根管治疗术治疗窦道型慢性根尖周炎的疗效观察

观察自1993年单纯使用根管治疗术治疗窦道型慢性根尖周炎3～5年，疗效满意，现报告如下。     

机用镍钛器械与超声根管冲洗联合应用于慢性根尖周炎一次性根管治疗的临床研究

目的 应用机用镍钛器械、超声根管冲洗对上下颌前牙患有慢性根尖周炎者进行一次性根管治疗的术后疼痛反应及远期临床疗效进行评价。方法 将280颗患牙随机分成对照组、镍钛组、超声组、联合组4组,对照组患牙69颗,采用K锉预备根管,注射器冲洗;镍钛组患牙70颗,采用机用镍钛锉预备根管,注射器冲洗; 超声组患牙70颗,采用K锉预备根管,超声冲洗;联合组患牙71颗,采用机用镍钛锉预备根管,超声冲洗。4组患牙均行一次性根管治疗,充填1周后评价各组术后疼痛反应发生率,2年后评价其远期临床疗效。结果 术后1周,联合组术后反应最轻,疼痛发生率为9.86%;镍钛组与超声组次之,疼痛发生率分别为28.6%和27.1%;对照组术后反应最重,疼痛发生率为50.7%。术后2年,对照组与联合组间临床疗效有显著差异（P<0.02）,而其他各两组间临床疗效差异均无统计学意义（P>0.05）。结论 联合应用机用镍钛器械与超声根管冲洗对上下颌前牙患有慢性根尖周炎者行一次性根管治疗,能明显减少术后疼痛反应,提高患牙远期临床疗效,临床上值得推广。     

机用镍钛器械ProTaper用于根管治疗的临床研究

目的：评价使用机用镍钛器械ProTaper预备根管的临床效果。方法：选取临床上患牙髓炎及根尖周炎需要进行根管治疗的患牙162个,其中83个运用冠向下技术,机用镍钛器械ProTaper进行根管预备,热牙胶垂直加压技术充填根管;另外79个患牙运用逐步后退法根管预备技术,国际标准手动不锈钢K锉进行根管预备,冷侧压技术充填根管。记录两组根管预备所需时间及器械折断数量,根据治疗前、中、后的X线片评价预备及根充效果。结果：用机用镍钛器械ProTaper根管预备组所有患牙根管锥度流畅度好,根管形态及工作长度无改变,操作时间短,有3例发生器械折断。结论：使用机用镍钛器械ProTaper预备根管成形、根充效果好,时间短,但要注意预防器械的折断。     

手用ProTaper根管扩大系统联合镍钛K锉在老年人磨牙根管治疗术中的应用

目的：评估手用ProTaper根管扩大系统联合镍钛K锉对老年人磨牙根管治疗的效果。方法：110例118个慢性根尖周炎磨牙随机分为两组,实验组60个患牙,采用手用ProTaper根管扩大系统和镍钛K锉进行根管预备,对照组58个患牙,采用不锈钢K锉根管预备,两组均以常规侧方加压法进行根管充填,在治疗前、中、后应用X线牙片了解根管数目、形态、确定根管工作长度、判断治疗效果。结果：对118个磨牙根管充填后拍摄X线牙片及观察术后反应,实验组根管成形及充填满意率85%,术后急症反应率3.33%,对照组满意率62.07%,术后急性反应率为15.5%。经x2检验,两组根管成形及充填满意率有显著性差异（P〈0.01）,术后急症反应率有显著性差异（P〈0.01）,实验组明显优于对照组。结论：手用ProTaper根管扩大系统联合镍钛K锉可有效提高老年人根管治疗的效果。     

