下顎小臼齒開放型牙根之治療－病例報告

Treatment of Mandibular Premolars with Immature Open Apex-Cases Report

張淑芳(Shu-Fang Chang)

《中華民國家庭牙醫學雜誌》 8卷1期 (2013/06) Pp. 41-48

https://doi.org/10.6566/JFD/2013.8(1).41

摘要

開放型牙根的特徵是根尖開口很大，在x光片上可以看很薄的根管壁，很短的牙根以及開展的根尖。這類型的牙齒一旦受到感染，常常會造成牙本質形成中斷以致根管壁太薄或是牙根無法繼續生成而導致牙齒斷裂。因為常發生於學齡期的兒童，造成許多治療上的困擾。本文報告之病例為雙側開放型牙根之下顎小臼齒先後因牙齦腫脹伴隨牙髓壞死而進行根尖生成/成形術。一側置放氫氧化鈣引導硬組織生成，使牙根繼續生長；另一側則使用三氧礦化物（mineral trioxide aggregate, MTA）當成人工根尖屏障，經過長期的追蹤，牙根增長、根尖病變癒合且根尖閉合，兩種術式顯示良好的治療結果。由於這類病例常發生在發育尚未完全成熟的恆牙牙根，所以治療時要更保守且謹慎小心。

關鍵字

開放型牙根 ； 三氧礦化物 ； 根尖生成/形成術

並列摘要

It is difficult to treat the young permanent tooth with a necrotic pulp and an incompletely developed root. Not only the root canal system is often difficult to fully debride, but the thin dentinal wall increases the risk of root fracture. This case report included two necrotic immature permanent lower premolar teeth treated by using conservative endodontic procedures with 2.5% NaOCl irrigation. One tooth treated longterm, the gutta-percha points were filled onto the Ca(OH)2-induced hard tissue barrier in the root canal. The other tooth treated short-term, the gutta-percha points were filled onto an artificial barrier of mineral trioxide aggregate (MTA). We found that all apical lesions showed complete resolved. All necrotic immature permanent teeth achieved continues root development and close apex. We concluded that immature permanent teeth with pulp necrosis and apical pathosis can achieve good prognosis after proper short-term or long-term regenerative endodontic treatment procedures.

並列關鍵字

open apex ； MTA ； Apexogenesis/Apexification