本文選題：根管治療 + 牙髓鈣化　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景:根管治療是牙髓病和根尖周病最有效和保留患牙時間最長的治療方法。在根管治療中,常會遇到鈣化不通的根管,其治療難度大,治療時間長,治療次數(shù)多,耗費材料、器械多,較為棘手。牙髓鈣化的發(fā)生率很高,可出現(xiàn)在任何牙上。根管及根管口的鈣化是導(dǎo)致根管遺漏的重要原因,而根管遺漏則是根管治療失敗的常見原因之一。研究表明,鈣化根管治療的失敗率可達(dá)25-80%。近年來,隨著口腔新材料、新器械的研發(fā)及新技術(shù)的應(yīng)用,對鈣化根管的醫(yī)治成功率有較大提高,使從前難以保留的患牙最大程度上得以保存。目的:通過對臨床鈣化根管治療的研究,分析鈣化根管的形成原因,探討其治療的常用方法及操作要點,觀察治療的效果,積累臨床經(jīng)驗,為更好地開展鈣化根管的臨床診療提供參考和依據(jù)。方法:選擇2015年3月至2017年2月就診于山東大學(xué)口腔醫(yī)院特診科及城西分院的鈣化根管治療的患者248例共286顆患牙。記錄患者就診時間、姓名、性別、年齡、牙位、診斷、處置。統(tǒng)計前牙、前磨牙、磨牙鈣化不通根管的病例數(shù),有無治療史,鈣化情況及其治療結(jié)果。結(jié)果:1.在本研究中,248例根管鈣化的患者,男性患者占37.9%,女性患者占62.1%,女性總體多于男性;根管鈣化可出現(xiàn)在各個年齡段上,臨床治療鈣化根管的年齡峰值位于青、中年;根管鈣化的形成也與增齡性變化有關(guān)。2.在本研究中,286顆根管鈣化的患牙,根據(jù)牙位和原因分組,齲病、牙周病、外傷、慢性磨損、再治療、隱裂等原因均可造成患牙的根管鈣化,男性和女性無明顯的性別差異。齲病(多為深齲露髓)和再治療(包括根管再治療和不良充填體再治療)的患牙發(fā)生根管鈣化的比率遠(yuǎn)高于其它幾種原因,其中因齲患牙占37.76%,再治療患牙占45.1%,而靠近齲損的根管的鈣化嚴(yán)重于其它根管;因外傷造成根管鈣化的多見于前牙,尤其是上前牙;隱裂或劈裂造成根管鈣化多見于磨牙;慢性磨損導(dǎo)致的根管鈣化可以發(fā)生在各個牙位上,慢性磨損包括因咬合關(guān)系不當(dāng)而造成的牙齒重度磨耗和因不當(dāng)?shù)乃⒀婪绞綄?dǎo)致的重度楔狀缺損。就牙位而言,磨牙發(fā)生根管鈣化的比率高于前牙、前磨牙,占總體的73.43%。3.在本研究中,248例患者286顆根管鈣化的患牙中,治療失敗者大部分為磨牙,再治療的患牙治療失敗的可能性更高,治療的疏通率為94.06%,成功率為89.86%,治療失敗率為10.14%。結(jié)論:鈣化根管的治療是臨床常見的復(fù)雜根管治療,其形成原因是多方面的,可能與外傷、慢性磨損、齲病、根尖周病、牙周病、牙齒發(fā)育異常、不當(dāng)?shù)闹委熓�、增齡性變化等有關(guān),因此治療過程繁復(fù)困難。鈣化根管的治療需制定全面的治療計劃,多種材料器械聯(lián)合應(yīng)用,C型先鋒銼、鎳鈦K銼、機用鎳鈦器械、超聲工作儀,EDTA凝膠及NaClO、H202沖洗液,電子根測儀配合X線片、CBCT,以及必要時Micro-CT、顯微鏡的運用,掌握根管的解剖尤其是解剖變異情況,謹(jǐn)慎細(xì)心,規(guī)范操作,逐步疏通鈣化物,最大程度地防止根尖偏移、根管側(cè)穿、器械分離、臺階形成等,使患牙得以保存。
[Abstract]:Background: root canal therapy is the most effective treatment for dental pulp disease and periapical periodontitis. In root canal therapy, the root canal often meets calcified root canal. It is difficult to treat, with long treatment time, more times, more materials, more instruments, and more difficult. The incidence of dental pulp calcification is very high and can appear on any tooth. The calcification of the canal and root canal is an important cause of leakage of root canal, and the omission of root canal is one of the common reasons for the failure of root canal therapy. The study shows that the failure rate of the calcified root canal treatment can reach 25-80%. in recent years. With the development of new oral materials, new instruments and new techniques, the success rate of calcified root canal treatment is greatly improved. Objective: to preserve the most difficult teeth which were previously difficult to retain. Objective: through the study of the clinical calcified root canal therapy, the causes of the formation of calcified root canal were analyzed, the common methods and operation points of the treatment were discussed, the effect of the treatment was observed and the clinical experience was accumulated, so as to provide reference and basis for the better clinical diagnosis and treatment of calcified root canal. Methods: from March 2015 to February 2017, 248 patients with 286 teeth were treated at the special diagnosis Department of the Shandong University oral hospital and the calcified root canal in the West Branch of Chengxi Branch. The patient's time, name, sex, age, tooth position, diagnosis and disposal were