窦道型根尖周炎根管治疗术一次法临床观察

目的：观察窦道型根尖周炎根管治疗术一次法的临床疗效。方法：用钙维他(Calvital)糊剂对窦道型根尖周炎进行根管治疗术一次法治疗，治疗后2—3周和6个月后随访，通过临床和X线检查评价其疗效。结果：经根管治疗术一次法治疗的298例窦道型根尖周炎，265例2d后牙齿功能恢复正常，2—3周窦道消失，6个月后X线片检查可见到根尖周稀疏区消失。23例失败牙经再次治疗后治愈。12例失败将患牙拔除(两个以上窦道，牙齿松动Ⅲ度)。成功率达88．33％。结论：窦道型根尖周炎经根管治疗术一次法临床观察，不受年龄限制，疗效满意。     

iRoot SP一次性根管治疗前牙窦道型慢性根尖周炎疗效观察

目的:观察iRoot SP一次性根管治疗前牙窦道型慢性根尖周炎的临床疗效.方法:纳入240 例前牙窦道型慢性根尖周炎患者,随机分成2 组(n=120),在Nd:YAG激光消毒下,进行一次性根管充填:观察组采用iRoot SP以热牙胶连续波垂直加压技术充填根管,对照组采用AH-plus糊剂以热牙胶连续波垂直加压技术充填根管,观察术后48 h疼痛发生情况、术后10 d窦道愈合情况及1 年后的疗效.结果:术后48 h观察组和对照组疼痛发生率分别为7.14%和15.0%(P=0.038);术后10 d,观察组和对照组窦道愈合情况有效率分别为95.8%和88.3%(P=0.031);术后1 年复诊,2 组疗效成功率分别为98.3%和94.8%(P>0.05).结论:iRoot SP和AH-plus糊剂在一次性根管治疗前牙窦道型慢性根尖周炎中均取得良好疗效,但iRoot SP术后反应发生率低,窦道愈合快.     

ProTaper根管预备器械的研究现状

ProTaper器械是一种新型的镍钛机动根管预备器械，它采用可变多锥度的刃部，凸三角形横截面的设计，使该器械具有更高的切削力、弹性和理想的成形根管能力。同时，ProTaper的器械数量少，操作省时，可以明显提高根管预备效率，尤其适于弯曲根管的预备。     

Vitapex糊剂一次法根管治疗乳牙窦道型慢性根尖周炎的疗效观察

目的探讨乳牙窦道型慢性根尖周炎简便有效的治疗方法。方法对108颗乳牙窦道型慢性根尖周炎的患牙采用Vitapex糊剂一次法根管治疗。结果术后1周复查无自觉症状，窦道消失有102颗，占94．44％；6个月复查成功97颗，成功率为89．81％。结论Vitapex糊剂一次法根管治疗乳牙窦道型慢性根尖周炎患牙切实可行。可以缩短疗程，适当超填有利于病变部位的愈合。     

Her0642联合ProTaper应用于磨牙根管预备的临床分析

目的评价联合使用Her0642和ProTaper两种镍钛机用器械在根管预备过程中的临床效果。方法选取2006年10月-2007年月10月因牙髓炎或根尖周炎需行根管治疗的磨牙共250颗，根管802个，机用Her0642联合ProTaper预备根管，侧压充填方法充填根管，记录根管工作长度的变化、器械使用次数及折断数量，根据术前、术后x线表现及术后1周的临床表现，评价根管预备和充填的效果。结果根管预备后弯曲度均有减少；共抛弃ProTaper19支、Hem64260支；Hem642折断9支，ProTaper折断2支；根管充填密度、根管锥度和流畅度良好的根管748个；术后1周发生疼痛55例且程度较轻。结论联合应用Her0642和ProTaper预备磨牙根管，根管成形、充填效果良好，既能体现Her0642操作简单、高效、安全的优点，亦能体现ProTaper良好成形的优点。     

Hero642联合ProTaper应用于磨牙根管预备的临床分析

目的 评价联合使用Hero642和ProTaper两种镍钛机用器械在根管预备过程中的临床效果.方法 选取2006年10月～2007年月10月因牙髓炎或根尖周炎需行根管治疗的磨牙共250颗,根管802个,机用Hero642联合ProTaper预备根管,侧压充填方法充填根管,记录根管工作长度的变化、器械使用次数及折断数量,根据术前、术后X线表现及术后1周的临床表现,评价根管预备和充填的效果.结果 根管预备后弯曲度均有减少;共抛弃ProTaper 19支、Hero642 60支;Hero642折断9支,ProTaper折断2支;根管充填密度、根管锥度和流畅度良好的根管748个;术后1周发生疼痛55例且程度较轻.结论 联合应用Hero642和ProTaper预备磨牙根管,根管成形、充填效果良好,既能体现Hero642操作简单、高效、安全的优点,亦能体现ProTaper良好成形的优点.     

