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目的 :评价上颌第一磨牙根管治疗疗效及其影响因素。方法 :回顾170颗诊断为牙髓炎、需行根管治疗的上颌第一磨牙,其中牙科手术显微镜下探查根管、Protaper机用镍钛器械根管预备、热牙胶垂直加压充填根管100颗;肉眼探查根管、Protaper机用镍钛器械根管预备、侧压法充填根管70颗。170颗牙术后行冠或桩冠修复。根据治疗前、后临床检查及X线片,综合充填长度和充填密度两方面,对根管充填质量和根管治疗疗效进行评价。采用Reversion 3.0.2软件包对数据进行统计学分析。结果:热牙胶垂直加压和侧压法充填根管在充填长度方面优良率分别达到93%、91.4%,两者无显著差异;热牙胶垂直加压充填在充填密度方面优良率达到96%,优于冷牙胶侧压法的84.3%,两者差异显著;2种方法的综合根管充填质量优良率分别达到91%、75.7%,差异显著。肉眼近颊第二根管(MB2)发现率为31.4%,根管显微镜下MB2发现率为55%,两者差异显著。热牙胶垂直加压和侧压法充填根管治疗术后5年临床成功率分别达到98%、81.4%,两者差异显著;术后5年热牙胶垂直加压法根管充填无论充填长度还是充填密度均无变化,稳定性好,维持高质量的根管充填,RCT优良率维持在91%;而侧压法根管充填长度无变化,但RCT优良率由75.7%下降为68.6%。术后5年无1例冠折。结论 :上颌第一磨牙根管形态复杂,根管显微镜有助于发现MB2。机用镍钛器械预备根管,热牙胶垂直加压充填上颌第一磨牙,无论充填长度还是充填密度,均可获得良好效果,上颌第一磨牙根管治疗术后应常规行冠或桩冠修复。
Objective: To evaluate the efficacy and influencing factors of root canal therapy in maxillary first molars. Methods: One hundred and seventeen maxillary first molars diagnosed as pulpitis underwent root canal treatment. The root canal was examined under a dental operation microscope, the root canal preparation was performed on a Ni-Ti Protaper machine, 100; exploration of the naked eye root canal, Protaper nickel-titanium instrument root canal preparation, lateral pressure method filling 70 root canal. 170 teeth after the crown or post crown repair. The quality of root canal filling and the effect of root canal treatment were evaluated according to the clinical examination, X-ray film, integrated filling length and filling density. Data was statistically analyzed using the Reversion 3.0.2 software package. Results: The excellent and good rates of hot dentin vertical filling and lateral filling filling of root canal were 93% and 91.4%, respectively. There was no significant difference between the two groups in filling length; %, Which is superior to 84.3% of collateral pressure of cold teethers. There is significant difference between the two methods. The excellent and good quality of the two methods are 91% and 75.7% respectively. The MB2 found on the buccal surface of the human eye was found to be 31.4%, and the MB2 was found to be 55% under the root canal microscope. The difference between the two was significant. The clinical success rates of hot denture vertical compression and lateral compression root canal treatment were 98% and 81.4% respectively after 5 years of operation, with a significant difference between the two groups The length of RCT and the filling density did not change, the stability was good and the quality of root canal filling was maintained. The excellent and good rate of RCT was maintained at 91%. However, the length of RCT did not change, but the rate of RCT decreased from 75.7% to 68.6% . No case of one case of coronary artery fracture after 5 years. Conclusion: The shape of root canal of the maxillary first molar is complex, and the root canal microscope is helpful to find the MB2. Machine with nickel-titanium equipment for root canal preparation, hot glue vertical pressure filling the maxillary first molar, regardless of filling length or filling density, can be obtained good results, maxillary first molar root canal treatment should be routine after the crown or pile repair.