Clinical and radiographic evaluation of a resin-based root canal sealer

PURPOSE: To conduct a preliminary clinical and radiographic evaluation of a resin-based root canal sealer used in conjunction with gutta percha. METHODS: In a retrospective study on 180 patients who were seen for root canal therapy, a total of 295 root canals were treated with laterally condensed gutta-percha cones in conjunction with a methacrylate-based endodontic sealer (EndoRez). Root canal therapy had been carried out in one visit using standardized techniques. The results were assessed clinically and radiographically 14-24 months postoperatively and a comparison to baseline radiographs was made. 145 patient records were available for a follow-up examination. Success of root canal treatment was based on absence of clinical symptoms, a normal or slightly widened periodontal ligament and reduction of periapical radiolucencies with an absence of pain in patients that had pre-existing lesions associated with pain. RESULTS: The overall success rate was 913%. Root canals had been adequately filled to the working length in 110 teeth (75.7%), short from the working length in six cases (4.1%) and flush in 19 teeth (13.1%). Extruded sealer occurred in 10 (6.9%) instances. 49 teeth out of 55 (89.1%) that had preoperative apical radiolucencies revealed partial or total healing at the 14-24 months recall evaluation. 83 teeth out of 90 (92.2%), without preoperative radiolucencies, showed no radiographic changes. At the 14-24 months recall all patients reported being comfortable. 13 (9.0%) cases were judged failures.     

Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment

The aim of this work was to identify the limitations of previously published systematic reviews evaluating the outcome of root canal treatment. Traditionally, periapical radiography has been used to assess the outcome of root canal treatment with the absence of a periapical radiolucency being considered a confirmation of a healthy periapex. However, a high percentage of cases confirmed as healthy by radiographs revealed apical periodontitis on cone beam computed tomography (CBCT) and by histology. In teeth, where reduced size of the existing radiolucency was diagnosed by radiographs and considered to represent periapical healing, enlargement of the lesion was frequently confirmed by CBCT. In clinical studies, two additional factors may have further contributed to the overestimation of successful outcomes after root canal treatment: (i) extractions and re-treatments were rarely recorded as failures; and (ii) the recall rate was often lower than 50%. The periapical index (PAI), frequently used for determination of success, was based on radiographic and histological findings in the periapical region of maxillary incisors. The validity of using PAI for all tooth positions might be questionable, as the thickness of the cortical bone and the position of the root tip in relation with the cortex vary with tooth position. In conclusion, the serious limitations of longitudinal clinical studies restrict the correct interpretation of root canal treatment outcomes. Systematic reviews reporting the success rates of root canal treatment without referring to these limitations may mislead readers. The outcomes of root canal treatment should be re-evaluated in long-term longitudinal studies using CBCT and stricter evaluation criteria.     

3种根充糊剂对伴有糖尿病的老年牙髓炎患者疗效观察

目的：比较不同根充糊剂对伴有糖尿病的老年牙髓炎患者的治疗效果。方法选取因牙髓炎就诊的150例糖尿病患者,随机分为3组,每组50例。采用一次性根管治疗术。I组用Cortisomol+牙胶尖根管充填;II组用Vitapex+牙胶尖根管充填;III组用氧化锌丁香油糊剂+牙胶尖根管充填。观察不同组别术后1周内疼痛程度及2年的成功率。结果根管充填1周内,I、II、III组患者无疼痛人数分别为40、34、18;轻度疼痛人数分别为7、8、15;中度疼痛人数分别为2、6、10;重度疼痛人数分别为1、2、7,3组间差异具有统计学意义（P<0.05）。根管充填术2年后,I、II、III组患者根管充填术成功率分别为88%、94%、78%,II组成功率优于III组（P<0.05）。结论伴有糖尿病的老年牙髓炎患者根充糊剂选择Cortisomol可有效降低术后疼痛反应,选择氧化锌丁香油糊剂2年成功率较低。     

