平衡力法结合改良双敞技术在老年人根管治疗术中的临床应用

目的:评价使用弹性K锉运用平衡力法结合改良双敞技术在老年人根管治疗术中的临床效果。方法:随机选取120例老年患者122颗患牙,分成实验组和对照组。实验组62例患者62颗患牙,采用弹性K锉(Flexofile)运用平衡力法结合改良双敞技术。对照组58例患者60颗患牙,采用不锈钢K锉运用逐步后退法结合改良双敞技术进行根管预备。两组应用侧方加压充填技术充填根管。根据治疗前、中、后X线片评价根管预备和充填效果,根据主诉及检查评价根管治疗期间急症情况。结果:两组在根管预备过程中均无器械折断,实验组无根尖阻塞、台阶形成、根尖孔敞开等情况发生,根管偏移少,能较好的维持根管弯曲度及走向,充填后的锥度和流畅度较好,术后急症反应率为4.83%。对照组有2例在根尖有台阶形成,发生根管偏移多于实验组(P<0.01),术后急症反应率有显著性差异(P<0.01)。结论:弹性K锉运用平衡力法结合改良双敞技术预备老年人根管能较好地维持根管的定向,根管偏移少,安全有效,可作为临床上预备老年人根管的有效方法。     

混合技术根管预备的临床应用

目的：评价混合技术法对根管预备的临床疗效。方法：91颗患牙分为两组,实验组45颗牙85个根管,采用混合技术进行根管预备,对照组46颗牙92个根管,采用逐步后退技术预备根管,两组均采用冷侧压技术充填根管。X线片结合临床评价根管预备效果。结果：实验组根管未有锥度、流畅度差者,对照组有5根管锥度、流畅度差者（P〈0.05）;术后疼痛实验组少于对照组。结论：混合技术法进行根管预备可形成大锥度、流畅根管形态,减少术后疼痛,可视为临床根管预备的有效方法。     

倒敞法结合2 种机用镍钛锉预备重度弯曲后牙根管的应用研究

目的:评价倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管的疗效.方法: 随机将100 颗患牙髓炎或根尖周炎、最大根管弯曲度≥25°的后牙分为2 组,各50 例.实验组(A组)采用倒敞法,而对照组(B组)不采用倒敞法机械预备.A组以机用开口锉根管中上端敞开后,手用K锉预备根尖,再先用镍钛器械Hero 642,后用ProTaper预备根管;B组则直接应用Hero 642和ProTaper冠向下法预备根管. 2 组均用侧压法充填根管.根据X线片情况,预备时间,器械折断、疼痛等并发症,评价根管预备和充填的疗效,1 年随访率95%.结果:A组倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管,锥度、流畅度好,术后疼痛少且程度轻,无器械折断;而B组发生器械折断3 支(P>0.05);充填恰充率、欠充率、流畅度、术后疼痛两者有显著性差异(P<0.05).结论: 倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管,成形、根充效果好,并发症少,最大限度发挥了各自优点,是预备重度弯曲后牙根管值得推广应用的有效方法.     

根管残余细菌对根管治疗预后的影响

目的　探讨根管预备后残留细菌对根管治疗预后的影响。方法　选取50颗患慢性根尖周炎的单根管牙,分为实验组和对照组。实验组21颗患牙采用逐步后退法及超声冲洗预备根管,根管预备后取样做细菌培养, 立即充填根管,一次性完成根管治疗。对照组采用常规根管治疗方法治疗。根管治疗后6个月、1年及2年复查。结果　①两组患牙根管治疗预后无明显差异。②实验组患牙根管预备后残余细菌与根管治疗预后无明显关系。 ③患牙术后疼痛与根充情况和术前症状无明显关系。结论　近期观察见经过彻底的根管预备,根管内微量残余细菌对根管治疗预后无明显影响。     

