根管治疗约诊间痛的非感染性和非医源性因素探讨

目的：收集临床上根管治疗资料,探讨非感染性和非医源性因素对约诊间痛的影响。方法：对恒牙149例根管治疗病例年龄、性别、牙位、就诊时牙齿状况、牙周状态及临床诊断等进行分析。结果：临床因素中,约诊间疼痛发生率后牙高于前牙,临床诊断为根尖周炎者约诊间疼痛发生率明显高于牙髓炎患者。牙髓坏死、有根尖区骨质破坏的患牙发生约诊间痛的几率较高。服用抗生素及年龄与性别对约诊间疼痛影响不明显。结论：牙位、临床诊断及根尖病变对根管治疗约诊间痛影响较大。     

氢氧化钙糊剂根管消毒的临床疗效观察

目的评价氢氧化钙作为根管内消毒药物预防术后疼痛的效果。方法选择96颗有根管治疗指征的患牙,将其随机分为A、B2组,每组48颗牙。每组患牙均为二次完成根管治疗,Α组患牙约诊期间根管内封Ca(OH)2糊剂,B组患牙约诊期间根管内封FC棉球或CP棉捻。分别于封药后1周和充填后1周复诊,并记录2组约诊期间和根管充填术后1周内患牙疼痛情况。结果Α组患者约诊期间和根管充填术后1周内患牙疼痛的发生率均明显低于Β组,经χ2检验,2组疼痛发生率的差异有统计学意义。结论氢氧化钙作为根管内消毒药物可有效地预防根管治疗约诊期间及充填后疼痛的发生。     

选择性去髓术中约诊间痛发生的研究

目的:探讨选择性去髓术中的约诊间痛发生率和影响因素。方法:对门诊中选择性去髓术的218个活髓牙(117例患者)进行根管预备后疼痛程度的临床调查;分析不同医师、根管预备方法等治疗因素对疼痛的影响。结果:选择性去髓术的根管预备后疼痛发生率为28.4%。约诊间痛发生率为0.46%。不同医师、不同根管预备方法对活髓牙根管预备后疼痛发生均无明显影响(P>0.05)。而牙根情况影响根管预备后疼痛发生(P<0.01)。结论:创伤因素可以引起约诊间痛,严格遵守操作规程是减少创伤、降低疼痛发生的关键。     

根管治疗术中约诊间痛与牙位、诊断的关系初探

目的:探讨根管治疗术中约诊间痛和牙位与诊断的关系。方法:临床上对100例牙髓根尖周病患牙根管治疗术中约诊间痛与牙位和诊断的关联作分析。结果:牙髓坏疽患牙、多根管磨牙在根管治疗术中约诊间痛机率较大。结论:牙髓坏疽或多根管磨牙在根管治疗术中应加强治疗的细致性和精确性。     

Mtwo根管预备系统根管治疗约诊间痛的临床分析

目的:采用Mtwo根管预备系统进行根管预备,观察约诊间痛的情况,探讨发生约诊间痛的影响因素。方法:选取临床因龋病或隐裂引起牙髓炎的患者共97例,其中男37例,女60例,年龄15～62岁。随机分为2组,机动组采用Mtwo根管预备系统,手动组采用不锈钢K锉预备根管。比较2组术后患牙约诊间痛的情况。采用SPSS13.0软件包中的非参数Mann-Whitney U检验进行2组间疼痛情况比较,采用Fisher精确χ2检验比较2组约诊间痛发生率。结果:采用Mtwo机动预备系统的约诊间痛发生率显著低于K锉常规法(P=0.027)。结论:与手动不锈钢K锉相比,Mtwo机动根管预备系统可以降低根管预备后约诊间疼痛的发生率。     

不同根管终末工作直径对约诊间痛发生率的影响

采用冠下法对2年间在我科就诊的下颌前磨牙慢性根尖周炎行根管治疗术的300颗患牙进行研究。根据终末工作直径分3组,各100例:A组为25#,B组为30#,C组为35#。结果 A、B、C 3组的约诊间疼痛发生率分别为32%、25%和19%(A vs C,P<0.05),认为终末工作直径达标准锉35#可明显降低根尖周炎患牙约诊间痛发生率。     

不同处理步骤对根管治疗诊间及术后疼痛的影响

目的观察不同根管治疗方法处理患牙后诊间急症和根充后疼痛的发生率。方法选择200例40岁以上患者共200颗牙髓坏死的磨牙随机分为A、B、C、D、E组,分别按照不同的根管治疗处理步骤进行治疗,A组开放2 d,封药1周,再行根管预备、根管充填;B组开放2 d,根管预备后封药1周,再行根管充填;C组开髓、拔髓后封药1周,根管预备后封药1周,再行根管充填;D组开髓、拔髓后封药1周,再行根管预备、根管充填;E组开髓、拔髓、根管预备后封药1周,再行根管充填。观察5组的约诊间疼痛和根充后疼痛的发生情况。结果 A、B组均未发生诊间痛,C、D组先行开髓,拔髓后诊间痛发生率最高分别为20.0%和22.5%,其中D组最高。结论对于易发生诊间疼痛和根充后疼痛的患者及患牙先行开放2 d,再行根管治疗可有效减少诊间急症和根充后疼痛的发生。     

