4种充填方法对椭圆形根管充填效果的体外研究

目的:研究不同充填方法对椭圆形根管的充填效果。方法:选60颗拔除的椭圆形根管的下颌前磨牙,用ProTaper机用旋转镍钛锉预备根管后,随机分成4组。分别用Dentsply变锥度牙胶尖单尖充填法、标准牙胶尖侧方加压充填法、System B ObturaⅡ充填法以及Thermafil充填法进行充填。将填充后的牙齿在距离根尖2、5、8mm处水平切断。对每个横断面进行显微拍照,并用图象处理软件分析获得充填面积占根管横截面面积的百分率。最后对所有牙的填充百分比进行统计分析和比较。结果:在2mm水平,Thermafil的牙胶百分比最高,空隙率和糊剂百分比最低(P<0.05)。在5mm水平,System B ObturaⅡ和Thermafil的牙胶百分比都高于其他2种方法,空隙率和糊剂百分比都较低(P<0.05),但两者之间无统计学差异(P>0.05)。System B Ob-turaⅡ在8mm处空隙率最低(P<0.05)。用变锥度单尖充填,牙胶百分比在各截面都最低,空隙百分比和糊剂百分比在2mm横截面与标准牙胶尖侧方加压充填法相近,无统计学差异(P>0.05)。结论:Thermafil充填法充填椭圆形根管的根尖区域效果好,System B ObturaⅡ充填法充填椭圆形根管的冠方更有优势,冷牙胶侧方加压和大锥度单尖充填椭圆形根管效果较差。     

三种根管充填方法对下颌第一前磨牙根尖区侧枝根管充填效果的实验研究

目的:比较ObturaⅡ&SystemB与Thermafil对下颌第一前磨牙侧枝根管的充填效果。方法:通过光透射选出在根尖区具有侧枝根管的离体下颌第一前磨牙60个,运用TF锉进行根管预备后随机分为3组,分别在手术显微镜下采用ObturaⅡ&SystemB、Thermafil及冷牙胶侧方加压进行根管充填,在距根尖孔2 mm侧枝根管处作横断面切片,电子显微镜下观察并记录侧枝根管内的牙胶、糊剂及空隙占根管横断面的比例,分析不同充填方式对根尖区侧枝根管的充填效果。结果:两种热牙胶充填组在距根尖2 mm处侧枝根管的充填效果均明显优于冷侧压充填组(P<0.05);ObturaⅡ&SystemB充填组稍优于Thermafil充填组,但无统计学差异(P>0.05)。结论:采用ObturaⅡ&SystemB充填技术可有效封闭下颌第一前磨牙根尖区侧枝根管。     

ObturaⅡ&System B与Thermafil在扁根管内断离器械旁路充填的实验研究

目的:比较热塑牙胶充填(ObturaⅡ&System B和Thermafil)与冷牙胶侧方加压充填在扁根管内器械断离行旁路根管充填的效果。方法:将60颗扁根管离体下颌第一前磨牙随机分为3组,每组20颗牙。将新的15#不锈钢K锉(25 mm)断离在距根尖4 mm处,断离长度3 mm;从断离器械旁用Mtwo镍钛锉配合vdw.silver机用马达行根管旁路预备。在手术显微镜下分别采用ObturaⅡ&System B、Thermafil与冷牙胶侧方加压旁路充填。在距根尖2、5、8 mm处横断牙根,电子显微镜下记录在距根尖5 mm处断离器械与根充材料之间的缝隙,充填后根管内残余的空隙;分别记录在距根尖2 mm与8 mm处牙胶、空隙与糊剂占根管横断面的比例,分析不同充填方式的效果。结果:在离体的条件下,热牙胶充填在扁根管内器械断离后行旁路根管充填的效果优于冷侧压充填(P<0.05),ObturaⅡ&System B优于Thermafil,但无统计学差异(P>0.05)。结论:当器械断离在扁根管内,从断离器械旁建立通路进行根管预备,ObturaⅡ&System B充填,可达到严密封闭根管的目的。     

