倒敞法结合2 种机用镍钛锉预备重度弯曲后牙根管的应用研究

目的:评价倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管的疗效.方法: 随机将100 颗患牙髓炎或根尖周炎、最大根管弯曲度≥25°的后牙分为2 组,各50 例.实验组(A组)采用倒敞法,而对照组(B组)不采用倒敞法机械预备.A组以机用开口锉根管中上端敞开后,手用K锉预备根尖,再先用镍钛器械Hero 642,后用ProTaper预备根管;B组则直接应用Hero 642和ProTaper冠向下法预备根管. 2 组均用侧压法充填根管.根据X线片情况,预备时间,器械折断、疼痛等并发症,评价根管预备和充填的疗效,1 年随访率95%.结果:A组倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管,锥度、流畅度好,术后疼痛少且程度轻,无器械折断;而B组发生器械折断3 支(P>0.05);充填恰充率、欠充率、流畅度、术后疼痛两者有显著性差异(P<0.05).结论: 倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管,成形、根充效果好,并发症少,最大限度发挥了各自优点,是预备重度弯曲后牙根管值得推广应用的有效方法.     

HERO642机用镍钛根扩系统的临床应用

目的观察HERO642机用镍钛根扩系统在后牙根管治疗中的临床应用。方法选择门诊患者53例,随机分成2组。机扩组采用HERO642机用系统进行根管预备,氯仿牙胶加牙胶尖充填;手扩组采用手用根扩器械进行根管预备,氯仿牙胶加牙胶尖充填;摄片比较两组根管充填质量、术后反应及根扩操作时间。结果机扩组根管充填质量优于手扩组,差异有显著性。两组术后反应发生率差异无显著性(P>0.05)。两组的根扩时间经t检验差异有显著性(P<0.01),机扩组所用时间少于手扩组。结论采用HERO642机用镍钛根扩系统进行后牙根管预备能有效缩短根扩操作时间,提高根充质量。     

新型旋转镍钛器械Mtwo在老年人根管治疗中的应用

评价旋转镍钛器械Mtwo在老年患者根管治疗中应用的临床效果.随机选取老年患者中因牙髓炎或根尖周炎需行根管治疗的患牙80例,均分为2 组: M组使用旋转镍钛器械Mtwo、改良步退法预备根管;K组使用手用不锈钢K锉、步退法预备根管, 2 组均采用冷侧压法充填根管.M组能维持根管原有的走向,无根管偏移、台阶、侧穿等并发症;K组并发症的发生率显著多于M组(P<0.05).M组操作时间短,术后疼痛少.在老年患者的根管治疗中, 使用旋转镍钛器械Mtwo进行根管预备,快速、有效,成形效果好,值得临床推荐.     

弯曲根管不同预备方法对其根管充填密封性的影响

目的 研究临床常用预备方法预备弯曲根管对其根管充填密封性的影响.方法 选取不同弯曲程度的离体单根管牙齿90颗,分别使用不锈钢K锉,机用ProTaper,Hero642进行根管预备.AH-PLUS根充糊剂加牙胶尖冷侧压法充填,染料浸泡,分光光度法定量分析微渗漏.结果 不锈钢K锉组预备出的根管,充填后根尖孔微渗量最大,显著大于其余两种镍钛器械预备出的根管(P＜0.05).不同根管弯曲程度对根管充填后根尖孔产生微渗漏的影响程度不同,随着根管弯曲程度增加,发生根尖孔染料微渗量增加(P＜0.05);不锈钢K锉预备的Ⅲ°弯曲根管充填后出现的根管微渗量最大.结论 当使用冷侧压法充填根管,镍钛器械预备的根管相比不锈钢预备的根管更有利于根管充填后根尖孔的密封,尤其对于弯曲根管.     

不同根管预备器械对根管充填后冠方微渗漏影响的实验研究

目的:比较不同根管预备器械对根管充填后冠方微渗漏的影响。方法:选择60个单根管前磨牙(弯曲度为10～20°)随机分为6组,分别以不锈钢K锉、VDW K锉、手动Protaper、机用Protaper、Hero642、Mtwo预备根管。采用冷侧压法进行根管充填,染色法比较不同根管预备器械对根管冠方封闭性能的影响。结果:不同根管预备器械对充填后根管冠方微渗漏影响不同,其中Hero 642预备组、Protaper预备组、VDWK锉组冠渗漏长度少于不锈钢K锉组,且差异有统计学意义(P<0.05),Hero 642预备组产生的冠方微渗漏最小。结论:不同根管预备器械预备根管后对冠渗漏影响不同,镍钛旋转器械预备根管后产生的冠方微渗漏较小,不锈钢K锉根管预备后产生的冠方微渗漏较大。     

