静态导航辅助治疗急性根尖周炎伴根管钙化1例报道及文献回顾  

Static navigation⁃assisted treatment of acute periapical periodontitis with pulp canal obliteration:a case report and literature review

作　　者：王海越 朱奇 周专元 刘伟 WANG Haiyue;ZHU Qi;ZHOU Zhuanyuan;LIU Wei(Shenzhen Stomatology Hospital(Pingshan)of Southern Medical University,Shenzhen 518000,China)

机构地区：[1]南方医科大学深圳口腔医院(坪山),广东深圳518000

出　　处：《口腔疾病防治》2025年第2期137-144,共8页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：深圳市自然科学基金基础研究面上项目(JCYJ20230807154304010);广东省临床教学基地教学改革项目(粤教高函[2023]32号62#)。

摘　　要：目的 探讨静态导航辅助定位钙化根管治疗过程中的优势,为钙化根管临床诊治提供参考。方法报道1例上前牙急性根尖周炎伴根管全长钙化,通过椅旁即刻制作的数字化导板以更保守的方法——舌侧微创入路,实现对患牙感染的控制和切端的保留,并结合文献对该类型病例的诊疗进行回顾性分析。结果 1例主诉为左上前牙咬物疼痛加重2 d,经检查诊断为21牙急性根尖周炎伴根管全钙化的患者,在静态导航的辅助下从舌侧开髓孔处入路进行微创牙髓治疗,10 min定位根管,15 min疏通钙化,患者当日急性疼痛症状得到缓解;1年复诊患牙无不适,根尖片检查根尖低密度影范围缩小;3年复诊患牙无不适,根尖片检查根尖低密度影进一步缩小。文献复习结果表明,静态导航技术的优势是,疏通钙化根管的成功率与操作者治疗经验和是否借助显微镜及超声设备无关,无论钙化程度如何,该方法均可显著降低医源性风险,但是与导板的精确度和稳定性密切相关;局限是不适用于钙化发生在根管弯曲下方,以及操作空间受限的钙化根管。锥形束计算机断层扫描(cone-beam computed tomography, CBCT)被推荐用于定位钙化根管,拍摄质量是影响制定正确术前计划的重要因素。进行静态导航牙髓治疗时,尽量选择直径较小且与导环直径匹配度高的钻,配合冷冻冲洗液冷却钻头是减少热损伤的可靠方法。结论 静态导航辅助治疗钙化根管,精准微创,节约临床治疗时间,舌侧入路进一步保护牙齿的完整性,为患牙的长久保存提供保障。Objective To explore the advantages of static navigation in locating calcified root canal therapy,and to provide reference for clinical diagnosis and treatment of calcified teeth.Methods A case of acute periapical periodonti-tis of anterior teeth with full-length calcification of root canal was reported.A lingual minimally invasive approach was used as a conservative method of controlling the infection of teeth and preserving the incisors through the digital guide plate.The diagnosis and treatment of this type of case were analyzed retrospectively with reference to the literature.Results One patient complained that the pain of left anterior teeth was aggravated for 2 days.After examination,he was diagnosed with acute periapical periodontitis of 21 teeth with total root canal calcification.With the assistance of static navigation,the root canal was located after 10 minutes,the calcification was dredged for 15 minutes,and the acute pain symptoms of the patient were relieved that day.After one year of follow-up,there was no discomfort in the teeth,and the range of low-density shadow in the apical film was reduced.After 3 years of follow-up,there was no discomfort in the teeth,and the low-density shadow of the apical root was further reduced by apical film examination.As shown by the results of the literature review,static navigation technology is advantageous because the success rate of dredging cal-cified root canals is neither associated with the operators treatment experience nor the use of microscope and ultrasonic equipment.Regardless of the degree of calcification,this method can significantly reduce the iatrogenic risk,but it is closely related to the accuracy and stability of the guide plate.However,this method is not suitable for calcified teeth with calcification under root canal curvature and limited operating space.Cone-beam computed tomography(CBCT)is recommended to locate calcified root canals,and the imaging quality is an important factor that affects the correct preoperative planning.When performing

关 键 词：根管钙化 根尖周炎 静态导航牙髓治疗 定位根管 微创入路 根管治疗 3D打印 导板 

分 类 号：R78[医药卫生—口腔医学]