根管糊剂在ObturaⅡ充填技术中对根尖微渗漏的影响

目的:探讨在Obtura Ⅱ注射式热熔牙胶充填中,不同根管糊剂对根尖微渗漏的影响。方法:40颗单根管牙随机分为4组,采用Obtura Ⅱ注射式热熔牙胶进行根管充填,A、B、C组分别以ZOE、Vitapex、AHplus作为根管糊剂,D组未用糊剂。充填后行墨汁渗透实验,制作透明标本,使用体视显微镜和显微照相系统观测染料渗透的长度。结果:染料自根尖孔渗入根管的长度,D组最长,为4.56±2.72mm,与A、B、C组间差异均有显著性(P<0.05)。在使用糊剂的实验组中,染色线的长度由小到大依次是AHplus1.70±0.82mm、Vitapex1.87±0.56mm和ZOE2.02±0.40mm,但3组之间没有统计学差异(P>0.05)。结论:根管糊剂的使用能显著降低Obtura Ⅱ根管充填后根尖的微渗漏。     

ObturaⅡ热牙胶系统根管充填的微渗漏研究

目的:比较ObturaⅡ热牙胶系统在3种加热温度设定下充填根管后根尖封闭效果的差异,并与冷牙胶侧压充填技术的密封性进行比较.方法:28个离体单根管恒牙,根管预备后随机均分为4组:A组用传统的泠牙胶侧压充填法进行充填,B、C、D组用ObturaⅡ系统将牙胶分别加热至160℃、180℃、200℃进行充填.使用染料渗入法检测根尖微渗漏的发生情况.结果:ObturaⅡ热牙胶系统在160℃、180℃、200℃的温度设定下充填后的微渗漏与冷牙胶侧压法相比差异有统计学意义(P<0.05),但温度设定不同的热牙胶充填组间的微渗漏差异无统计学意义(P<0.05).结论:ObturaⅡ热牙胶系统加热温度设定在160℃、180℃、200℃进行充填时根尖封闭能力无显著差异,但其根管封闭能力明显优于冷牙胶侧压充填技术.     

BeeFill~（TM） 2in1热牙胶根管充填系统根管封闭性的体外研究

目的：研究BeeFill TM2in1热牙胶根管充填系统对扁形根管的充填效果。方法：将20颗根管的近远中径与颊舌径之比小于0.5的单根管前磨牙,根管预备后,随机分别采用冷牙胶侧方加压充填术和BeeFill TM2in1热牙胶根管充填系统行根管充填。充填后的样本自根尖向冠方垂直于牙体长轴每间隔1mm制备横切片。体视显微镜下观测各横截面中是否存在空隙并计算空隙面积。结果：BeeFill TM2in1组空隙发生率、空隙面积的百分比均低于冷牙胶侧压组并存在统计学差异性;BeeFill TM2in1组在各层次横截面的空隙面积百分比平均值均低于冷牙胶侧压组并存在统计学差异性。结论：和冷牙胶侧方加压充填术相比,BeeFill TM2in1热牙胶根管充填系统在封闭扁形根管方面具有明显优势。     

常温流动牙胶Guttaflow充填根管密合性的体外评价

目的 体外评价常温流动牙胶(Guttaflow)充填根管的致密性。方法 选择60个单根管下颌第一前磨牙,使用ProTaper冠向下法预备根管,然后随机分为3组进行根管充填。组1:以Guttaflow(加06锥度单牙胶尖)根管充填;组2:连续波热牙胶根管充填;组3:冷侧压法根管充填。然后在距根尖狭窄2、4、6、8mm处垂直于牙体长轴切开牙体,体视显微镜下观察切片中根管充填的情况,并采集图像,利用图像分析软件计算根管充填物中牙胶面积的百分比(PGP)。结果 在距根尖2mm和4mm处Guttaflow组的PGP明显高于热牙胶组和冷侧压组P<0.05),而热牙胶组和冷侧压组无显著差异(P>0.05)。在距根尖6mm和8mm处,Guttaflow组与热牙胶组无显著差异(P>0.05),但两者都高于冷侧压组P<0.05)。结论 Guttaflow根管充填法充填具有很好的密合性。     

Obtura Ⅱ热牙胶充填根管的微渗漏研究

目的:研究ObturaⅡ热牙胶充填根管的密封性能.方法:将40颗新鲜拔出人的单根管牙,随机分为2组,每组20颗.分别用根管糊剂加牙胶尖和ObturaⅡ热牙胶充填根管,用印度墨水染色法对比研究不同根管充填材料的密封性能.结果:根管糊剂加牙胶尖组的染色线均值为1.85±0.51mm;ObturaⅡ热牙胶组的染色线均值为0.45±0.12mm,两组之间差异显著(P＜0.05).结论:ObturaⅡ热牙胶具有较好的密封性能,用ObturaⅡ热牙胶充填根管对提高根管治疗的质量具有重要作用.     

