使用錐狀射束電腦斷層輔助鈣化根管病例之非手術性根管治療：病例報告

Non-surgical Endodontic Treatment of Calcified Canal with Cone-beam Computed Tomography-A Case Report

梁瓊云(Chiung-Yun Liang) ； 左凱勻(Kai-Yun Tsuo)

《中華民國家庭牙醫學雜誌》 14卷3期 (2019/12) Pp. 35-40

https://doi.org/10.6566/JFD.201912_14(3).0005

摘要

牙髓組織的鈣化是很常見的，臨床上對於根管系統鈣化的治療則是個困難的議題。關於牙髓鈣化是否是與各種形式的損傷或自然現象相關的病理過程，目前沒有明確的證據。若發生嚴重鈣化的牙髓腔和根管系統，則可能在定位根管開口及後續根管治療上都會遇到問題，包括尋找不到根管開口、斷離器械、根管穿孔、及根管破洞等併發症。若遇到根管嚴重鈣化的牙齒，使用高倍率顯微鏡仔細地使用超音波器械去移除少量牙本質，及多角度的根尖X光片去確認根管工作長度，是目前被證明是最安全的方法。本病例為27歲女性患者，經各項診斷後右上顎正中門齒為牙髓壞死，及根管系統嚴重鈣化，因此安排後續錐狀射束電腦斷層評估。經過錐狀射束電腦斷層評估後，於高倍率的顯微鏡輔助超音波器械尋找到根管開口，並且經過充分清潔後進行根管充填，後續追蹤病人狀況良好。

關鍵字

錐狀射束電腦斷層 ； 鈣化根管

並列摘要

Calcification of pulp tissue is a common occurrence. In clinical practice, it's a challenging issue of treating the calcified canal system. There is no clear evidence as to whether pulp calcification is a pathologic process related to various forms of injury or a natural phenomenon. When the chambers and roots that demonstrate significant calcifications, it may present problems with locating canal orifices, separating instrument, perforating canals, and negotiating the pulpal spaces. Painstaking removal of small amounts of dentin with the aid of the high magnification, ultrasonic instrument and radiographic confirmation of multi-angle film for working length determination has proved to be the safest approach. We present a case of upper incisor with severe pulpal calcification. Due to severe calcified root canal system, we took cone-beam computed tomography (CBCT) evaluation. So we checked the tooth axis and chamber depth, and well debrided the root canal system with the aid of dental operative microscope (DOM) and ultrasonic instrument, we successfully finished the treatment and relived patient's discomfort.

並列關鍵字

calcified canal ； cone-beam computed tomography ； CBCT