根管治疗失败原因及再治疗诊治策略
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摘要
牙髓病和根尖周病主要是细菌感染性疾病,根管治疗术则是国际上公认的最有效的治疗方法。随着口腔新技术、新材料的研发和应用,其成功率也在不断提高。但由于根尖周感染状况不同、根管系统和髓腔的解剖结构的复杂性和多样性、微生物变种及毒力改变、医疗器械或医生临床技能的差异等因素,仍有一些病例治疗效果不佳或者治疗失败,需要进行根管再治疗。文章旨在通过分析初次根管治疗失败的原因,对根管再治疗的诊治策略做一介绍。
Pulpitis and apical periodontitis are mostly casued by microbial infection. The most effective method internationally recognized is root canal therapy. With the development and application of new technology and material,the success rate is increasing. However,because of the infection variety,anatomic complexity of root canal,the variety of the microbe and toxicity,and the limitation of current technology or the clinicians′ skills,the unsatisfactory result and failure in treatment still exist. Endodontic retreament is an effective way to solve the problem. The paper aims to introduce the diagnosis and management strategy of endodotic retreament by analyzing the reason for failure of previous root canal therapy.
Pulpitis and apical periodontitis are mostly casued by microbial infection. The most effective method internationally recognized is root canal therapy. With the development and application of new technology and material,the success rate is increasing. However,because of the infection variety,anatomic complexity of root canal,the variety of the microbe and toxicity,and the limitation of current technology or the clinicians′ skills,the unsatisfactory result and failure in treatment still exist. Endodontic retreament is an effective way to solve the problem. The paper aims to introduce the diagnosis and management strategy of endodotic retreament by analyzing the reason for failure of previous root canal therapy.
引文
[1]Lin LM,Rosenberg PA,Lin J.Do procedural errors cause endodontic treatment failure?[J].J Am Dent Assoc,2005,136(2):187-193.
[2]Stuart CH,Schwartz SA,Beeson TJ,et al.Enterococcus faecalis:its role in root canal treatment failure and current concepts in retreatment[J].J Endod,2006,32(2):93-98.
[3]R??as IN,Siqueira Jr JF,Santos KRN.Association of enterococcus faecalis with different forms of periradicular diseases[J].JEndod,2004,30(5):315-320.
[4]皮根丽,尹仕海.根管治疗期间急症的相关因素及防治[J].华西口腔医学杂志,2004,22(6):471-473.
[5]Nair PN,Henry S,Cano V,et al.Microbial status of apical root canal system of Human mandibular first molars with primary apical periodontitis after“one-visit”endodontic treatment[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2005,99(2):231-252.
[6]Degemess RA,Bowles WR.Dimension,anatomy and morphology of the mesiobuccal root canal system in maxillary molars[J].JEndod,2010,36(6):985-989.
[7]Wolcott J,Ishley D,Kennedy W,et al.A 5 yr clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars[J].J Endod,2005,31(4):262-264.
[8]Zitzmann NU,Krastl G,Hecker H,et al.Endodontics or implants?A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions[J].Int Endod J,2009,42(9):757-774.
[9]Gomes AC,Nejaim Y,Silva AIV,et al.Influence of endodontic treatment and coronal restoration on status of periapical tissues:a cone-beam computed tomographic study[J].J Endod,2015,41(10):1614-1618.
[10]Song M,Kim H,Lee W,et al.Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery[J].J Endod,2011,37(11):1516-1519.
[11]Schwartz RS,Robbins JW.Post placement and restoration of endodontically treated teeth:a literature review[J].J Endod,2004,30(5):289-301.
[12]Ng YL,Mann V,Rahbaran S,et al.Outcome of primary root canal treatment:systematic review of the literature.Part 2.Influence of clinical factors[J].Int Endod J,2008,41(1):6-31.
[13]Gillen BM,Looney SW,Gu LS,et al.Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment:a systematic review and metaanalysis[J].J Endod,2011,37(7):895-902.
