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应用牙科手术显微镜和锥形束CT评估
下颌第二磨牙C形根管患病率

一项关于印度西马哈拉施特拉地区下颌第二磨牙C形根管患病率与形态学特征的体内研究翻译

📄 Cureus 2024, 16(6), e62026 ✍️ Shaikh S, Patil AG, Kalgutkar VU, et al. 📅 2024年6月9日 🏛️ 印度DY帕蒂尔牙科学院等
摘要

背景

了解根管解剖变异，特别是C形根管，对于成功的牙髓治疗至关重要。本研究采用临床和影像学方法评估印度西马哈拉施特拉地区下颌第二磨牙C形根管的患病率和特征。

材料与方法

本研究为前瞻性研究，纳入需要行下颌第二磨牙牙髓治疗的患者。临床评估使用牙科手术显微镜和锥形束CT（CBCT）成像。纳入和排除标准确保选择聚焦且同质的样本。数据分析包括单侧/双侧发生情况评估、根管分布和横截面特征。

结果

在200颗下颌第二磨牙中，7.5%呈现C形根管，无显著性别差异。根管分布在冠方、中部和根尖三个水平存在差异，常见构型为C1、C2、C3和C4。基于根管水平的根管分布无显著差异。根面沟的存在未见显著性别差异。

结论

本研究为印度西马哈拉施特拉地区下颌第二磨牙C形根管的患病率和特征提供了有价值的见解。进一步研究组织学和遗传学方面可加深我们的理解，从而改善复杂根管解剖变异的治疗策略。

关键词：种族群体，根管变异，根管构型，牙髓治疗，根管解剖，锥形束CT（CBCT），下颌第二磨牙，C形根管

1. 引言

了解根管解剖及其在种族群体间的变异对于成功的牙髓治疗至关重要。一个重要的解剖变异是C形根，由赫特维希上皮根鞘未能在舌侧或颊侧根面融合形成C形根管所致[2,3]。这种变异的特点是一个鳍状或桥状结构连接各个根管，在根管口处形成"C"字形[2,4]。C形根管最常见于下颌第二磨牙，在亚洲人群中患病率更高[4]。本前瞻性研究旨在利用牙科手术显微镜和CBCT评估印度西马哈拉施特拉地区下颌第二磨牙C形根管的比例和特征。

2. 材料与方法

本前瞻性研究在印度马哈拉施特拉邦马尔卡普尔的克里希纳医学科学研究院牙科学院进行，涉及18个月内前来接受下颌第二磨牙牙髓治疗的100例患者（200颗牙齿）。研究方案获得伦理委员会批准。纳入标准为需要行下颌第二磨牙牙髓治疗、根尖完全形成且无既往根管治疗者。排除标准包括根尖未发育完全、根折、根面裂纹、解剖异常、根龋、根吸收等。评估使用牙科手术显微镜和CBCT进行。根管预备后使用热牙胶充填，根据Melton等[7]的分类进行分型。

3. 结果

200颗下颌第二磨牙中识别出15个C形根管（7.5%），来自8名男性和7名女性。女性双侧42.86%、单侧57.14%；男性双侧25%、单侧75%（p=0.4645，无显著差异）。根管构型分布：冠方和中部以C1最常见（40%），根尖以C3最常见（40%），C4在根尖增加至26.6%。但各水平间无显著差异（p>0.05）。根面沟以舌侧最常见（66.67%），性别间无显著差异（p=0.3328）。

4. 讨论

C形根管在不同地区的患病率存在显著差异：沙特7.90%、巴西15.30%、韩国36.80%-40%、中国38.60%、葡萄牙8.50%、希腊10.80%、伊拉克17.40%、委内瑞拉19.50%、印度9.70%、土耳其8.90%。本研究（7.50%）与沙特、葡萄牙接近，低于亚洲其他地区[12-23]。本研究中C形根管主要采用Fan等（2004）分类[4]。在治疗方面，C形根管的识别需结合多角度X线片和CBCT[50]。开髓洞形制备是成功关键，手术显微镜可提高效率[51,52]。清洁时应关注峡部、槽和鳍作为细菌储库[3,57,58]。根管充填可采用冷侧压或热垂直加压技术[61]。因根管壁厚度限制，通常不建议放置桩[60,63]。根管治疗失败时建议拔除、根尖倒充填或意向性再植。

局限性：样本量较小且局限于西马哈拉施特拉地区，横断面设计无法建立因果关系，缺乏纵向随访。

5. 结论

本研究显示印度西马哈拉施特拉地区下颌第二磨牙C形根管患病率为7.5%，无显著性别差异。CBCT和牙科显微镜增强了对这种复杂根管形态的可视化，有助于更准确的诊断和治疗计划制定。未来研究应关注遗传和发育因素，并进行纵向研究以评估不同治疗方式的临床结局。

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