Cotti Elisabetta, Esposito Stefano, Jacobs Reinhilde, Slagmolen Pieter, Bakland Leif K
Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.
Department Oral health Scienced, Head Oral Imaging center, Catholic University of Leuven, Leuven, Belgium.
Dent Traumatol. 2014 Oct;30(5):400-405. doi: 10.1111/edt.12064. Epub 2013 Sep 2.
A 24-year-old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone-beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4-5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1-year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.
一名24岁女性患者因腭部肿胀及22号牙面部窦道前来就诊。她自述15年前该牙受过伤，记不清是否接受过治疗，不过牙冠有根管治疗的迹象。影像学检查显示牙根似乎停止发育，且伴有较大的根尖周病变。在使用氢氧化钙（CH）进行3次根尖诱导成形术均失败后，进行了包括使用锥形束计算机断层扫描（CBCT）在内的进一步检查。CBCT有助于更好地评估病情，并为制定更全面的治疗方案（包括手术切除根尖病变）提供更好的规划。较大的透射区从21号牙延伸至23号牙。使用专门开发的与CBCT配套使用的软件工具，对病变进行了体积评估以跟踪愈合情况。从根尖方向用新研制的加速硅酸盐水泥对根尖进行充填，充填至根管根尖部分4 - 5毫米处。随后，根管其余部分也用同类型水泥充填。术后1年随访时，该牙无症状，使用CBCT体积测量程序可显示骨质愈合情况。
