上颌第二磨牙根管解剖形态的初步研究

上海口腔医学 ›› 2014, Vol. 23 ›› Issue (2): 179-183.

上颌第二磨牙根管解剖形态的初步研究

李莉¹, 詹福良¹, 金英武²

1.中国医科大学附属口腔医院牙体牙髓病科, 辽宁沈阳 110002;
2.沈阳金英武口腔诊所, 辽宁沈阳 110000

收稿日期:2013-06-14 出版日期:2014-04-20 发布日期:2014-05-21
通讯作者: 詹福良, Tel:024-22895932, E-mail:940596052@qq.com
作者简介:李莉(1987-), 女, 硕士, 医师, E-mail:359476764@qq.com

Preliminary study on root canal morphology of maxillary second molars

LI Li¹, ZHAN Fu-liang¹, JIN Ying-wu²

1. Department of Endodontics, School of Stomatology, China Medical University. Shenyang 110002;
2. JIN Ying-wu Dental Clinic. Shenyang 110000, Liaoning Province, China

Received:2013-06-14 Online:2014-04-20 Published:2014-05-21

摘要/Abstract

摘要： 目的: 利用透明牙技术和锥形束CT(cone-beam computed tomography, CBCT)体层扫描技术对上颌第二磨牙根管解剖形态进行研究, 比较CBCT对根管形态的识别与透明牙有无一致性。方法: 对50颗离体牙进行CBCT扫描, 数据导入用计算机软件, 根据Vertucci根管分型, 记录每颗离体牙每个牙根的根管分型。用改良根管染色技术对离体牙进行透明牙制作, 根据Vertucci分类, 将离体牙按每个牙根进行根管类型统计。采用SPSS17.0软件包对所得数据进行统计学处理。结果: 经过对透明牙的观察, 上颌第二磨牙远中颊根和腭根根管形态以Ⅰ型(1-1)为主, 发现新的根管分型(3-2-2)。近颊根的变异比较复杂, 主要以Ⅰ型居多(54.4%), Ⅱ型(2-1)、Ⅳ型(2-2)、Ⅴ型(1-2)和Ⅵ型(2-1-2)均有发生。近颊第二根管发生率为41.3%;经一致性检验, CBCT与透明牙在根管分型上具有一致性(P<0.001)。结论: 上颌第二磨牙根管解剖形态复杂, 尤其近颊根根管类型多变。CBCT与透明牙对根管的识别具有一致性, 其提供的三维影像技术对临床工作具有指导意义。

关键词: 上颌第二磨牙, 根管形态, 改良透明牙技术, 锥形束CT, 一致性分析

Abstract: PURPOSE: To investigate the root canal morphology and anatomy of maxillary second molars using transparent tooth technique and cone-beam computed tomography (CBCT), and explore the consistency of 2 methods in identifying root canal configurations and morphology. METHODS: Fifty extracted maxillary second molars were scanned by CBCT and analyzed using assistant software. Root canal configurations of each root were identified based on Vertucci's classification and recorded. All transparent teeth samples were made with modified root canal staining technique, and the root canal configurations of each root were classified based on Vertucci's classification. The results were analyzed statistically with SPSS17.0 software package. RESULTS: According to transparent tooth technique, typeⅠ was the most common configuration in distobuccal root and palatal root. An additional configuration type 3-2-2 was found in the present study, which was not included in Vertucci’s classification. The wide variety of canal systems was seen in the mesiobuccal root. TypeⅠconfiguration was most prevalent(54.4%), followed by TypeⅡ, Ⅳ, Ⅴ, Ⅵ. The prevalence of second canal in mesiobuccal root (MB2) was 41.3%. The results of canal morphology and configuration were consistent between transparent tooth technique and CBCT. CONCLUSIONS: Maxillary second molars have the most complex root and canal morphology, especially for the mesiobuccal root. For identifying root canal and root anatomy, CBCT can be used as an alternative to transparent tooth technique in clinical practice. The application of 3D reconstruction based on CBCT helps us to visualize the root canal anatomy.

Key words: Maxillary second molars, Configurations of the root canals, Transparent tooth, CBCT, Consistency test

中图分类号:

R780.2

李莉, 詹福良, 金英武. 上颌第二磨牙根管解剖形态的初步研究[J]. 上海口腔医学, 2014, 23(2): 179-183.

LI Li, ZHAN Fu-liang, JIN Ying-wu. Preliminary study on root canal morphology of maxillary second molars[J]. Shanghai Journal of Stomatology, 2014, 23(2): 179-183.

参考文献

[1] 朱征, 赵守亮.上颌第二磨牙五根管1例报告[J]. 上海口腔医学, 2011, 20(2): 219-221.
[2] Barbizam JV, Ribeiro RG, Tanomaru Filho M. Unusual anatomy of permanent maxillary molars[J]. J Endod, 2004, 30(9): 668-671.
[3] Holderrieth S, Gernhardt CR. Maxillary molars with morphologic variations of the palatal root canals: a report of four cases[J]. J Endod, 2009, 35(7):1060-1065.
[4] Ozcan E, Aktan AM, Ari H. A case report: unusual anatomy of maxillary second molar with 3 mesiobuccal canals[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 107(1):e43-46.
[5] Kottoor J, Hemamalathi S, Sudha R, et al. Maxillary second molar with 5 roots and 5 canals evaluated using cone beam computerized tomography: a case report[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109(2): e162-165.
[6] Singla M, Aggarwal V. C-shaped palatal canal in maxillary second molar mimicking two palatal canals diagnosed with the aid of spiral computerized tomography[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109(6): 92-95.
[7] Weng XL, Yu SB, Zhao SL, et al. Root canal morphology of permanent maxillary teeth in the Han Nationality in Chinese Guanzhong area: a new modified root canal staining technique [J]. J Endod, 2009, 35(5): 651-656.
[8] Vertucci FJ, Seelig A, Gillis R. Root canal morphology of the human maxillary second premolar[J]. Oral Surg Oral Med Oral Pathol, 1974, 38(3): 456-464.
[9] Matherne RP, Angelopoulos C, Kulild JC, et al. Use of cone-beam computed tomography to identify root canal systems in vitro[J]. J endod, 2008, 34(1): 87-89.[10] Imura N, Hata GI, Toda T, et al. Two canals in mesiobuccal roots of maxillary molars [J]. Int Endod J, 31(6): 410-414.
[11] 李健, 杨婕, 杨莹, 等. 离体上颌第二磨牙根管形态的研究[J]. 河北医学, 2010, 16(10): 1172-1174.
[12] Eskoz N, Weine FS. Canal configuration of the mesiobuccal root of the maxillary second molar [J]. J Endod, 1995, 21(1): 38-42.
[13] Sempira HN, Hartwell GR. Frequecy of second mesiobuccal canals in maxillary molars as determined by use of an operating microscope: a clinical study [J]. J Endod, 2000, 26(11): 673-674.
[14] Kulid JC, Peters DD. Incidence and configuration of canal systems in the mesiobuccal root of maxillary first and second molars [J]. J Endod, 1990, 16(7): 311-317.
[15] 沈漪. 下颌第二磨牙牙根根管数目及形态研究 [J]. 中国实用口腔科杂志, 2008, 1(11): 678-679.
[16] Reuben J, Velmuruqan N, Kandaswamy D. The evaluation of root canal morphology of the mandibular first molar in an Indian population using spiral computed tomography scan: an in vitro study [J]. J Endod, 2008, 34(2): 212-215.