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目的观察恒磨牙与乳磨牙发生牙髓炎时并发根分叉病变的异同,以及活髓切断术后的疗效。方法选取本院2014年4月-2015年4月资料齐全,随访记录完整的42例牙髓炎病例,其中恒磨牙组21例,乳磨牙组21例。治疗前常规X线片检查,记录根分叉病变情况。局麻下开髓,常规制备洞型,揭开髓室顶,用锐利挖匙齐根管口处切除冠髓,切勿扯拉。用0.9%氯化钠溶液反复冲洗,去甲肾上腺素小棉球轻压片刻,将氢氧化钙糊剂覆盖于根管口根髓断面上,氧化锌丁香油糊剂暂封窝洞,勿加压,全程严格无菌操作。观察1周后复诊,若无症状永久充填。术后半年复查。结果 21例恒磨牙牙髓炎病例中发生根分叉病变1例(4.76%),治疗后无症状19例,轻度不适2例,未出现疼痛病例;21例乳磨牙牙髓炎发生根分叉病变19例(90.48%),治疗后无症状16例,轻度不适4例,疼痛1例。结论恒磨牙牙髓炎较少并发根分叉病变,经活髓切除术疗效好。而乳磨牙牙髓炎90%以上可引起根分叉病变,活髓切断术治疗效果相对较差。
Objective To observe the similarities and differences of root bifurcation lesions of permanent molars and deciduous molars when pulpitis occurs, and the curative effect after pulpotomy. Methods A total of 42 cases of pulpitis with complete molars and complete records were collected from April 2014 to April 2015 in our hospital, including 21 cases of permanent molar group and 21 cases of primary molar group. Pre-treatment routine X-ray examination, record the root bifurcation lesions. Local anesthesia under the open pulp, conventional preparation of the hole, opened the pulp chamber top, with a sharp digging spoon Qi root canal resection of the coronal, do not pull. Repeatedly rinsed with 0.9% sodium chloride solution, norepinephrine cotton balls gently pressed a moment, the calcium hydroxide paste covered root canal root marrow cross section, zinc oxide clove oil paste tentative temporary nest cavity, do not add Pressure, the entire strict aseptic operation. Referral 1 week after the referral, if permanent asymptomatic filling. Six months after the review. Results There were 1 case of root bifurcation in 21 cases of permanent tooth pulpitis (4.76%), asymptomatic in 19 cases, mild discomfort in 2 cases and no pain cases in 21 cases. Trigeminal lesions in 19 cases (90.48%), asymptomatic after treatment in 16 cases, mild discomfort in 4 cases, pain in 1 case. Conclusions There is less pulpitis in the permanent molars and root bifurcation lesions, and the curative effect is good after the pulpotomy. The deciduous pulpitis can cause more than 90% of the root bifurcation lesions, pulpotomy treatment results are relatively poor.