冠部预处理对磨牙重度弯曲根管工作长度影响的研究

目的：观察根管冠部预处理对磨牙重度弯曲根管工作长度的影响。方法：选择磨牙根管弯曲度在25°～45°的牙髓炎、根尖炎的460颗患牙588个重度弯曲根管,随机分为A、B、C组,A组153颗磨牙192个根管不预处理冠部,手用不锈钢K锉逐步后退法预备根管,分别测量预备前、后根管长度;B、C组分别用GG钻、机用ProTaper成形锉进行冠部预处理后测量根管工作长度,之后B组151颗磨牙196个根管手用不锈钢K锉逐步后退法预备根管;C组156颗磨牙200个根管机用ProTaper器械完成锉预备根管,两组预备完成后测量根管长度,并对数据进行统计学分析。结果：A组磨牙重度弯曲根管预备前后长度有明显改变（P＜0．01）,B、C组经根管冠部预处理后长度改变差异无统计学意义（P＞0．05）。结论：磨牙重度弯曲根管冠部预处理后测量根管工作长度可以提高根管工作长度测量的准确性。     

两种根管预备方法对老年人磨牙根管治疗期间急症的影响

目的探讨2种根管预备方法对老年人磨牙根管治疗期间急症（endodontic interappointment emergen-cies,EIAE）发生率的影响。方法选取老年人磨牙204颗,随机分为2组：试验组102颗,改良双敞法预备根管;对照组102颗,逐步后退法预备根管。比较2组的EIAE发生率。结果试验组EIAE发生率为25.49%,对照组为44.12%,2组间差异有统计学意义（χ2=7.80,P〈0.01）。2组下颌磨牙EIAE发生率均高于上颌磨牙,差异有统计学意义（P〈0.01）。2组死髓牙EAIE发生率高于活髓牙,差异有统计学意义（P〈0.05）。结论采用改良双敞法进行根管预备能够降低老年人磨牙EIAE发生。     

根管治疗期间急症的相关因素及防治

目的　探讨根管治疗期间急症(EIE)的临床相关因素及防治方法。方法　544颗患牙分为3组:①常规治疗组　392颗患牙按常规步骤行根管治疗;②口服药物组　91颗患牙在根管预备后给予患者地塞米松口服,余同常规治疗组;③开放引流组　61颗患牙初诊时预备根管后开放引流2~3 d,余同常规治疗组。记录各相关因素,统计各组EIE发生率和急性发作指数(FUI)。比较各因素与EIE关系以及不同实验组EIE的差异。结果　常规治疗组中,19·1%的患牙发生EIE;根管预备超出根尖孔的患牙EIE发生率和FUI值均显著高于根管预备长度欠和恰的患牙;患者的年龄、性别及患牙的牙位、病变程度与EIE发生率无明显关系。口服药物组较常规治疗组FUI值显著降低。开放引流组与常规治疗组比较,其EIE发生率和FUI值均无显著差异。结论　操作因素与EIE发作有显著关系,药物等预防措施可能减少EIE发作。     

Raypex5根尖定位仪在测量根管工作长度中的临床应用

目的评价Raypex5根尖定位仪测量根管工作长度与X线法的符合性。方法用Raypex5根尖定位仪对205颗患牙共403个根管进行根管工作长度测量，以此长度进行根管预备充填后拍摄X线片观察根管充填的质量。结果Raypex5根尖定位仪测量根管工作长度后根管适充率为96．28％。结论Raypex5根尖定位仪是一种准确可靠安全有效根管工作长度测量仪器。     

ProTaper手动锉预备弯曲根管的临床评价

目的评价ProTaper手动锉预备弯曲根管的临床疗效。方法将40颗具弯曲根管需行根管治疗的患牙随机分为两组：试验组用ProTaper手动锉及冠根向技术预备根管，对照组用K锉及逐步后退技术预备根管。两组均采用侧向加压充填法充填根管，用X线片评价根管预备的效果。结果ProTaper手动锉组无根管偏移、根尖堵塞、台阶形成、器械折断等并发症发生，能维持根管的弯曲度和走向，根管锥度和流畅度佳；操作时间短，且术后疼痛发生率低。结论ProTaper手动锉预备弯曲根管快速、安全、有效，临床应用价值较高。     

