Kin-kńg tī-liâu

Kin-kńg tī-liâu (hàn-jī: 根管治療, Eng-gí: root canal treatment) iū-koh kiò-chò gê-chhóe-pēⁿ tī-liâu (牙髓病治療, pulp disease treatment), he̍k-sī khí-lāi tī-liâu (齒內治療, endodontic treatment), it-poaⁿ lâng lóng kā chheng-hȯ chò thiu-sîn-keng (抽神經), sī chhùi-khí pēⁿ ê 1 khóan tī-liâu hong-sek, i chú-iàu pau-koah gê-chhóe chân-î cho·-chit ê î-tû chheng-chhòng (清創, debridement) kap kin-kńg ê chheng-kiat, khok-tōa (擴大, enlargement) hām tiân-pó͘ (填補, obturation), lâi pâi-tû sè-khún tī kin-kńg ê cheng-seng (增生, proliferation).

Oân-choân ê kin-kńg tī-liâu

Sek-èng-chèng

Sek-èng-chèng (適應症, indications):

• Gê-chhóe hoat-iām bô-hoat-tō·hôe-ho̍k, kap/he̍k gê-kin chiu-ûi ū pēⁿ-chàu ê chêng-hêng.
• Giâm-tiōng khoat-sún beh chò khí-lông (齒籠, crown) he̍k kò·-tēng kio̍k-pō· gī-khí (固定局部義齒, fixed partial denture) ê chhùi-khí.
• Gê-chhóe oa̍h-sèng (牙髓活性, pulp vitality) ū hoâi-gî, iū-koh ài chò khí-lông he̍k-chiah kò·-tēng kio̍k-pō· gī-khí ê chhùi-khí.
• Chò ho̍k-kài-sek gī-khí (覆蓋式義齒, overdenture) ê sî-chūn só· beh pó-liû ê chhùi-khí.

Kin-kńg tī-liâu ê pō·-chō·

Fig.Kin-kńg tī-liâu ê pō·-chō·

• Ji̍p-kháu siu-hêng (access cavity preparation)

Ji̍p-kháu siu-hêng ê bo̍k-tek chi-it sī beh î-tû gê-chhóe-khiuⁿ ê chân-î gê-chhóe, chi-jī sī hong-piān soah--lâi beh chìn-sêng ê kin-kńg siu-hêng. Ji̍p-kháu ê hêng-chōng ài chò kàu kin-kńg siu-hêng ê ke-si bē hō· ji̍p-kháu ê chhiûⁿ-piah oan-khiau--tio̍h, koh ē-sái ti̍t-chiap chhun kàu kin-kńg ê kin-chiam-toan saⁿ-hun-chi-it (apical third of root canal) chham tiong-kan saⁿ-hun-chi-it (middle third of root canal) sio-chiap ê só·-chāi. Ji̍p-kháu siu-hêng 3-ê pō·-chō· :

• Phah-khui gê-chhóe-khiuⁿ (opening chamber)
• Î-tû gê-chhóe-khiuⁿ ê chhù-téng (removing the roof of the pulp chamber)
• Chòe-āu oân-sêng ji̍p-kháu ê siu-hêng (completing the shape of the access cavity)

• Kin-kńg ê chheng-chhòng kap siu-hêng (debridement and preparation of the root canal)
• Kin-kńg thiâm-that (filling the root canal)

Kin-kńg ê chheng-chhòng kap siu-hêng

Kin-kńg ê chheng-chhòng kap siu-hêng (debridement and preparation of the root canal) chú-iàu sī teh kóng lī-iōng kok-chióng kin-kńg ke-si kap hòa-ha̍k io̍h-bu̍t, lâi khì-tû kin-kńg hē-thóng lāi-té kám-jiám ê iú-ki-bu̍t kap bû-ki-bu̍t, koh tiau-sok chhut te̍k-tēng ê hêng-chōng, lâi ta̍t-kàu tì-bi̍t ê kin-kńg thiâm-that. Kin-kńg ê chheng-chhòng ē-tàng hun-chò 3 pō·-hūn:

• Ki-hâi-sèng ê chheng-chhòng:

Chú-iàu lī-iōng kok-chióng kin-kńg ke-si, kì-tû kin-kńg hē-thóng lāi-té khó-lêng chhiok-chìn sè-khún seng-tióng kap ín-khí kin-chiam chō·-chit hoat-iām ê iú-hāi bu̍t-chit, pau-koah chiù-khí chō·-chit, chia̍h-mi̍h chân-liû-bu̍t, khí-chhóe-chio̍h (pulp stone), sè-khún, chân-liû ê khí-chhóe, siū tio̍h kám-jiám ê kin-kńg pia̍h-bīn, ù-jiám ê kin-kńg thiâm-that châi-liāu, téng-téng. Chú-iàu ke-si ū reamer, file, Ni-Ti rotary instrument, Gates-Glidden drill.

