上颌窦对上颌后牙显微根尖手术的影响

显微根尖手术是临床上保存牙髓根尖周病患牙的有效手段之一,也是治疗其疑难病例的必备技术。但由于位置靠后操作空间狭小、根尖与上颌窦毗邻,导致在上颌后牙区进行根尖外科手术仍存在一定挑战。本文就上颌窦与上颌后牙解剖关系、对显微根尖手术影响以及辅助技术如:3D打印手术导板、超声骨刀等在上颌后牙区手术中的应用进行总结。文献复习结果表明,上颌后牙根尖与上颌窦空间关系通常分3类:根尖突进上颌窦底;根尖与上颌窦底相接触;根尖和上颌窦底之间有间隙或空间。术前CBCT检查后结合患牙根尖周和上颌窦状态以及根尖病损到上颌窦距离评估手术难度,术中应用导板、内窥镜、超声骨刀等以使手术更加安全可靠和精准微创,但后者在临床上的普及仍需进一步推广。目前尚缺乏高质量的上颌后牙区现代显微根尖手术长期疗效的临床研究。

The influence of the maxillary sinus on maxillary posterior tooth endodontic microsurgery

Endodontic microsurgery is one effective method for preserving teeth affected by periapical disease,and is also an essential technique for treating difficult cases.However,due to the restricted operating space at the posterior site and the proximity of the root apex to the maxillary sinus,endodontic surgery in the posterior maxillary area repre?sents great challenges.This article summarizes the anatomical relationship between the maxillary sinus and the maxil?lary posterior teeth,the influence on endodontic microsurgery,and the application of assistive techniques on maxillary posterior teeth,such as 3D?printed surgical guides and ultrasonic osteotomes.Literature review results show that the spa?tial relationship between the apex of maxillary posterior teeth and the maxillary sinus is usually divided into three cate?gories:the apex enters the maxillary sinus;the apex contacts the bottom of the maxillary sinus;and there is a distance between the apex and the bottom of the maxillary sinus.CBCT should be performed before the operation,and the peri?apical state of the tooth and the maxillary sinus and the distance between the lesions and the sinus floor should be con?sidered to evaluate the difficulty of the operation.Meanwhile,during surgery,equipment such as surgical guides,endo?scopes and ultrasonic osteotomes should be used to ensure that the operation is safer,reliable,precise and less invasive,but the clinical popularity of ultrasonic osteotomes still needs further promotion.Moreover,high?quality clinical studies on the long?term effects of micro?apical surgery in the posterior maxillary area are still lacking.