[14]Pratt I,Aminoshariae A,Montagnese TA,et al.Eight-year retrospective study of the critical time lapse between root canal completion and crown placement:its influence on the survival of endodontically treated teeth[J].J Endod,2016,42(11):1598-1603.
[15]Azim AA,Griggs JA,Huang GTJ.The tennessee study:factors affecting treatment outcome and healing time following nonsurgical root canal treatment[J].Int Endod J,2016,49(1):6-16.
[16]Carratu P,Amato M,Riccitiello F,et al.Evaluation of leakage of bacteria and endotoxins in teeth treated endodontically by two different techniques[J].J Endod,2002,28(4):272-275.
[17]Nudera WJ.Selective root retreatment:a novel approach[J].JEndod,2015,41(8):1382-1388.
[18]Schwendicke F,Stolpe M.Secondary treatment for asymptomatic root canal treated teeth:a cost-effectiveness analysis[J].JEndod,2015,41(6):812-816.
[19]Torabinejad M,Corr R,Handysides R,et al.Outcomes of nonsurgical retreatment and endodontic surgery:a systematic review[J].J Endod,2009,35(7):930-937.
[20]Duncan HF,Chong BF.Removal of root filling materials[J].Endod Topics,2011,19:33-57.
[21]Magalhaes BS,Johann JE,Lund RG,et al.Dissolving efficacy of some organic solvents on gutta-percha[J].Braz Oral Res,2007,21(4):303-307.
[22]Colaco AS,Pai VA.Comparative evaluation of the efficiency of manual and rotary gutta-percha removal techniques[J].J Endod,2015,41(11):1871-1874.
[23]Iriboz E,Sazak OH.Comparison of ProTaper and Mtwo Retreatment systems in the removal of resin-based root canal obturation materials during retreatment[J].Aust Endod J,2014,40(1):6-11.
[24]Marfisi K,Mercade M,Plotino G,et al.Efficacy of three different rotary files to remove gutta-percha and Resilon from root canals[J].Int Endod J,2010,43(11):1022-1028.
[25]Somma F,Cammarota G,Plotino G,et al.The effectiveness of manual and mechanical instrumentation for the retreatment of three different root canal filling materials[J].J Endod,2008,34(4):466-469.
[26]Zou L,Shen Y,Li W,et al.Penetration of sodium hypochlorite into dentin[J].J Endod,2010,36(5):793-796.
[27]Marending M,Luder H,Brunner T,et al.Effect of sodium hypochlorite on human root dentine-mechanical,chemical and structural evaluation[J].Int Endod J,2007,40(10):786-793.
[28]冯瑞明,薛明.根管内感染控制的难点及策略[J].中国实用口腔科杂志,2017,10(4):202-206.
[29]Soares JA,Roque de Carvalho MA,Cunha Santos SM,et al.Effectiveness of chemomechanical preparation with alternating use of sodium hypochlorite and EDTA in eliminating intracanal Enterococcus faecalis biofilm[J].J Endod,2010,36(5):894-898.
[30]Ordinola-Zapata R,Bramante CM,Aprecio RM,et al.Biofilm removal by 6%sodium hypochlorite activated by different irrigation techniques[J].Int Endod J,2014,47(7):659-666.
[31]Wang Z,Shen Y,Haapasalo M.Effectiveness of endodontic disinfecting solutions against young and old Enterococcus faecalis biofilms in dentin canals[J].J Endod,2012,38(10):1376-1379.
[32]Vizzotto MB,Silveira PF,Arús NA,et al.CBCT for the assessment of second mesiobuccal(MB2)canals in maxillary molar teeth:effect of voxel size and presence of root filling[J].Int Endod J,2013,46(9):870-876.
[33]Silva EJ,Nejaim Y,Silva AI,et al.Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomogmphic imaging:an in vivo study[J].J Endod,2014,40(2):173-176.
[34]Nur BG,Ok E,Altunsoy M,et al.Root canal morphology analysis of maxillary permanent first and secound molars in a southeastern turkish population useing cone beam computed tomography[J].Eur J Dent,2014,8(2):154-159.