• Hòa-ha̍k-sèng sat-khún:

Chiam-tùi bô-hoat-tō· sú-iōng kin-kńg ke-si chò chheng-chhòng ê sí-kak kap iú-ki-bu̍t, tio̍h lī-iōng hòa-ha̍k bu̍t-chit chò siau-tok sat-khún ê tōng-chok, chú-iàu sī sú-iōng Sodium hypochlorite solution, Calcium hydroxide, EDTA téng-téng.

• Chúi-liû chhiong-sé:

Lī-iōng kin-kńg chhiong-sé-sio̍h chhiong-sé, kap chhiau-īm-pho ê acoustic chúi-liû, lâi kā kin-kńg lāi ê chân-liû-bu̍t chhiong-chhut.

Kin-kńg chheng-chhòng kap siu-hêng ê ki-hâi-sèng goân-chek

Kin-kù Dr. Hebert Schilder tī 1960 nî-tāi só· kiàn-li̍p ê goân-chek, lí-sióng ê kin-kńg siu-hêng èng-kai kū-pī í-hā 5-ê tiaû-kiāⁿ.

• Tē-1. Hêng-sêng 3-tō· khong-kan liân-soah chui-tō· ê laū-taú hêng-chōng:

Su-iōng kin-kńg ke-si kā kui-ê kin-kńg piaú-bīn chò oân-choân ê chheng-chhòng, siu-hêng chhut laū-taú ê hêng-chōng, án-ne ē-tàng cheng-ka kin-kńg chhiong-sé ê haū-lu̍t, sīm-chí chhiong-sé kaù hù-kin-kńg (accessory canal) lāi-té. Ah tī kin-kńg thiâm-that ê sî-chūn, thiâm-that ê ki-si chiah ē-tàng chāi kin-kńg lāi-té chū-iû î-tōng hoat-hui kong-lêng, hêng-sêng ǹg kin-chiam hong-hiòng ê thiâm-that le̍k-liōng, ta̍t-kaù tì-bi̍t ê thiâm-that kiat-kó. Kin-kńg kin-chiam 3-hun-chi-1 só·-chāi ê siu-hêng, chhiat-bīn (cross section) ài pó-chhî îⁿ-hêng ê chōng-thāi; kin-kńg tiong-kan 1/3 kap khí-ām-kún 1/3 só·-chāi ê siu-hêng tio̍h-ài àn-chiaù khí-kin ê goā-hêng lâi chò, í bē phò-hāi chhùi-khí ê kiat-kò·, phiah-khui hûi-hiám khu-e̍k ûi goân-chek.

• Tē-2. Siu-hêng liáu-aū, kin-chiam só·-chāi ê chia̍t-bīn-chek ài pí koan-toan só·-chāi ê chia̍t-bīn-chek khah sè:

Chit-tiám kah tē-1 tiám chha-put-to ê ì-sù.

• Tē-3. Pit-su-iaù tùi kin-kńg hē-thong ū oân-choân ê liáu-kái:

Kin-kńg hē-thóng pēng-m̄-sī it-poaⁿ só·-siūⁿ--ê án-ne ti̍t-ti̍t ê khoáⁿ, ia̍h-m̄-sī chhiūⁿ 2-tō· khong-kan ê tiān-kong-phìⁿ só· hián-sī--ê án-ne hiah-nih kán-tan, kî-si̍t kin-kńg hē-thóng tio̍h-ná chham-chhiūⁿ chhiū-á ê chhiū-kin, ū chú-iaù--ê khah-toā ê kin-kńg, koh-ū hù-sio̍k--ê khah-iù ê hù-kin-kńg.

• Tē-4.Pó-chhî goân-lâi kin-chiam khui-kháu ê ūi-tì:

Pó-chhî goân-lâi kin-chiam khui-kháu ê ūi-tì Pó-chhî goân-lâi kin-kńg ê cháu-hióng, ē-tàng phiah-bián kin-chiam khui-kháu sán-sêng thó-îⁿ-hêng (oval) he̍k lūi-chu-hêng (tear-shaped) ê piàn-hêng.

• Tē-5.Pó-chhî goân-lâi kin-chiam khui-kháu ê tōa-sè:

Pêng-kin lâi-kóng, goân-choân hoat-io̍k ê kin-chiam-khang tōa-sè sī 0.25 mm, in-chhú kiàn-gī tāi-pō·-hūn ê kin-chiam kin-kńg chí-iaù khok-toā kaù 25-hō tio̍h ē-sái.

