von Arx T
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Berne, Berne, Switzerland.
Int Endod J. 2005 Mar;38(3):160-8. doi: 10.1111/j.1365-2591.2004.00915.x.
To analyse the occurrence of canal isthmuses in molars following root-end resection.
The material consisted of 56 mandibular and 32 maxillary first molars subjected to periradicular surgery. Based on radiographic, clinical, as well as intraoperative status, only roots with associated pathological lesions were treated. In total, 124 roots were resected (80 mandibular and 44 maxillary molar roots). The cut root faces were inspected with a rigid endoscope following apical root-end resection. The number of canals as well as the presence and type of canal isthmuses were recorded.
In maxillary first molars, 76% of resected mesio-buccal roots had two canals and an isthmus, 10% had two canals but no isthmus, and 14% had a single canal. All disto-buccal and palatal roots had one canal. In mandibular first molars, 83% of mesial roots had two canals with an isthmus. In 11%, two canals but no isthmus were present, and 6% demonstrated a single canal. Sixty-four per cent of distal roots had a single canal and 36% had two canals with an isthmus.
This clinical study during periradicular surgery and intraoperative endoscopic examination of first permanent molars found a high frequency of canal isthmuses at the resection level. Endoscopic inspection also demonstrated that none of the isthmuses were filled, emphasizing the difficulty of orthograde instrumentation and root filling of canal isthmuses.
分析根尖切除术后磨牙根管峡部的发生率。
材料包括56颗下颌第一磨牙和32颗上颌第一磨牙，均接受了根尖周手术。根据影像学、临床及术中情况，仅对伴有相关病理病变的牙根进行治疗。总共切除了124个牙根（80个下颌磨牙牙根和44个上颌磨牙牙根）。根尖切除术后，用硬式内窥镜检查牙根断面。记录根管数量以及根管峡部的存在情况和类型。
在上颌第一磨牙中，76%的切除近中颊根有两个根管和一个峡部，10%有两个根管但无峡部，14%有一个根管。所有远中颊根和腭根均有一个根管。在下颌第一磨牙中，83%的近中根有两个带峡部的根管。11%有两个根管但无峡部，6%有一个根管。64%的远中根有一个根管，36%有两个带峡部的根管。
这项关于第一恒磨牙根尖周手术及术中内窥镜检查的临床研究发现，在切除水平处根管峡部的发生率很高。内窥镜检查还表明，峡部均未充填，这突出了根管峡部顺行器械操作和根管充填的困难。
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