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。     

三种热牙胶根管充填技术牙胶充填面积百分数的比较研究

目的:比较3种热牙胶根管充填术后牙胶密度即牙胶充填而积百分数(percentage of gutta-percha-filled area,PGFA),评价3种热牙胶充填技术的充填效果.方法:采用人完整单根管离体牙40颗随机分成4组,根管预备后分别采用冷牙胶侧向加压法、热牙胶垂直加压法、热塑牙胶注射加压法(Obtura Ⅱ)和超声振动侧向加压法进行根管充填.每个根管分别在距离解剖根尖3、6和9 mm处横断,通过图像分析软件记录根管横断面积和牙胶充填的面积,计箅出牙胶充填面积百分数.结果:热牙胶垂直加压组和Obtura Ⅱ组的PGFA显著高于冷牙胶侧压组和超声侧压组(P＜0.05),热牙胶垂直加压组和Obtura Ⅱ组的PGFA之间无显著性差异(P＞0.05),且与根管充填的深度也无明显相关性(P＞0.05).热牙胶垂直加压组和Obtura Ⅱ组的PGFA在9 him和3 mm处明显大于冷牙胶侧压和超声侧压组(P＜0.05);在6 mm处,3种热牙胶的PGFA无显著性差异(P＞0.05).超声侧压组的PGFA与根管深度明显相关(P＜0.05).结论:热牙胶垂直加压法和Obtura Ⅱ允填后牙胶密度高,在9 mm和3mm处效果优于超声振动侧向加压法.超声振动侧向加压法充填效果受到根管深度影响.     

Assessing the shape of root canals: an in vitro method using microradiography

The aim of this paper is to describe an in vitro method which provides clear and accurate details of root canal shape. The method utilizes the technique of contact microradiography to produce high resolution, two-dimensional, real-size images of canals in a longitudinal plane. Specimens can be accurately rotated through 90° allowing images to be produced in a bucco-lingual and mesio-distal direction. The method is simple, relatively rapid and can process large numbers of teeth without the need for complicated and expensive mounting blocks or film holders. The technique can be used to produce pre- and post-operative images of canal shape which can be superimposed to delineate the dentine removed during canal preparation. The method is thus suitable for the evaluation of the shaping ability of endodontic instruments and preparation techniques.     

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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.     

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在美国牙髓病学专家Gutmann<牙髓病学解难>一书的开卷语中,引用了1884年一位英国牙髓病研究者的话:治疗前花一小会儿时间思考一下根尖病的病因,使我们理解欲达到成功目的所必须做的事;倘若病变来自感染牙髓的分解,那么将其清除,即可将多数病例治愈.     

根管钙化治疗的研究进展

根管钙化是牙髓病和根尖周病临床治疗中较为棘手的问题.了解各类钙化根管的治疗方法,对提高治疗成功率有重要意义.yynw文就根管钙化的原因、X线摄片技术、钙化根管口的寻找方法及临床治疗的研究现状作一综述.     

The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide

Abstract— Calcium hydroxide (CH) is often used as a routine interappointment dressing during the endodontic treatment of teeth with apical periodontitis. However, it fails to consistently produce sterile root canals. The present study was set up to find out whether an antimicrobial strategy including the use of CH could be made more effective if: 1) canals were pretreated with 5% iodine potassium iodide (IPI), and 2) the dressing period was extended up to 2 months. Fifty human teeth, with radiographically verified apical periodontitis, were microbiologically sampled. After chemomechanical preparation the canals were pretreated with IPI for 3–7 days. Teeth where microorganisms persisted were then treated with CH for 2 months. Following instrumentation and dressing with IPI, 43 bacterial strains were recovered in 22 of the teeth. Samples obtained after the CH dressing period disclosed growth of 13 facultative and two strict anaerobic strains in 10 teeth. Enterococcus faecalis was identified in two specimens. In conclusion, the present study gave no evidence for an increased antimicrobial effect of CH if it was left for longer periods in the root canal. Although pretreatment with IPI from a quantitative point of view did not seem to add antimicrobial power, it might reduce the frequency of persisting strains of E. faecalis .     

