摘要
牙齒疼痛的反應，可能是告訴我們這顆牙齒需要進行根管治療，或者是宣告之前的根管治療已經失敗。因此要預防根管治療中與治療後造成的疼痛是牙醫師與病患的共識，適當的局部麻醉雖可排除療程中大部分的疼痛，然而根管治療後偶會有相當不舒服的經驗。本研究的目的是要探討根管充填後疼痛的發生與其他因素如根尖病灶(apical lesion)之大小、年齡、性別、牙齒部位、及根管充填的緻密程度、回診時間、操作者、治療前症狀等的相關性。收集自西元 2000年10月至2001年12月間，根管充填後大部分約三至四星期至台大牙髓病科之回診病患共計482位583顆牙齒，假使疼痛繼續存在，回診時間則繼續到症狀消失為止，記錄上述因素並用Chi-square方法加以統計、分析，並用Logistic regression model進一步深入探討這些相關因素真實原因何在。本研究發現疼痛與年齡、性別、牙齒部位、及根管充填的緻密程度等較無相關性，不具有統計上的意義(P>0.01)，而若就根管充填個別程度如充填過度、充填不足、充填可接受、充填良好與疼痛的相關性作比較，卻具有統計上的意義(P<0.01)。而根管充填後疼痛與牙齒有根尖病灶相的關性作比較，而具有統計上的意義(P<0.01)。同時也發現當瘻管存在時，或在下顎前牙區域，疼痛極少發生。年齡小於20歲，根管充填後發生疼痛的情形最少，在41歲至50歲的這個年齡層牙齒數量佔最多，而疼痛佔有率(百分比)方面則以60歲以後佔最大。當發現牙根尖有出現骨質喪失(apical bone loss)的時候就應該把這顆牙齒當作是已經受到感染的牙根來看待，而當有這種牙齒出現而必須進行根管治療時，引起嚴重急性發炎反應發生的機會很大，因為在根管治療操作過程中，容易把存在管內的細菌或細菌的產物推向根尖。治療前出現的症狀與充填後產生的疼痛有著密切的關聯性，且具有統計上的意義(P<0.001)，根管充填後的疼痛並未在一個月以內全部消失，相反的疼痛的症狀部分持續到半年以上。牙齒治療前若有症狀，必須注意充填後極大可能會發生疼痛的現象，尤其牙齒有根尖病灶時，根管充填後疼痛的發生必然增加。
關鍵字
根管充填後疼痛並列摘要
The aim of this study was to investigate whether certain factors such as patient’s age and sex, size of apical lesion, tooth arch, tooth position, tooth number, quality of root canal filling, initial symptom/sign, operator and recall time were associated with post-obturation pain. A follow-up study of patients who had undergone root canal obturation procedures was done over a 14- month period from October 2000 to December 2001. In this study, most of the patients were returned to (National Taiwan University Hospital (NTUH) endodontic department for follow-up study within three to four months after root canal filling. This study included a total of 482 patients involving583 teeth. Patients with the presence of pain were placed in periodic follow up until the symptom/sign subside. The influencing factors which include size of apical lesion, age, sex, tooth arch, tooth position, tooth number, quality of root canal filling and post-obturation pain were statistically analyzed by Chi-square (P<0.01) and Logistic regression was used to evaluate their relationships with pain. As a result, the size of the apical lesion and post-obturation pain were significantly correlated. It was also found that the incidence of post-obturation pain was rare when procedures were done on mandibular anterior teeth and when fistula was present. In addition, patients below the age of twenty were reported to have less pain than those between the age of forty and fifty. Teeth which showed apical bone loss must be assumed to have infected root canals; therefore, the higher incidence of severe acute reaction in these cases could be explained by presence of bacteria or their by products which may have been forced into the periradicular region during instrumentation procedures. In conclusion, the initial symptom/sign was significantly correlated with post-obturation pain. Finally, but not surprisingly, the longer the follow-up period, the fewer the clinical symptoms that may be found in the patients.