[35]Siew K,Lee AHC,Cheung GSP.Treatment outcome of repaired root perforation:a systematic review and meta-analysis[J].JEndod,2015,41(11):1795-1804.
[36]Madarati AA,Hunter MJ,Dnmmer PM.Management of intracanal separated instruments[J].J Endod,2013,39(5):569-581.
[37]高原,徐佳蕾,杨倩,等.根管内分离器械的处理评估与取出策略[J].国际口腔医学杂志,2016,43(3):249-259.
[38]冯瑞明,薛明.镍钛器械分离的影响因素及防治策略[J].中国实用口腔科杂志,2018,11(4):193-199.
[39]El Karim I,Kennedy J,Hussey D.The antimicrobial effects of root canal irrigation and medication[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2007,103(4):560-569.
[40]Su L,Gao Y,YuC,et al.Surgical endodontic treatment of refractory periapical periodontitis with extraradicular biofilm[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2010,110(1):40-44.
[41]Kim S,Kratchman S.Modern endodontic surgery concepts and practice:a review[J].J Endod,2006,32(7):601-623.
[42]Song M,Jung IY,Lee SJ,et al.Prognostic factors for clinical outcomes in endodontic microsurgery:a retrospective study[J].J Endod,2011,37(7):927-933.
[43]Lui JN,Khin MM,Krishnaswamy G,et al.Prognostic factors relating to the outcome of endodontic microsurgery[J].J Endod,2014,40(8):1071-1076.
[44]Choi YH,Bae JH,Kim YK,et al.Clinical outcome of intentional replantation with preoperative orthodontic extrusion:a retrospective study[J].Int Endod J,2014,47(12):1168-1176.
[45]李雪,贾春蓉,赵晓曦.四手操作应用于意向性牙再植术的护理探讨[J].国际口腔医学杂志,2016,43(4):409-411.
[46]Dorow C,Krstin N,Sander FG.Experiments to determine the material properties of the periodontal ligament[J].J Orofac Othop,2002,63(2):94-104.
[47]Bader HI.Treatment planning for implants versus canal therapy:a contemporary dilemma[J].Implant Dent,2002,11(3):217-223.
[48]Dawaon AS,Cardaci SC.Endodntics versus implantology:to extirpate or integrate?[J].Aust Endod J,2006,32(2):57-63.
[49]Torabinejad M,Goodacre CJ.Endodontic or dental implant therapy:the factors affecting treatment planning[J].J Am Dent Assoc,2006,137(7):973-977.
[50]Torabinejad M,Dinsbach NA,Turman M,et al.Survival of intentionally replanted teeth and implant-supported single crowns:a systematic review[J].J Endod,2015,41(7):992-998.
[51]Zitzmann NU,Krastl G,Hecker H,et al.Strategic considerations in treatment planning:deciding when to treat,extract,or replace a questionable tooth[J].J Prosthe Dent,2010,104(2):80-91.
[2]Stuart CH,Schwartz SA,Beeson TJ,et al.Enterococcus faecalis:its role in root canal treatment failure and current concepts in retreatment[J].J Endod,2006,32(2):93-98.
[3]R??as IN,Siqueira Jr JF,Santos KRN.Association of enterococcus faecalis with different forms of periradicular diseases[J].JEndod,2004,30(5):315-320.
[4]皮根丽,尹仕海.根管治疗期间急症的相关因素及防治[J].华西口腔医学杂志,2004,22(6):471-473.
[5]Nair PN,Henry S,Cano V,et al.Microbial status of apical root canal system of Human mandibular first molars with primary apical periodontitis after“one-visit”endodontic treatment[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2005,99(2):231-252.
[6]Degemess RA,Bowles WR.Dimension,anatomy and morphology of the mesiobuccal root canal system in maxillary molars[J].JEndod,2010,36(6):985-989.
[7]Wolcott J,Ishley D,Kennedy W,et al.A 5 yr clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars[J].J Endod,2005,31(4):262-264.
