连续波热牙胶在后牙弯曲根管治疗中的作用

目的：评价连续波热牙胶根管充填技术（continuous wave of condensation technique,CW）充填后牙弯曲根管的效果。方法：选取2008年6月～2010年1月确诊为牙髓根尖周病的后牙弯曲根管60例,随机分为三组（每组各20例）,实验组分别采用连续波热牙胶、ObturaⅡ、冷牙胶侧压三种方法充填根管,记录单个根管的根管充填时间,根充后即刻拍X线牙片评价根充效果,术后半年定期复查评价疗效。比较三种充填方法的根充时间、充填效果以及疗效。结果：连续波热牙胶组根管充填时间少于ObturaⅡ与冷牙胶侧压组,充填效果优于冷牙胶侧压组,疗效优于ObturaⅡ组与冷牙胶侧压组。结论：连续波热牙胶根管充填适用于后牙弯曲根管,操作快速有效,是一种值得在临床推荐使用的根管充填方法。     

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.     

连续波热牙胶垂直充填术根尖微渗漏的研究

目的 评价连续波热牙胶垂直充填术在根充后3、7、30d的根尖微渗漏情况,并与根管冷侧压充填做比较.方法 将87颗单根人离体牙,常规根管预备,随机分为2组,S组43颗牙采用连续波热牙胶垂直根管充填术;L组44颗牙选用冷侧压根管充填术.2组根管充填后进行染色,分别在3、7、30d纵向劈开牙后,测量染色线长度并进行统计学分析.结果 S3d组,L3d组,S7d组,L7d组的染色线长度分别为2.13±2.13mm,3.50±2.05mm,5.36±3.58mm,3.58±2.95mm,统计学无显著性差异(P＞0.05).S30d组和L30d组的染色线长度分别为4.73±3.90mm,7.33±5.05mm,S30d比L30d短,但统计学没有差异(P＞0.05).结论 连续波热牙胶垂直充填术在根尖微渗漏方面,短期内与冷牙胶侧压充填术无明显差异.长期(1个月以上)优于冷牙胶侧压充填术,但统计学无差异.     

上颌第一前磨牙根管峡区充填技术的实验研究

目的：体外研究配合或不配合使用超声冲洗的条件下连续波热牙胶充填技术和冷侧方加压充填技术对上颌第一前磨牙的根管及根管峡区的充填质量。方法：选择单牙根双根管的上颌第一前磨牙40颗,根管预备后随机分为4组：A组,侧方加压充填;B组,超声冲洗＋侧方加压充填;C组,连续波热牙胶加压充填;D组,超声冲洗＋连续波热牙胶加压充填。充填后拍摄X线片,记录根管类型和峡区发生情况。从根尖方向冠方水平片切牙根,间隔1mm,选择有根管峡区的横断面在体视显微镜下观察其充填质量并进行评分。结果：X线片和横断面上单牙根双根管的上颌第一前磨牙根管峡区的发生率分别为87.5%和90%。D组根管峡区充填质量优于其它3组（P〈0.05）,B组和C组之间无显著性差异,A组充填质量最差。结论：连续波热牙胶充填技术配合超声冲洗能显著提高对根管峡区的处理能力,值得临床推广应用。     

上颌中切牙根中环状侧枝根管1例

目的：报道l例上颌中切牙根中环状侧枝根管病例,探讨上颌中切牙侧枝根管的诊断及治疗方法.方法：1例上颌中切牙牙龈反复肿胀、瘘管病例,X线片发现根中远中侧低密度影,对患牙根管行机械及化学预备、超声荡洗后氢氧化钙封药,热牙胶连续波技术完成根管充填.结果：根充后X线片示根中出现环状侧枝根管影像.患者术后1周复诊无主观症状,牙龈肿胀及瘘管消失.结论：对于上颌中切牙病例,术前仔细阅读X线片,如发现根尖周围或根侧低密度影像,提示侧枝根管存在,应对患牙进行彻底的机械及化学预备、超声荡洗,使用热牙胶连续波技术完成根管的三维充填.     

手用Protaper预备根管后注射式热塑牙胶充填系统充填效果的观察

目的观察Protaper手用法预备的后牙根管使用注射式热塑牙胶充填系统(Ultrafil-3D)充填的效果。方法10颗离体人上颌磨牙,开髓拔髓,截冠并截除腭根,按照Protaper的使用要求对颊根进行根管预备,均至F2(相当于主尖锉为25#K-file),测量根尖孔直径,干燥根管,涂布封闭剂(Roekoseal),Ultrafil-3D(Endoset)牙胶充填根管,记录注射针头进入的最大深度,直接观察超充情况,然后X线片评价整体的充填效果。结果①20个根管中有8个出现少量牙胶(伴封闭剂)超充,9个出现单纯的封闭剂超充;②根尖孔直径均≤0.25mm,注射针头距根尖孔的距离(L)均在8～10mm,牙胶超充组与无牙胶超充组差异无显著性(P>0.05)。③X线片显示牙胶未见欠充,与管壁未见明显空隙,可充填进入侧支根管。结论使用Protaper预备根管简便快速,根管形态好,有可能出现牙胶超充,但超出量较少,根管能获得整体良好的三维充填效果。     

