精准微创根管治疗—3D导板指引下的钙化根管疏通术

doi:10.13701/j.cnki.kqyxyj.2017.04.020

口腔医学研究 ›› 2017, Vol. 33 ›› Issue (4): 427-431.DOI: 10.13701/j.cnki.kqyxyj.2017.04.020

精准微创根管治疗—3D导板指引下的钙化根管疏通术

封琼, 王一舟, 黄雨婷, 张晓蓉, 江千舟^*, 杨雪超^*

广州医科大学附属口腔医院·广州口腔疾病研究所·口腔医学重点实验室广东广州 510140

收稿日期:2016-09-13 出版日期:2017-04-20 发布日期:2017-04-24
通讯作者: 江千舟,电话:020-61350524
杨雪超,电话:020-61359836
作者简介:封琼(1989~ ),女,湖南人,硕士在读,主要从事牙体牙髓病学的基础与临床研究。
基金资助:
广东省科技厅科技计划项目(编号:2016ZC0134)广东省教育厅特色创新项目(编号:2014TSCX103)

Negotiation of Calcified Root Canal under Guidance of 3D Guides: Precise Minimally Invasive Root Canal Treatment.

FENG Qiong, WANG Yi-zhou, HUANG Yu-ting, ZHANG Xiao-rong, JIANG Qiang-zhou^*, YANG Xue-chao^*.

Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China.

Received:2016-09-13 Online:2017-04-20 Published:2017-04-24

摘要/Abstract

摘要： 目的:研究3D导板指引下采用精准微创的方法,疏通钙化根管治疗根尖周炎的临床新技术。方法:针对根管不通的前牙患者拍摄CBCT,收集CBCT数据并结合口内三维扫描数据,三维重建确定牙根方向,精确定位根管的长度及方向。进行3D导板的设计并打印,超声工作尖在3D导板的指引下去除根管内钙化物质,疏通根管,镍钛根管预备、超声冲洗结合热牙胶充填进行根管治疗。结果:使用3D导板引导,钙化根管得以精准疏通,X线检查显示疏通根管沿固有根管方向走行,根管壁破坏小,根管治疗得以顺利实施。结论:CBCT测量结合3D打印导板可以安全精准的定位根管方向和深度,微创进行根管治疗,对于钙化根管治疗具有较好的指导性。

Abstract: Objective: To present an approach for root canal treatment of the teeth with root canal calcification and apical periodontitis. Methods: For patients with root canal calcificationin the anterior teeth, a cone beam computed tomography (CBCT) and an intraoral surface scan were precise positioned the direction and the length of the root canal. Related data were performed and matched.Software was used for virtual implant planning and 3D printer used for template fabrication. Ultrasound was used to clear calcified canals under the guidance of the guide plate,the root canalswere prepared by nickel-titanium instruments combined with ultrasonic irrigation.The root canal was filled with vertically condensed gutta-percha with epoxy sealer. Results: The root canal was successfully negotiated and accessible and minimally invasive access to the apical was obtained. The root canal was showed clearly on the radiograph along the natural direction row.Theroot canal therapy was successfully completed. Conclusions: CBCT measurements combined with 3D printing guides couldlocate the direction and depth of root canal safely and precisely. The presented guided endodontic approach seems to be a precise and feasible method to locate the calcifiedroot canals and prevent root perforation in teeth clinically.

Key words: 3-dimensional printed guide model, Pulp canal calcification , Periapical periodontitis

中图分类号:

R781.05

封琼, 王一舟, 黄雨婷, 张晓蓉, 江千舟, 杨雪超. 精准微创根管治疗—3D导板指引下的钙化根管疏通术[J]. 口腔医学研究, 2017, 33(4): 427-431.

FENG Qiong, WANG Yi-zhou, HUANG Yu-ting, ZHANG Xiao-rong, JIANG Qiang-zhou, YANG Xue-chao.. Negotiation of Calcified Root Canal under Guidance of 3D Guides: Precise Minimally Invasive Root Canal Treatment.[J]. Journal of Oral Science Research, 2017, 33(4): 427-431.

参考文献

[1] 樊明文,周学东.牙体牙髓病学[M].北京:人民卫生出版社,2012, 263-264
[2] Khabbaz MG, Serefoglou MH. The application of the buccal object idle for the determination of calcified root canals [J]. IntEndod, 1996, 29(4)∶284-287
[3] Sudell JR, Stanley HR, White CL. The relationship of coronal pulp stone formation to experimental operative procedures [J]. Oral Surgery Oral Med Oral Pathol, 1968, 25(4)∶579-89
[4] American Association of Endodontists. AAE Endodontic Case Difficulty Assessment and Referral. Endodontics 2005 Spring/Summer: 1-7
[5] 王嘉德,高学军.牙体牙髓病学[M].北京:北京大学医学出版社,2006, 226-230
[6] 周学东,岳松龄.实用牙体牙髓病治疗学[M].北京:人民卫生出版社.2004, 233-237
[7] Oginni AO, Adekoya-Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision [J]. Dent Traumatol, 2009, 25∶620-625
[8] McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge [J]. IntEndod, 2012, 45∶177-97
[9] Kernen F, Benic GI, Payer M, et al. Accuracy of three-dimensional printed templates for guided implant placement based on matching a surface scan with CBCT [J]. Clin Implant Dent RelatRes , 2016, 18(4)∶762-768
[10] Ludlow JB, Timothy R, Walker C, et al. Effective dose of dental cbct-a meta analysis ofpublished data and additional data for nine cbct units [J]. Dento-maxillofacRadiol, 2015, 44(1)∶20140197
[11] 孟艾奇,暋甘泉,暋孙晗.青少年埋伏阻生牙CBCT三维定位辅助诊断的临床研究[J].口腔医学研究,2015,31(3)∶265-267
[12] Zehnder MS, Connert T, Weiger R, et al. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal localization [J]. IntEndod. 2015. doi: 10.1111/iej.12544. [Epub ahead of print]
[13] Krastl G, Zehnder MS, Connert T, et al. Dent Traumatol [M]. 2016, 32(3)∶240-246
[14] Lui JN, Kuah HG, Chen NN, et al. Effect of EDTA with and without surfactants or ultrasonics on removal of smear layer [J]. J Endod, 2007, 33(4)∶472-475
[15] Burklein S, Tsotsis P, Schafer E. Incidence of dentinal defects after root canal preparation: reciprocating versus rotary instrumentation [J]. J Endod, 2013, 39∶501-504
[16] Ceyhanli KT, Erdilek N, Tatar I, et al. Comparison of protaper, race and safesider instruments in the induction of dentinal microcracks: a micro-ct study [J]. IntEndod, 2016, 49(7)∶684-689
[17] Wilcox LR, Roskelley C, Sutton T. The relationship of root canal enlargement to finger-spreader induced vertical root fracture [J]. J Endod, 1997, 23(8)∶533-534
[18] Krishan R, Paque F, Ossareh A, et al. Impacts of conservative endodontic cavity on root canal instrumentation efficacy and resistance to fracture assessed in incisors, premolars, and molars [J]. J Endod, 2014, 40(8)∶1160-1166
[19] 倪龙兴,余擎,陈兴兴,等.根管冲洗和根管消毒[J].中国实用口腔科杂志,2008,01(01)∶14-18

精准微创根管治疗—3D导板指引下的钙化根管疏通术

Negotiation of Calcified Root Canal under Guidance of 3D Guides: Precise Minimally Invasive Root Canal Treatment.

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