口腔疾病防治 ›› 2019, Vol. 27 ›› Issue (10): 613-620.DOI: 10.12016/j.issn.2096-1456.2019.10.001

• 专家论坛 • 上一篇    下一篇

显微根尖外科手术适应证的考量

曾雄群(),徐帅妹   

  1. 南方医科大学口腔医院牙体牙髓科,广东 广州(510280)
  • 收稿日期:2019-02-18 修回日期:2019-05-04 出版日期:2019-10-20 发布日期:2019-10-20
  • 通讯作者: 曾雄群
  • 基金资助:
    广东省自然科学基金项目(2015A030313810)

Consideration of indications for endodontic microsurgery

ZENG Xiongqun(),XU Shuaimei   

  1. Department of endodontics, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
  • Received:2019-02-18 Revised:2019-05-04 Online:2019-10-20 Published:2019-10-20
  • Contact: Xiongqun ZENG

摘要:

根管治疗后疾病是临床较为棘手的问题,对于无法通过根管再治疗解决问题的病例,根尖外科手术是一种重要且有效的手段。近年来,随着口腔手术显微镜的应用与显微器械的发展,显微根尖外科手术较传统根尖外科手术减小了治疗创伤,进一步提高了临床治疗成功率。然而,显微根尖外科手术作为一种侵入性的手术方式,在临床应用当中,应该严格把握其适应证和时机。本文针对这一重要问题进行文献回顾,同时结合作者团队的临床经验进行探讨。阐述在根管治疗后疾病发生后,有效的根管再治疗与良好的冠部封闭是首要的考量;当根管再治疗确认失败或无法完成时,应充分考虑患牙解剖因素、病损范围以及牙周情况等,谨慎制定显微根尖外科手术的治疗策略。

关键词: 根尖周病变, 显微根尖外科手术, 根管再治疗, 根管治疗后疾病, 适应证

Abstract:

Posttreatment disease is a difficult clinical problem. Periradicular surgery is an important and effective method for cases that cannot be resolved by root canal therapy. In recent years, with the application of microscope for oral surgery and the development of microsurgical instruments, microsurgery in endodontics has reduced treatment trauma compared to traditional periradicular surgery and further improved the success rate of clinical treatment. However, as an invasive surgical method, the indications and timing of microsurgery in endodontics should be strictly defined for clinical applications. This paper reviews the literature on this important issue and discusses it with regard to the clinical experience of the author′s team. Explaining the effective root canal retreatment and good coronary closure are the primary considerations when posttreatment disease occurs. When root canal retreatment fails or cannot be completed after the initial treatment, the anatomical factors, lesion extent and periodontal lesion combination should be fully considered, and the microsurgery treatment strategy should be carefully formulated.

Key words: periapical lesion, endodontic microsurgery, root canal retreatment, posttreatment disease, indications

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