【摘要】：研究目的： 應(yīng)用全口根尖片統(tǒng)計(jì)分析中國(guó)人下頜第一前磨牙和第二前磨牙雙牙根的發(fā)生率,尤其是雙側(cè)同時(shí)發(fā)生雙根的概率,為臨床進(jìn)行下頜第一、二前磨牙的根管治療和修復(fù)提供解剖依據(jù)。 材料和方法： 隨機(jī)抽取2011年4月至2012年4月就診于北京大學(xué)口腔醫(yī)院的中國(guó)人患者的全口根尖片,共2015例。2名有20年臨床工作經(jīng)驗(yàn)的口腔科醫(yī)生,包括1名牙體牙髓主任醫(yī)師和1名口腔頜面影像診斷學(xué)主任醫(yī)師以及1名牙體牙髓專業(yè)在讀研究生對(duì)這2015例全口根尖片進(jìn)行診斷,分別記錄下頜第一二前磨牙近遠(yuǎn)中向雙根,頰舌向雙根,其中包括確定的頰舌向雙根及疑似的頰舌向雙根；記錄下頜第一、二前磨牙雙根發(fā)生的病例數(shù)、牙數(shù)。統(tǒng)計(jì)下頜第一、二前磨牙雙牙根的發(fā)生率尤其是雙側(cè)同時(shí)發(fā)生雙牙根的概率。3名醫(yī)師同時(shí)進(jìn)行診斷,有疑問(wèn)的病例三人共同讀片討論達(dá)成共識(shí)。 結(jié)果： 1.下頜第一前磨牙雙牙根發(fā)生率統(tǒng)計(jì) 2015例全口根尖片中,除去5例雙側(cè)缺失的下頜第一前磨牙,共2010例全口根尖片入選,除去48例單側(cè)缺失的下頜第一前磨牙外,牙齒總數(shù)為3972顆。診斷的雙牙根的病例數(shù)為120例,一共159顆牙齒,雙側(cè)同時(shí)發(fā)生雙根的病例數(shù)是39例。按照牙齒數(shù)統(tǒng)計(jì),下頜第一前磨牙雙牙根發(fā)生率為4.03%(159/3972)；雙側(cè)同時(shí)發(fā)生雙牙根的概率為32.5%(39/120)。 2.下頜第二前磨牙雙牙根發(fā)生率統(tǒng)計(jì) 2015例全口根尖片中,除去17例雙側(cè)缺失的下頜第二前磨牙,共1998例全口根尖片入選,除去116例單側(cè)缺失的下頜第二前磨牙外,牙齒總數(shù)為3880顆。診斷的雙牙根的病例數(shù)為24例,一共33顆牙齒,雙側(cè)同時(shí)發(fā)生雙根的病例數(shù)是9例。按照牙齒數(shù)統(tǒng)計(jì),下頜第二前磨牙雙牙根發(fā)生率為0.85%(33/3880)；雙側(cè)同時(shí)發(fā)生雙牙根的概率為37.5%(9/24)。 結(jié)論： 通過(guò)本研究作者認(rèn)為,雖然不同地區(qū)學(xué)者研究得出的雙根發(fā)生率不盡相同,但是可以肯定的是,下頜前磨牙具有一定的雙根發(fā)生率。在根管治療操作以及口腔外科操作前,一定要考慮到有牙根變異情況的出現(xiàn),根管治療是目前治療牙髓根尖周病最有效的方法,其原理是對(duì)復(fù)雜的根管系統(tǒng)進(jìn)行徹底的清潔、消毒并充填,杜絕感染的再發(fā)生。牙根解剖變異的出現(xiàn)無(wú)疑是增加了根管治療以及操作的難度,臨床上許多根管治療失敗的病例,一方面是由于術(shù)者對(duì)牙根解剖變異認(rèn)識(shí)的不足,另-方面是術(shù)者不能辨認(rèn)出其變異。因此,對(duì)牙根形態(tài)特征及其變異表征的系統(tǒng)研究具有一定的臨床意義。術(shù)前對(duì)牙根變異的了解,仔細(xì)閱讀術(shù)前X線片,結(jié)合臨床髓室底探查,適當(dāng)改變根管的入路,都是根管治療成功必不可少的步驟。
[Abstract]:Objective: to analyze the incidence of mandibular first premolars and second premolars in Chinese by whole apical radiography, especially the probability of bilateral simultaneous occurrence of double roots. Root canal therapy and restoration of two premolars provide anatomical basis. Materials and methods: a total of 2015 Chinese patients from April 2011 to April 2012 in Peking University Stomatological Hospital were randomly selected. Two stomatologists with 20 years of clinical work experience were randomly selected. Including 1 chief dental pulp physician, 1 oral and maxillofacial imaging diagnostics chief physician and 1 graduate student majoring in dental pulp, the 2015 cases of whole oral apical film were diagnosed, and the mandibular first and second premolars were recorded. Buccal tongue to double root, including confirmed buccal tongue to double root and suspected buccal tongue to double root; The number of cases and teeth of the first and second premolars were recorded. The incidence of double roots of mandibular first and second premolars, especially the probability of bilateral double roots occurred at the same time, was counted. Three doctors diagnosed at the same time, and three of the questionable cases were discussed together to reach a consensus. Result: 1. Statistics of the root incidence of mandibular first premolars in 2015 cases, 2010 cases of mandibular first premolars were selected except for 5 cases of bilateral missing mandibular first premolars, except 48 cases of unilateral missing mandibular first premolars. The total number of teeth is 3972. The number of cases of double roots diagnosed was 120 cases, a total of 159 teeth, and 39 cases of bilateral double roots occurred at the same time. According to the number of teeth, the incidence of double roots of mandibular first premolars was 4.03% (159 鈮，

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