根管治疗中器械分离的预后评估与处理决策

doi:10.3877/cma.j.issn.1674-1366.2025.06.002

器械分离是根管治疗中的常见并发症，其预后取决于根尖周状态及器械分离位置等多因素。活髓牙或无根尖周炎病例中，保留器械并严密充填通常预后良好；而在感染根管或存在根尖周炎时，器械取出及必要的牙髓外科干预更具意义。随着显微技术、超声、锥形束CT（CBCT）及人工智能等新兴手段的发展，器械分离的诊断与处理日益精细化，但仍需更多循证研究支持。本文以现有证据结合临床经验进行分析与归纳，以期为临床决策提供参考。

关键词: 根管治疗并发症, 器械分离, 治疗决策

Instrument separation is a common complication in endodontic treatment, and its prognosis depends on multiple factors, including the periapical status and the location of the separated instrument. In teeth with vital pulp or without periapical lesions, retaining the instrument followed by careful root canal obturation generally results in a favorable prognosis. In contrast, for infected canals or those with periapical periodontitis, instrument removal and, when necessary, endodontic surgical intervention are more clinically significant. With the development of advanced techniques such as dental microscopy, ultrasonics, cone-beam computed tomography (CBCT), and artificial intelligence, the diagnosis and management of separated instruments have become increasingly precise. Nevertheless, further evidence-based research is required. This article analyzes and summarizes the existing evidence in combination with clinical experience to provide a reference for clinical decision-making.

Key words: Endodontic complications, Instrument separation, Treatment decision-making

图1 器械分离的临床标准化决策流程图

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Prognosis assessment and management decisions for separated instruments in endodontic treatment

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Prognosis assessment and management decisions for separated instruments in endodontic treatment