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。     

ProTaper机用镍钛锉根管预备的临床效果分析

目的 评价ProTaper机用镍钛锉根管预备的临床效果。方法 选择300颗患牙（638个根管）随机分为ProTaper组和K锉组,分别用ProTaper机用镍钛锉和K锉进行根管预备,采用χ2检验比较根管预备后的疼痛反应、根管充填效果及器械分离情况。结果 ProTaper组根管预备后疼痛发生率为6.00%,较K锉组的根管预备后疼痛发生率（26.67%）少（P<0.01）,ProTaper组根管恰填率为93.77%,较K锉组（88.64%）高（P<0.05）,两组间的器械分离则无统计学差异（P＞0.05）。结论 ProTaper机用镍钛锉能有效降低根管预备后疼痛的发生和提高根管充填质量,而且较为安全。     

镍钛旋转锉在老年人根管治疗中应用

目的:探讨机用镍钛器械ProTaper在老年患者根管治疗中应用的临床效果。方法:选取临床上因牙髓炎及根尖周炎需要进行根管治疗的老年患者46例,患牙56颗(94个根管),运用冠向下技术,采用机用镍钛器械ProTaper进行根管预备,热牙胶垂直加压技术充填根管。记录根管预备所需要的时间及器械折断的数量,根据治疗前、中及根充后的X线片评价预备及根充效果。结果:所有患者的根管预备锥度流畅度好,根管形态及工作长度无改变,无1例发生器械分离。结论:在老年患者的根管治疗中,使用机用镍钛器械ProTaper进行根管预备,可以获得比较好的临床效果。     

ProFile ProTaper镍钛根管器械与不锈钢K锉预备弯曲根管的比较研究

目的：比较ProFile镍钛机用根管器械，ProTaper镍钛手用根管器械和不锈钢K锉用于弯曲根管预备时的根管拉直和根尖偏移，为ProFile和ProTaper的临床应用提供实验依据。方法：将正畸前减数拔除的30个下颌第一前磨牙随机分为3组，分别用不锈钢K锉、ProTaper镍钛手用根管器械、ProFile镍钛机用根管器械做根管预备，分析评价其根管拉直和根尖偏移情况。结果：不锈钢K锉组的根管拉直、根尖偏移显著大于ProTaper和ProFile预备组。结论：ProFile和ProTaper镍钛根管预备器械与传统的不锈钢器械相比更适合弯曲根管的根管预备。     

ProTaper手用镍钛锉在根管治疗中的应用研究

目的:观察ProTaper手用镍钛锉预备根管的临床效果。方法:280例根管治疗病例随机分为PT组(镍钛根管锉组)140例,300个根管,采用ProTaper手用镍钛锉和冠根向深入法预备根管,KH组140例,296个根管,采用ISO标准型不锈钢K型锉和H型锉根管针,按标准法预备根管,评估预备后疼痛情况、根充效果及根充后反应。结果:PT组根管适填率(91.87%)与KH组(88.51%)无显著性差异(p>0.05);PT组根管预备后疼痛率(4.29%)明显低于KH组(11.43%)(p<0.05);PT组根充术后疼痛率(2.14%)明显低与KH组(8.57%)(p<0.05)。结论:ProTaper手用镍钛锉技术在根管治疗术中及术后反应少。     

Comparison of root canal preparation using RaCe and ProTaper rotary Ni-Ti instruments