Success rate of root canal treatment in primary molars

OBJECTIVES: The purpose of the present retrospective large-scale study is to evaluate rate of success of root canal treatments in primary infected molars using Endoflas F.S as a filling material. METHODS: The study material consisted of 382 records of root canal treated primary molars of which 174 teeth with high quality radiographs and sufficient data comprised the 'study group'. The technique for root canal treatment in one visit is described. Treatment was considered success if clinically the tooth was asymptomatic and radiographs showed decrease or no change in pre-existing pathologic radiolucent defects. RESULTS: In the total pulpectomy group there was a statistically significant difference between mandibular teeth presented with a periapical lesion prior to the treatment compared to maxillary teeth. This difference was not significant in the study group. Decrease in post treatment radicular radiographic defects was statistically significant more in the maxilla compared to the mandible. The success rate of teeth restored with a permanent restoration (stainless steel crown or amalgam filling) was statistically significant higher than those teeth left with a temporary filling. There was no statistically significant difference between success rate and the extent of root canal filling material. Rate of success was not statistically different depending on pre-existing radiolucent area prior to RCT. CONCLUSIONS: Endoflas F.S. can be used as an alternative root canal filling material for primary teeth. One condition for success is the prevention of microleakage. A permanent restoration should be placed as soon as possible after clinical signs and symptoms of inflammation are eliminated.     

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目的比较空管药物疗法和根管充填术治疗乳牙牙髓炎的临床疗效。方法选择2008年3月至2009年12月在惠州市第三人民医院口腔科门诊就诊的乳牙牙髓炎患儿160例(160颗患牙),随机分为空管药物组(空管药物疗法)和根管充填组(根管充填术),各80颗患牙。比较2种治疗方法的临床疗效。结果空管药物组治疗成功率为97.5%,略高于根管充填组(93.8%),组间差异无统计学意义(P>0.05)。结论空管药物疗法成功率较高,操作简单,可减少患儿群体复诊次数,是适合儿童的一种较好的治疗方法。     

手术显微镜联合超声技术在塑化根管再治疗中的应用评价

目的:评价手术显微镜联合超声技术在塑化根管再治疗中的应用。方法:选取曾进行过塑化治疗的患牙63颗,在手术显微镜下,采用超声根管锉疏通塑化根管的上段,小号手用K锉配合EDTA溶液逐步疏通根管下段,机动镍钛器械Hero642完成根管预备,侧向加压充填法充填根管,观察并评价疗效。结果:54颗患牙的根管疏通成功,并完成根管治疗,根管再通成功率为85.7%。治疗过程中无牙根折裂、台阶形成、根管壁侧穿或器械折断发生。结论:手术显微镜和超声器械去除根管内塑化物快速高效,可作为临床上处理塑化再治疗患牙的有效方法,但不推荐将超声器械用于根管的下段或弯曲部位。     

根管充填质量对根管治疗术远期疗效的影响

目的：从X线影像角度分析根管充填质量对根管治疗远期疗效的影响。方法：选择已行根管治疗2a或2a以上的牙,运用平行投照法对根管治疗牙进行摄片;询问、查阅病史,了解患者年龄、性别、牙病病因及治疗时间;检查目前该牙根尖周状况;用SPSS13．0软件进行χ^2检验。结果：共调查病例215例,根管治疗牙376颗．成功率为54．79％。若以根管计算,共有513个根管,成功率为61．4％。根管充填质量（根充位置和密合度）对根管治疗疗效有显著的影响（P〈0．01）,根充距离X线片根尖0．5．2mm时最理想;根充密合者成功率高,尤其是根尖部。性别、年龄和根管充填时间对根管治疗疗效无影响。结论：根管充填质量对根管治疗远期疗效有显著影响。     

41例自体成熟移植牙的长期生存回顾分析

目的： 分析41例自体成熟移植牙的长期生存情况,为临床上修复牙缺失提供参考。方法： 回顾分析41例行自体成熟牙移植患者（共46颗牙）的临床资料,所有患者术后定期随访行临床检查和X线检查。分析所有移植牙5年累积生存率、累积成功率,X线片检出病变情况,并分析性别、年龄、根管治疗对移植牙累积生存率、成功率的影响。采用SPSS 19.0软件包对数据进行统计学分析。结果： 5年随访期内,46颗自体成熟移植牙共留存39颗,5年累积生存率为84.78%;39颗留存自体成熟移植牙中,33颗移植成功,5年累积成功率为71.74%;46颗自体成熟移植牙X线片检出病变10例,检出率为21.74%;根管治疗对自体移植牙累积成功率有显著影响（P<0.05）。结论： 自体成熟移植牙具有较高的5年累积生存率和成功率,可作为修复牙列缺损的有效方法之一。移植后应完善根管治疗,以提高成功率。     