2种侧压器进入弯曲根管的深度及充填质量的比较

目的 比较镍钛（NiTi）侧方加压器和不锈钢（SS）侧方加压器进入不同程度弯曲根管的深度和根充质量。方法 选择40颗离体弯曲单根管的下颌前磨牙,依据根管弯曲度将其分为小于等于20°和大于20°。采用机用镍钛ProFile器械预备根管,测定2种侧压器进入有主牙胶尖根管的深度,并采用冷牙胶侧方加压充填技术充填根管,在距根尖2 mm和4 mm处对根管作水平片切,记录图像并分析根管中牙胶面积的百分比（PGP）。结果 在弯曲度大于20°的根管中,NiTi侧压器进入根管的深度及根尖2 mm处PGP均大于SS侧压器（P<0.05）;在弯曲度小于等于20°的根管中,二者的差异无统计学意义（P>0.05）。采用不同侧压器充填的根管距根尖4 mm处的PGP的差异均无统计学意义（P>0.05）。结论 NiTi侧压器在严重弯曲根管中较SS侧压器能获得较好的进入深度及充填质量。     

Root and canal morphology of the mesiobuccal and distal roots of permanent first molars in a Kuwait population--a clinical study

Aim To identify the number of roots and canal configurations in permanent first molars of the indigenous Kuwaiti sub‐population and compare them against a similar group of non‐Kuwaiti population in different age groups and gender, and to determine the frequency of a second canal in the mesiobuccal root of maxillary first molars and distal root of mandibular first molars that could be located and treated in routine practice without using magnification or special lighting conditions. Methodology A total of 220 permanent first molar teeth of patients scheduled for root canal treatment over a period of 1 year were included. Patients were identified and grouped according to their nationality as Kuwaiti and non‐Kuwaiti (which included Filipinos, Indonesian Indians, Srilankans, Egyptians, Saudi Arabians and Syrians). In both nationality groups, patients were successively distributed into four groups based on their age. The first age group included patients below 20 years, the second 21–30 years, the third 31–40 years and the fourth were over 40 years. The first three groups comprised of 15 male and 15 female patients whilst the fourth group had 10 patients of each gender. Teeth with open apices, resorptions and calcification were excluded from the study. The teeth included were both clinically and radiographically examined for number of roots, the canal configuration and the presence of the additional mesiobuccal and distal canals and recorded. The simplified classification of canal configurations proposed by Weine was utilized. Results The incidence of a second canal in the mesiobuccal (MB) root of maxillary first molars and the distal root of mandibular first molars was not influenced significantly by nationality and gender. All the 110 maxillary first molars treated had three roots; 58% of MB root had one canal and 42% had two canals. The majority of the mesial roots had Weine type II canal configuration when the second mesiobuccal canal was present. All distobuccal and palatal roots had a single or type I canal configuration. Of the 110 mandibular first molars that were treated, 96% had two roots and 4% had three roots. When present, the third root was located either buccal or lingual to the main distal root. Overall 51% of the single distal roots had one canal whilst 49% had two canals. The mesial root frequently had a Weine type II canal configuration as did the distal root when a second canal was present. Pearson’s correlation analysis of both molars revealed a significant (P < 0.05) negative correlation (r = ?0.274, r = ?0.144) between age and number of canals as well as the type of canal. Conclusions The incidence of a second canal in distal roots of permanent mandibular first molars was 49% in the Kuwaiti population and this was similar to other Asian ethnic populations. Adopting modified access and troughing procedures revealed a 42% frequency of MB2 canals in maxillary first molars. The incidence of a second canal in both mesiobuccal roots of maxillary molars and distal roots of mandibular molars decreased significantly with age; no differences were noticed amongst the nationalities and gender studied. The possibility of extra roots should be anticipated in mandibular molars.     

