上颌磨牙远颊根行显微根尖外科手术保存活髓病例报告及文献复习  

Case report and literature review of vital pulp preservation by endodontic microsurgery at the distal buccal root of maxillary molar

作　　者：谭学莲 甯佳丽 徐玮哲 汪鎏 张岚[1] 郑广宁[1] 黄定明[1] TAN Xuelian;NING Jiali;XU Weizhe;WANG Liu;ZHANG Lan;ZHENG Guangning;HUANG Dingming(State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Department of Cariology and Endodontics,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院牙体牙髓病科,四川成都610041

出　　处：《口腔疾病防治》2020年第11期723-727,共5页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81771063);四川省科技厅项目基金项目(2017JY0068)。

摘　　要：目的探讨非牙源性根尖周病变患牙的诊断、治疗和预后,为该类疾病的诊治提供参考。方法回顾性分析四川大学华西口腔医院收治的1例右上磨牙活髓伴根尖透射影合并局部牙骨质结构不良的病例,并结合文献对显微根尖手术与活髓保存术后疗效进行分析。结果16活髓,影像学特征表现为远颊根根尖区透射影合并局部阻射影,局麻下行显微根尖外科手术,术中见远颊根尖区软组织覆盖,未探及高密度阻射影组织,截取远颊根根尖3 mm,超声倒预备,无机三氧化物聚合物(mineral trioxide aggregate,MTA)倒充填,置骨粉胶原膜后严密缝合;术后病理结果见纤维结缔组织样病变;术后1周复查,影像检查显示倒充填严密,根尖区未见透射影,牙髓活力电测试正常;术后4年复查,16无变色,牙髓活力温度测试、电测试与对照牙无明显差异。结合临床表现、影像学特征、手术探查以及病理学报告,该病例临床诊断为16根尖区牙骨质结构不良。通过文献回顾分析发现,在保存牙齿的前提下,通过显微根尖外科手术治疗该类病例并保留健康的牙髓组织,目前尚未见相关文献报道。结论对存在根尖周病变但牙髓健康的上颌后牙,通过对牙髓状态的准确判断、显微根尖外科探查术以及生物活性材料的应用,可在去除病变的同时实现对患牙的活髓保存。Objective To investigate the diagnosis,treatment and prognosis of nonodontogenic periapical lesions and to provide a reference for clinical diagnosis and treatment.Methods A case of a patient with right upper molar pulp with apical penetration and local occlusion admitted to the West China Stomatological Hospital of Sichuan Univer⁃sity was retrospectively analyzed,and the curative effect of microapical surgery and pith preservation was also analyzed.Results The imaging features of tooth 16 showed periradicular radiolucency combined with local radiopaque lesions around the distal buccal apical area.Endodontic microsurgery was performed under local anesthesia.Soft tissue cover⁃age was observed in the distal buccal apical area during the surgery,and no radiopaque tissue was detected.The distal buccal root apex was cut by 3 mm,and mineral trioxide aggregate was used for root⁃end backfilling.The postoperative pathological results revealed fibrous connective tissue.One⁃week recall X⁃ray examination showed tight root⁃end back⁃filling and no periradicular radiolucency;an electrical test of pulp vitality showed positive results.The four⁃year follow⁃up showed that there was no discoloration in tooth 16 and no significant difference in thermal and electrical tests of pulp vitality compared with control teeth.Combining the clinical manifestations,imaging features,surgical exploration results and pathological reports,the case was most likely to be cemental hypoplasia.Through the literature review,the treatment and healthy pulp preservation of such cases by endodontic microsurgery under the premise of preserving teeth has not been reported.Conclusion For maxillary posterior teeth with periapical lesions but healthy pulp,accurate esti⁃mation of pulp status,endodontic microsurgical exploration and application of bioactive materials can achieve vital pulp preservation while removing the lesions.

关 键 词：活髓保存 根尖周病 牙髓源性 显微根尖外科手术 激光多普勒血流仪 无机三氧化物聚合物 牙骨质结构不良 

分 类 号：R781.05[医药卫生—口腔医学]