口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (1): 11-19.DOI: 10.12016/j.issn.2096-1456.2021.01.002
收稿日期:
2020-03-17
修回日期:
2020-06-11
出版日期:
2021-01-20
发布日期:
2020-11-18
通讯作者:
孙书昱
基金资助:
Received:
2020-03-17
Revised:
2020-06-11
Online:
2021-01-20
Published:
2020-11-18
Contact:
Shuyu SUN
Supported by:
摘要:
根管峡区(root canal isthmus,RCI)是位于同一牙根内、根管之间含有牙髓或牙髓衍生组织,呈现为带状狭窄的连接或含有交通支及横向吻合的解剖学结构,它常存在于含有两个根管的牙根中,解剖结构复杂。不同牙位的RCI发生率不尽相同,发生率最高的部位是下颌第一磨牙近中根和上颌第一磨牙近中颊根。RCI的存在增加了根管治疗的难度,并给患牙治疗带来了预后的不确定性。临床上,对于可能存在RCI的患牙建议使用锥形束CT及牙科显微镜进行识别;同时,对含RCI患牙治疗时应考虑选择合适的器械以及超声辅助下加强根管冲洗,有助于提高根管治疗以及根尖手术的成功率。目前的技术对于RCI的清理和充填仍存在一定的局限性,相应技术设备的研发改进是目前的研究热点,也是未来的研究方向。
中图分类号:
孙书昱,王贺. 根管峡区的定位、发生率及临床意义[J]. 口腔疾病防治, 2021, 29(1): 11-19.
SUN Shuyu,WANG He. Location, incidence and clinical implications of the root canal isthmus[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(1): 11-19.
图2 上颌磨牙近中颊根根管峡区与遗漏根管口
Figure 2 Root canal isthmus from the maxillary molar and missed root canal orifice a:arrow show the root canal isthmus before the missed root canal preparation; b:arrow show the missed root canal after the missed root canal preparation
Nationality | Sample number | Method | Prevalence (%) | Year of publication | Note |
---|---|---|---|---|---|
South Korea | 31 | Section observation | 100 | 2020[ | The value was measured 3mm from the root tip |
China | 823 | CBCT | 64.6 | 2019[ | Mongoloid population |
Brazil | 140 | Micro-CT | 74.3 | 2019[ | The proportion of Type I-V was 52.9%,7.7%,2.9%,19.2% and 17.3% from the Hsu & Kim's classification |
Iran | 150 | X-ray and Stereomicroscope | 44.6 | 2017[ | The RCI prevalence of distal roots was 27.3% |
USA | 122 | CBCT | 64.7 | 2017[ | Mandibular second molars got a higher RCI prevalence without statistically difference |
Brazil | 132 | CBCT | 87.9 | 2015[ | |
India | 150 | Section observation | 30 | 2012[ | The RCI prevalence of distal roots was 10 |
China | 36 | Micro-CT | 49.5-66.1 | 2009[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 4-6 mm from the root tip The RCI prevalence of distal roots was 17.3%-17.8% |
UK | 20 | Micro-CT | 17.25-50.25 | 2005[ | The value was observed 3-5 mm from the root tip, the highest RCI prevalence occurred in 3 mm from the root tip |
Poland | 50 | Section observation | 20 | 2004[ | The value was observed 3 mm from the root tip. The RCI prevalence of mandibular second molar was 18% |
Brazil | 50 | Section observation | 59 | 2003[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 3-5 mm from the root tip |
表1 下颌第一磨牙近中根根管峡区发生率
Table 1 Incidence of mesiobuccal root canal isthmus in mandibular first molar
Nationality | Sample number | Method | Prevalence (%) | Year of publication | Note |
---|---|---|---|---|---|
South Korea | 31 | Section observation | 100 | 2020[ | The value was measured 3mm from the root tip |
China | 823 | CBCT | 64.6 | 2019[ | Mongoloid population |
Brazil | 140 | Micro-CT | 74.3 | 2019[ | The proportion of Type I-V was 52.9%,7.7%,2.9%,19.2% and 17.3% from the Hsu & Kim's classification |
Iran | 150 | X-ray and Stereomicroscope | 44.6 | 2017[ | The RCI prevalence of distal roots was 27.3% |
USA | 122 | CBCT | 64.7 | 2017[ | Mandibular second molars got a higher RCI prevalence without statistically difference |
Brazil | 132 | CBCT | 87.9 | 2015[ | |
India | 150 | Section observation | 30 | 2012[ | The RCI prevalence of distal roots was 10 |
China | 36 | Micro-CT | 49.5-66.1 | 2009[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 4-6 mm from the root tip The RCI prevalence of distal roots was 17.3%-17.8% |
UK | 20 | Micro-CT | 17.25-50.25 | 2005[ | The value was observed 3-5 mm from the root tip, the highest RCI prevalence occurred in 3 mm from the root tip |
Poland | 50 | Section observation | 20 | 2004[ | The value was observed 3 mm from the root tip. The RCI prevalence of mandibular second molar was 18% |
Brazil | 50 | Section observation | 59 | 2003[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 3-5 mm from the root tip |
Nationality | Sample number | Method | Prevalence (%) | Year of publication | Note |
---|---|---|---|---|---|
South Korea | 28 | Section observation | 89.3 | 2020[ | The value was measured 3mm from the root tip |
China | 494 | CBCT | 92.5 | 2019[ | Investigated from a 9 to 12 years old population |
Brazil | 102 | CBCT | 60.8 | 2015[ | |
Brazil | 50 | Section observation | 29 | 2003[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 3-5 mm from the root tip |
Canada | 50 | Section observation | 62.5 | 2002[ | |
USA | 50 | Section observation | 100 | 1995[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 4 mm from the root tip |
表2 上颌第一磨牙近中颊根根管峡区发生率
Table 2 Incidence of mesiobuccal root canal isthmus in maxillary first molar
Nationality | Sample number | Method | Prevalence (%) | Year of publication | Note |
---|---|---|---|---|---|
South Korea | 28 | Section observation | 89.3 | 2020[ | The value was measured 3mm from the root tip |
China | 494 | CBCT | 92.5 | 2019[ | Investigated from a 9 to 12 years old population |
Brazil | 102 | CBCT | 60.8 | 2015[ | |
Brazil | 50 | Section observation | 29 | 2003[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 3-5 mm from the root tip |
Canada | 50 | Section observation | 62.5 | 2002[ | |
USA | 50 | Section observation | 100 | 1995[ | The value was observed 0-6 mm from the root tip, the highest RCI prevalence occurred in 4 mm from the root tip |
图3 上颌第二磨牙根管峡区根管上下段的差异
Figure 3 The difference between the upper part and the lower part of the root canal isthmus from maxillary second molar a: RCI morphology of the upper part from the cross section of the CBCT image (arrow show); b: RCI morphology of the lower part from the cross section of the CBCT image (arrow show); RCI: root canal isthmus; CBCT: cone beam CT
图4 不同检测手段对根管峡区检出的影响
Figure 4 The effect of root canal isthmus detection via different methods a: X-ray can not show clear morphology of the root canal system; b: CBCT clearly shows the band-area of the fused roots (arrow show); RCI: root canal isthmus; CBCT: cone beam CT
图5 下颌磨牙C形根管根尖段根管峡区充填空隙
Figure 5 The root canal isthmus root filling missed space of the C-shaped root canal system from mandibular molar arrow indicates the RCI root filling missed space; RCI: root canal isthmus
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