Kin-kńg chheng-chhòng kap siu-hêng ê seng-bu̍t-sèng goân-chek

Khí-goân-sèng (odontogenic) kin-chiam bah-gê-chéng (根尖肉芽腫; apical granulma), kin-chiam long-chéng (根尖囊腫; radicular cyst), kin-chiam lâng-chéng (根尖膿腫; periradicular abscess) ê goân-in sī kin-kńg lāi-té ê hoat-iām kám-jiám hāi-sí cho·-chit, só·-í nā-kā kin-kńg lāi-té ê piàn-sèng cho·-chit ti̍t-thaù chheng-tû, tio̍h ē-sái hō· kin-chiam goā-khaú ê pēⁿ-piàn hó-sè. Só·-í nā chun-siú ē-kha 3 tiám seng-bu̍t-sèng goân-chek, tio̍h ē-sái khak-pó kin-kńg tī-liaû ê sêng-kong-lu̍t kap tī-liâu koè-têng tiōng pēⁿ-hoān ê sóng-koài.

• Tē-1. Tiāⁿ-tio̍h pó-chhî kin-kńg ke-si kan-taⁿ tī kin-kńg lāi-té chok-iōng:

Kin-kńg ke-si mài thóng-chhut kin-chiam-khang goā, mā mài khok-toā kin-chiam-khang he̍k kā piàn-hêng, bô, chiâⁿ-gaû chō-sêng kin-chiam cho·-chit hoat-iām.

• Tē-2. Chhian-bān m̄-thang kā kin-kńg lāi ê hoāi-sí cho·-chit thuh chhut-khì kin-kńg goā-khaú:

Nā bô-sió-sim kā kin-kńg lāi-té ê hāi-sí cho·-chit sak-chhut kin-kńg goā-khaú, hoān-sè ē chō-sêng chèng-chōng thut-hoat (flare-up) he̍k su̍t-aū kin-chiam kip-sèng thiàⁿ-thàⁿ.

• Tē-3. Oân-choân khì-tû kin-kńg lāi ê cho·-chit :

Tû-liaú kî-hâi-sèng chheng-chhòng í-goā, koh-ài phòe-ha̍p sú-iōng io̍h-chúi chhiong-sé, siōng-chiap sú-iōng--ê sī 5.25-pha ê sodium hypochlorite solution, i ē iôⁿ-kái bû-ki-bu̍t-chit; lī-iōng calcium hydroxide koân-kiⁿ-sèng (高鹼性) ê hydroxide ion lâi phò-hāi sè-khún sè-pau-mo̍h, ta̍t-kaù sat-khún ê haū-kó; lī-iōng EDTA khì-tû smear layer, kap nńg-hoà kài-hoà chó·-that ê só·-chāi.

Kin-kńg thiâm-that

Kin-kńg tī-liâu chòe-āu ê 1-pō· sī thiâm-that chheng-chhòng khok-tōa siu-hêng liáu-āu ê kin-kńg khong-kan, í-bián chiâⁿ-chòe chhat-khut, phiah-bián sè-khún koh-chài chu-seng. Thiâm-that ê châi-liāu ē-sái hun-chòe 2-lūi, filler kap sealer. Filler bat iōng-kòe a-má-káng, gîn-chiam (silver point), tāi-chiam (titanium point), sok-ka chiam (plastic point), kap gutta percha, bok-chiân (2006 nî) piau-chún ê choh-hoat sī sú-iōng gutta-percha phòe-ha̍p sek-tòng ê sealer lâi thiâm-that. Gutta-percha phòe-ha̍p sealer thiâm-that ê ki-su̍t ū kúi-nā-chióng, chhan-chhiūⁿ sú-iōng kúi-nā-ki gutta percha point ê léng ê chhek-hong chiⁿ-ah (cold lateral condensation), un ê chhek-hong chiⁿ-ah (warm), kap sio ê sûi-tit chiⁿ-ah (hot vertical condensation); sú-iōng ko·-1-ki gutta percha point ê jiat thiâm-that (thermal compaction); hiān-tiûⁿ chè-chō ê gutta percha point (custom made point), sek-iōng tī kin-chiam khui-chhùi hêng-sêng bô oân-sêng ê kheh-suh (open apex).

Bô-oân-choân ê kin-kńg tī-liâu

Fig: Bô-oân-choân ê kin-kńg tī-liâu

Kin-kńg tī-liâu èng-kai kā kin-kńg chheng hō· chheng-khì, kin-kńg ê hêng-thài siu-hêng hō· sek-tòng, hó-thang thiâm-that chiâu-choân. Gutta-percha sī tiān-kong khah thàng-bē-koè (radiopaque) ê châi-chit. It-poaⁿ lâi kóng, tī tiān-kong-tô· koân-téng èng-kai khoàⁿ tio̍h sek-tòng khoah-tō· kap tn̂g-tō· ê gutta -percha ê pe̍h-sek iáⁿ-siòng. Gutta-percha ài thiâm-that kàu kī-lî khí-kha-chiam 0~2 mm ê só·-chāi chiah-sī phiau-chún ê chò-hoat.