手用ProTaper镍钛器械预备弯曲根管的疗效评价

目的 评价手用ProTaper镍钛器械预备弯曲根管的临床疗效.方法 选取有弯曲根管的牙髓炎和根尖周炎患牙48颗,使用手用ProTaper镍钛锉冠根向深入法预备根管,侧向加压充填法充填根管,根据治疗前、中、后的X线片评价根管预备和充填的效果.结果 患牙在根管预备中均无器械折断、根尖阻塞、台阶形成等并发症,根管充填后显示发生根管偏移少,能较好地维持根管的弯曲度和走向.结论 手用ProTaper镍钛器械预备弯曲根管能较好地维持根管的走向和弯曲度,减少根管偏移,安全有效,可作为预备弯曲根管的有效方法推广应用.     

A comparison of spreader penetration depth and load required during lateral condensation in teeth prepared using various root canal preparation techniques

AIM: To compare the influence of various root canal preparation techniques on spreader penetration depth and load required during lateral condensation with gutta-percha and sealer. METHODOLOGY: Eighty extracted human teeth with single and straight canals were used. Twenty teeth were instrumented using one of four root canal preparation techniques. The four preparation techniques were: step-back technique without Gates-Glidden drills, step-back technique with Gates-Glidden drills, crown-down pressureless technique and hybrid technique (step-down/step-back). After root canal preparation had been completed a simulated periodontal ligament was fabricated from a uniform layer of silicone impression material. The roots were then mounted in an acrylic resin to simulate the physical condition found in tooth socket. A standardized stainless steel hand spreader of the same size as the master apical file was mounted in an Instron testing machine and lateral compaction with gutta-percha and sealer was performed. The load value was recorded from the Instron testing machine. The spreader penetration depths were measured with an endodontic ruler. The data obtained were analysed statistically using anova and Student's t-tests. RESULTS: No significant difference in initial spreader load needed to condense the master cone was found amongst the four canal preparation techniques (P > 0.05). The step-back technique with Gates-Glidden drills and the hybrid technique demonstrated the least difference between the initial spreader penetration and the working length (mean 1.925 and 2.25 mm, respectively). The step-back technique without Gates-Glidden drills and the crown-down pressureless technique had the greatest difference between initial spreader penetration and the working length (mean 4.425 and 4.75 mm, respectively). CONCLUSION: The flare created by canal preparation affected spreader penetration depth, but had no effect on the spreader load.     

EVALUATION OF THE APICAL INFILTRATION AFTER ROOT CANAL DISRUPTION AND OBTURATION

The aim of this study was to evaluate two root canal filling techniques used in teeth that had their apical foramen disrupted and compare the apical infiltration with an ideal clinical situation. Twenty-seven freshly extracted single-rooted teeth were selected and radiographed to confirm the existence of a single and straight root canal. The crowns were removed at a mean distance of 11 mm from the apex. The teeth had the root canals instrumented and were randomly assigned to 3 groups (n=9): ND group - root canals were filled using the lateral compaction technique and no disruption was performed; DRF group - the apical constriction was disrupted by advancing a #40 K-file 1 mm beyond the original working length, the canals were reinstrumented to create an apical ledge at 1 mm from the apical foramen and were obturated with a master gutta-percha cone with same size as the last file used for reinstrumentation; DF group - the teeth had the apical constriction disrupted and the canals were obturated with a master gutta-percha cone that fit at 1 mm from the apex. The teeth were submitted to dye leakage test with Rhodamine B for 7 days, using vaccum on the initial 5 min. The teeth were sectioned longitudinally and the leakage was measured in a linear fashion from apex to crown. There was no statistically significant difference (p>0.05) between the groups that had the apical foramen disrupted (DF, DRF), but significant difference was found between the disrupted groups and the non-disrupted one (p<0.01). In conclusion, none of the evaluated techniques was able to prevent apical infiltration, so working length so the working length determination has to be established and maintained carefully.     