AIM: To compare various parameters of root canal preparation using RaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) nickel-titanium (Ni-Ti) instruments. METHODOLOGY: Fifty extracted mandibular molars with mesial root canal curvatures between 20 degrees and 40 degrees were embedded in a muffle system. All root canals were prepared to size 30 using RaCe or ProTaper rotary instruments in low-torque motors with torque control and constant speed of 300 r.p.m. (ProTaper with ATR Tecnika, Advanced Technology Research, Pistoia, Italy; RaCe with EndoStepper, S.E.T., Olching, Germany). In both groups irrigation was performed with 2 mL NaOCl (3%) after each instrument size. Calcinase-Slide (lege artis, Dettenhausen, Germany) was used as a chelating agent with each instrument. The following parameters were evaluated: straightening of curved root canals, postoperative root canal cross-sections, safety issues and working time. Cleanliness of the root canal walls was investigated under the SEM using 5-score indices for debris and smear layer. Statistical analysis was performed using the following tests: Wilcoxon's test for straightening and working time was used (P < 0.05); Fisher's exact test for comparison of cross-sections and root canal cleanliness (P < 0.05). RESULTS: Both Ni-Ti systems maintained curvature well; the mean degree of straightening was less than 1 degrees for both systems. Following preparation with RaCe, 49% of the root canals had a round or oval diameter and 50% an irregular diameter, ProTaper preparations resulted in a round or oval diameter in 50% of the cases. For debris, RaCe and ProTaper achieved 47 and 49% scores of 1 and 2, respectively; there was no significant difference. For smear layer, RaCe and ProTaper achieved 51 and 33% scores 1 and 2, respectively; no statistically significant differences were apparent for the coronal and middle sections of the root canals, but RaCe performed significantly better in the apical region (Fisher's exact test, P = 0.0392). Two roots lost working length with RaCe instruments, whilst ProTaper preparation resulted in two roots loosing working length and one fractured instrument. Mean working time was shorter for ProTaper (90.9 s) than for RaCe (137.6 s); the difference was significant (Wilcoxon's test, P = 0.011). CONCLUSIONS: Both systems respected original root canal curvature well and were safe to use. Cleanliness was not satisfactory for both systems.     

SEM evaluation of canal wall dentine following use of Mtwo and ProTaper NiTi rotary instruments

AIM: To compare using scanning electron microscopy (SEM) root canal walls following instrumentation in vitro with two different rotary NiTi instruments. The hypothesis was that no difference should be observable between the experimental groups in terms of debris on canal walls and surface morphology. METHODOLOGY: Twenty-four single-rooted human teeth were selected. Two types of NiTi instruments were used, Mtwo (Sweden & Martina, Padova, Italy) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland). Irrigation for both groups was performed after each instrument change with 5% NaOCl, 3% H2O2 and 17% EDTA solutions. Three different areas (coronal, middle and apical thirds) of the root canal were evaluated using SEM. The canal wall of each sample was assessed and compared using a predefined scale of four parameters, namely, smear layer, pulpal debris, inorganic dentine debris, surface profile. Data were analysed statistically using the Kruskal-Wallis test (anova). RESULTS: A statistically significant difference (P < 0.01) was found between the apical third and the middle and coronal thirds for both groups. No difference was observable between instrumentation groups. In the apical third canal walls were often contaminated by inorganic debris and by smear layer. In the apical third, the surface profile was affected by uninstrumented regions, comprising dentine depressions and grooves in which predentine was still visible. CONCLUSION: Both instruments produced a clean and debris-free dentine surfaces in the coronal and middle thirds, but were unable to produce a dentine surfaces free from smear layer and debris in the apical third. The presence of deep grooves and depression on dentine walls in the apical third may well explain the presence of less-instrumented areas.     

