口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (2): 140-147.DOI: 10.12016/j.issn.2096-1456.2022.02.011

• 综述 • 上一篇    下一篇

上颌窦对上颌后牙显微根尖手术的影响

孙明新(), 宋东哲, 黄定明()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院牙体牙髓病科,四川 成都(610041)
  • 收稿日期:2020-12-15 修回日期:2021-08-28 出版日期:2022-02-20 发布日期:2021-11-25
  • 通讯作者: 黄定明
  • 作者简介:孙明新,住院医师,硕士,Email: 1309980248@qq.com
  • 基金资助:
    国家自然科学基金项目(81771063);四川省重点研发项目(2021YFS0031);四川大学华西口腔医院探索与研发项目(LCYJ2019-6)

The influence of the maxillary sinus on maxillary posterior tooth endodontic microsurgery

SUN Mingxin(), SONG Dongzhe, HUANG Dingming()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2020-12-15 Revised:2021-08-28 Online:2022-02-20 Published:2021-11-25
  • Contact: HUANG Dingming
  • Supported by:
    National Natural Science Foundation of China(81771063);Sichuan Province Key R&D Program(2021YFS0031);Research and Develop Program, West China Hospital of Stomatology, Sichuan University(LCYJ2019-6)

摘要:

显微根尖手术是临床上保存牙髓根尖周病患牙的有效手段之一,也是治疗其疑难病例的必备技术。但由于位置靠后操作空间狭小、根尖与上颌窦毗邻,导致在上颌后牙区进行根尖外科手术仍存在一定挑战。本文就上颌窦与上颌后牙解剖关系、对显微根尖手术影响以及辅助技术如:3D打印手术导板、超声骨刀等在上颌后牙区手术中的应用进行总结。文献复习结果表明,上颌后牙根尖与上颌窦空间关系通常分3类:根尖突进上颌窦底;根尖与上颌窦底相接触;根尖和上颌窦底之间有间隙或空间。术前CBCT检查后结合患牙根尖周和上颌窦状态以及根尖病损到上颌窦距离评估手术难度,术中应用导板、内窥镜、超声骨刀等以使手术更加安全可靠和精准微创,但后者在临床上的普及仍需进一步推广。目前尚缺乏高质量的上颌后牙区现代显微根尖手术长期疗效的临床研究。

关键词: 显微根尖手术, 上颌后牙区, 上颌窦, 锥形束CT, 3D打印手术导板, 超声骨刀, 内窥镜

Abstract:

Endodontic microsurgery is one effective method for preserving teeth affected by periapical disease, and is also an essential technique for treating difficult cases. However, due to the restricted operating space at the posterior site and the proximity of the root apex to the maxillary sinus, endodontic surgery in the posterior maxillary area represents great challenges. This article summarizes the anatomical relationship between the maxillary sinus and the maxillary posterior teeth, the influence on endodontic microsurgery, and the application of assistive techniques on maxillary posterior teeth, such as 3D-printed surgical guides and ultrasonic osteotomes. Literature review results show that the spatial relationship between the apex of maxillary posterior teeth and the maxillary sinus is usually divided into three categories: the apex enters the maxillary sinus; the apex contacts the bottom of the maxillary sinus; and there is a distance between the apex and the bottom of the maxillary sinus. CBCT should be performed before the operation, and the periapical state of the tooth and the maxillary sinus and the distance between the lesions and the sinus floor should be considered to evaluate the difficulty of the operation. Meanwhile, during surgery, equipment such as surgical guides, endoscopes and ultrasonic osteotomes should be used to ensure that the operation is safer, reliable, precise and less invasive, but the clinical popularity of ultrasonic osteotomes still needs further promotion. Moreover, high-quality clinical studies on the long-term effects of micro-apical surgery in the posterior maxillary area are still lacking.

Key words: endodontic microsurgery, maxillary posterior area, maxillary sinus, CBCT, 3D-printed surgical guide, ultrasonic osteotome, endoscope

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