根管阻塞的临床研究

目的：总结根管阻塞的主要原因及影响阻塞根管疏通的主要因素。方法：收集病例89例,共107个根管阻塞,在显微镜下使用超声器械和小号手用器械进行根管疏通。记录根管阻塞的情况和效果。结果：根管阻塞的原因主要有根管治疗史及钙化等。磨牙的根管较前牙及前磨牙易发生阻塞,且疏通成功率较低。因牙胶充填、塑化、钙化和其他原因导致的根管阻塞疏通的成功率依次为85％、52．8％、69．7％和55．6％。在X线片上有根管影像的阻塞根管疏通成功率（75．3％）高于无根管影像者（47．6％）（P〈0．05）。根管上段阻塞的疏通成功率明显高于根管下段阻塞者（P〈0．05）。结论：塑化和钙化是较常见的导致根管阻塞的主要因素,塑化根管阻塞的再通成功率不高,根管阻塞的位置和牙位影响疏通成功率。     

光动力疗法对伴糖尿病根尖周炎患者的根管治疗效果

目的 观察光动力疗法对伴糖尿病根尖周炎患者的根管治疗疗效。方法 随机选择180例伴有糖尿病的根尖周炎患者，随机平均分为试验组和对照组，每组90例，对照组常规进行根管预备消毒，试验组行根管预备消毒+光动力辅助根管消毒。使用视觉量表法（VAS）评价根管预备术后3天局部疼痛状况，2年后根据患者临床症状、临床检查和X线检查情况统计根管治疗的成功率。结果 根管预备后3天，试验组疼痛反应轻于对照组，具有统计学差异(P<0.05)。根管治疗后2年，试验组成功率（93.33%）大于对照组（83.33%），具有统计学差异(P<0.05)。结论 对伴有糖尿病的根尖周炎患者，使用光动力疗法对其根管进行消毒，可减轻根管预备后急性疼痛症状，提高根管治疗的成功率。     

根管治疗过程中影响牙根纵裂的因素

牙根纵裂最常发生于根管治疗之后且临床症状不具有明显的特异性,常常症状不明显,早期诊断较为困难,常出现漏诊和误诊。本文从病因学的角度出发,针对根管治疗过程中的每个步骤,就牙根纵裂的影响因素作一综述,以供临床操作参考。     

The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study

BACKGROUND: The decision between pulp capping and root canal therapy after pulp exposure is a clinical issue. The aim of the authors' study was to evaluate the outcome of direct pulp-capping procedures performed by dental students. METHODS: The authors followed the treatment outcomes of 193 patients with 204 pulp exposures with direct pulp capping. They determined the outcome of pulp capping radiographically using periapical radiographs taken at least three years after pulp exposure. The outcome was considered as successful if the tooth was present and not associated with periapical radiolucency or root canal treatment; otherwise, the outcome was considered as being a failure. RESULTS: Overall, the success rate of pulp capping was 59.3 percent. The success was associated more with mechanical exposure than with carious exposure (92.2 versus 33.3 percent) (P < .001), more with permanent restoration than with temporary restoration (80.8 versus 47.3 percent) (P < .001) and more with class I occlusal restoration (83.8 percent) than with proximal multiple surface restorations (Class II, 56.1 percent; Class III, 58.8 percent; mesial-occlusal-distal, 28.6 percent) (P = .009). Patients' age, sex, and tooth location and position had no significant effect on the outcome (P > .05). CONCLUSION: The success rate of direct pulp capping was 92.2 percent with mechanical exposure and 33.3 percent with carious exposure. CLINICAL IMPLICATIONS: Direct pulp capping is recommended after mechanical exposure with immediate placement of permanent restoration, while root canal therapy would be the choice of treatment if the exposure was due to caries.     

