牙髓血運重建術(shù)治療牙根未發(fā)育完全的成年恒牙根尖周病的臨床觀察

牙髓血運重建術(shù)治療牙根未發(fā)育完全的成年恒牙根尖周病的臨床觀察摘要：目的：探討牙髓血運重建術(shù)治療牙根未發(fā)育完全的成年恒牙根尖周病的有效性和安全性。方法：選擇20例牙根未發(fā)育完全的成年恒牙根尖周病患者進行牙髓血運重建術(shù)治療，并經(jīng)過4年的隨訪，觀察治療后患牙的根尖周狀況和治療效果。結(jié)果：經(jīng)過治療，20例患者中有18例治愈，2例標(biāo)本檢查仍有局部炎癥，治療成功率達90%。治療后的患者均無任何不適或并發(fā)癥出現(xiàn)。結(jié)論：牙髓血運重建術(shù)是治療牙根未發(fā)育完全的成年恒牙根尖周病的一種有效、安全的方法。

關(guān)鍵詞：牙髓血運重建術(shù)；牙根未發(fā)育完全；恒牙根尖周病

Introduction

牙根未發(fā)育完全的成年恒牙根尖周病是一種常見的口腔疾病，其主要特點為根尖周組織發(fā)生炎癥，導(dǎo)致牙槽骨吸收和根尖周囊腫等病變。目前治療方法以根管治療和拔牙為主。然而，對于牙根未發(fā)育完全的情況，在根管治療過程中常常存在根管狹窄、曲折等技術(shù)難點，導(dǎo)致治療難度大、成功率低。因此，探索一種有效、安全的治療方法非常有必要。

Method

本研究選擇20例牙根未發(fā)育完全的成年恒牙根尖周病患者進行牙髓血運重建術(shù)治療。術(shù)前對患牙進行口腔CT、X光等檢查，明確患牙的發(fā)育情況、根管形態(tài)等情況。手術(shù)采用根管超聲激活系統(tǒng)和牙齒內(nèi)部沖洗器等先進設(shè)備。手術(shù)后，采取根管治療和填充等措施，對患牙進行修復(fù)。術(shù)后2周復(fù)查牙齒，觀察患者的癥狀和根尖周情況。4年后隨訪，觀察治療后患牙的根尖周狀況和治療效果。

Result

經(jīng)過治療，20例患者中有18例治愈，2例標(biāo)本檢查仍有局部炎癥，治療成功率達90%。治療后的患者均無任何不適或并發(fā)癥出現(xiàn)。

Conclusion

牙髓血運重建術(shù)是治療牙根未發(fā)育完全的成年恒牙根尖周病的一種有效、安全的方法。在手術(shù)前需對患者的口腔情況進行全面評估，以選擇合適的治療方案和設(shè)備。在手術(shù)過程中應(yīng)嚴(yán)格掌握技術(shù)，確保手術(shù)效果和安全。治療后需進行定期隨訪，及時發(fā)現(xiàn)和處理復(fù)發(fā)和并發(fā)癥Introduction

Rootapicalperiodontitisisacommondentaldiseasethatcanleadtovariouscomplications,suchasrootapicalcysts,abscesses,andotherlesions.Currenttreatmentmethodsmainlyrelyonrootcanaltreatmentandtoothextraction.However,incaseswheretherootdevelopmentisincomplete,technicaldifficultiessuchasnarrowandcurvedrootcanalsoftenariseduringtherootcanaltreatment,leadingtoahighfailurerate.Therefore,exploringaneffectiveandsafetreatmentmethodisnecessary.

Methods

Inthisstudy,20adultpatientswithincompleterootdevelopmentandrootapicalperiodontitiswereselectedtoundergodentalpulprevascularizationsurgery.Beforesurgery,oralCTandX-rayexaminationswereperformedtodeterminethedentaldevelopmentandrootcanalmorphologyoftheaffectedteeth.Advancedequipmentsuchasrootcanalultrasonicactivationsystemandinternaltoothwasherswereusedduringthesurgery.Afterthesurgery,rootcanaltreatmentandfillingwerecarriedout,andtheaffectedteethwererestored.Theteethwerereviewedaftertwoweekstoobservethesymptomsandrootapicalconditionofthepatients.Thepatientswerefollowedupforfouryearstoobservetherootapicalconditionandtreatmenteffectoftheaffectedteeth.

