根管内折断器械的超声取出方法

根管内器械折断是根管治疗的常见并发症,随着显微根管治疗技术的发展,大部分根管折断器械可以通过超声技术取出。本文对根管内器械折断的原因、超声技术取根管内折断器械的方法及应用中可能出现的问题进行介绍,强调超声法取根管内折断器械时建立直线通路的重要性,对超声振动过程中有水或无水下操作、工作尖是否需要旋转以及是否需要根管显微镜辅助等问题进行讨论,对临床医师预防和处理根管器械折断具有指导意义。     

根管内折断器械取出的影响因素

根管内器械折断是根管治疗术中常见的并发症,随着显微根管治疗技术的发展,大多数折断器械可以安全取出。折断器械能否取出与多方面因素有关,其中根管的弯曲度、器械折断在根管中的相对位置是影响取出的主要因素。     

根管内折断器械处理方法的临床研究

目的 探讨根管内折断器械的处理方法及影响取出因素分析。方法对86个根管内器械折断的病例。应用不同取出方法处理，总结根管内折断器械的取出效果。结果使用非手术方法，在器械折断的86个根管中，全根管和根管上部的折断器械38例，全部取出；折断器械位于根管中部的20个，13个取出；折断器械位于根尖部的28例中，6例取出。在使用非手术方法未能取出的29例中，18例通过折断器械建立旁路根管充填；11例行根尖手术取出并根管倒充填。结论应用适当的非手术方法，根管中上部的折断器械大部分可取出，根尖部的折断器械取出较困难，根尖部的折断器械可以通过根尖手术的方法取出。     

显微超声技术取根管内折断器械致根管侧穿并发症的研究

目的分析影响显微超声技术取出根管内折断器械的成功率及导致根管侧穿并发症的因素。方法45例患者,45颗患牙采用显微超声技术取出根管内折断器械,观察根管内折断器械的取出成功率以及根管侧穿发生的情况,分析影响因素。结果当折断器械位于根管冠1／3、中1／3和尖1／3时,应用显微超声技术取出的成功率分别为90．00％、94．12％和38．89％,根管侧穿发生率分别为10．00％、5．88％和50．00％,后者取出的成功率明显低于前二者（P〈0．05）,而根管侧穿的发生率却明显高于前二者（P〈0．05）;当折断器械位于直根管、中度弯曲以及重度弯曲根管内时,取出成功率分别为91．67％、85．71％和47．37％,根管侧穿的发生率分别为8．33％、7．14％和47．37％,后者的取出成功率明显低于前二者（P〈0．05）,而根管侧穿的发生率却明显高于前二者（P〈0．05）;另有2例断针推出根尖孔外。结论显微超声技术取出根管内折断器械时可能发生根管侧穿,尤其当折断器械位于根管尖1／3段或重度弯曲根管时更应该慎重。     

根管治疗中器械分离是否需要取出

由于根管系统的复杂性,根管内器械分离是根管治疗中常见的并发症之一,从远期疗效来看,有些根管内分离的器械可充当根管内充填物的作用,并不影响根管治疗的预后效果,但也有可能是导致根管治疗失败的一个隐患因素,但在取出分离器械的过程中往往又会给患牙带来新的并发症,比如根管侧穿、牙根折断等,是否需要将其取出是困扰临床工作者的棘手问题。本期争鸣栏目特别邀请了5位国内牙体牙髓疾病领域的知名专家就这一问题进行探讨,以期能为临床工作带来些许启示。     

显微超声技术处理根管内折断器械的影响因素及临床应用

目的用显微超声技术处理根管内折断器械并对其影响因素进行分析。方法对2003年10月—2006年10月就诊于南京医科大学附属口腔医院的47例根管内器械折断的患者进行诊断和治疗,用根管手术显微镜配合超声器械进行治疗处理。结果47例患者中有34例根管内折断器械被完全取出,取出率为72.3%。折断器械的位置与操作难度密切相关,根管弯曲前段、中段和后段内折断器械取出率依次降低;根管弯曲度小于30度者较弯曲度大于30度者其折断器械取出率高。结论手术显微镜结合超声器械是处理根管内折断器械的较有效方法。     

根管内金属阻塞物的取出方法

根管内金属阻塞物的取出是根管治疗和再治疗过程中一个极为困难的过程，常很繁琐费时且成功率低。使用特殊装置如Masserannkit、根管探寻系统及超声器械等在显微镜的帮助下可提高取出成功率。银尖和根管桩的取出成功率较折断器械为高。     

根管中器械折断的原因和处理对策

分析了根管治疗中发生器械折断的各种原因,总结了目前临床上取出折断器械的各种方法,以及折断器械未能取出时的几种处理方案,提出了临床上减少器械折断发生的几种措施.     

防治根管治疗中器械折断的研究进展

在根管治疗过程中,器械折断是一种比较常见的并发症,器械折断后处理不当,往往造成根管治疗失败。本文就根管治疗中器械折断的影响因素、处理、预后及预防等方面做一综述。     

显微镜联合超声技术处理根管内器械分离

根管治疗技术在治疗牙髓和根尖周疾病中的普及,使得根管内器械分离、折断已成为根管治疗中的重要并发症之一[1],并越来越得到牙科医生的重视.根管内分离的器械往往会阻塞根管,导致治疗无法顺利完成,从而大大降低了根管治疗成功率.而随着牙科显微镜技术在各级口腔医院的开展,取出分离器械无疑是最为理想的治疗途径.     