[8]Zitzmann NU,Krastl G,Hecker H,et al.Endodontics or implants?A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions[J].Int Endod J,2009,42(9):757-774.
[9]Gomes AC,Nejaim Y,Silva AIV,et al.Influence of endodontic treatment and coronal restoration on status of periapical tissues:a cone-beam computed tomographic study[J].J Endod,2015,41(10):1614-1618.
[10]Song M,Kim H,Lee W,et al.Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery[J].J Endod,2011,37(11):1516-1519.
[11]Schwartz RS,Robbins JW.Post placement and restoration of endodontically treated teeth:a literature review[J].J Endod,2004,30(5):289-301.
[12]Ng YL,Mann V,Rahbaran S,et al.Outcome of primary root canal treatment:systematic review of the literature.Part 2.Influence of clinical factors[J].Int Endod J,2008,41(1):6-31.
[13]Gillen BM,Looney SW,Gu LS,et al.Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment:a systematic review and metaanalysis[J].J Endod,2011,37(7):895-902.
[14]Pratt I,Aminoshariae A,Montagnese TA,et al.Eight-year retrospective study of the critical time lapse between root canal completion and crown placement:its influence on the survival of endodontically treated teeth[J].J Endod,2016,42(11):1598-1603.
[15]Azim AA,Griggs JA,Huang GTJ.The tennessee study:factors affecting treatment outcome and healing time following nonsurgical root canal treatment[J].Int Endod J,2016,49(1):6-16.
[16]Carratu P,Amato M,Riccitiello F,et al.Evaluation of leakage of bacteria and endotoxins in teeth treated endodontically by two different techniques[J].J Endod,2002,28(4):272-275.
[17]Nudera WJ.Selective root retreatment:a novel approach[J].JEndod,2015,41(8):1382-1388.
[18]Schwendicke F,Stolpe M.Secondary treatment for asymptomatic root canal treated teeth:a cost-effectiveness analysis[J].JEndod,2015,41(6):812-816.
[19]Torabinejad M,Corr R,Handysides R,et al.Outcomes of nonsurgical retreatment and endodontic surgery:a systematic review[J].J Endod,2009,35(7):930-937.
[20]Duncan HF,Chong BF.Removal of root filling materials[J].Endod Topics,2011,19:33-57.
[21]Magalhaes BS,Johann JE,Lund RG,et al.Dissolving efficacy of some organic solvents on gutta-percha[J].Braz Oral Res,2007,21(4):303-307.
[22]Colaco AS,Pai VA.Comparative evaluation of the efficiency of manual and rotary gutta-percha removal techniques[J].J Endod,2015,41(11):1871-1874.
[23]Iriboz E,Sazak OH.Comparison of ProTaper and Mtwo Retreatment systems in the removal of resin-based root canal obturation materials during retreatment[J].Aust Endod J,2014,40(1):6-11.
[24]Marfisi K,Mercade M,Plotino G,et al.Efficacy of three different rotary files to remove gutta-percha and Resilon from root canals[J].Int Endod J,2010,43(11):1022-1028.
[25]Somma F,Cammarota G,Plotino G,et al.The effectiveness of manual and mechanical instrumentation for the retreatment of three different root canal filling materials[J].J Endod,2008,34(4):466-469.
[26]Zou L,Shen Y,Li W,et al.Penetration of sodium hypochlorite into dentin[J].J Endod,2010,36(5):793-796.
[27]Marending M,Luder H,Brunner T,et al.Effect of sodium hypochlorite on human root dentine-mechanical,chemical and structural evaluation[J].Int Endod J,2007,40(10):786-793.
[28]冯瑞明,薛明.根管内感染控制的难点及策略[J].中国实用口腔科杂志,2017,10(4):202-206.
[29]Soares JA,Roque de Carvalho MA,Cunha Santos SM,et al.Effectiveness of chemomechanical preparation with alternating use of sodium hypochlorite and EDTA in eliminating intracanal Enterococcus faecalis biofilm[J].J Endod,2010,36(5):894-898.