根管治疗中根尖片使用的临床分析

目的了解专科医生、全科医生、实习医生在根管治疗中使用根尖片的现状,分析根充质量与根尖片使用的关系。方法以在四川大学华西口腔医院门诊完成根管治疗的患者的患牙为调查对象,根据治疗医生的不同将调查对象分为专科医生组、全科医生组和实习医生组,对调查对象的根尖片应用情况进行问卷调查,并对术后根充片进行根充质量评价。采用卡方检验分析3组医生的根尖片使用频率,秩和检验分析根充质量与根尖片使用的关系。结果412例患者571颗牙的根管治疗中,专科医生组、全科医生组和实习医生组的术前片使用率分别为95.3%、89.5%和92.1%,初尖片使用率为5.2%、1.1%和5.8%,主尖片使用率为94.8%、72.1%和97.4%,根充片使用率为97.9%、76.3%和95.3%。3组初尖片、主尖片、根充片使用率均有统计学差异（P<0.05）。根充质量合格病例和不合格病例的根尖片使用张数分别为（3.14±0.639）和（2.84±0.736）张,二者之间有统计学差异（P<0.05）。结论专科医生和实习医生较全科医生更加规范使用根尖片。根尖片的使用频率与根充质量有关,规范化使用根尖片有利于提高根管治疗的质量。     

The quality of apical canal preparation using hand and rotary instruments with specific criteria for enlargement based on initial apical file size

The aim of this study was to compare the quality of apical enlargement of mesiobuccal canals of mandibular molars using conventional stainless steel hand files (K files) and nickel-titanium (Ni-Ti) rotary instruments (LightSpeed). Thirty freshly extracted mandibular molars were randomly assigned to three equal groups (n = 10 each group). The mesiobuccal canals were instrumented with K file using step-back technique without coronal flaring (control; group 1), K file using step-back technique after coronal flaring (group 2), and LightSpeed instrumentation (group 3). Specific criteria for apical enlargement based on initial apical size were used. For step-back techniques, the master apical file sizes were based on the Grossman criterion of three sizes larger than the first file that bound at working length, without coronal flaring (group 1) and with flaring (group 2). For the LightSpeed (LS) group, the master apical rotary sizes were based on the manufacturer's recommendation. Canal cleanliness, canal transportation, and final canal shapes were determined histologically at 1-mm and 3-mm levels short of the working length. Canals were prepared to significantly larger sizes using LS instrumentation than with either hand instrumentation techniques (15-17 ISO units, p < 0.001). LS instrumentation allowed greater apical enlargement with significantly cleaner canals, less apical transportation, and better canal shape than both hand instrumentation groups at both levels (p < 0.05). None of the three techniques was totally effective in cleaning the apical canal space. It was concluded that greater apical enlargement using LS rotary instruments is beneficial as an attempt to further debride the apical third region in mesiobuccal canals of mandibular molars. Instrument designs, alloy properties, and canal curvature are important factors that determine the feasibility of greater apical enlargement in narrow canals.     

