Page 50 - 根管治療的美麗與哀愁 (貳部曲)

፭ృطᐕ๟ۆdމ 45 τɪዖͤღdᔫฐή࿁ନڿېΥࠦᝤݸdආБ᜖ഢ၊ݸක࢝f
ίᜑฆᗝ՘пɨdනлආɝ˴࣬၍ഢd஼Ӊ૶ৰᕦழٙ࣬̂يfீཀ൴ࠪتਗɢdε

ϣ᎖ᐿዧ᛻eݺʷәݹ૰ (NaOCl 5.25%, full strength)dΎ஼Ӊֻ࣬φ݄Бᓒ௴ձࡌҖ
(crown down - debridement coronal two-third first)f຅͟ᜑฆᗝᏨൖd᜖ഢʊೌ̙Ԉᔁ
يא׼ᜑဎओᕏሯdяତٙே݊૶ယ๓૰ܝdਗ਼әݹ૰ዢܓሜࠥϓɓছ੬ٙ͜ 2.5%d
ක֐࿁࣬φݬЪڋӉٙᓒ࢝ၾࡌҖ (initial apical third preparation)f຅ʃ໮ቛ০ (#10
file) уਗ਼ଉ༺ [ ׵طᐕක֐ۃהཫПϤ࣬၍ٙʈЪڗܓ (tentative working length, tWL)]

ࣛd[ ɰఱ݊๟௪ࠅਗ਼Ϥቛ০๞̈ (peeking through) З׵࣬φ၌ί༆࡚Җ࿒ɪהፗٙ॥
ᐵᓃ (apical constriction)] ࣛdतйΎਗ਼әݹ૰ዢܓሜࠥՑˇ׵ 1%dϾவሜࠥәݹ૰
ዢܓʘͦٙே݊ίซ˙ணجdᒒеᜫཀεٙәݹ૰ආɝ࣬φਜ኉ᅻ৶ʕdிϓ࿁Ϟዚ

ଡ଼ᔌٙෆ࢔d[ ϤࣩԷ༰तйdɗΪ࣬φषΊਜቌڐ⫄ग़຾ˆdவၾ࣬φ၌ʊ຾஗іϗ
(resorption)eॎᕸ (destruction or perforation)eא೯ԃ͊ҁΌ (immature or open apex)
ࣩٙԷ޴Νd຅࣬၍૶௴൳݊ટڐ࣬φݬࣛdܔᙄᏐ༈ቇܓሜࠥәݹ૰ዢܓ ]i߰݊ί
ర੬ࣩԷdɰఱ݊຅࣬φ೯ԃҁΌ٫d̥ࠅ݄ஔ٫͍ᆽή݄Б࣬၍૶௴dཀ೻ʕӚϞਗ਼
࣬φ̈ɹମЗ (transportation the canal opening)eאॎᕸࣛdԨʔცࠅeɰʔܔᙄνϤ

तจሜࠥәݹ૰ዢܓfϾ຅ʃ໮ቛ০̙˸නл๞̈࣬φ၌̈ɹdуڌͪʊɪஷɨ༺dᆽ
֛੻Ցə༈࣬၍ʊ຾ஷ࿫ (canal patency)dΝࣛ߰ঐΎ຾͟ X Έᅂ྅ᆽႩவ˕ʃ໮ቛ০d
ʊ຾ת༺ί׳࢛ᅂ྅ɪٙהፗ࣬၍ஷ༸୞ᓃ (radiographic terminus, RT, of the canal)d
ԟჿdҢࡁఱ੻Ցə࿁வࡈ࣬၍૶௴ၾࡌҖٙڋ֐ʈЪڗܓ (initial working length,

iWL)fϞᗫ݄ᅃ ᔼࢪܔᙄνО࿁࣬၍ʈЪڗܓЪඎ಻ʿ֛Зk ( ሗਞԈ˜ৎᇐ™ٙሞ
ࠑձʧୗf)
ટഹdҢࡁఱ̙˸ᎇːІίήίʔ൴ཀவࡈڋ֐ʈЪڗܓᇍఖʫd˸܆଄༶ਗ
(envelope of motion) ˓ج஼Ӊᓒ௴eࡌҖ዆ࡈ࣬၍˴ഢd( Ш˴ࠅʥ䋠ࠠί׵࿁ڿ௅ձ

ʕݬ௅Зٙක࢝ )dΝࣛίϤཀ೻ʕd݄ஔ٫੻ɓΎ౤፴Іʉცࠅࣛ੬Ϋ᎘͜࡝࡝ԟ˕
ʃ໮ቛ০dᆽႩԱᔚঐ੄౛છ੻И࣬၍ஷ࿫ (canal patency)dԨӚϞίʘۃה݄Б૶௴
ၾࡌҖٙ΂ɓචݬdʔ຅ήਗ਼Ϥ࣬၍ੁ෦əi౛છ˜࣬၍ஷ࿫™வ݊ɓࡈڢ੬୚ጰeɰ

݊ცࠅ޴຅ᑺӺeձІҢࠅӋٙ࣬၍૶௴฿ׂf( ߰ᛘ٫࿁ʘϞጳሳdሗ༉Ԉ˜וᇐ™
ٙሞࠑf)
ʘܝd຅್ఱ݊ࠅ࿁࣬φݬЪ௰ܝٙ૶௴ၾࡌҖfஷ੬dίطᐕක֐ۃd݄ஔ
٫ఱ੻މӊɓࡈ˫࣬ٙ࣬၍˴ഢdཫ΋ண֛ίՉ࣬φݬซࠅ༺ϓٙ࣬၍ࡌҖͦᅺ፿ܓ
(taper)f࿁ኹϞర੬ێྼܓٙ˫࣬dਗ਼Չ࣬φݬ၍ഢஷ༸ᓒ௴Ց፿ܓ˜ʬ™ܓ݊ਿ͉ࠅ

Ӌi˸͉ࣩԷ 45 வࡈ˫࣬ϾԊdΪՉێྼܓԑ੄d˲̥Ϟఊɓ࣬၍dΪϤ࿁Չ࣬φݬ
၍ഢٙᓒ࢝d௰λঐ༺Ց፿ܓɞeޟЇՑ༺፿ܓɤdேᒔঐટաi࿁ˢቌࣙ 46 ٙჃː
࣬၍dΪމɰ݊ఊɓ࣬၍dה˸຅ϋ࿁Չ࣬φݬٙᓒ௴dɰ݊༺ՑЇˇ፿ܓɤ˸ɪiˀ

ᝈ 46 ٙڐː ( Љਉ ) ࣬၍d͟׵຅ࣛʥೌجᆽ֛Չ࣬φݬ݊щॆ̥ٙϞਬɓٙ࣬၍ஷ༸d
ΪϤ̥݊ਗ਼Չᓒ௴Ї፿ܓʬdνʦ޶Ըdᙂ੻࿁Ϥ࣬φݬٙ၍ഢකᓒ೹෶ʔԑdཀ׵ᑛ
ࢮəԬfШ͟׵طᐕۃdࡡ͉ 46 ٙڐː࣬φԨೌ̈ତ׼ᜑषΊdΪϤ࿁Չ࣬φݬකᓒ
Ї፿ܓʬdᏐ༈ɰ݊Υ֝ٙfΎΫ޶ 45dᒱ̴್ኹϞێྼܓԑ੄ٙ˫࣬dϾ˲ɦ݊ఊɓ

34 ࣬၍طᐕఱ݊ίੂБ࿁࣬၍ӻ୕ٙชݑછՓ