连续波热牙胶充填技术根尖封闭性能的评估

目的体外实验比较不同器械预备根管后连续波热牙胶根管充填技术的根尖封闭能力。方法离体双根管上颌前磨牙随机分为机用ProFile预备组和不锈钢K锉预备组,分别采用连续波热牙胶充填技术和冷侧压法进行根管充填,用染料渗透法和透明标本法测量根尖微渗漏,评价各组根尖封闭能力。结果各组根尖微渗漏距离无统计学差异(P>0.05)。结论连续波热牙胶充填技术与冷牙胶侧方加压充填技术的根尖封闭能力无显著性差异;对直根管和轻度弯曲的根管,不同器械根管预备后其根管充填效果无明显影响。     

热牙胶垂直加压与冷牙胶侧压法充填根管的致密度研究

目的:评价System B&ObturaⅡ高温热牙胶垂直加压充填和冷牙胶侧压充填根管的致密度。方法:收集新鲜拔除的完整单根管上、下颌前磨牙30个,随机分为两组(n=15),分别用热牙胶垂直加压法及冷牙胶侧压法进行根管充填后,硬组织纵剖面切片,光镜观察根尖、根中、根上1/3处根管充填的致密度,计算牙胶充填面积百分比,评价两种根充方法的根充致密度。结果:根尖1/3根充面积(%)热垂压(95.6±1.7)显著高于冷侧压(84.4±2.5)(P<0.05);根中1/3根充面积冷侧压(93.6±3.1)显著高于热垂压(90.2±1.4)(P<0.05);根上1/3处根充面积冷侧压(97.4±3.4)与热垂压(98.3±2.3)无显著差异(P>0.05)。结论:热牙胶垂直加压法较冷牙胶侧压充填法可获得更好的根尖充填致密度。     

三种热牙胶根管充填治疗牙髓根尖周病的观察

目的　探讨 3种热牙胶充填法治疗牙髓根尖周病的临床效果。方法　镍钛根管预备后分别以热牙胶垂直加压技术 ,THERMAFIL热牙胶充填术 ,OBTURA注射式热牙胶充填术治疗牙髓根尖周病。结果　随访了治疗 374人 4 6 5颗牙成功率达 98.3%～ 99.2 %。失访率为 4 .7%。结论　热牙胶充填术密封的三维充填实现了对根尖孔的良好封闭 ,对根管源性牙髓根尖周病有较好的治疗作用。     

热牙胶用于根管内器械分离后行旁路充填的效果评价

目的:评价热牙胶用于后牙器械分离根管行旁路根管充填的效果。方法:选取27例27颗出现根管内器械分离未能取出的患牙,从分离器械旁建立通路并采用热牙胶连续波充填技术对根管进行旁路充填,X线观察根管充填情况,追踪随防2年,通过临床及X线片检查评价其疗效。结果:2年后接受回访24例,根据根管治疗疗效评价标准,治疗成功19颗牙,治疗成功率79.2%。5颗治疗失败的患牙中4颗治疗前患根尖炎,1颗为牙髓炎。结论:当器械分离在根管内不能取出时,在分离器械旁建立通路并采用热牙胶连续波充填技术进行旁路根管充填是一种行之有效的治疗方法。     

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目的对比评价三种根管充填技术的根尖封闭能力。方法收集2011年10月至2012年5月中国医科大学附属口腔医院口腔颌面外科门诊因正畸或牙周病拔除的新鲜离体单根管牙34颗,根管清理后用机用ProTaDer镍钛锉经Crown—Down技术预备,然后随机分为A、B、C三组。A组（11颗）采用冷牙胶侧方加压充填技术充填根管,B组（10颗）采用超声侧方加压充填技术充填根管,c组（13颗）采用连续波热牙胶垂直充填技术充填根管。所有实验牙均使用AHPlus根充糊剂。根管充填后的各组实验牙采用染料渗透法检测根尖微渗漏的发生情况,体式显微镜下测量自根尖孔向冠方的染料渗透长度,采用SPSS11．5统计软件包对测量数据进行分析。结果A组与B、c组的根尖微渗漏数值间差异有统计学意义（P〈0．05）,B组与c组的根尖微渗漏数值间差异无统计学意义（P〉0．05）。结论超声侧方加压充填技术和连续波热牙胶垂直充填技术的根管封闭能力优于冷牙胶侧方加压技术,而前两种充填技术的根管封闭能力无明显差别。     