逐步后退法和逐步深入法根管预备后约诊间痛发生的比较

目的 比较2种根管预备方法约诊间痛的发生情况。方法 对144例患者的23l颗患牙分别采用逐步后退法和逐步深入法进行根管预备，观察各自约诊间疼痛的发生情况。结果活髓牙中，分别有14．7％(逐步后退法组)和13．1％(逐步深入法组)发生约诊间痛，两组间无显著性差异。死髓牙中，分别有28．0％(逐步后退法组)和15．5％(逐步深入法组)发生约诊间痛，逐步后退法组明显高于逐步深入法组。结论 对死髓牙患者，采用逐步深入法进行根管预备可以减少约诊间痛的发生。     

氢氧化钙预防根管治疗术后疼痛的临床观察

目的评价氢氧化钙作为根管内药物预防根管治疗术后疼痛的效果。方法选择90颗牙髓坏死的前磨牙,将其随机分为A、B、C组,每组30颗牙。A组患牙1次完成根管治疗;B组患牙2次完成根管治疗,但约诊期间根管内不封任何药物;C组患牙2次完成根管治疗,但约诊期间根管内封Ca(OH)2糊剂。采用改良10点视觉模拟量表对患者根管治疗后疼痛的严重程度进行评价,比较3组患者根管治疗后的疼痛水平。结果A组与B组、B组与C组患者根管治疗术后疼痛的差异有统计学意义(P<0.05),A组与C组患者根管治疗术后疼痛的差异无统计学意义(P>0.05)。结论氢氧化钙作为根管内封药可有效预防根管充填后疼痛的发生。     

232例根管治疗术中术后疼痛肿胀的原因分析

目的 探讨如何减少根管治疗术中、术后疼痛肿胀的发生率。方法 应用三次法对350颗患牙进行根管治疗,观察术中、术后疼痛肿胀的情况。结果 在350颗患牙经三次法行根管治疗术,有27颗出现了术中或术后疼痛肿胀。其中后牙、下牙的发生率较前牙、上牙高,且牙髓坏死,急性根尖周炎患牙发生率较高。结论 牙髓坏死,急性根尖周炎患者在根管治疗过程中出现疼痛肿胀的发生率相对活髓牙较高。     

戊二醛联合超声技术在根管治疗术一次法中应用的临床评价

目的：观察戊二醛联合超声技术在根管治疗一次法中应用的术后反应和远期疗效。方法：选择慢性根尖周炎患牙290个，随机分成实验组147个牙和对照组143个牙。实验组以2％戊二醛作冲洗液联合超声技术预备根管，采用根管治疗术一次法。对照组采用传统手持器械预备根管，行常规根管治疗多次法。比较两组患牙在根管治疗期间发生疼痛的比率和远期疗效。结果：实验组疼痛发生率为12．24％，对照组21．68％。两组有显著性差异(P＜0．05)。远期疗效分别为92．66％、91．40％，无显著性差异(P＞0．05)。结论：戊二醛是较理想的超声根管冲洗液，联合超声技术可有效地杀灭根管内的细菌，预防根管治疗期间急症的发生，提高感染根管治疗的成功率。     

空管药物消毒根管对预防根管治疗术复诊间痛的临床观察

目的：通过暂封空管药物来消毒根管，达到预防根管治疗术复诊间痛的发生。方法：选择患急、慢性根尖周炎，牙髓坏死需接受根管治疗的362例患者共376个患牙为受试对象，随机分成实验组180例186个患牙和对照组182例190个患牙。两组均行两次法完成根管治疗术。实验组暂封空管药物，对照组暂封FC。比较两组患牙在根管治疗期间发生疼痛的比率。结果：暂封空管药物组发生疼痛的患牙为21个（11.29%），对照组发生疼痛的患牙为41个（21.58%），经统计学检验，两组有显著差异（P＜0.01）。结论：暂封空管药物可以有效预防根管治疗术复诊间痛的发生。     

Endodontic postoperative flare-up: An update

Endodontic treatment corresponds to a combined chemical and mechanical approach, followed by a three dimensional hermetic obturation, that eliminate the pulpal and periradiculare disease and boost healing and repair of periradiculare tissue. Despite the advances in the endodontic field, the inter-appointment flare up remains a true nightmare that encounters every dentist. This complication commences a few hours or days after root canal procedures and it is characterized by the development of pain and/or swelling, requiring an unscheduled appointment for emergency treatment. Different studies showed that flare-ups represent a multifactorial phenomenon including mechanical, chemical and microbial factors. In addition, a correlation was found between flare-up and age, gender, tooth type, presence of preoperative pain, tooth condition before treatment, irrigation techniques, number of visits as well as intracanal medication. Moreover, some medicine intake was proved to be efficient in controlling this postoperative pain. However, a clear procedure to avoid its occurrence is yet to be established. In this review, we summarize knowledge about the etiology of flare-up and its related factors. This could be effective in helping dentists to adapt some strategies to prevent it.     

Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis

This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%— a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.     

Molecular evaluation of residual endodontic microorganisms after instrumentation, irrigation and medication with either calcium hydroxide or Septomixine

BACKGROUND AND OBJECTIVE: The correct choice of antimicrobial agents as inter-appointment medicaments is as important as the instrumentation and irrigation to remove pathogens from infected root canals. Calcium hydroxide [Ca(OH)2] and framycetin sulfate (Septomixine) are common endodontic medicaments. Therefore, we evaluated the efficacy of either calcium hydroxide or Septomixine in eliminating residual intra-canal bacteria, particularly Actinomyces spp., during inter-appointment interval in endodontic therapy using molecular methods. METHODS: A total of 31 single-rooted teeth with primary root canal infections were studied immediately after opening the canals and subsequently after instrumentation, irrigation with sterile saline and 1-week medication with either Ca(OH)2 (n = 25) or Septomixine (n = 6). Whole bacterial genomic DNA was isolated directly from samples and PCR with universal primers performed to detect total intra-canal bacteria. The variable regions of 16S rDNA of bacteria were amplified and labeled with digoxigenin for further hybridization to detect Actinomyces spp. A total of seven oligonucleotide probes specific for A. bovis, A. gerencseriae, A. israelii, A. meyeri, catalase-negative A. naeslundii (genospecies 1 and 2), catalase-positive A. naeslundii genospecies 2 and A. odontolyticus were used to detect Actinomyces spp. in 22 of 31 medicated root canals [Ca(OH)2: n = 17; Septomixine: n = 5]. RESULTS: The PCR results showed that 25 of 31 examined canals were positively detected with residual microorganisms after instrumentation, irrigation with sterile saline and 1-week medication with either Ca(OH)2 (n = 20) or Septomixine (n = 5). Thus, only six canals [Ca(OH)2: n = 5, Septomixine: n = 1] were aseptic after treatment. Hybridization results showed higher detection frequency of both A. odontolyticus and A. gerencseriae after treatment. Significant correlation was found between exposed pulp before treatment and positive detection of Actinomyces spp., particularly A. odontolyticus on the second visit (P < 0.05). CONCLUSION: The conventional, 1-week medication of either Ca(OH)2 or Septomixine in endodontic therapy may not effectively inhibit residual bacterial growth in all root canals during inter-appointment intervals. Further investigations using, for instance quantitative real-time PCR analyses, are required to substantiate the present findings.     

What we leave behind in root canals after endodontic treatment: some issues and concerns

The benefits of using sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) as endodontic irrigants, and calcium hydroxide as an inter-appointment medicament, are well known to dentists. Many steps undertaken during endodontic treatment and retreatment are rather mechanical in nature, and less attention is committed to understanding the biological issues underlying endodontic treatment and retreatment. It should be noted that dentine is the fundamental substrate in endodontic treatment, and its properties and characteristics are the key determinant of nearly all disease and post-disease processes in the teeth. In this article the effects and counter-effects of NaOCl and EDTA on root canal dentine, and some other related issues are reviewed. This information will enable clinicians to use the beneficial effects of these chemicals, while necessary steps are considered to reduce their harmful effects on dentine substrate.     

从微生物学角度思考感染根管的治疗

根管治疗术已被公认为治疗感染根管的有效方法,日渐受到临床医师的重视和采用。但随着此技术的推广应用,特别是用于根管形态较复杂的磨牙,发生了一些问题,如过度根管预备引起的管壁侧穿、根尖偏移、约诊间痛、牙根纵裂以及根充后的再感染等。如何解释这些问题,采用什么方法防治这些问题,使我们感到有必要从现代微生物学的观点探讨细菌在感染根管中生存的状态,并对治疗感染根管的方法进行思考和评估。     

牙髓应急治疗效果的对比研究

对３１５例急性牙髓炎和２４０例急性牙髓炎合并根尖周炎采用开髓引流术和牙髓摘除术或牙髓切断术和失活性的封髓疗法。结果封髓疗法对照疼痛缓解明显高于开髓引流术组（Ｐ〈０．０１）;术后疼痛加重和急性根尖周炎发生率明显低于开髓引流术组（Ｐ〈０．０１）,完成牙髓治疗的总次数明显低于开髓引流术组（Ｐ〈０．０１）。结果表明急性牙髓炎或急性牙髓炎合并根尖周炎时,采用开髓引流术的应急处理可致牙髓治疗复杂化,止痛不彻底