前牙根管闭锁残冠的修复

目的：探讨根管完全闭锁钙化残冠、残根的临床修复设计与方法,为修复临床对这类病例提供解决方案。方法：收集我院2001～2003年门诊病例中根管完全闭锁,口腔内科无法进行根管治疗,且根尖周无病变的前牙残冠、残根18例20颗患牙,所有病例均设计为铸造桩核,临床采用碘酊染色法寻根管入口,直接进行根管预备后,间接法完成钴铬合金铸造桩核制作,烤瓷冠修复。结果：18例20颗患牙除1例失访,1例无效外,余疗效均满意。结论：临床诊断为根管完全闭锁的残根残冠,如无尖周炎症可直接进行桩核冠修复,在功能和美观上均获得良好效果。     

3种根管糊剂的根管密封性能研究

目的比较Vitapex糊剂、AH-Plus糊剂和GuttaFlow常温流动牙胶根管充填的致密性。方法选择30颗单根管牙,随机分3组,每组10颗牙。分别用Vitapex糊剂(A组)、AH-Plus糊剂(B组)、GuttaFlow常温流动牙胶(C组)充填根管。分别对每颗牙在距根尖2、4、6、8 mm进行片切,MIAS-2000图像分析并计算各横断面的根管面积(area of canal,AC)以及其中的空隙面积百分比(perceentage of voild-filled area,PV)。记录结果,并进行统计学分析。结果各组根充材料在距离根尖相同处的根管面积(AC值)虽有所差异,但无统计学意义(P>0.05)。在距根尖2、4、6、8 mm处C组材料的PV值与其他各组均有统计学意义(P<0.05);在距根尖2、4 mm处A、B组的PV值有统计学意义(P<0.05),B、C组的PV值无统计学意义(P>0.05);在距根尖6、8 mm处3组间的PV值均有统计学意义(P<0.05)。结论 GuttaFlow常温流动牙胶和AH-Plus糊剂在距根尖不同部位均显示出较好的致密度;Vitapex糊剂的致密度欠佳。     

根管预备并发症及充填质量的临床评价

目的：对根管预备并发症及充填质量进行临床评价。方法：从Digora图像系统中抽取我科2002—04—05所完成的根管治疗病例805例，分别对前牙、前磨牙和磨牙根管预备并发症的发生和充填质量进行分析。结果：形成台阶和侧穿的比例在前磨牙分别为4％，而在磨牙中则分别为33％和5％。前牙、前磨牙和磨牙适充的比例分别为74％、69％和50％。结论：磨牙根管预备和充填的质量仍有待进一步提高。     

热塑牙胶充填根管临床观察

目的：观察连续波热塑牙胶注射法充填根管的临床效果.方法：选择360例根管治疗患者,共380颗牙,其中240颗牙用热塑牙胶注射充填仪做连续波热塑牙胶充填根管,140颗牙用常规冷牙胶侧方加压充填根管,通过X线片比较两组病例的充填质量并比较两组病例间每根管根充需用时间.结果：X线片显示连续波热塑牙胶充填组欠填率1.67％,超填率2.91％,恰填率95.41％,冷牙胶侧压充填组欠填率8.57％,超填率2.85％,恰填率88.57％,比较两组间欠填率与恰填率有统计学差异（P＜0.05）,连续波热塑牙胶充填组平均每根管根充时间8 min.冷牙胶侧压组充填平均每根管根充时间12 min.连续波热塑牙胶充填组缩短根充时间30％.结论：连续波热塑牙胶充填术比冷牙胶侧方加压充填术根管充填质量更高且节约根充时间,提高了工作效率.     

根管充填的方法

根管充填是根管治疗中的重要步骤,目的是从三维方向封闭根管系统,阻隔微生物和外界营养物质的进入,包埋根管预备和冲洗后的残余病原微生物,防止患牙再感染.为获得良好的根管封闭,专家们在不断改进根管充填的方法.文章就常用根管充填方法的适应证及注意事项做一介绍.     

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根管治疗是牙髓和根尖周疾病的最有效治疗方法,根管的清理和成形、根管系统的消毒、完善的根管充填是保证根管治疗成功的重要因素,没有三维根管预备就不会有三维充填,从根管系统去除感染物质比向根管系统放入充填材料更重要,但临床上仍有约60%的根管治疗失败归于不完善充填.本文仅从三维根管充填角度做一评述.     