手用ProTaper镍钛器械预备弯曲根管的临床研究

目的:观察手用ProTaper镍钛器械预备弯曲根管的临床效果。方法:117例患者分为两组,手用ProTaper镍钛(PT)组59例,采用手用ProTaper镍钛器械预备根管,不锈钢K型根管锉(SS)组58例,采用改良双敞法预备根管。记录操作时间、器械折断情况、根管偏移发生情况、术后疼痛的发生、根管充填效果。结果:根管预备时间PT组为(5.59±1.66)min,SS组为(11.88±2.36)min;断针率PT组为3.39%,SS组为0;根管偏移率PT组为3.39%,SS组为17.24%;根充术后疼痛率PT组为5.08%,SS组为20.69%。结论:用手用ProTaper预备弯曲根管成形效果好,操作时间短,能很好地维持根管的走向和弯曲度,极少发生根管偏移等并发症,与目前较常用的K锉/改良双敞法相比有着明显的优势,可作为临床上预备弯曲根管的有效方法。但要注意预防因器械疲劳造成的折断,在形态复杂的根管中须小心操作。     

Efficacy, cleaning ability and safety of different rotary NiTi instruments in root canal retreatment

Aim To evaluate the efficacy, cleaning ability and safety of three different rotary nickel‐titanium instruments with and without a solvent (eucalyptol) versus hand files in the removal of gutta‐percha root fillings. Methodology Eighty extracted single‐rooted anterior teeth were enlarged to size 35 and obturated with laterally condensed gutta‐percha using AHPlus as the sealer. Removal of gutta‐percha was performed with the following devices and techniques: FlexMaster, GT Rotary, ProTaper and Hedström files. All techniques were used with and without the solvent eucalyptol. The following data were recorded: time taken to reach the calculated working length and time required for the removal of gutta‐percha. The teeth were split longitudinally and photographed. Cleanliness of the root canal walls was scored using the projected slides with a total magnification of approximately 70×. Statistical analysis was performed using the two‐way anova (P < 0.001) for the analysis of working time. Results The technique that reached the working length most rapidly was that using ProTaper instruments and eucalyptol (+E), followed by FlexMaster + E, ProTaper, FlexMaster, Hedström files + E, GT Rotary + E, Hedström files, and GT Rotary. No significant differences were found for retreatment with or without a solvent in all groups. ProTaper and FlexMaster worked significantly more rapidly than Hedström files and GT Rotary (anova , P < 0.001). Time for complete removal of gutta‐percha was again shortest with ProTaper + E, followed by FlexMaster + E, ProTaper, FlexMaster, GT Rotary + E, Hedström files + E, Hedström files, and GT Rotary. ProTaper and FlexMaster again worked significantly faster than the other techniques (anova , P < 0.001). There was no visible filling material extruded apically. Root canal cleanliness proved best following the use of FlexMaster + E, and Hedström files + E, followed by ProTaper + E, and GT Rotary + E. Conclusion Under the experimental conditions, FlexMaster and ProTaper NiTi instruments proved to be efficient and time‐saving devices for the removal of gutta‐percha. The use of eucalyptol as a solvent shortened the time to reach the working length and to remove the gutta‐percha, but this was not significant.     

机用ProTaper两步法预备根管的器械折断情况的体外研究

【摘要】 目的 评价分析机用镍钛器械在两步预备根管时的器械折断情况。方法 采集600颗离体磨牙,分成对照组与实验组,各300颗,对照组用常规机用ProTaper一步预备到位(S1-Sx-S2-F1-F2),实验组分两步预备根管(第一次:S1-G Grill-S2;第二次:F1-F2),最后统计分析每组器械折断情况,使用SPSS18.0软件包对结果进行卡方检验。结果 2种方法预备根管过程中发生器械折断率和器械折断长度显著性差异（p<0.05）,但在不同根管长度里预备器械折断率实验组虽然比对照组少但差别无统计意义,下颌磨牙器械折断36个(76.6%) 较上颌磨牙多, 且上下颌磨牙多发生在近中根管;器械折断的位置多位于根管弯曲的中段28个(59.6%);器械折断多发生于弯曲度大于30°的复杂根管41个(87.2%),两组之间无统计学差异。结论 根管治疗中机用Protaper使用两步法预备可以降低器械折断率。