g/LEDTA冲洗,纸尖干燥,AH-plus糊剂+牙胶充填根管GIC暂封。术后X线片示:根管充填严密,适填。转修复科择日冠修复。1年后复诊:16烤瓷冠修复,无叩痛无松动,患者无自觉症状,咀嚼功能良好。
 

图1 16治疗前后X线片
 
2.讨论
 
完善的根管预备是RCT成功的关键。理想的根管预备要求预备后的根管形态、锥度及解剖流向与原根管基本保持一致。根管预备质量、效果与根管的解剖形态、器械的材质、设计及使用方法密切相关,并显著受切削器械物理性能、根管系统复杂性的影响,选择合适的方法和器械有助于节省根管预备时间,提高根管预备质量,进而可显著提高弯曲根管的疗效。根据Schneider弯曲根管分类:0°~5°为直根管,10°~20°为中度弯曲根管,25°~75°为重度弯曲根管,本病例中的根管弯曲度>25°,属于重度弯曲根管,治疗难度较高。传统手用不锈钢K锉预备根管治疗费时费力,且易造成根管偏移、工作长度丧失、台阶等。
 
镍钛器械的应用,可弥补传统不锈钢k锉的使用局限和缺点,减少并发症,并明显提高根管预备的效率。以ProTaper行根管预备较传统K锉逐步后退法有多种突出的优势:①镍钛根管器械抗扭力、抗折力明显优于常规不锈钢锉;②ProTaper镍钛系统采用大锥度逐步深入法行根管预备,以不同的部位选择性切割根管适当部位,有助于减少根管壁的接触面积;③使用较少的器械即可完成根管预备;④镍钛器械具有良好的弹性,理论上能更好地维持根管的原始形态;⑤大锥度根管预备更有利于冲洗液及牙本质碎屑的排出,从而减轻术后疼痛。有学者通过临床实验证实,镍钛合金制备的器械尤其是ProTaper具有良好的切割能力,其在治疗弯曲根管时可保持器械中轴的不偏移,能均匀切削管壁及避免或减少了根尖偏移。本病例采用ProTaper镍钛锉治疗重度弯曲根管,1年后疗效满意。
 
原始出处:

安京涛.ProTaper镍钛锉治疗重度弯曲根管1例[J].牙体牙髓牙周病学杂志,2018,28(06):372+355.

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    2020-03-20 30397613
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    2019-05-16 sunylz

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