显微根尖外科手术临床决策的口腔多学科考量  

Oral multidisciplinary considerations for clinical strategies of endodontic microsurgery

作　　者：林正梅[1] 何颖聪 黄舒恒[1] 黄绮婷[1] 张馨方 林鸿锟 LIN Zhengmei;HE Yingcong;HUANG Shuheng;HUANG Qiting;ZHANG Xinfang;LIN Hongkun(Guanghua School of Stomatology,Hospital of Stomatology,Sun Yat-sen University,Guangzhou 510055,China)

机构地区：[1]中山大学光华口腔医学院·附属口腔医院,广东广州510055

出　　处：《口腔疾病防治》2022年第10期685-691,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81873713,82170939)。

摘　　要：显微根尖外科手术是针对非手术治疗未治愈的根管治疗失败病例,通过手术方法到达病损区探查失败原因、清除感染、促进根尖周组织愈合的重要治疗手段。虽然显微根尖外科手术技术已趋规范化,手术成功率较高,但其预后仍受局部解剖结构、牙周状况、冠根比、咬合关系、根尖病变的大小与性质、牙体修复与否等多种因素影响。临床上牙体牙髓病专科医师常专注于“根尖”的处理,易忽略从不同学科角度进行术前的全面评估与准确诊断,进而无法完善治疗计划,影响患牙的预后。本文将根据国内外近年的研究证据及笔者团队的临床实践,探讨显微根尖外科手术临床决策过程中的口腔多学科考量因素,包括但不限于牙周病学、口腔修复学、口腔种植学、口腔颌面外科学、口腔正畸学等。对于复杂疑难根尖周疾病的诊疗,需要各专业医师根据患牙的根管系统状态、根尖周病损程度、毗邻关系、牙周健康情况、咬合关系、美学重建等进行综合分析,优化治疗程序,共同制订出最佳的综合治疗计划,为临床疗效提供保障。Endodontic microsurgery is a vital treatment modality for teeth with persistent periradicular pathoses that have not responded to nonsurgical retreatment.The principle is to determine the reason for failure,completely eliminate the infection and promote periapical healing.Within recent years,endodontic microsurgery has evolved to become standardized and presents with a high success rate.However,its outcome is still influenced by many factors,including anatomy,periodontal condition,crown-to-root ratio,occlusion,the type of periradicular lesion,and prosthesis.Moreover,endodontists always concentrate on“the apex”,paying little attention to the general preoperative evaluation,accurate diagnosis,and comprehensive treatment plan.This article reviews the latest literature on these issues and the clinical experience of our research group and discusses the correlation between endodontic microsurgery and other oral disciplines,including periodontology,prosthodontics,oral implantology,oral and maxillofacial surgery and orthodontics.The oral interdisciplinary assessment should be made with comprehensive consideration of the root canal system,periradicular lesion,adjacent anatomical relationships,periodontal condition,occlusion,and esthetic rehabilitation.Based on these findings,the continuity of treatment will be optimized,and the best treatment plan will be proposed to provide clinical strategies for the diagnosis and treatment of complex periradicular diseases.

关 键 词：根尖周疾病 显微根尖外科手术 口腔多学科 牙周牙髓联合病变 引导组织再生技术 屏障膜 冠根比 冠延长术 即刻种植 根尖周囊肿 正畸治疗 

分 类 号：R78[医药卫生—口腔医学]