The apical seal of root canal sealing cements using a radionuclide detection technique

The aim of this study was to evaluate the apical seal obtained with various root canal sealing cements using a new method based on the use of a radionuclide and an external detection technique. A total of 150 maxillary incisors and canines, which had been kept in saline solution, were used. The root canals were instrumented with a stepback technique and circumferential filing. Six experimental groups and two control groups were randomly formed. Each experimental group was obturated by a lateral condensation technique with gutta-percha points and a different sealing cement (two based on zinc oxide-eugenol cement, two based on resins and two on calcium hydroxide); the positive control used gutta-percha without sealing cement, while in the negative control the apex was covered with nail varnish, leaving the root canal empty. The apical leakage was measured using an external detection technique after submerging the root apices in a solution containing the radioisotope metastable 99Tc. No leakage was observed in the negative control group. There was a large difference between the leakage observed in the positive control group and the experimental groups. The best seal was obtained using Sealapex cement, which differed significantly from AH26, Tubli-Seal and Diaket; there was no significant difference between the latter. The poorest results were obtained with Endomethasone and CRCS; there was a significant difference between these and the previous three sealing cements.     

试尖对根管充填质量的影响--附1500例Digora图像分析

目的 :利用计算机数字化图像系统 (Digora)能储存大量图像的特点 ,了解试尖对侧向加压法根管充填质量的影响。方法 :随机从Digora系统中提取我院从 1998年 10月至 1999年 4月所完成的根管充填病例 15 0 0例 ,按试尖与未试尖 ,分别对前牙、前磨牙和磨牙根管充填质量进行分析。结果 :在 75 2例未试尖根管充填病例中 ,前牙、前磨牙和磨牙的适充比例分别为 4 4%、3 5 %和 2 6% ,欠充为 2 2 %、3 2 %和 4 5 % ,超充为 3 4%、3 3 %和 2 9% ;在 74 8例试尖病例中 ,前牙、前磨牙和磨牙的适充比例分别为 62 %、64 %和 5 1% ,欠充为 7%、13 %和 19% ,超充为 3 1%、2 3 %和3 0 %。结论 :在侧向加压法根管充填中 ,试尖可明显改善充填质量     

根管超填临床预后的研究进展

根管充填是使用充填材料严密封闭清理成形后的根管系统,控制感染,促进根尖周病变愈合。根管充填质量是影响根管治疗预后的重要因素。理想的根管充填应是充填物内部致密,末端到达根管壁牙骨质牙本质界,无超填和欠填。本文主要阐述根管超填对根管治疗远期疗效的影响及其原因、超填对患牙邻近组织结构的影响以及超填的预防和处理策略,以期更好地...     

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目的评价电子根尖定位仪测量根管工作长度进行根管充填的质量。方法选取2007年8月至2008年4月郑州市第一人民医院口腔科门诊经X线及临床检查确诊为牙髓病及根尖周病需作根管治疗的患牙136颗,共265个根管。按患者就诊顺序编号,随机分成实验组(141个根管)和对照组(124个根管)。实验组的根管工作长度用电子根尖定位仪测定,对照组的根管工作长度用X线拍片法测定。两组均用逐步后退法根管预备,侧方加压法根管充填,以X线拍片检验根管充填质量。结果实验组适充率为86.52%,对照组适充率为76.61%,两组间差异有统计学意义(P<0.05)。结论采用根尖定位仪测量根管工作长度能明显提高根管充填质量。     

显微CT在测量根管解剖结构中的方法应用

近年来,显微CT(micro-CT)在显示根管解剖结构中的微细变化,以及离体牙在根管预备前后结构变化中的应用,越来越受到关注。本文对micro-CT的测量方法进行综述。     

Quality of root fillings performed with two root filling techniques. An in vitro study using micro-CT

Abstract

Objective. The aim of this study was to compare the presence of voids in root fillings performed in oval and ribbon-shaped canals with two root filling techniques, lateral compaction technique (LCT) or hybrid technique (HT), a combination of a gutta-percha masterpoint and thermoplastic gutta-percha. Furthermore, the obturation time for the two techniques was evaluated. Materials and methods. Sixty-seven roots with oval and ribbon-shaped canals were prepared using Profile Ni-Ti rotary files. After preparation, the roots were randomly allocated to two groups according to root filling technique. All roots were filled with AH plus and gutta-percha. Group 1 was filled using LCT (n = 34) and group 2 was filled using HT (n = 33). The obturation time was measured in 30 cases evenly distributed between the two techniques. Voids in relation to the root canal fillings were assessed using cross-section images from Micro-computed Tomography scans. Results. All root canal fillings had voids. Permutation test showed no statistically significant difference between the two root filling techniques in relation to presence of voids (p = 0.092). A statistically significant difference in obturation time between the two techniques was found (p < 0.001). Conclusion. The present study found no statistically significant difference in percentage of voids between two root filling techniques. A 40% reduction in obturation time was found for the HT compared to the LCT.     