两种根管预备方法根管治疗效果的临床观察

目的：采用Protaper手用镍钛根管锉和不锈钢K锉改良双敞技术进行根管预备,对其治疗效果进行比较。方法：对急、慢性牙髓炎或慢性根尖周炎病例120例,随机分为两组分别采用Protaper手用镍钛根管锉和不锈钢K锉改良双敞技术进行根管预备,用标准牙胶尖和根管糊剂以侧方加压法完成根管充填。结果：Protaper组根管预备所需时间明显短于不锈钢K锉组,根管预备1周内患牙疼痛发生率明显低于不锈钢K锉组,根管适充率则高于不锈钢K锉组,差异具有统计学意义。结论：Protaper手用镍钛根管锉,能缩短根管预备时间、提高工作效率,根管预备后疼痛发生率较低,而且其根管成形效果好、根管充填质量高。     

机用镍钛Hero642与不锈钢K锉预备弯曲根管的比较研究

目的:比较机用镍钛器械Hero642和手用不锈钢K锉对弯曲根管的预备效果。方法:随机选择有弯曲根管的患牙髓炎和尖周炎的前磨牙和磨牙80个,分别采用机用镍钛器械Hero642和手用不锈钢K锉进行根管预备,采用侧方加压充填,比较根管弯曲度的变化。结果:Hero642组平均减小1.85°,K锉组平均减小9.26°,二者之间有显著性差异(P<0.01)。结论:Hero642能够更好地保持根管的原始走向,并且并发症少。     

手用ProTaper镍钛根管器械在后牙根管治疗中的应用研究

目的 观察手用镍钛根管器械ProTaper在后牙根管治疗中的效果。方法 220例后牙根管治疗病例随机分为PT组(镍钛根管锉组)110例,392个根管,采用ProTaper手用镍钛锉冠根向深入法预备根管;KH组110例,397个根管,采用ISO标准型不锈钢K型锉和H型锉,冠根向深入法预备根管。比较2组根管预备时间、预备后疼痛发生率、根管充填恰填率。结果 PT组在根管预备时间、根管预备后疼痛发生率上均低于KH组(P<0.05),根管充填恰填率高于KH组(P<0.05),差异有显著性。结论 手用ProTaper能够保持根管初形、省时省力、安全,明显提高根充效果,值得推广。     

不同锥度牙胶尖热垂直加压法根管充填的临床疗效分析

目的研究采用不同锥度牙胶尖热垂直加压法行根管充填的临床X线片评价及术后1年的临床疗效。方法选择上颌前牙单、直根管患牙40颗为研究对象,采用Hero 642机用镍钛锉预备至0.06锥度30号锉,随机分为2组,每组20颗患牙。分别使用0.02锥度和0.06锥度牙胶尖采用热垂直加压法充填根管。对术后即刻X线片进行2组患牙根管充填质量、侧支根管充填及超填情况的比较;并比较2组患牙术后1年的临床疗效。结果0.02锥度组与0.06锥度组根管充填质量、侧支根管充填及超填情况没有明显差异。术后1年复查,0.02锥度组与0.06锥度组的治疗成功率一致,但0.06锥度组病变愈合趋势快于0.02锥度组。结论对于镍钛旋转器械预备的较大锥度单、直根管,采用热牙胶垂直加压法行根管充填,使用与根管预备锥度相一致的大锥度牙胶尖能够提高根管治疗的临床疗效。     

3种机动镍钛器械预备磨牙根管的效果评价

目的:评价3种机动镍钛器械预备磨牙根管的效果,为临床选择机动镍钛系统提供参考。方法:将临床需行根管治疗的90颗磨牙随机分为ProTaper、K3、Mtwo3组,ProTaper和K3组采用冠向下法预备根管,Mtwo组采用常规法预备根管,3组均采用冷侧压法充填根管。根据治疗前后的X线片评价根管预备效果,比较器械损耗、预备时间及术中、术后并发症的发生率。使用SAS9.0软件包进行统计分析,根管弯曲度和操作时间的比较用t检验,根管内并发症和术后疼痛的发生率用χ2检验。结果:3种机用镍钛器械均能很好地维持根管的弯曲和走向,根管的锥度和流畅度好。无根管偏移、根尖阻塞、台阶形成等并发症发生,术后疼痛发生少且程度轻。预备过程中,ProTaper组有4根锉发生器械折断,K3组有3根锉发生器械折断,Mtwo组有1根锉发生器械折断。Mtwo的操作时间(3.94min)比ProTaper(4.71min)和K3(4.58min)短,差异有统计学意义(P<0.05)。结论:3种机动镍钛预备系统用于预备磨牙根管,效率高,成形能力佳。Mtwo机动镍钛器械使用常规法预备方法更简单,预备时间短且有效。     

