上海口腔医学

上海口腔医学 ›› 2023, Vol. 32 ›› Issue (4): 395-400.doi: 10.19439/j.sjos.2023.04.011

• 论著 • 上一篇    下一篇

下颌第二磨牙C形根管治疗前后根管壁厚度测量分析

李贵宏1, 谢思静1, 林梓桐2, 张婷1, 汤旭娜1, 胡勤刚3   

  1. 1.南京大学医学院附属口腔医院,南京市口腔医院 牙体牙髓病科,江苏 南京 210008;
    2.南京大学医学院附属口腔医院,南京市口腔医院 放射科,江苏 南京 210008;
    3.南京大学医学院附属口腔医院,南京市口腔医院 口腔颌面外科,江苏 南京 210008
  • 收稿日期:2022-03-11 修回日期:2022-06-06 发布日期:2023-09-07
  • 通讯作者: 汤旭娜,E-mail: xunatang@126.com
  • 作者简介:李贵宏（1995-）,女,硕士,E-mail: 1635089254@qq.com
  • 基金资助:
    南京市医学科技发展资金（YKK21185）

An analysis of the wall width before and after root canal therapy in mandibular second molars with C-shaped canals

LI Gui-hong1, XIE Si-jing1, LIN Zi-tong2, ZHANG Ting1, TANG Xu-na1, HU Qin-gang3   

  1. 1. Department of Endodontics, Medical School of Nanjing University. Nanjing 210008, Jiangsu Province, China;
    2. Department of Radiology, Medical School of Nanjing University. Nanjing 210008, Jiangsu Province, China;
    3. Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University. Nanjing 210008, Jiangsu Province, China
  • Received:2022-03-11 Revised:2022-06-06 Published:2023-09-07

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摘要： 目的 应用锥形束CT（cone beam CT,CBCT）分析根管治疗前后下颌第二磨牙C形根管壁厚度变化。方法 收集南京市口腔医院2020年1月—2021年7月就诊拍摄CBCT的患者38例,共55颗下颌第二磨牙（均为C形根管）,其中10颗已行根管治疗,45颗未行根管治疗。采用Mimics Research 20.0软件对图像进行重建,垂直牙长轴从牙根尖至髓室底每隔1 mm做切面,以从根尖开始出现根管影像的第一个切面记为切面1,切面1向冠方1 mm的切面称为切面2,以此类推。分别测量纳入研究的C形根管每个切面近远中壁厚度及颊舌侧壁厚度。采用SPSS 26.0软件包分析根管治疗前后根管壁不同位置厚度。结果 下颌第二磨牙C形根管治疗前后其近远中根管壁厚度平均值均大于1 mm;除靠近冠方的2~3个切面外,每一切面近、远中壁厚度均显著大于该切面颊、舌侧壁厚度（P<0.05）。未行根管治疗的C形根管,舌侧壁在1~4个切面中,相当于根尖1/3部分,每一切面根管壁厚度平均值均低于1 mm;除靠近冠方的11及12切面外,每一切面舌侧壁厚度均小于颊侧壁。已行根管治疗的C形根管,颊侧壁厚度在1~5切面中、相当于根方1/2部分,舌侧壁厚度在1~7切面中、相当于根方2/3部分,每一切面根管壁的平均厚度均低于1 mm;且除靠近根尖的切面1与靠近根冠方的切面9外,每一切面舌侧壁厚度平均值均小于颊侧壁厚度。C形根管壁预备前后远中壁厚度无显著差异（P>0.05）,颊侧壁厚度、近中壁厚度及舌侧壁厚度均有显著差异（P<0.05）。结论 C形根管治疗前舌侧壁根尖1/3管壁薄弱,根管治疗时需注意。治疗后颊侧壁根方1/2及舌侧壁根方2/3管壁薄弱,桩冠修复时需慎重考虑。根管治疗前后颊舌侧壁厚度变化较大,根管预备时注意对根管颊舌侧壁的切削。

关键词: 下颌第二磨牙, 锥形束CT, 根管治疗, C形根管

Abstract: PURPOSE: To measure the wall width in mandibular second molars with C-shaped canals before and after root canal therapy using cone-beam CT(CBCT). METHODS: A total of 55 mandibular second molars from 38 patients which met the criteria for inclusion at Nanjing Stomatological Hospital, Affiliated Stomatological Hospital of Medical School of Nanjing University from January 2020 to July 2021 were analyzed.From this sample, ten teeth had been treated, while another 45 of them not. CT images of the teeth were reestablished by Mimics software 20.0. Then we made a section every 1mm perpendicular to the long axis of the teeth from apex to pulp floor. The first slice from apex to pulp chamber was named the slice 1. Along the slice 1 to crown 1 mm was called slice 1, and so forth. The wall thickness at different locations of all the slices was measured. The data was entered into SPSS 20.0 software package for analysis. RESULTS: Regardless of whether the teeth were treated or not, both the mesial and distal canal walls’ average width were thicker than 1mm in all slices. At the same time, the mesial and distal canal walls’ width were thicker than the width of buccal and lingual canal walls in all the slices from C-shaped root canal, except slices which were near pulp chamber(P<0.05). As for the C-shaped root canals without root canal therapy, the width of lingual wall in the slice 1 to 4, as well as apex third root, was thinner than 1 mm. The width of buccal canal wall was thicker than the width of lingual canal wall in all slices except slice 11 and 12. As for the C-shaped root canals with root canal therapy, the width of buccal canal wall in slice 1 to 5, equivalent of apex half root, and the width of lingual wall in the slice 1 to 7, amount to apex two-thirds of root, was thinner than 1 mm. The width of buccal canal wall was thicker than the width of lingual wall in all slices except slice 1 and 9. There was no significant difference between the distal canal walls' width of C-shaped canals with and without root canal therapy(P>0.05) . There was significant difference between the buccal canal walls' width of C-shaped canals with and without root canal therapy, as same as the mesial canal walls' width and the width of lingual canal wall (P<0.05). CONCLUSIONS: The lingual canal walls’ width in apex third root of C-shaped root canal were thin before canal preparation. The buccal walls’ width in apex half root and the lingual canal walls’ in apex two-thirds of root of C-shaped root canal were thin after canal preparation.

Key words: Mandibular second molars, CBCT, Root canal therapy, C-shaped root canal

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