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根管治疗失败原因的临床分析

Clinical analysis of failure factors in root canal therapy

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【作者】 徐琼王阿丹石莹凌均棨黄霞吴韫

【Author】 Xu Qiong,Wang Adan,Shi Ying,et al.Department of Endodontics,Guanghua College of Stomatology,Sun Yat-sen University,Guangdong 510055,China

【机构】 中山大学光华口腔医学院牙体牙髓科,中山大学光华口腔医学院牙体牙髓科,中山大学光华口腔医学院牙体牙髓科,中山大学光华口腔医学院牙体牙髓科,中山大学光华口腔医学院牙体牙髓科,中山大学光华口腔医学院牙体牙髓科 510055,510055,510055,510055,510055,510055

【摘要】 目的:探讨根管治疗失败的原因。方法:按纳入标准选取206名患者,分析根管治疗失败患牙215颗,根据初次治疗情况、临床检查、术前X线片以及术中对患牙根管系统的探查等判断原治疗失败的原因。结果:失败病例中慢性根尖周炎患牙最多,占67.9%,其次是无根尖暗影、但因欠充要求再治疗的患牙,以及存在冠渗漏的患牙;X线片显示84.2%的患牙欠充,多数后牙根管锥度欠佳;遗漏根管多见于上颌第一磨牙和前磨牙;18.1%的患牙存在台阶、根管偏移等并发症。结论:因预备和充填不当等造成的根管清理不彻底、封闭不严密使根管系统再感染是根管治疗失败的主要原因,遗漏根管、冠部渗漏等也可造成治疗失败。

【Abstract】 Objective:To analyze the failure factors in root canal therapy(RCT)by analysis of the failed cases.Methods:215 teeth of 206 patients were analyzed according to former treatment records,clinical examination,pretreatment radiographs,and root canal exploration during endodontic retreatment.Results:67.9% of failed teeth showed apical radiolucency,12.6% showed under-filled canal material without apical radiolucent area,and 8.4% involved coronal leakage.When examined with X ray,84.2% of teeth indicated under-filling,and most canals of premolars and molars had poor taper.Most missed root canals were found in maxillary first molars and premolars.18.1% of teeth had complications such as ledge and apical transportation.Conclusions:The factors associated with RCT failure involve cleaning,obturation and poor seal of root canal system resulted from inadequate shaping.Coronal leakage and missed canals also contribute to the endodontic treatment failure.

【关键词】 根管治疗; 治疗失败; 欠充;

【Key words】 Root canal therapy; Endodontic failure; Under-filling;

【分类号】R45;R781.05;R322.41;

【基金】 2004年卫生部部属医疗机构临床学科重点项目

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