中国人群上颌第二磨牙变异根管发生率及治疗策略分析  

Treatment strategy analysis and prevalence of root canal variation of maxillary second molars from a native Chinese population

作　　者：冯晓黎 孙书昱 FENG Xiaoli;SUN Shuyu(Department of Endodontics,Stomatological Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学口腔医院牙体牙髓科,广东广州510280

出　　处：《口腔疾病防治》2025年第3期176-185,共10页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：广东省自然科学基金青年提升项目(2024A1515030269);广东省普通高校特色创新项目(2024KTSCX071);南方医科大学口腔医院面上项目(PY2023020)。

摘　　要：上颌第二磨牙牙根及根管系统解剖形态复杂且变异多见,导致对其进行根管治疗难度较大,甚至会出现治疗失败。因此,了解上颌第二磨牙牙根及根管解剖形态的多样性是成功治疗的前提。融合根是上颌第二磨牙最常见的牙根变异类型之一,在国内人群中其发生率在23.9%~42.25%。融合根常伴有复杂的根管融合,在国内人群中上颌第二磨牙VI型融合根中融合根管发生率可达90.5%。针对上颌第二磨牙变异根管的治疗策略,主要包括根管口定位、融合根管峡区清理及充填等方面。临床上对融合根变异根管口进行定位时,可联合应用锥形束CT、牙科手术显微镜、数字化动静态导航技术等辅助手段。在根管治疗过程中,对于融合根管峡区的清理及充填,应加强化学预备,适时采用激光辅助根管冲洗、光动力治疗,以及显微根尖手术都将有效提高变异根管的治疗成功率。本文对中国人群上颌第二磨牙变异根管发生率及治疗策略进行分析,以期为临床上颌第二磨牙牙髓及根尖周疾病的成功治疗提供参考。The anatomical morphology of root canal systems in maxillary second molars(MSMs)is complex and shows diverse variations,which leads to challenging root canal treatments that could end in failure.Therefore,under-standing the diverse nature of root canal anatomy is an important prerequisite for the successful treatment of MSMs.The fused root is among the most prevalent root variants of MSMs,exhibiting a distribution rate ranging from 23.9%to 42.25%within the Chinese population.Fused roots are often accompanied by complex root canal fusion,as the inci-dence of root canal fusion in type VI fused roots of MSMs is 90.5%within the Chinese population.There are several treatment strategies for the root canal variations in MSMs,including the location of the root canal orifice and clearing and filling of the isthmus within the fused root canal.Cone-beam computed tomography,dental operating microscopy,and digital dynamic and static navigation technologies can be employed to accurately identify the root canal variations associated with fused roots.In the treatment of fused root canals,for the cleaning and filling of the isthmus in fused ca-nals,enhanced chemical preparation,timely application of laser-assisted irrigation,photodynamic therapy,and micro-apical surgery significantly improve the success rate of endodontic procedures.The treatment strategies and prevalence of root canal variation of MSMs from a native Chinese population were summarized in this paper to provide guidance and reference for the successful treatment of MSMs.

关 键 词：上颌第二磨牙 根管变异 融合根 根管口定位 峡区 根管治疗 锥形束CT 牙科手术显微镜 数字化导航技术 

分 类 号：R78[医药卫生—口腔医学]