Sealing ability of thermoplasticized gutta-percha in root canal obturation using a sectional vs. a single-phase technique

Abstract Properly prepared straight root canals of freshly extracted maxillary canines and central incisors were used to evaluate the sealing ability of the sectional thermoplasticized gutta-percha obturation technique, with or without sealer and the single-phase thermoplasticized gutta-percha filling technique. The teeth were divided into 3 groups (A, B, C) of 20 teeth and were obturated using the 3 thermoplasticized gutta-percha techniques. Group A: single phase with sealer; group B: sectional technique without sealer; and group C: sectional technique with sealer. The obturated teeth were immersed in India ink for 3 days followed by clearing procedures. The teeth were then examined under a stereo microscope and the linear leakage was recorded. Statistical unpaired Student's t-tests showed significantly less dye penetration in teeth obturated using the sectional technique with sealer (group C) than in teeth obturated with the single-phase technique with sealer (group A) or the sectional technique without sealer (group B).     

根管充填质量与临床疗效观察

目的：对试尖后根管充填患牙进行临床疗效观察。方法：随机选取2006～2007年完成的根管充填病例共486个患牙X线片及临床资料,按试尖与未试尖分成实验组263个牙和对照组223个牙,通过对比充填内1周疼痛发生率观察两组根管充填质量。结果：①实验组和对照组恰填、超填和欠填率分别为88.97%和72.65%、4.18%和15.25%及6.84%和12.11%。恰填率和超填率两组间有统计学差异（p〈0.05）。②实验组和对照组无痛率、可自愈疼痛率和非自愈疼痛率分别为90.11%和79.82%、9.13%和14.80%及1.14%和4.93%。无痛率和非自愈疼痛率两组间有统计学差异（p〈0.05）。③两组恰填率与无痛率呈负相关（p〈0.05）。结论：试尖可明显提高根管充填质量,提高近期临床治疗效果。     

Periodontal tissue reactions following root canal obturation with an injection-thermoplasticized gutta-percha technique

Abstract The thermoplasticized gutta-percha obturation technique is a relatively recent development in endodontics. In this study we evaluated the possible effects of heat transmitted to the periodontal tissues when the Obtura root canal filling device was used in dog teeth. Two 8-month-old beagle dogs were used; 56 root canals of 36 teeth (maxillary incisors and first, second and third premolars of both jaws) were divided into two groups. In Group A 26 root canals were obturated with the lateral condensation technique, while in Group B 30 root canals were obturated using the Obtura device, without sealer. Observation periods were 1, 3, 7, 28 and 56 days. After routine laboratory procedures, hematoxylin-eosin stained sections were examined under a light microscope. In this experimental model the thermoplasticized gutta-percha obturation technique caused a periapical inflammatory reaction at all observation periods. Inflammatory reaction and destruction of collagen fibers were localized in the area around the apical delta, while the alveolar founding bone, the roots of the teeth and the periodontal ligament at the side of the root surfaces remained normal.     

Percentage of canals filled in apical cross sections - an in vitro study of seven obturation techniques

AIM: To compare the apical density of several obturation techniques when used in palatal roots of extracted maxillary molars. METHODOLOGY: Seventy extracted molars were randomly divided into seven groups with 10 teeth each. The palatal root canals were instrumented to size 60 MAF, coated with Kerr's Pulp Canal Sealer, and obturated using one of seven techniques. The palatal roots were separated from the crowns, decalcified, and sectioned horizontally at 2 and 4 mm from the apex. The cross-sections were photographed through a microscope, the photos were analysed, and the amount of area in the canal that was obturated with gutta-percha was measured. The means for the 20 sections per group were calculated and the means were compared using mixed analysis of variance test. RESULTS: Simplifill used in accordance with the manufacturer's directions and Thermafil had the greatest mean obturated area, but neither were statistically better than mechanical lateral or warm vertical compaction (WVC; Schilder Technique). Simplifill as recommended and Thermafil were statistically better than cold lateral (P = 0.0210 and 0.0433, respectively), WVC (continuous wave) (P = 0.0006 and 0.0015), and the modified Simplifill group (P = 0.0010 and 0.0012). In addition, mechanical lateral and WVC (Schilder) had statistically more obturated area than WVC (continuous wave) (P = 0.0054 and 0.0073) and modified Simplifill (P = 0.0015 and 0.0016). Cold lateral and WVC (continuous wave) had significantly more obturated area than modified Simplifill (P = 0.0040 and 0.0087). CONCLUSIONS: Simplifill as recommended, Thermafil, mechanical lateral and WVC (Schilder) obturation techniques created more complete obturation using gutta-percha at the 2 and 4 mm levels than cold lateral, WVC (continuous wave), and Simplifill not used as directed.     

