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锥形束计算机断层扫描作为多根管磨牙牙髓治疗的先进诊断辅助手段:两例病例报告。

Cone-beam computed tomography as advanced diagnostic aid in endodontic treatment of molars with multiple canals: Two case reports.

作者信息

Kamble Amit Pralhad, Pawar Rohini Rangarao, Mattigatti Sudha, Mangala T M, Makandar Saleem

机构信息

Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India.

出版信息

J Conserv Dent. 2017 Jul-Aug;20(4):273-277. doi: 10.4103/0972-0707.219194.

Abstract

The purpose of these case reports is to emphasize the importance of knowledge regarding the root canal morphology and current diagnostic aids one should have as both of these important factors going to affect the prognosis of the endodontic treatment. These two case reports describe the maxillary and mandibular first molars with multiple canals. After clinical and radiographic diagnosis, additional help of cone-beam computed tomography (CBCT) of mandibular molar has been taken to evaluate the morphology and canal pattern; while maxillary molar was evaluated using CBCT scan to evaluate the canal configuration and obturation. In CBCT evaluation, the mandibular molar was diagnosed with six separated canals with three mesial and three distal canals and with radix paramolaris and radix entomolaris. The maxillary molar had five canals with three mesiobuccal (MB) canals. Both molars were instrumented with conventional hand and rotary file systems and obturated by conventional lateral compaction method. The axial images from CBCT show Vertucci Type VIII canal pattern in both roots of first mandibular molars and in MB root of maxillary first molar Sert and Bayirli Type XVIII canal configuration and no accessory canal in distobuccal and palatal root. With the recent innovations in diagnostic and operating aids, we can come across many variations in the root canal morphology of both mandibular and maxillary teeth, especially multi-rooted one (i.e., molars), and the knowledge of which leads to successful endodontic treatment with an excellent prognosis.

摘要

这些病例报告的目的是强调了解根管形态和当前应具备的诊断辅助手段的重要性,因为这两个重要因素都会影响牙髓治疗的预后。这两个病例报告描述了上颌和下颌第一磨牙的多根管情况。经过临床和影像学诊断后,对下颌磨牙采用锥形束计算机断层扫描(CBCT)进行进一步辅助检查,以评估其形态和根管模式;而上颌磨牙则通过CBCT扫描来评估根管形态和充填情况。在CBCT评估中,下颌磨牙被诊断为有六条分离的根管,其中三条近中根管和三条远中根管,以及副磨牙根和远中磨牙根。上颌磨牙有五条根管,其中包括三条近中颊侧(MB)根管。两颗磨牙均采用传统的手动和旋转锉系统进行预备,并通过传统的侧向加压法进行充填。CBCT的轴向图像显示,下颌第一磨牙的两个牙根以及上颌第一磨牙MB根呈现Vertucci VIII型根管模式,远中颊根和腭根为Sert和Bayirli XVIII型根管形态,且无副根管。随着诊断和操作辅助手段的最新创新,我们会发现下颌和上颌牙齿,尤其是多根牙(即磨牙)的根管形态存在许多变异情况,了解这些知识有助于实现牙髓治疗的成功并获得良好的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1b0/5721512/cb89bca430d4/JCD-20-273-g001.jpg

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