选择性刮治在显微根尖手术中的疗效评估

doi:10.13591/j.cnki.kqyx.2024.05.010

口腔医学 ›› 2024, Vol. 44 ›› Issue (5): 375-380.doi: 10.13591/j.cnki.kqyx.2024.05.010

选择性刮治在显微根尖手术中的疗效评估

王轲¹,游婧¹,卢伟²()

1 南京医科大学附属口腔医院牙体牙髓病科,口腔疾病研究与防治国家级重点实验室培育建设点(南京医科大学),江苏省口腔转化医学工程研究中心,江苏南京(210029)
2 南京医科大学附属口腔医院牙周病科,口腔疾病研究与防治国家级重点实验室培育建设点(南京医科大学),江苏省口腔转化医学工程研究中心,江苏南京(210029)

收稿日期:2024-01-03 出版日期:2024-05-28 发布日期:2024-05-21
通讯作者: 卢伟 E-mail:1040518852@qq.com
基金资助:
2021南京市医学科技发展项目(YKK21276);江苏省科教能力提升工程——江苏省研究型医院(YJXYYJSDW4);江苏省医学创新中心(CXZX202227)

Evaluation of the efficacy of selective curettage in endodontic microsurgery

WANG Ke¹,YOU Jing¹,LU Wei²()

Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases (Nanjing Medical University), Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China

Received:2024-01-03 Online:2024-05-28 Published:2024-05-21

摘要/Abstract

摘要：

目的评估显微根尖手术(endodontic microsurgery,EMS)中根尖病损邻近或累及重要结构时采用选择性刮治的疗效。方法选取2021年1月—2023年1月在南京医科大学附属口腔医院牙体牙髓病科就诊并完成显微根尖手术的264例患者作为研究对象,按根尖刮治方法分为选择性刮治组(SC-EMS组)和常规刮治组(C-EMS组)。SC-EMS组中,患者根尖病损邻近或累及重要结构(颏孔、下颌神经管、鼻腭神经管、上颌窦、鼻底、活髓邻牙),对邻近区域进行选择性刮治;C-EMS组中,患者根尖病损邻近重要结构,进行常规根尖刮治。术后随访12个月,观察患者术后症状并进行影像学检查,评估疗效。对失败病例进行拔牙术后检查和病理诊断回顾,记录失败原因。结果 SC-EMS组成功率90.2%,C-EMS组成功率95.4%,C-EMS组成功率较高但两组间无统计学差异(P>0.05),根折是两组患者手术失败的主要原因。SC-EMS组术后患者存在短期不适6例,长期不适2例;C-EMS组中无明显不适病例。结论选择性刮治对显微根尖手术成功率无显著影响,是术中保护重要结构的有效方法。术后可能出现短期不适,少数病例导致邻牙不可逆性牙髓损伤。

关键词: 根尖周炎, 持续性根尖周围病变, 显微根尖手术, 选择性刮治

Abstract:

Objective To evaluate the efficacy of selective curettage when apical lesions are adjacent or involved to important structures in endodontic microsurgery (EMS). Methods A total of 264 patients who underwent EMS in the Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University from January 2021 to January 2023 were selected as the research subjects. The cases of EMS were divided into selective curettage group (SC-EMS) and conventional curettage group (C-EMS). In SC-EMS group, patients with apical lesions involving or adjacent to important structures (mental foramen, mandibular neural tube, nasopalatine neural canal, maxillary sinus, nasal base and adjacent vital pulp teeth) were included, and the adjacent areas around important structures were selectively cureted. In C-EMS group, patients with apical lesions adjacent to important structures were treated with conventional apical curettage. The postoperative follow-up was 12 months, and the postoperative symptoms and imaging examinations of the patients were observed, and the efficacy was evaluated. The failure cases were examined after tooth extraction and preoperative pathological review to analyze the causes of failure. Results The success rate of SC-EMS group is 90.2%, and the success rate of C-EMS group is 95.4%. The rate of success in C-EMS group was higher, but there was no statistical difference between the two groups(P>0.05). Root fracture is the important causes for the failure of the two groups. There were 6 cases of short-term discomfort and 2 cases of long-term discomfort after SC-EMS. The C-EMS group didn’t meet any short-term or long-term discomfort case. Conclusion Selective curettage has no significant effect on the success rate of EMS surgery, and is an effective method to protect important structures during surgery. Short-term discomfort may occur after surgery, and irreversible pulp damage of adjacent teeth occurs in a few cases.

Key words: periapical periodontitis, persistent periapical lesions, endodontic microsurgery, selective curettage

中图分类号:

R781.3

王轲, 游婧, 卢伟. 选择性刮治在显微根尖手术中的疗效评估[J]. 口腔医学, 2024, 44(5): 375-380.

WANG Ke, YOU Jing, LU Wei. Evaluation of the efficacy of selective curettage in endodontic microsurgery[J]. Stomatology, 2024, 44(5): 375-380.

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参考文献 19

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选择性刮治在显微根尖手术中的疗效评估

Evaluation of the efficacy of selective curettage in endodontic microsurgery

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患牙疗效	重要结构影响	累及重要结构
患牙疗效	重要结构影响	下颌神经管	颏孔	鼻腭神经管	上颌窦	鼻底	活髓邻牙
成功	无症状	8	7	21	23	14	22
	短期不适	2	1	0	0	0	3
	长期不适	0	0	0	0	0	2
失败	无症状	1	0	2	2	1	3
	短期不适	0	0	0	0	0	0
	长期不适	0	0	0	0	0	0

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