四种根管充填法对根管密合度的实验研究

目的：使用新型根管糊剂，比较四种充填方法对根管密合度的影响，从而指导临床根管充填法的选择。方法：在离体前牙上行根管预备及根管充填，而后用印度墨水染色法在显微镜下比较充填效果。结果：显微镜下观察糊剂加牙胶的侧方加压充填法组和单纯使用糊剂的机用螺旋充填法组有较好的封闭性能。结论：本实验为新型糊剂的合理应用提供了可靠的参考依据。     

The long-term sealing ability of an epoxy resin root canal sealer used with five gutta percha obturation techniques

AIM: The aim of the present study was to evaluate the long-term sealing ability (both apical and coronal) of an epoxy resin root canal sealer (AH26) when used with different gutta-percha obturation techniques. METHODOLOGY: Straight single-rooted teeth with mature apices were divided into 10 groups of 75 teeth and one group of 40 control teeth. Root canals were prepared according to the crown-down/step-back technique and using both 2.5% sodium hypochlorite and an EDTA paste. Root canals were obturated using cold lateral condensation, warm vertical condensation and hybrid condensation of gutta-percha; and with Thermafil and Soft-Core obturators. AH26 was used as the sealer in all cases. After root canal filling, each group was divided into five individual groups of 15 teeth. The first group of 15 teeth was kept for 1 day, the second for 1 week, the third for 4 months, the fourth for 6 months and the fifth for 12 months at 37 degrees C in vacutainers in 80% relative humidity. The teeth were immersed in India ink for 90 h, each root was split and sectioned longitudinally, and the maximum extent of leakage was measured using a stereomicroscope at x6 magnification. RESULTS: Leakage occurred whatever filling technique was combined with AH26. The number of teeth with gross leakage increased with time up to 4 months, but did not appear to increase between 6 and 12 months storage. The degree of apical leakage and the number of leaking teeth in the Soft-Core obturator groups was significantly higher than all four other gutta-percha obturation techniques. Up to 4 months the degree of coronal leakage and the number of leaking teeth in the Thermafil groups was significantly higher than the other gutta-percha obturation techniques, except for Soft-Core. In the Soft-Core obturator groups the degree of coronal leakage and the number of leaking teeth was significantly higher than the other gutta-percha obturation techniques, except for Thermafil at all evaluation times. CONCLUSION: The hybrid gutta-percha condensation technique was superior to the other four obturation techniques in respect of apical leakage. Coronal leakage was significantly greater during the first 4 months for the Thermafil system as compared to the three condensation techniques; coronal leakage was significantly greater at all time periods for the Soft-Core system. There were no significant differences between the Thermafil and the Soft-core system.     

Comparison of cold lateral condensation and a warm multiphase gutta-percha technique for obturating curved root canals

AIM: The aim of this project was to evaluate and compare the radiographic quality and sealability of root fillings in extracted human teeth using lateral condensation of gutta-percha or multiphase gutta-percha obturation (Alphaseal). METHODOLOGY: A total of 108 freshly extracted human, mature single-rooted teeth were divided into two identical groups of 54 teeth on the basis of root canal shape. The canals were prepared to a minimum 0.055 taper and enlarged to size 35 at the apex. All root canals were flushed with 17% EDTA solution and 2.5% NaOCl to remove the dentinal smear layer. The canals of one group were obturated using cold lateral condensation of gutta-percha and the canals of the other group were filled using a warm multiphase gutta-percha obturation technique. The extrusion of sealer and/or gutta-percha through the apex of the teeth was recorded using a simple yes/no scheme. The sealability of each technique was assessed by a dye penetration method. The radiographic quality of obturation was determined for each canal using a four-point scale. RESULTS: Root canals filled by multiphase obturation had significantly more extrusion of sealer (P < 0.001) and gutta-percha (P < 0.001) than canals filled by lateral condensation. Canals filled by multiphase gutta-percha obturation had significantly less apical dye leakage than those obturated by lateral condensation (P < 0.05). Lateral condensation achieved significantly better scores for radiographic quality than multiphase obturation from the bucco-lingual view (P < 0.01). CONCLUSIONS: Under laboratory conditions multiphase gutta-percha had better sealability but poorer radiographic quality than lateral condensation.     