A comparative study of root canal preparation with HERO 642 and Quantec SC rotary Ni-Ti instruments

AIM: The purpose of this study was to compare several parameters of root canal preparation using two different rotary nickel-titanium instruments: HERO 642 (Micro-Mega, Besancon, France) and Quantec SC (Tycom, Irvine, CA, USA). METHODOLOGY: Fifty extracted mandibular molars with root canal curvatures between 20 micro and 40 micro were imbedded into a muffle system. All root canals were prepared to size 45 (Quantec SC), or 40 (HERO 642), respectively. The following parameters were evaluated: straightening of curved root canals, postoperative root canal diameter, safety issues (file fractures, perforations, apical blockages, loss of working length), cleaning ability, and working time. RESULTS: Both Ni-Ti-systems maintained curvature well; the mean degree of straightening was 2.3 degrees for Quantec SC and 1.6 degrees for HERO 642. Most procedural incidents occurred with Quantec SC instruments (five fractures, three apical blockages, eight cases of loss of working length), HERO 642 preparation resulted in three blockages and one perforation. Following preparation with HERO 642, 63% of the root canals showed a round, 24% an oval, and 17% an irregular diameter; Quantec SC preparations resulted in a round diameter in 24% of the cases, oval shape in 29%, and irregular cross-section in 47% of the cases. Mean working time was shorter for HERO 642 (52 s) than for Quantec (117 s). Cleanliness of the root canal walls was investigated under the SEM using a five-score system for debris and smear layer. For debris HERO 642 achieved better results (80% scores 1 and 2) than Quantec SC (76%). The results for smear layer were similar: cleaner root canal walls were found after preparation with HERO 642 (53% scores 1 and 2), followed by Quantec SC (41%). CONCLUSIONS: Both systems respected original root canal curvature well and showed good cleaning ability; Quantec SC showed deficiencies in terms of safety.     

3种机用镍钛器械去除根管内充填材料的比较研究

目的：研究3种机用镍钛器械去除根管内充填材料的能力。方法：80颗下颌第二前磨牙采用改良双敞技术预备根管,热牙胶垂直加压技术充填根管。水浴37℃2周后分为4组,去除根管内牙胶充填物：A组为H锉;B组为机用Protaper;C组为K3;D组为Hero642。记录操作时间。将牙根纵劈,显微镜下观察根管内整体及上、中、下3部分的残留物并评分。将结果进行统计学分析。结果：对于去除根管内充填物,B组所需时间最短,但B、C、D3组之间并无显著性差异;且3组均快于A组（P〈0.05）。观察牙根整体及各部分的残留物,A组残留物显著性高于其它3组（P〈0.05）,而B、C、D3组两两之间均无统计学差异。各组均无器械折断。结论：3种机用镍钛器械均不能完全去除根管内充填材料。但同H锉相比,镍钛器械去除效果更好且操作时间显著减少。     

新型机动镍钛器械预备根管的疗效评价

目的:探讨新型机动镍钛器械Hero642预备根管的临床疗效。方法:选取患牙髓炎或根尖周炎的恒磨牙60例(60颗患牙),试验组用机动镍钛器械Hero642及根向预备技术预备根管,对照组用K锉及逐步后退技术预备根管,两组均采用侧向加压充填技术充填根管。根据治疗前后的X线片评价根管预备和充填效果,t检验比较两组根管弯曲度和操作时间,χ2检验比较根管内并发症和术后疼痛的发生率。结果:试验组能维持根管的原走向,无根尖阻塞、台阶、根管偏移及侧壁穿孔等并发症发生,对照组并发症的发生显著多于试验组(P<0.005);试验组操作时间短,术后疼痛发生少。结论:机动镍钛器械Hero642预备根管快速、有效,成形效果好,值得临床推广应用。     

A comparative study of root canal preparation using FlexMaster and HERO 642 rotary Ni-Ti instruments