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迄今为止,根管治疗术仍是治疗牙髓和根尖周疾病最有效的方法,近二十多年来的发展,使根管治疗不仅在基础研究方面取得了长足的发展,而且根管治疗的预备器械、预备方法也有了很大的改进.根管充填材料和方法的进一步完善以及根管手术显微镜的使用,使根管治疗的临床成功率可达90%以上.     

Apical placement of needle tip with an injection-thermoplasticized gutta-percha technique for root canal obturation

Abstract It is recommended that when injection-thermoplasticized gutta-percha is used as the obturation technique, the root canal space should be prepared in such a way that the 23-gauge injection needle tip can be placed at a distance 3 to 5 mm short of the working length. In this study the apical seal and extent of gutta-percha were evaluated when the 23-gauge tip was placed at a distance 4 mm, 6 mm, and 8 mm short of the working length. Ninty-nine human single-rooted mandibular incisors and premolars divided into 3 equal groups were used. Their crowns were separated at the cementoenamel junction and their roots were stored in sodium hypochlorite for 1 week. The roots were then instrumented from size 20 at the working length to size 70:4 mm short of the working length in group A, 6 mm in group B, and 8 mm in group C. Following instrumentation, 3 randomly selected roots of each group were used as control. The remaining 30 roots of each group were covered with aluminium foil and embedded in acrylic blocks. The root canals were then dried, coated with sealer (Roth 811) and obturated by injection of thermoplasticized gutta-percha using the single-phase technique. Vertical condensation followed. The roots were immersed in dye for 3 days and then demineralized, dehydrated and cleared in xylene. Measurements of linear dye penetration for the apical seal and for underextension were done by 2 independent examiners under a stereomicroscope. The results of this study showed no statistically significant difference in leakage between the groups. However, statistically significant differences were found in linear underextension between groups A and C as well as between groups B and C, while no significant difference was found between groups A and B.     

In vitro evaluation of apical leakage of root canal fillings after in situ obturation with thermoplasticized and laterally condensed gutta-percha

The purpose of this investigation was to compare In vitro the sealing ability of root canal treatments performed In situ with injected thermoplasticized gutta- percha compared with the lateral condensation technique. Thirty single-rooted teeth with straight canals, due for extraction For orthodontic or periodontal reasons were prepared using a step-back technique. Teeth were then divided randomly into groups A and B and obturated, respectively, with the sectional injection thermoplasticized gutta-percha and the lateral condensation techniques. Teeth were extracted after 15 days, immersed in India ink for 3 days and the leakage was determined using area-metric analysis. The roots were ground transversally and the root portion was incrementaly removed with successive steps of 250 μm each, up to the coronal level of the dye penetration. Every section was photographed with a stereoscopic microscope under the same magnification (×20); 310 photographs were taken. Measurements of the area covered by ink as well as the whole cross-sectional area of the canal were made from each photograph with the aid of a digitizing computer. The measurements were subjected to non-parametric statistical analysis. No significant difference was found (P>0.05). The technique of lateral condensation proved to be better in the first five sections (1.2 mm from the foramen) while thermoplasticized gutta-percha technique was superior in the rest of the root canal.     

Area-metric analysis of dye leakage for evaluation of sealing ability of root canal obturation techniques

Abstract Root canal sealing ability of obturation techniques has been assessed in vitro with various methods. The majority of the methods employ microleakage tracers and particularly dyes. In vitro measurements of dye penetration are either linear or volumetric. Area-metric analysis is a three dimensional registration method of dye leakage. The purpose of the present study was to evaluate in cleared teeth area-metric analysis as opposed to linear analysis of dye penetration. Forty freshly extracted single rooted human teeth were used. Instrumentation was carried out using Hedstroem files with a step back technique. The root canals were obturated using Roth sealer and gutta-percha cones and lateral condensation technique. The roots were then subjected to dye leakage tests under vacuum of 50mmHg for 20min. India ink was used as the tracer. The roots were randomly divided in two groups. In Group A the roots were cleared and linear measurements of the dye penetration were recorded The roots in Group B were ground stepwise transversally and subjected to area metric analysis. The results showed that area-metric analysis enabled sufficient recordings of the dye leakage patterns and the volume of the dye penetration could also be calculated.