镍钛器械Waveone治疗磨牙根管的临床效果

目的 评价使用机用镍钛器械Waveone预备磨牙根管的临床效果。方法 使用新型单根根管预备锉Waveone采用冠向下法预备67颗磨牙,不锈钢K锉采用逐步后退技术预备54颗磨牙。均使用侧方加压技术进行根管充填。比较两组根管预备所需时间、器械分离情况和根管充填效果。结果 使用Waveone进行根管预备根管充填恰充率为91.1%,高于不锈钢器械组的66.7%（P＜0.01）,预备时间为(17.76±1.96)min少于不锈钢器械组的(33.82±2.37)min（P＜0.01）。结论 使用Waveone进行根管预备时间短,预备锥度好根管充填密合度强。     

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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。     

Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments

This in vitro investigation examined pre- and postinstrumentation working length (WL) measurements in curved root canals. The conditions compared were combinations of (a) stainless steel hand files + Gates Glidden drills (SS) versus nickel-titanium rotary files (Ni-Ti); and (b) early coronal flaring (flaring completed before WL determination) versus late coronal flaring (flaring completed after WL determination). Coronal flaring was accomplished for the SS group using Gates Glidden drills and for the Ni-Ti group using rotary Ni-Ti files (n = 15/group). WL was determined before coronal flaring, immediately after coronal flaring, and again after canal preparation. Results indicated that WL decreased for all canals as a result of canal preparation. The mean decrease in WL was significantly greater for the SS group (-0.48 mm +/- 0.32) than for the Ni-Ti group (-0.22 mm +/- 0.26). Less change in WL occurred in both groups when initial WL was determined after coronal flaring (SS: -0.12 mm +/- 0.13, Ni-Ti: -0.14 mm +/- 0.25).     

Comparative investigation of two rotary nickel-titanium instruments: ProTaper versus RaCe. Part 1. Shaping ability in simulated curved canals

AIM: To compare the shaping ability of ProTaper with Reamer with Alternating Cutting Edges (RaCe) instruments. Part 1 of this two-part report describes the efficacy of these two nickel-titanium instruments in simulated curved root canals. METHODOLOGY: Simulated canals with 28 degrees and 35 degrees curves in resin blocks were prepared with ProTaper and RaCe instruments using a crown-down preparation technique (n = 24 canals in each case). Pre- and postinstrumentation images were recorded, and assessment of canal shape was completed with a computer image analysis program. Material removal was measured at 20 measuring points, beginning 1 mm from the apex. Incidence of canal aberrations, preparation time, changes of working length and instrument failures were also recorded. The data were analysed statistically using the Mann-Whitney U-test or the chi-square test. RESULTS: On average, canals prepared with RaCe instruments remained better centred compared with those enlarged with ProTaper files. Three RaCe instruments and two ProTaper files fractured during preparation (P > 0.05). Between both the canal types, RaCe was significantly faster (P < 0.001) than ProTaper and maintained working length significantly better (P < 0.05). CONCLUSION: Both instruments prepared curved canals rapidly and were relatively safe. RaCe respected original canal curvature better than ProTaper, which tended to transport towards the outer aspect of the curve.     

Endomethasone根充糊剂用于去髓术、根管治疗术一次法的近期疗效

目的：比较Endomethasone根管充填糊剂加牙胶尖、传统根管充填剂加牙胶尖在去髓术、根管治疗术一次法根管充填术后的急性反应及近期疗效.方法：选择活髓患牙和适合行去髓术、根管治疗术一次法的患牙共678个,随机分为2组,根管预备后实验组和对照组分别采用Endomethasone糊剂加牙胶尖、根管充填剂加牙胶尖充填根管.观察2组患牙术后1周内的急性反应及术后3、6个月的疗效.结果：实验组去髓术根充后急性反应率显著低于对照组（P＜0.01）;实验组根管治疗术根充后急性反应率显著低于对照组（P＜0.05）.实验组和对照组中,单根管患牙在去髓术、根管治疗术根充后急性反应率均显著低于多根管患牙（P＜0.01）.术后3、6个月复查,实验组去髓术、根管治疗术疗效均稍高于对照组,但无显著差异（P＞0.05）.结论：在去髓术、根管治疗术一次法中,Endomethasone糊剂充填根管较根管充填剂可有效地减少术后急性反应的发生.但在近期疗效上两者无明显差异,长期疗效有待进一步观察.