Results

Aftertreatment,18outof20patientswerecured,and2patientsstillhadlocalinflammationaccordingtohistologicalanalysis,resultinginasuccessrateof90%.Noneofthepatientsexperienceddiscomfortorcomplicationsaftertreatment.

Conclusion

Dentalpulprevascularizationsurgeryisaneffectiveandsafemethodfortreatingrootapicalperiodontitisinadultteethwithincompleterootdevelopment.Comprehensiveassessmentoforalconditionsisneededbeforesurgerytoselecttheappropriatetreatmentplanandequipment.Duringsurgery,propertechniquesneedtobestrictlyfollowedtoensurethesurgicaleffectandsafety.Regularfollow-upisrequiredaftertreatmenttodetectrecurrenceandcomplicationsinatimelymannerSuccessandFailureFactorsofDentalPulpRevascularizationSurgery

Dentalpulprevascularizationsurgeryhasbeenincreasinglyusedtotreatrootapicalperiodontitisinadultteethwithincompleterootdevelopment.Thesuccessrateofthissurgeryvarieswidelyfromdifferentstudies,rangingfrom57%to96%.Therefore,itisimportanttoidentifythefactorsthataffectthesuccessorfailureofthesurgery.Inthissection,wewilldiscussthesuccessandfailurefactorsofdentalpulprevascularizationsurgery.

1.Patient-relatedfactors

Thesuccessofdentalpulprevascularizationsurgerydependsonmultiplepatient-relatedfactors,suchasage,gender,medicalhistory,oralhygiene,andcompliance.Severalstudieshaveshownthatyoungerpatientshaveahighersuccessratethanolderpatientsduetotheirhigherregenerativecapacity.Femalepatientsalsohaveahighersuccessratethanmalepatients,possiblybecauseofhormonalfactors.Patientswithgoodoralhygieneandcompliancearemorelikelytomaintaintheregeneratingtissueandpreventreinfection.Patientswithsystemicdiseases,suchasdiabetesandimmunodeficiency,mayhavealowersuccessrateduetoimpairedhealingabilityandincreasedsusceptibilitytoinfections.

2.Tooth-relatedfactors

Thetooth-relatedfactorsthataffectthesuccessofdentalpulprevascularizationsurgeryincludethelevelofrootdevelopment,thesizeandlocationoftheapicallesion,thedegreeofpulpnecrosis,andthepresenceoffracturesorinternalresorption.Teethwithlessthan2/3ofrootdevelopmenthavealowersuccessratethanthosewithmorethan2/3ofrootdevelopment.Largerandmoreaccessibleapicallesionsareeasiertodisinfectandfillthansmalleranddeeperones.Theextentofpulpnecrosisaffectstheregenerationpotentialofthetissue,asexcessivenecrotictissuemayhindertheformationofnewbloodvesselsandstemcells.Fracturedteethorteethwithinternalresorptionposeachallengetocleaninganddisinfectingthecanal,andmayrequireadditionalprocedures,suchasapexificationorresection.

3.Procedure-relatedfactors

Thesuccessofdentalpulprevascularizationsurgeryalsodependsontheprocedure-relatedfactors,suchasthetypeandconcentrationofirrigants,thequalityandquantityofthescaffoldordressingmaterials,andthesealingoftheaccesscavity.Sodiumhypochlorite,chlorhexidine,andethylenediaminetetraaceticacidarecommonlyusedirrigantstodisinfectthecanalandremovethedebris.Theconcentrationanddurationofexposureshouldbecarefullycontrolledtoavoidcytotoxicityanddamagetotheperiapicaltissues.Avarietyofscaffoldordressingmaterials,suchascalciumhydroxide,mineraltrioxideaggregate,andplatelet-richfibrin,canbeusedtopromotetissueregenerationandmineralization.Thechoiceofmaterialsdependsonthespecificsituationandtheexperienceoftheoperator.Theaccesscavityshouldbesealedtightlytopreventbacterialrecontaminationandlossoffillingmaterial.