[30]Ordinola-Zapata R,Bramante CM,Aprecio RM,et al.Biofilm removal by 6%sodium hypochlorite activated by different irrigation techniques[J].Int Endod J,2014,47(7):659-666.
[31]Wang Z,Shen Y,Haapasalo M.Effectiveness of endodontic disinfecting solutions against young and old Enterococcus faecalis biofilms in dentin canals[J].J Endod,2012,38(10):1376-1379.
[32]Vizzotto MB,Silveira PF,Arús NA,et al.CBCT for the assessment of second mesiobuccal(MB2)canals in maxillary molar teeth:effect of voxel size and presence of root filling[J].Int Endod J,2013,46(9):870-876.
[33]Silva EJ,Nejaim Y,Silva AI,et al.Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomogmphic imaging:an in vivo study[J].J Endod,2014,40(2):173-176.
[34]Nur BG,Ok E,Altunsoy M,et al.Root canal morphology analysis of maxillary permanent first and secound molars in a southeastern turkish population useing cone beam computed tomography[J].Eur J Dent,2014,8(2):154-159.
[35]Siew K,Lee AHC,Cheung GSP.Treatment outcome of repaired root perforation:a systematic review and meta-analysis[J].JEndod,2015,41(11):1795-1804.
[36]Madarati AA,Hunter MJ,Dnmmer PM.Management of intracanal separated instruments[J].J Endod,2013,39(5):569-581.
[37]高原,徐佳蕾,杨倩,等.根管内分离器械的处理评估与取出策略[J].国际口腔医学杂志,2016,43(3):249-259.
[38]冯瑞明,薛明.镍钛器械分离的影响因素及防治策略[J].中国实用口腔科杂志,2018,11(4):193-199.
[39]El Karim I,Kennedy J,Hussey D.The antimicrobial effects of root canal irrigation and medication[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2007,103(4):560-569.
[40]Su L,Gao Y,YuC,et al.Surgical endodontic treatment of refractory periapical periodontitis with extraradicular biofilm[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2010,110(1):40-44.
[41]Kim S,Kratchman S.Modern endodontic surgery concepts and practice:a review[J].J Endod,2006,32(7):601-623.
[42]Song M,Jung IY,Lee SJ,et al.Prognostic factors for clinical outcomes in endodontic microsurgery:a retrospective study[J].J Endod,2011,37(7):927-933.
[43]Lui JN,Khin MM,Krishnaswamy G,et al.Prognostic factors relating to the outcome of endodontic microsurgery[J].J Endod,2014,40(8):1071-1076.
[44]Choi YH,Bae JH,Kim YK,et al.Clinical outcome of intentional replantation with preoperative orthodontic extrusion:a retrospective study[J].Int Endod J,2014,47(12):1168-1176.
[45]李雪,贾春蓉,赵晓曦.四手操作应用于意向性牙再植术的护理探讨[J].国际口腔医学杂志,2016,43(4):409-411.
[46]Dorow C,Krstin N,Sander FG.Experiments to determine the material properties of the periodontal ligament[J].J Orofac Othop,2002,63(2):94-104.
[47]Bader HI.Treatment planning for implants versus canal therapy:a contemporary dilemma[J].Implant Dent,2002,11(3):217-223.
[48]Dawaon AS,Cardaci SC.Endodntics versus implantology:to extirpate or integrate?[J].Aust Endod J,2006,32(2):57-63.
[49]Torabinejad M,Goodacre CJ.Endodontic or dental implant therapy:the factors affecting treatment planning[J].J Am Dent Assoc,2006,137(7):973-977.
[50]Torabinejad M,Dinsbach NA,Turman M,et al.Survival of intentionally replanted teeth and implant-supported single crowns:a systematic review[J].J Endod,2015,41(7):992-998.
[51]Zitzmann NU,Krastl G,Hecker H,et al.Strategic considerations in treatment planning:deciding when to treat,extract,or replace a questionable tooth[J].J Prosthe Dent,2010,104(2):80-91.