Steinig Torsten H, Regan John D, Gutmann James L
Department of Endodontics, Texas A&M University System Health Science Center, Baylor College of Dentistry, Dallas, TX 75246, USA.
Aust Endod J. 2003 Apr;29(1):34-42. doi: 10.1111/j.1747-4477.2003.tb00496.x.
Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which to compact an interim dressing of calcium hydroxide (Ca(OH)2), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH)2-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through to completion. This may lead to ultimate failure of the case. Mineral Trioxide Aggregate (MTA) has recently been introduced for use in endodontics. Current literature supports its efficacy in a multitude of procedures including apexification. The focus of this paper is to propose a one-visit apexification protocol with MTA as an alternative to the traditional treatment practices with Ca(OH)2. One-visit apexification may shorten the treatment time between the patient's first appointment and the final restoration. The importance of this approach lies in the expedient cleaning and shaping of the root canal system, followed by its apical seal with a material that favours regeneration. Furthermore, the potential for fractures of immature teeth with thin roots is reduced, as a bonded core can be placed immediately within the root canal.
对根尖未发育成熟的无髓牙进行根管治疗对临床医生来说是一项特殊的挑战。遇到的主要困难是缺乏根尖止点，无法在此基础上压实氢氧化钙（Ca(OH)₂）临时敷料或最终的充填材料。在这些情况下，使用传统的（基于Ca(OH)₂的）根尖诱导成形技术时，结果的不可预测性、在治疗期间创建防漏临时修复体的困难以及保护薄壁牙根免于折断的困难可能会导致并发症。此外，鉴于当今社会人们流动性增加，冗长的治疗方案充满问题，可能无法坚持完成。这可能导致病例最终失败。三氧化矿物凝聚体（MTA）最近已被引入用于牙髓病学。当前文献支持其在包括根尖诱导成形在内的多种操作中的有效性。本文的重点是提出一种使用MTA的一次性根尖诱导成形方案，作为传统Ca(OH)₂治疗方法的替代方案。一次性根尖诱导成形可以缩短患者首次就诊与最终修复之间的治疗时间。这种方法的重要性在于对根管系统进行快速的清理和预备，随后用有利于再生的材料进行根尖封闭。此外，由于可以立即在根管内放置粘结核，薄壁未成熟牙齿折断的可能性降低。