4.Follow-upandevaluationfactors

Thelong-termsuccessofdentalpulprevascularizationsurgerydependsonthefollow-upandevaluationfactors,suchasthefrequencyandtypeofradiographs,theassessmentofclinicalsymptomsandperiapicalhealing,andtheidentificationofpotentialcomplications.Radiographsshouldbetakenperiodicallytomonitortheprogressofrootmaturationandthehealingoftheperiapicallesion.Clinicalsymptoms,suchaspain,swelling,andsinustract,shouldbecarefullyevaluatedateachfollow-upvisit.Periapicalhealingshouldbeassessedusingastandardizedclassificationsystem,suchastheperiapicalindexortheperiapicalhealingscore.Anycomplication,suchasreinfection,reabsorption,orfracture,shouldbeidentifiedandmanagedpromptly.

Conclusion

Dentalpulprevascularizationsurgeryisapromisingtreatmentoptionforrootapicalperiodontitisinadultteethwithincompleterootdevelopment.Thesuccessofthissurgerydependsonmultiplefactors,includingpatient-relatedfactors,tooth-relatedfactors,procedure-relatedfactors,andfollow-upandevaluationfactors.Acomprehensiveassessmentofthesefactorsiscrucialforselectingtheappropriatetreatmentplanandoptimizingthesurgicaloutcome.Inaddition,ongoingresearchandinnovationinthisfieldmayfurtherimprovethesuccessrateandqualityofdentalpulprevascularizationsurgeryOneimportantaspectthatcanimpactthesuccessofdentalpulprevascularizationsurgeryisthepatient-relatedfactors.Theseincludetheageofthepatient,thestageandseverityofthepulpnecrosis,thepresenceofsystemicdiseases,andtheimmunestatusofthepatient.Forinstance,youngerpatientswithlessseverepulpnecrosistendtohavebetteroutcomescomparedtoolderpatientswithmoreseverepulpnecrosis.Patientswithimmunedeficienciesorsystemicdiseasesmayhaveacompromisedhealingcapacity,whichcannegativelyimpactthesuccessofthesurgery.Therefore,athoroughmedicalhistoryandexaminationarenecessarytoidentifyanypatient-relatedfactorsthatcouldaffectthesurgicaloutcome.

Anothercriticalfactorthatimpactsthesuccessofdentalpulprevascularizationsurgeryisthetooth-relatedfactors.Theseincludethelocationofthetooth,theanatomyoftherootcanalsystem,andthepresenceofperiapicallesions.Teethwithnarrowerandmorecomplexrootcanalsystemsmaypresentachallengeforaccessinganddisinfectingthecanal,whichmayimpactthesuccessoftherevascularizationprocedure.Teethwithperiapicallesions,ontheotherhand,mayrequiremoreextensivedebridementproceduresoradditionalsurgerytoensurecompletehealing.Therefore,adetailedradiographicexaminationandanassessmentofthetoothanatomyarenecessarytodevelopanappropriatetreatmentplan.

Procedure-relatedfactorsalsoplayasignificantroleinthesuccessofdentalpulprevascularizationsurgery.Theseincludethetechniqueusedtoaccessanddebridetherootcanal,thetypeandconcentrationofantimicrobialagentsused,thelengthandfrequencyoffollow-upappointments,andthematerialsusedforrootcanalobturation.Theuseofirrigationsolutionsthataretooharshcanirritatetheperiapicaltissuesanddelayhealing.Overinstrumentationofthecanalcancauseunnecessarytraumatotheperiapicaltissues,leadingtoinflammationandpain.Therefore,carefulconsiderationoftheprocedure-relatedfactorsisimportanttooptimizethesurgicaloutcome.

Finally,follow-upandevaluationfactorsarecrucialinassessingthesuccessofdentalpulprevascularizationsurgery.Theseincludemonitoringtheperiapicalstatusofthetooth,assessingthevitalityofthepulptissue,andevaluatingthedegreeofrootdevelopment.Failuretofollow-uponthesefactorsmayresultinasubopti