recorded. The number of cases of anterior teeth, premolar and calcified root canal were counted, there was no history of treatment and calcification. Results: 1. in this study, in this study, 248 cases of root canal calcification, male and female accounted for 37.9%, women accounted for 62.1%, and women were more than men; root canal calcification could occur at all ages. The peak age of clinical treatment of calcified root canal was in green and middle age; the formation of root canal calcification was related to.2. in this study. In the case of 286 teeth with calcified root canal, caries, periodontitis, periodontitis, trauma, chronic wear, retreatment, and cleft can cause root canal calcification of the affected teeth. There is no significant gender difference between men and women. Caries (mostly deep caries) and retreatment (including root canal retreatment and retreatment of bad filling body) The ratio of rooting tube calcification is much higher than other reasons, of which 37.76% of dental caries are caused by decayed teeth and 45.1% of the affected teeth, and the calcification of the root canal near the caries is more serious than the other root canals; the root canal calcification is often seen in the anterior teeth, especially the anterior teeth; the root canal calcification is often found in the molar; the root canal calcification is often found in the molar; the root canal caused by chronic abrasion is the root cause. Tube calcification can occur on the various teeth. Chronic wear includes severe tooth wear caused by improper occlusion and severe wedge-shaped defects caused by improper brushing. The ratio of root canal calcification in molar teeth is higher than that of anterior teeth, premolar, and the total 73.43%.3. in this study, 286 root canals in 248 patients. In calcified teeth, most of the losers are the molars, and the treatment failure is more likely, the rate of dredging is 94.06%, the rate of success is 89.86%, the rate of failure is 10.14%. conclusion: the treatment of calcified root canal is a common complex root canal treatment in clinical, and the cause is many aspects, it may be associated with trauma, chronic wear and tear. Caries, periapical disease, periodontitis, abnormal tooth development, improper history of treatment, aging changes, and so on. Therefore, the treatment process is difficult. The treatment of calcified root canal needs comprehensive treatment plan, combined application of various materials and instruments, C avant-garde file, nickel titanium K file, mechanical nickel titanium instrument, ultrasonic instrument, EDTA gel and NaClO, H202 flushing fluid In conjunction with X-ray, CBCT, and the use of Micro-CT and microscope, the electronic root measuring apparatus mastered the anatomy of the root canal, especially the anatomic variation, carefully and carefully, standardized operation, gradually dredged the calcification, prevented the root excursion, the root canal side piercing, the instrument separation, the step formation and so on, so that the affected teeth could be preserved.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R781.05

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