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目的:分析应用显微超声技术结合CBCT检查对上颌第一磨牙MB2根管再治疗的临床效果。方法:选择89颗上颌第一磨牙进行显微超声根管再治疗病例,将CBCT的检查结果作为金标准,并依据CBCT影像特征及牙冠与髓底的形态特点判断是否存在MB2,术中采用斜方形开髓入口,小号K锉探查,使用手术显微镜定位MB2根管,镍钛机用根管锉冠向下法预备根管,1.5%次氯酸钠和17%EDTA冲洗根管系统,采用热牙胶垂直加压充填根管,记录近颊根根管分型、根管预备过程中并发症的情况,统计MB2的发现率及根管形态,评价其临床疗效。结果:89颗患牙根管再治疗中,在根管显微镜下去除原根管充填物,并探查MB2,发现MB2 72个。发现率为80.89%(72/89),疏通61个,疏通率68.54%。近颊根双根管以2-1型、2-2型较常见(67.42%)。治疗过程中未发生器械折断、管壁侧穿等并发症,有8个根管超填,6个根管欠填。结论:上颌第一磨牙MB2的发生率高,多数根管细小弯曲,小号K锉配合EDTA疏通根管,应用显微超声技术结合CBCT探查,有意识地寻找和可视化操作,能有效地提高上颌第一磨牙MB2的发现率及根管治疗成功率。
OBJECTIVE: To analyze the clinical effect of using microscopic ultrasonography combined with CBCT in the re-treatment of maxillary first molar MB2 canal. Methods: Eighty-nine maxillary first molars were selected for microsurgical root canal re-treatment. The results of CBCT were taken as the gold standard. According to the features of CBCT and the characteristics of the crown and the medullary fundus, the presence or absence of MB2 was determined. Oblique square open pulp entrance, small K file exploration, the use of surgical microscope positioning MB2 root canal, nitinol with the root canal file coronal down preparation of root canal, 1.5% sodium hypochlorite and 17% EDTA irrigation root canal system, the use of hot teeth The vertical pressure filling rubber root canal, recording the type of the buccal root canal, root canal complications in the process of preparation, statistics MB2 detection rate and root canal morphology, evaluate its clinical efficacy. RESULTS: Of the 89 teeth treated with root canal re-treatment, the root canal filling was removed under the root canal microscope and 72 MB2 were detected. The discovery rate was 80.89% (72/89), dredging 61, dredging rate of 68.54%. The double buccal root canal type 2-1, 2-2 type more common (67.42%). There were no complications such as device breakage and side wall wear during treatment. There were 8 root canal overfilling and 6 root canal underfilling. Conclusion: The incidence of MB2 in the maxillary first molar is high, most of the canals are small and bended. The small K-file with EDTA dredges the root canal. Using microscopic ultrasound combined with CBCT exploration, consciously looking for and visualizing the operation can effectively improve the maxillary The discovery rate of a molar MB2 and the success rate of root canal therapy.