乳磨牙龋源性牙髓炎的根分叉异常表现(附24例术后分析)

　　〔摘要〕　目的：观察龋源性乳磨牙牙髓炎的根分叉异常表现及其活髓切断术后疗效分析。方法：对临床诊断为慢性牙髓炎、慢性牙髓炎急性发作的24例29个下颌乳磨牙行活髓切断术，摄取术前X线片，冠髓组织进行病理学检查。半年、1年定期复查。结果：牙髓组织炎症的患牙绝大多数X线片均显示其根分叉处骨组织的异常表现。术后1年除3例外，X线片显示根分叉处异常现象消失。半年、1年后疗效明显。结论：乳磨牙牙髓炎症常常伴发根分叉下方的根周组织感染。乳磨牙活髓切断术后需定期拍摄X线片复查。

Abnormality of the furcation in deciduous molar with carious pulpitis: Observation of 24 cases after pulpectomy

Wang Xiaojing,Wen Lingying,Dong Shaozhong,et al.Department of Pediadontology,Stomatological College,Fourth Military Medical University,Xi\an,710032

　　〔Abstract〕 Objective:To observe the changes of furcation in deciduous molar with carious pulpitis and the effecfs of pulpectomy,Method:Pulpectomy followed by calvital pulp capping was performed in 29 mandibular deciduous molars of 24 cases diagnosed as chronic pulpitis and acute exacerbation of chronic pulpitis.The cronal pulps were examined pathologically. X-ray photographs of the treated teeth were taken before,6 months and one year after the treatment respectively.Results:The destruction of alveolar bone around the furcation was positively correlated with the inflammation of the pulp tissue in most cases.One year after treatment,the abnormal changes around furcation disappeared in 26 out of the 29 molars.Conclusion:Deciduous molar pulpitis is always associated with inflammation in the bone tissue around furcation.Pulpectomy is effective in the treatment and it is necessary to examine with X-ray film at regular intervals after treatment.

　　Key words Deciduous tooth;Pulpotomy;X-ray film

　　牙髓炎是龋病的常见并发症。龋源性乳磨牙牙髓炎是当前常见的儿童口腔疾病之一。由于乳磨牙髓底部位的解剖结构特殊，例如硬组织较薄，侧、副根管较多等，使牙髓炎症常常伴发根分叉下方的根周组织感染，往往牙髓尚未坏死，即可引起根分叉部位的异常表现〔1〕。以往的研究多在乳磨牙尖周炎症及其周围牙槽骨破坏程度上探讨，对乳磨牙牙髓炎症时根分叉部位的异常改变研究较少。本文将炎症牙髓的组织病理学与X线的根分叉异常表现进行对比研究，旨在探讨两者间的相互关系，并对其活髓切断术后半年、1年的临床疗效进行分析。

　　1　临床资料与方法

　　1.1　一般资料

　　患儿24例29个牙，其中男14例16个牙，女10例13个牙，年龄3～8.5岁，牙根处于稳定期，即从乳磨牙牙根形成到开始吸收这一时期。为便于X线观察，临床均选用下颌第一、二乳磨牙。就诊时详细询问病史，常规口腔检查，依据患龋时间、疼痛程度和疼痛性质等判定慢性牙髓炎或慢性牙髓炎急性发作诊断，施行切髓术治疗。局麻下去尽龋，制备洞型，揭开髓室顶，用锐利挖匙于根管口处切除冠髓，切下的冠髓组织立即置入体积分数为10%福尔马林液中，随后常规制作组织切片，光镜下观察。用生理盐水反复冲洗，干棉球压迫止血后，置Calvital盖髓剂，氧化锌丁香油水门汀、磷酸锌水门汀基底，银汞合金充填。所有患牙均于术前、术后摄取X线片，并嘱定期复查，观察疗效。

　　1.2　病理学诊断

　　慢性牙髓炎　牙髓组织中血管轻度扩张、充血、渗出，并有淋巴细胞、中性粒细胞、浆细胞等炎性细胞浸润。

　　慢性牙髓炎急性发作　除与慢性牙髓炎相似的病理变化外，局部血管明显扩张、充血、渗出，浸润的炎性细胞中以中性粒细胞为多。