根管内器械分离后行旁路根管治疗的临床评价

目的观察根管内器械分离患牙行旁路根管治疗后的临床疗效。方法选择32颗根管内器械分离不能完全取出的患牙为试验组,采用从分离器械旁建立通路到达根尖的方法进行根管预备和充填;同时选择器械分离后不能取出也不能行旁路根管治疗的患牙13颗为对照组,未发生器械分离的常规根管治疗患牙30颗为常规治疗组。观察3组患牙2年后的临床疗效并进行评价。结果试验组2年后回访牙数25颗,根管治疗成功率为80.00%;对照组2年后回访牙数11颗,成功率为36.36％;2组失败病例均为器械分离发生在根尖1/3处的患牙。常规治疗组2年后回访牙数22颗,成功率为90.91％。结论旁路根管治疗法是器械分离后进行根管治疗的一种可行和有效的方法。     

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在牙髓病的治疗中,牙髓腔钙化是临床上经常遇到的较为棘手的问题,常常妨碍根管治疗术的顺利进行。近20多年来,随着根管治疗术的普遍发展,技术的不断改进以及新器械的应用为临床上牙髓腔钙化的处理提供了一些行之有效的方法。了解钙化的成因、特点和治疗方法对提高根管治疗术成功率有重要意义。     

根尖区机用镍钛器械折断的临床治疗体会

目的：探讨机用镍钛器械在根尖区折断的特点及临床治疗经验。方法：收集根尖区机用镍钛器械折断患者18例,记录折断器械的种类,型号,患者的年龄,牙位及其治疗结果。结果：18例折断器械中,发生于前牙3例,前磨牙3例,磨牙12例;其中ProTaper锉11例,Waveone锉5例,Mtwo锉1例,S3锉1例。折断器械成功取出10例,成功率55.6%。其中显微超声技术取出8例,成功率为44.5%;显微镜下加压冲洗法2例,成功率11.1%;保留作为根管充填物5例,旁路通过术2例,显微根尖手术1例。1年根管治疗成功率77.8%。结论：镍钛器械折断好发于磨牙细小根管及复杂根管,折断器械取出的难度大,有效预防器械折断及选择合适的治疗方案是提高根管治疗成功率的关键。     

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目的 比较前牙唇侧入路一次性根管治疗与传统的根管治疗的临床疗效与冠折率。方法 将2007年4月至2008年10月山西医科大学第二附属医院就诊的102例因牙齿根面龋和楔状缺损引起前牙慢性牙髓病变、根尖病变的患者随机分成两组,51例采用传统的根管治疗方法,51例采用前牙唇侧入路碧兰糊剂一次性根管治疗,对其术后的冠折率和愈合率进行对比和观察。结果 前牙唇侧入路一次性根管治疗的成功率为90.20%,传统的根管治疗成功率为86.27%,两组治疗效果差异无统计学意义 （P＞0.05）。传统的根管治疗冠折率为9.80%,前牙唇侧入路一次性根管治疗冠折率1.96%,两组冠折率比较有差异有统计学意义（P＜0.05）。结论 前牙唇侧入路一次性根管治疗的成功率与传统的根管治疗无差异,但术后冠折率低,且减少了患者的复诊次数,满意效果。     

An assessment of orofacial clefts in Tanzania

Background

To determine the prevalence of periapical lesions in root canal-treated teeth in a rural, male adult, Turkish population and to investigate the influence of the quality of root canal fillings on prevalence of periapical lesions.

Methods

The sample for this cross-sectional study consisted of 552 adult male patients, 18-32 years of age, presenting consecutively as new patients seeking routine dental care at the Dental Sciences of Gulhane Military Medicine, Ankara. The radiographs of the 1014 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. The criteria used for the examination were slightly modified from those described by De Moor. Periapical status was assessed by the Periapical Index scores (PAI) proposed by Orstavik.

