口腔医学研究

口腔医学研究 ›› 2024, Vol. 40 ›› Issue (7): 617-621.DOI: 10.13701/j.cnki.kqyxyj.2024.07.009

• 牙体牙髓病学研究 • 上一篇    下一篇

根管治疗后隐匿性牙根纵裂特征的体外及micro-CT研究

刘文静1, 高安天1, 潘笑1, 曹丹彤2, 林梓桐1*   

  1. 1.南京大学医学院附属口腔医院,南京市口腔医院,南京大学口腔医学研究所 口腔颌面医学影像科 江苏 南京 210008;
    2.南京大学医学院附属口腔医院,南京市口腔医院,南京大学口腔医学研究所 江北口腔医疗中心 江苏 南京 210031
  • 收稿日期:2024-01-29 出版日期:2024-07-28 发布日期:2024-07-24
  • 通讯作者: *林梓桐,E-mail:linzitong710@163.com
  • 作者简介:刘文静(1998~ ) 女,安徽人,硕士在读,主要从事口腔医学的研究工作。
  • 基金资助:
    国家自然科学青年基金项目(编号:82201135);江苏省卫生健康委面上项目(编号:M2021077);南京大学医学院附属口腔医院2015学科带头人后备人才资助项目(编号:0223A204)

Fracture Characteristics of Subtle Vertical Root Fracture in Endodontical Treated Tooth: An In Vitro Observation and Micro-CT Study

LIU Wenjing1, GAO Antian1, PAN Xiao1, CAO Dantong2, LIN Zitong1*   

  1. 1. Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing 210008, China;
    2. Jiangbei Dental Medical Center, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing 210031, China
  • Received:2024-01-29 Online:2024-07-28 Published:2024-07-24

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摘要： 目的:收集根管治疗后隐匿性牙根纵裂牙(subtle vertical root fracture,SVRF),对其进行裂纹特征体外观察及micro-CT扫描,探索其裂纹特征并探讨其发生发展过程。方法:收集我院2021年10月~2023年10月拔除的根管治疗后SVRF患牙共计21颗,收集SVRF患牙的牙位及裂纹发生的牙根位。在直视或透照法下观察裂纹数目,以根管为中心,颊、舌、近中、远中分别计算,以及裂纹纵向长度根据裂纹是否累及釉牙骨质界及根尖区分为4类。使用micro-CT扫描并评价裂纹是否累及根管,裂纹在轴位图像上的方向(颊舌,近远中向),并在裂纹最宽层面进行裂纹宽度测量,将裂纹最宽处在牙根上的分布分为根上部、根中部及根下部。结果:本研究共收集21颗SVRF患牙,累及24个牙根,其中17个牙根为完全性裂纹,7个为不完全性裂纹,共计41条裂纹。上颌前磨牙牙根及下颌磨牙近中根为发生牙根纵裂最多的牙根,且这些牙根均表现为颊舌/腭向扁根并分为颊舌/腭向双根管。所有裂纹均为颊舌/腭向,均累及根中区及根管内壁。裂纹最大宽度无论是在牙根上的纵向分布还是在水平面上的分布都没有明显的规律。结论:根管治疗后SVRF的裂纹均累及根中区,均由根管壁向根面延伸,裂纹宽度无明显规律;推测根中区的根管内壁为牙根纵裂发生的起始部位;裂纹扩展的过程具有无序性和多样性。

关键词: 隐匿性牙根纵裂, 裂纹特征, 显微CT

Abstract: Objective: To collect endodontically treated teeth with subtle vertical root fracture (SVRF), to analyze the fracture characteristics through in vitro observation and micro-CT scanning, and to investigate their initiation and development. Methods: A total of 21 SVRF teeth extracted in our hospital from October 2021 to October 2023 were collected. The position of the teeth and the specific root where the fractures occurred were documented. The number of fractures (calculated separately for buccal, lingual, mesial, and distal sides) and the longitudinal distribution of fractures (divided into four categories based on involvement of the enamel-dentin junction and the apex) were recorded by direct observation or trans-illumination method. Micro-CT images were utilized to assess whether the fracture was involved the root canal, the direction of the crack in axial images (buccal-lingual, mesial-distal), and the widest fracture width of each tooth. The widest level on the root was categorized into upper, middle, and apical third level. Results: A total of 21 SVRF teeth involving 24 roots were analyzed in this study. Of them, 17 roots were complete fractures and 7 roots were incomplete fractures, resulting in a total of 41 fractures. SVRFs were more often found in roots of maxillary premolars and mesial roots of mandibular molars. All these roots exhibited buccal-palatal/lingual oval roots with two root canals. All fractures were in a buccal-lingual/palatal direction, affecting the middle region of the root and the root canal. There was no discernible pattern of fractures width either vertically or horizontally along the root. Conclusion: The SVRFs in endodontically treated tooth involve the middle region of the root, extending from the root canal to the root surface, and the crack width shows no obvious regularity. Therefore, we believe that the inner wall of the root canal in the middle region of root serves as the initial site for root fractures. The diverse and unpredictable fractures widths further highlight the intricate process of fractures development and expansion.

Key words: subtle vertical root fracture, fracture characteristics, micro-CT