Aim To compare several parameters of root canal preparation using two different rotary nickel–titanium (Ni–Ti) instruments: FlexMaster (VDW, Munich, Germany) and HERO 642 (Micro‐Mega, Besançon, France). Methodology Fifty extracted human mandibular molars with root canal curvatures between 20 and 40° were embedded into a muffle system. All root canals were prepared to size 45 using a high‐torque motor with two different Ni–Ti instruments, FlexMaster and HERO 642. In both groups, irrigation was performed with 2 mL NaOCl (3%) after each instrument size. RC‐Prep (Premier, Philadelphia, USA) was used as a chelating agent with each instrument. The following parameters were evaluated: straightening of curved root canals, postoperative root canal diameter, working safety (file fractures, perforations, apical blockages, loss of working length), cleaning ability and working time. Statistical analysis was performed using the Wilcoxon's test (P < 0.05) for straightening and Fishers's exact test (P < 0.05) for comparison of cross‐sections, contact between pre‐ and postoperative diameter, root canal cleanliness and working time. Results Both Ni–Ti systems maintained the curvature well: the mean degree of straightening was 0.6° for FlexMaster and 0.5° for HERO 642. One file was fractured with the FlexMaster system, but further procedural incidents were not recorded. Following preparation with FlexMaster, 18% of the root canals had a round diameter, 53% an oval diameter and 29% an irregular diameter; HERO 642 preparations resulted in a round diameter in 25%, oval shape in 47% and irregular cross‐sections in 28% of the cases. Mean working time was shorter for HERO 642 (66.0 s) than for FlexMaster (71.1 s). Cleanliness of the root canal walls was investigated under the SEM using 5‐score indices for debris and smear layer. For debris, HERO 642 and FlexMaster achieved 73 and 70% scores of 1 and 2, respectively. The results for smear layer were similar: HERO 642 and FlexMaster achieved 33 and 26% scores of 1 and 2, respectively. Significant differences between the two systems were not detected for any of the parameters evaluated. Conclusions Both systems respected original root canal curvature well and were safe. Both systems failed to remove debris and smear layer in the majority of the cases.     

Comparative study of two canal obturation techniques by image analysis and EDS microanalysis

AIM: The aim of this in vitro study was to compare the marginal adaptation achieved by two obturation techniques (lateral condensation and Thermafil) using human teeth prepared by continuous rotation with the HERO 642(R) system. METHOD: The percentages of gaps and sealer on the root canal surface were determined by analysing the images of 12 sections per tooth. Tubule sealer penetration was assessed by backscattered scanning electron microscopy and energy dispersive spectrometry microanalysis. RESULTS: The Thermafil obturation technique resulted in virtually no gaps and very low amounts of sealer on the root surface, unlike the lateral condensation technique. Tubule sealer penetration occurred with both techniques, but was deeper, especially in the mid and apical zones, with the lateral condensation technique.     

Effectiveness of HERO 642 versus Hedström files for removing gutta-percha fillings in curved root canals: an ex vivo study

Aim  To compare the effectiveness of gutta-percha removal and the maintenance of canal anatomy when using the HERO 642 system or Hedström files (H-files) in mandibular molar teeth.
Methodology  The root canals of 40 mandibular molar teeth were instrumented using H-files and filled with gutta-percha and sealer. After 1 year in storage, the roots were sectioned horizontally to provide apical, middle and coronal root thirds. Sections were photographed, and an individual muffle was produced for each tooth. Teeth were randomly divided into four groups ( n  = 10) and the gutta-percha removed using either the HERO 642 system or H-files, with or without solvent. Digital images of the root canals were then re-taken. Root thirds were inspected for lateral perforations, and the percentage of the residual canal filling was determined on postoperative images. Transportation and centring ratio were calculated using preoperative and postoperative images of the cross-sections of root thirds.
Results  H-files groups were associated with less filling material than the HERO 642 system (H-files–HERO 642 P  = 0.056, H-files–HERO 642+solvent P  = 0.041, H-files + solvent–HERO 642 P  = 0.018, H-files + solvent–HERO 642 + solvent P  = 0.016). The percentage of residual filling material was similar in the apical thirds, and the contribution of solvent to canal debridement was not statistically significant ( P  > 0.05). Perforation occurred mesiobuccally in 48% of specimens in the apical sections of mesial roots. There were no significant differences for centring ratio, transportation and perforation rate between groups.
Conclusions  H-files left less gutta-percha overall; however, there was no difference in the apical third. The effect of solvent was not remarkable. Both instrument systems created a large number of perforations.     

手用ProTaper镍钛器械在老年人根管治疗中的临床应用

目的：比较手用ProTaper镍钛器械与手用K锉在老年人根管治疗中的临床应用研究。方法：老年患者127例,138颗患牙。其中手用ProTaper组65例,72颗患牙为实验组;手用K锉组62例,66颗患牙为对照组。结果：实验组无根管偏移、根尖阻塞、台阶形成及根尖孔敞开等根管内并发症的发生,根管的锥度及流畅度极佳。对照组有5个根管发生根尖阻塞,3个根管在根尖1/3处有台阶形成;有5个中度弯曲的根管和4个重度弯曲的根管有轻度至中度的根尖孔偏移。结论：2种器械根管预备有显著差异,ProTaper镍钛器械根管预备后维持厚根管形态和高充填质量。