显微根尖外科手术180例回顾性分析  

A retrospective study of 180 cases of apical microsurgery

作　　者：王捍国[1] 李丹[1] 田宇[1] 余擎[1] 

机构地区：[1]第四军医大学口腔医学院牙体牙髓病科军事口腔医学国家重点实验室,西安710032

出　　处：《中华口腔医学杂志》2014年第7期421-426,共6页Chinese Journal of Stomatology

基　　金：国家自然科学基金（81271126）

摘　　要：目的 分析显微根尖外科手术的临床应用、成功率及其预后影响因素,以期为临床提供参考.方法 回顾性分析进行显微根尖外科手术,即显微镜下使用显微手术器械和超声工作尖进行切开翻瓣、去骨开窗、根尖切除、根管倒预备和三氧化矿物凝聚体倒充填、缝合的患者资料,术后1、3、6及12个月进行回访,通过临床和放射学检查确定疗效,并对预后影响因素进行统计学分析.结果 2010年7月至2012年12月期间完成显微根尖外科手术180例共计240颗患牙,其中上颌前牙132颗、下颌前牙22颗,上颌前磨牙31颗,下颌前磨牙18颗,上颌磨牙19颗,下颌磨牙18颗.术后1年随访152例207颗患牙,回访率为86.3％（207/240）.显微根尖外科手术主要应用于根管（再）治疗术难以或者不能治疗的复杂、疑难根尖周病,包括根管治疗术失败、因修复体等原因不能进行根管治疗术、根尖周囊肿、根管钙化、根管内外分离器械、超填、根管粗大、根折、根尖手术失败、根尖穿孔及特殊根管系统共计11种类型.显微根尖外科手术的1年成功率达90.8％（188/207）.根据患者性别、年龄、牙位、根尖周阴影类型、有无窦道以及临床应用类型分别统计手术疗效,组间差异均无统计学意义（P＞0.05）,有无牙周炎组间差异有统计学意义（P＜0.05）.失败18例19颗患牙,主要原因为合并重度牙周炎和根裂.结论 显微根尖外科手术是治疗复杂、疑难根尖周病的有效方法,病例选择和规范化操作是手术成功的关键.Objective To evaluate the outcome and the potential prognostic factors of apical microsurgery.Methods The teeth with persistent periapical diseases were treated by microsurgery using micro instruments,ultrasonic retrotips and mineral trioxide aggregate（MTA） under dental operate microscope.The procedure includes incision and flap retraction,osteotomy,apicoectomy,retro-preparation and retro-filling of root canal.Patients were recalled at 1,3,6,and 12-month intervals.The outcome was evaluated by clinical and radiographic examinations,and the potential prognostic factors were analyzed.Results One hundred and eighty cases（240 teeth）,including 132 upper anterior teeth,22 lower anterior teeth,31 upper premolars,18 lower premolars,19 upper molars and 18 lower molars,were treated by microsurgery between July 2010 and December 2012.A total of 152 cases（207 teeth） were recalled.The application of the apical microsurgery included failure of previous endodontic treatment,periapical lesion with post,periapical cyst,calcified canals,separated instruments,overfilling,open apex,root facture,failure of previous apical surgery,apical fenestration,and special root canal system.The success rate was 90.8% （188/207）.Age,sex,tooth position,type of periapical radiolucency,fistula and clinical application type appeared to have a negative effect on the outcome.Endo-perio lesion was a significant factor.Eighteen cases （19 teeth） failed mainly because of periodontally involved lesion and vertical root fracture.Conclusions Apical microsurgery,which combines the magnification and illumination provided by the microscope with the proper use of micro instruments,can treat the teeth with persistent periapical diseases precisely and less traumatically with high success rate.Case selection and standardized operations play a key role for success.

关 键 词：根尖周疾病 显微外科手术 回顾性研究 根尖外科 

分 类 号：R781.05[医药卫生—口腔医学]