不同锥度牙胶尖热垂直加压法根管充填的临床疗效分析

目的研究采用不同锥度牙胶尖热垂直加压法行根管充填的临床X线片评价及术后1年的临床疗效。方法选择上颌前牙单、直根管患牙40颗为研究对象,采用Hero 642机用镍钛锉预备至0.06锥度30号锉,随机分为2组,每组20颗患牙。分别使用0.02锥度和0.06锥度牙胶尖采用热垂直加压法充填根管。对术后即刻X线片进行2组患牙根管充填质量、侧支根管充填及超填情况的比较;并比较2组患牙术后1年的临床疗效。结果0.02锥度组与0.06锥度组根管充填质量、侧支根管充填及超填情况没有明显差异。术后1年复查,0.02锥度组与0.06锥度组的治疗成功率一致,但0.06锥度组病变愈合趋势快于0.02锥度组。结论对于镍钛旋转器械预备的较大锥度单、直根管,采用热牙胶垂直加压法行根管充填,使用与根管预备锥度相一致的大锥度牙胶尖能够提高根管治疗的临床疗效。     

Root canal obturation by ultrasonic condensation of gutta-percha. Part II: an in vitro investigation of the quality of obturation

AIM: To compare the quality of root canal obturation using ultrasonic or cold condensation of gutta-percha and to determine the effect of power setting and activation time on the quality of obturation using the former technique. METHODOLOGY: An extracted human maxillary canine was used in an in vitro split tooth model to allow repeated obturation of the same root canal system using an ultrasonic device to thermocompact gutta-percha without sealer. After each obturation, the root filling was removed from the tooth to allow evaluation of its quality and for the tooth to be re-obturated. The influence of combinations (n = 10 per combination) of power setting (1, 3, 5) and activation times (4, 10, 15 s) was tested on the quality of root filling, assessed by measuring the voids within the body of the root filling as well as at the surface. Image analysis was used to quantify the voids within the body of the root filling. Cold lateral condensation of gutta-percha served as a control. RESULTS: Both surface and cross-sectional analyses revealed that different power setting and activation time combinations produced significantly fewer voids than cold lateral condensation (P < 0.05) at the apical, mid-root and coronal levels. CONCLUSIONS: Taking surface and cross-sectional analysis together only power setting 5 and activation times of 10 and 15 s consistently produced ultrasonically thermocompacted root canal fillings with fewer voids than cold lateral condensation without sealer.     

Obtura Ⅱ热塑牙胶改良充填法的实验研究

目的探讨将常温流动牙胶充填术融入高温注射式热牙胶充填技术的可行性。方法 70颗单根管离体牙根管预备后随机分组,分别采用ObturaⅡ充填(A组)、Touch-heat+ObturaⅡ充填(B组)、GuttaFlow+ObturaⅡ充填(C组)、冷牙胶侧压充填(D组)、不做充填(E组),根充完成后修整所用充填根管内牙胶长度为10 mm,建立葡萄糖微渗漏模型,通过对葡萄糖定量分析检测根管充填后根尖部微渗漏,观察比较根尖封闭效果。结果各组葡萄糖微渗漏随观察时间延长持续增加,3组实验组微渗漏差异无统计学意义(P>0.05)。结论 GuttaFlow+ObturaⅡ充填法封闭效果可靠且操作易行,有一定的可行性。     

Literature survey of apexification in connection with three cases

Endodontic treatment of three non-vital immature teeth is discussed. According Moorrees et al. root formation was in the stage two, six and four respectively. After access to the root canal, removing necrotic pulp and effective chemo-mechanical cleansing, Ca(OH)2 paste was used as a temporary filling material in each case. In two cases after closing the apical opening, permanent obturation was performed with half heated gutta-percha and lateral condensation to obtain a good seal. In one case permanent filling of the canal occurred with gutta-percha and AH26 as a sealer. In the first case two years, in the second case five years after obturation of the root canal with gutta-percha, periapical healing was evident in the control radiograph. In the third case using gutta-percha with AH26 as a sealer after two years new periapical lesion has developed. On the bases of literature data and our experiences in the case of non-vital immature teeth. Ca(OH)2 paste is the best temporary filling material to induce apexification process, and the half heated gutta-percha obturation is the most suitable permanent root filling material.     

Evaluation of different root canal filling techniques in severely curved canals by micro-computed tomography

AimTo fill the severely curved root canals with different filling techniques and to compare these techniques using micro-computed tomography (micro-CT).Materials and methodsSixty extracted mandibular first molars (degree of root canal curvature >25°) were selected. All samples were divided into four groups and filled with one of the following techniques: lateral condensation, single-cone, continuous-wave obturation, and core carrier. After they were scanned by micro-CT, the total area, filled area and void area of the root canal were calculated. The Mann–Whitney U and Kruskal–Wallis tests were used for statistical analysis (p < 0.05).ResultsIt was shown that significantly more filling material was used in the lateral condensation and core carrier technique groups at 2 and 5 mm than in the single-cone and continuous-wave obturation technique groups (p < 0.05). It was observed no statistically significant difference at 8 mm (p > 0.05).ConclusionNo technique could completely fill in root canal. Regarding the coronal part, all techniques can be used for more effective filling as long as a good condensation is achieved. The use of a plugger with an optimal size according to the localisation of root canal curvature and the choice of a heat-resistant root canal sealer affects the success of the treatment in the thermoplastic techniques.