Shaping ability of ProFile and K3 rotary Ni-Ti instruments when used in a variable tip sequence in simulated curved root canals

AIM: To compare the shaping ability of ProFile and K3 rotary Ni-Ti instruments when used in a variable tip sequence in simulated curved root canals with different curvature and radius. METHODOLOGY: ProFile or K3.06 taper instruments were used to prepare simulated canals of 20 degrees curvature and 5 mm radius (n = 10) and 30 degrees curvature and 3 mm radius canals (n = 10) in resin blocks. All canals were prepared to an apical size 40 at 0.5 mm from the canal terminus using a variable tip crown-down sequence. Pre- and postinstrumentation digital images were recorded, and an assessment of the canal shape was determined using a computer image analysis program. The material removal from the inner and outer wall of the canal was measured at 28 measuring points, beginning 0.5 mm from the end-point of the canal and the data compared using the Mann-Whitney U-test. RESULTS: In 20 degrees and 30 degrees canals both instruments significantly removed more (P < 0.05) material on the outer wall than the inner wall in the apical half of the canal. For ProFile files there was no significant difference in the amount of material removed on the outer canal wall between the 20 degrees and 30 degrees canals. However, in the K3 groups significantly more (P < 0.05) outer canal wall was removed in the apical area in 20 degrees canals. When comparing both instruments the results showed that in 20 degrees canals K3 instruments removed more outer and inner canal wall than ProFile instruments (P < 0.05) but that there was no significant difference (P > 0.05) between the instruments in 30 degrees canals. CONCLUSION: Within the limitation of this study, both rotary nickel-titanium instruments prepared a well-shaped root canal with minimal canal transportation.     

Quality of preparation of oval distal root canals in mandibular molars using nickel-titanium instruments

AIM: The aim of this study was to compare the preparation of oval distal root canals in mandibular molars using three different nickel-titanium (NiTi) instruments: Lightspeed (Lightspeed Inc., San Antonio, TX, USA). ProFile .04 (Maillefer Ballaigues. Switzerland) and Quantec SC (Tycom, Irvine, CA, USA). METHODOLOGY: Three groups of 20 extracted mandibular molars with oval distal root canals were embedded in a muffle system as described by Bramante et al. (1987) and modified by Hülsmann et al. (1999). Preparation of the root canals was performed with particular emphasis on the buccal and lingual extensions of the oval shape. The following parameters were evaluated: comparison of pre- and postoperative photographs with regard to the buccal and lingual extensions of the preparation, safety issues (file fractures, perforations, apical blockages, loss of working length), cleaning ability (SEM investigated using a 5-score system for remaining debris and smear layer) and working time. RESULTS: Superimposition of pre- and postoperative cross-sections in the majority of specimens revealed uninstrumented or incompletely instrumented buccal or lingual extensions (Lightspeed and Quantec SC, 56.7%; ProFile .04, 55%) For debris removal, Quantec SC achieved the best results (54.2% scores 1 and 2), followed by ProFile .04 (52.5%) and Lightspeed (46.7%). Preparation resulted in substantial smear layer covering the canal walls for every system (ProFile .04, 38.3%; Quantec SC, 36.6%; Lightspeed, 28.3%). Differences between the three systems were not significant for any of the parameters investigated. Preparation with Lightspeed resulted in two fractured instruments; with Quantec SC. two apical blockages occurred. With ProFile .04, no complications were noticed. Mean working time was shorter for ProFile .04 (261.2 s) than for Quantec SC (272.4 s) and Lightspeed (338.9 s); the differences were not significant. CONCLUSIONS: The flexibility of the NiTi instruments investigated in this study did not allow controlled preparation of the buccal and lingual extensions of oval root canals. The instruments frequently produced a circular bulge in the canal whilst the buccal and lingual extensions remained unprepared, leaving smear layer and debris.     

钙化根管治疗的研究进展

根管钙化是临床进行根管治疗术时的多见现象。了解各类钙化根管的治疗方法，对提高治疗成功率有重要意义。本文对钙化根管治疗技术的研究现状进行了综述。