Jordan Rainer A, Markovic Ljubisa, Holzner Anna L, Richter Benjamin, Gaengler Peter
Department of Operative and Preventive Dentistry, Faculty of Dental Medicine, University of Witten/Herdecke, Witten, Germany.
Int Dent J. 2009 Jun;59(3):141-7.
Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under-served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow-up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care.
25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step-back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single-cone technique with gutta-percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively.
None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work.
Preliminary clinical follow-ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.
非创伤性修复治疗（ART）是社区牙科向前迈出的重要一步，但在全球服务不足地区，对于深龋病变或牙髓受累的治疗选择仍集中在拔牙上。为了弥合ART与拔牙之间的差距，这项试点研究旨在为冈比亚共和国（西非）农村牙科保健设施开发并随访一种基本的根管治疗方法，该地区面临缺乏技术设备且正在发展初级口腔保健的环境。
对25颗患有急性不可逆性牙髓炎的单根牙采用标准化的牙髓治疗器械套件和特定程序进行根管治疗。采用逐步后退技术，间歇性使用0.2%氯己定和生理盐水冲洗。使用牙胶采用单锥技术并使用格罗斯曼根管粘固剂进行根管充填。采用ART进行冠部充填。在治疗前、术后1天、5天、6个月和12个月记录临床检查情况。
由于术后并发症，没有根管充填需要修改。25颗牙齿中有9颗，短暂的根尖疼痛在几天后消失。6个月后，所有ART充填在临床上都可接受，有两颗充填需要校正。12个月后，四颗Ⅱ类修复体和三颗Ⅳ类修复体需要更换。患者对与健康相关的生活质量的评估有显著改善，尤其是在牙齿疼痛、咀嚼能力和工作适应性方面。
初步临床随访显示基本根管治疗方法的结果令人鼓舞。需要更大样本量的纵向临床研究来证实这些结果。冠部充填技术的改进更有利于提高扩展ART窝洞修复体的临床性能。
