Bucchi Cristina, Gimeno-Sandig Alvaro, Manzanares-Céspedes Cristina
a Department of Patology and Experimental Terapeuthics , Universidad de Barcelona , Barcelona , Spain.
b Department of Integral Adult Dentistry , CICO Research Centre, Universidad de La Frontera , Temuco , Chile.
Acta Odontol Scand. 2017 Oct;75(7):488-495. doi: 10.1080/00016357.2017.1344877. Epub 2017 Jul 5.
In the last few years there have been attempts to revascularize mature necrotic teeth instead of performing a standard root canal treatment. Apical foramen enlargement (AFE) would be necessary for regenerative treatments of mature teeth. In the literature, AFE has been made through apicoectomy and instrumentation. However, no standardized methods have been described yet, which may affect the success of the therapy. Our aim was to describe the effectiveness and damage to dental structures of five methods for AFE.
Two hundred and ten human teeth were assigned to one control group (n = 10) and four treatment groups (n = 50 each): instrumentation was up to file #80 0.5 mm coronal to the apex (I), at apex level (II), 0.5 mm beyond the apex (III) and apicoectomy at 2 and 4 mm from the apex (IV). The apical foramen diameter was measured before and after treatment. The formation of clinically visible fractures (CVF) and microcracks was analysed clinically and with ESEM, respectively. Thirty-two in situ sheep's teeth were also instrumented, to compare damage in in situ and ex vivo teeth.
The foramen diameter was augmented by 0.15, 0.47, 0.54 0.06 and 0.32 mm in human teeth of groups I, II, III, apicoectomy at 2 and 4 mm, respectively. CVF were more frequent as the working length was augmented. No statistical differences were found for microcrack formation. In situ teeth showed significantly less damage.
Instrumentation at apex level seems to be the most effective and least harmful technique for AFE, while apicoectomy is not a useful method.
在过去几年中，人们尝试对成熟的坏死牙齿进行血管再生，而非进行标准的根管治疗。对于成熟牙齿的再生治疗，根尖孔扩大术（AFE）是必要的。在文献中，AFE是通过根尖切除术和器械操作来完成的。然而，尚未描述标准化的方法，这可能会影响治疗的成功率。我们的目的是描述五种AFE方法对牙齿结构的有效性和损害。
将210颗人牙分为一个对照组（n = 10）和四个治疗组（每组n = 50）：器械操作分别至根尖上方0.5 mm处的80号锉（I组）、根尖水平（II组）、根尖下方0.5 mm处（III组）以及距根尖2和4 mm处的根尖切除术（IV组）。在治疗前后测量根尖孔直径。分别通过临床检查和环境扫描电子显微镜（ESEM）分析临床可见骨折（CVF）和微裂纹的形成情况。还对32颗原位羊牙进行了器械操作，以比较原位牙和离体牙的损害情况。
I组、II组、III组、距根尖2 mm处根尖切除术组和距根尖4 mm处根尖切除术组的人牙，根尖孔直径分别增加了0.15、0.47、0.54、0.06和0.32 mm。随着工作长度增加，CVF更常见。微裂纹形成方面未发现统计学差异。原位牙的损害明显更少。
根尖水平的器械操作似乎是AFE最有效且危害最小的技术，而根尖切除术不是一种有效的方法。