Dental pulp response to traumatic injuries – a retrospective analysis with case reports

Abstract The reactions of the denial pulp to traumatic injuries can be extremely varied. They range from almost immediate pulp death to long-term slow pulp canal calcification. In this study the pulpal reactions were divided into three types: pulps with a very poor prognosis that required endodontic therapy soon alter the tooth was traumatized. Seventy-nine teeth were studied in this category, and all 79 teeth required endodontic therapy; pulps with a moderate prognosis that required endodontic intervention some 18 to 24 months after the traumatic episode. Forty-eight teeth were studied in this category, and 27 of them required endodontic therapy: pulps with a very good prognosis that rarely required endodontic therapy. Fifty-two teeth were studied in this category, and only 2 required endodontic therapy. The prognosis of a particular pulp depends on the degree and type of trauma.     

Managing complications of radiation therapy in head and neck cancer patients: Part II. Management of radiation-induced caries

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral complications after radiation therapy. The management of xerostomia has been reviewed in Part I of this series. In this article, the management of dental caries, a sequalae of xerostomia following radiation therapy is reviewed.     

Regression of cyclosporia-induced gingival overgrowth upon interruption of drug therapy

Immunosuppressive therapy with cyclosporin has been known to cause gingival overgrowth in humans. It usually is not feasible to suspend this therapy to treat the adverse side effect. This case report describes a renal transplant patient who had used both cyclosporin and nifedipine for more than 10 years but had to discontinue immunosuppressive drug therapy due to organ rejection. Discontinuing therapy led to almost complete regression of the gingival overgrowth in a few months after interruption of cyclosporin therapy only. These findings suggest that the discontinuation of cyclosporin results in the reversal of gingival overgrowth without surgical intervention and may be the most definitive form of therapy for this condition in susceptible individuals as new drugs become available.     

Assessing the quality of life in infants with deformational plagiocephaly

This was a parent-reported outcome study on the impact of helmet therapy on the quality of life of infants with deformational plagiocephaly and their caregivers. Using survey-based analysis, we compared the quality of life in infants with deformational plagiocephaly with a cohort of their healthy peers. In addition, we compared infant quality of life before and after helmet therapy to evaluate the impact of this mainstay therapy for deformational plagiocephaly.Our results demonstrated that infants with plagiocephaly and their caregivers had a significantly decreased quality of life compared with healthy controls. This reframes our understanding of deformational plagiocephaly and emphasizes the need for therapeutic intervention in these individuals. A common therapeutic option — helmet remolding therapy — was shown to have no negative impact on quality of life, underscoring this as an appropriate therapeutic option. These data will allow us to counsel our future parents more effectively regarding the impact of deformational plagiocephaly and helmet therapy.     

Managing complications of radiation therapy in head and neck cancer patients: Part III. Provision of dentures

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Pretreatment dental assessment should be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally and, as a result, they succumb to complicated oral adverse effects after radiation therapy. The management of radiation-induced caries, a sequelae of xerostomia has been reviewed in Part II of this series. In this article, the management of difficulty with dentures, another sequelae of xerostomia following radiation therapy is reviewed.     

牙周维护治疗的重要性

牙周病是由菌斑微生物所引起的牙周支持组织慢性感染性疾病。菌斑微生物的控制是牙周病重要的治疗手段。由于口腔环境及牙周组织结构的特殊性,牙周系统治疗无法一劳永逸,是一个长期的过程。因此,牙周维护治疗应贯穿整个治疗过程,是牙周系统治疗中必不可少的组成部分,也是牙周疗效得以长期保持的重要手段。文章就牙周系统治疗中牙周维护治疗的重要性做一综述。     

Managing complications of radiation therapy in head and neck cancer patients: Part VI. Management of opportunistic infections

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. The last part of this series reviews the opportunistic infections that can occur to the perioral structure. Their management is briefly discussed.     

Managing complications of radiation therapy in head and neck cancer patients: Part V. Management of mucositis

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. The second last part of this series reviews and discusses the management of complication that commonly occur to the oral mucosa, i.e. mucositis.     

Non-surgical treatment of adults with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients.We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation.Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy.In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.     

DIAGNOdent对乳牙龋牙本质再矿化量化监测效果的评估

传统ART(atraumatic restorative treatment)法治疗乳牙龋病后容易出现较高的继发病变,而这类病变的产生多是因为充填前忽视了龋洞的消毒和残留脱矿牙本质的再矿化.近年来,臭氧联合再矿化治疗已逐渐成为ART充填治疗前窝洞处理的必要步骤之一,但对其疗效的评估一直缺乏量化的评价标准.以往的研究显示,激光荧光检测笔(DIAGNOdent)可量化龋损程度,在龋病疗效的监测方面具有优势.因此,作者对DIAGNOdent在ART法配合臭氧联合再矿化治疗充填前的过程进行了跟踪,结果显示,DIANGOdent不具备监测优势.