Results

The overall success rate of root canal treatment was 32.1%. The success rates of adequately root canal treatment were significantly higher than inadequately root canal treatment, regardless of the quality or presence of the coronal restoration (P < .001). In addition, the success rate of inadequate root canal treatment was also significantly affected by the quality of coronal restorations.

Conclusions

Our results revealed a high prevalence of periapical lesions in root canal treatment, which is comparable to that reported in other methodologically compatible studies from diverse geographical locations. In addition, the results from the present study confirm the findings of other studies that found the quality of the root canal treatment to be a key factor for prognosis with or without adequate coronal restoration.     

Accidental swallowing of an endodontic file

Aim  To report the management of an iatrogenic incident in which an endodontic file was swallowed accidentally and passed into the gastrointestinal tract.
Summary  A 51-year-old male swallowed a 21 mm, size 30 endodontic file during root canal treatment without rubber dam. In the absence of clinical complications, the patient was reviewed with serial chest and abdominal radiographs, and stool tests for occult blood until the instrument was discharged at 3 days. This report discusses early differential diagnosis for locating foreign bodies and underlines the importance of serial radiographic evaluation for signs of foreign body migration.
Key learning points • The use of rubber dam is mandatory for patient safety during root canal treatment.
• Early location of an inhaled or ingested foreign body facilitates appropriate and timely treatment management and referral.
• When a foreign body passes into the gastrointestinal tract, clinical symptoms and signs should be monitored closely until it is excreted or removed.
• An endodontic file can pass through the gastrointestinal tract asymptomatically and apparently atraumatically within 3 days.     

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目的评价ProTaper机用镍钛锉用于根管治疗术一次法的临床效果。方法选择2008年7月至2010年7月广州医学院第一附属医院口腔科就诊患者206例(206颗患牙),随机分为两组。试验组的106颗患牙用ProTaper机用镍钛锉预备根管,对照组的100颗患牙用不锈钢K型锉预备根管,两组均以常规侧方加压法进行根管充填。拍摄牙片以了解根管数目形态、确定根管工作长度及判断治疗效果,并观察根管预备及充填后1～2周的术后反应。结果试验组患牙根管充填成功率(88.7%)高于对照组患牙(64.0%),试验组患牙根管预备及充填术后急性反应发生率(1.9%)明显低于对照组(14.0%),差异均有统计学意义(P<0.05)。结论 ProTaper机用镍钛锉用于根管治疗术一次法的根管充填成功率较高,且能明显减少术后根尖不良反应的发生,近期疗效可靠。     

iRoot SP单尖法充填技术对根管治疗临床效果影响的回顾性研究

目的通过回顾性分析，研究iRoot SP辅助单尖充填法及多种预后因素对根管治疗临床效果的影响。 方法从2014—2018年于中山大学附属口腔医院接受根管治疗且能追踪复查的患者中，选择使用iRoot SP辅助单尖充填后且复诊时间为1年以上患者的110颗患牙纳入分析。根据每颗患牙复诊时临床和影像学检查结果，将患牙的预后分为成功和失败两组。使用连续性修正卡方检验和Fisher精确检验，对术前是否存在根尖阴影、术前根尖阴影的直径大小和有无封闭剂超充等8项可能影响iRoot SP单尖充填临床效果的预后因素进行统计分析。 结果110颗接受iRoot SP单尖充填治疗的患牙总体成功率为95.5%。其中，83颗术前有根尖阴影患牙的治疗成功率为96.4%，68.7%为已愈合；27颗术前无根尖阴影患牙的治疗成功率为92.6%。术前有根尖阴影和无根尖阴影患牙的治疗成功率差异无统计学意义（χ² = 0.084，P = 0.772）。术前根尖阴影直径小于或等于5 mm的患牙共53颗，治疗成功率为98.1%；而阴影直径大于5 mm的患牙共30颗，治疗成功率为93.3%。两组患牙治疗成功率的差异无统计学意义（χ² = 0.259，P = 0.611）。44颗封闭剂超充患牙的治疗成功率为97.7%，患牙有无iRoot SP超充的治疗成功率差异也无统计学意义（χ² = 0.218，P = 0.640）。 结论iRoot SP单尖充填法是可行的根管充填技术。