2013年7月4日 星期四

Isolation with Temporary Crown in Root Canal Treatment


No rubber dam, no endodontics.是現今的共識。如果沒有rubber dam的根管治療,就如同未鋪無菌單的開刀房手術,治療結果將大打折扣。甚至有文獻指出,非專科醫師治療成功率低至五成,和無菌設備應當有直接的關係(專科醫師成功率可高達94%)。

但臨床上,牙齒破壞程度不一,總是有蛀牙到難以隔溼隔菌的狀況。若在rubber dam isolation不能完全時,其中一種選擇就是製作temporary crown,再reentry 重新開始open chamber,完成access opening。

Temporary crown輔助之isolation,臨床治療水平相當要求。為避免遺留感染源,事前需將已經蛀開的齒質做完整的清除,初步的open chamber,找到根管開口後並加以保護,再修型製作temporary crown。

這樣的方式需要專門的假牙科醫師協助,所有環節都要小心。若有以下的狀況都會導致失敗:

1,蛀牙沒有清除乾淨,遺留感染源。

2,coronal sealing沒有紮實,周邊滲漏。

3,coronal sealing選擇失當,材料崩解。

4,臨時牙冠空隙過大或不合,或黏著劑脫膠,導致沖洗液流出。

5,臨時牙冠修型不良,固持力不佳,療程(常需數次)中脫落。

若有以上狀況發生,幾乎就是要從頭開始。說會讓療程功虧一簣,進度歸零,其實也不為過。


[以下照片經患者同意,分享於豐采牙醫相關]


上圖箭頭可見,臨時假牙與齒質交接處。製作十分精密,完全貼合。看了真是敲感動的。


上圖箭頭可見,之前coronal sealing遺留的材料。完整留置,未崩潰鬆脫。


我只能說,有這麼好的假牙科醫師作為醫療團隊,真的是三生有幸阿~~

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