根管治疗失败牙再治疗疗效分析

目的 探讨根管治疗失败的原因及再治疗方法。方法 对148颗根管治疗失败牙进行原因分析,对失败牙彻底消毒后应用复方甲硝唑根管糊剂再充填。结果 根管治疗失败的主要原因为根管继发感染、根尖超填及根尖周机械损伤。失败牙再治疗后经2年疗效观察,治疗成功率95.27％。结论 复方甲硝唑根管糊剂治疗根管治疗失败牙疗效可靠。     

乳牙根管治疗失败原因及再治疗疗效分析

目的 :探讨乳牙根管治疗失败的原因及再治疗方法。方法 :对 12 5个乳牙根管治疗失败病例进行原因分析 ,再治疗应用复方甲硝唑、碘仿、氧化锌糊剂充填根管。结果 :根管治疗失败的主要原因为根管继发感染 ,根尖部及根分歧部骨质破坏 ,炎症未能有效控制、充填导致瘘管及牙周脓肿形成。失败牙再治疗后经 1.5 -2年观察 ,成功率为 96.80 %。结论 :甲硝唑、碘仿、氧化锌糊剂作乳牙根管充填较为理想 ,对根尖部有阴影的患牙作必要的超填 ,可获得满意疗效     

根管治疗失败的原因分析

目的探讨根管治疗失败的原因。方法收集2003-2007年间根管治疗失败患牙56例,分别从根管预备、充填以及其它方面进行分析失败原因。结果根管欠充、超充、侧填不足、根管侧穿和根管遗漏是根管治疗失败的主要原因。结论根管治疗中应熟悉根管解剖形态,准确掌握根管长度,坚持无菌操作,配合熟练的操作以及良好的根管预备是根管治疗成功的关键。     

根管治疗失败与根内感染

持续性和（或）继发性根内感染是根管治疗失败的主要原因之一，其微生物主要通过3个途径存在于根管内。本文就根内感染的主要途径及常见微生物作一简要综述。     

根管治疗处理牙髓治疗牙髓治疗失败牙的疗效观察

根管治疗是牙髓根尖周病的治疗方法之一 ,进行根管治疗需要精湛的技术和先进的设备[1] 。发达国家对牙髓根尖周病主要采用根管治疗术。目前我国仍多种治疗方法并存 ,牙髓治疗失败率较高。本文就近年收集的 16 2例牙髓治疗失败患牙进行病因分析、再处理及临床疗效观察。1　材料和方法1.1　病例选择选择 1996～ 1998年间中山医科大学口腔医学院牙体牙髓科就诊的 148例、16 2颗牙髓治疗失败患牙 (纵折除外 )。出现下述任何一项即为牙髓治疗失败 :①治疗后 6～ 2 4个月出现骨质破坏或骨质破坏区扩大 ;②瘘管未消失 ;③治疗6个月后仍诉疼痛和肿胀…     

根管治疗处理牙髓治疗失败牙的疗效观察

根管治疗是牙髓根尖周病的治疗方法之一,进行根管治疗需要精湛的技术和先进的设备\+\{［1］\}。发达国家对牙髓根尖周病主要采用根管治疗术。目前我国仍多种治疗方法并存,牙髓治疗失败率较高。本文就近年收集的162例牙髓治疗失败患牙进行病因分析、再处理及临床疗效观察。 1 材料和方法 1．1 病例选择 选择1996～1998年间中山医科大学口腔医学院牙体牙髓科就诊的148例、162颗牙髓治疗失败患牙（纵折除外）。出现下述任何一项即为牙髓治疗失败：①治疗后6～24个月出现骨质破坏或骨质破坏区扩大;②瘘管未消失;③治疗6个月后仍诉疼痛和肿胀。患牙原治疗情况及牙位分布见表1。 1．2 方法 再处理：①充分揭开髓顶,清理髓腔、根管。对曾行干髓术者,彻底清除干髓剂及根管内残余牙髓等;曾行塑化治疗者,采用乙二胺四乙酸（EDTA）辅助清除髓室和根管内塑化物等;曾行根管治疗者,用氯仿溶解、去除原充填物。②利用镍钛根管器械（Profile 系列）及超声根管治疗仪（Odontoson M ,丹麦）进行常规法或逐步后退法（弯曲根管）预备根管。③用Spreader侧压器进行不加热侧方加压法充填根管。 牙髓治疗失败患牙经再处理后,充填成功牙每3个月复查1次,作临床检查及X线片复查,随访2年。     

牙髓治疗失败后再治疗的疗效观察

材料与方法：病例选择 收集1998～2001年间接诊的牙髓治疗失败的患牙312例(纵折除外)，年龄16～78岁，男性134例，女性178例。     

应用CBCT评判根管治疗失败原因

目的 应用CBCT判断分析根管治疗失败原因,比较CBCT与根尖X线片在诊断根管治疗失败方面的差异。方法 收集拍摄CBCT的根管治疗失败病例74例,对其病因以及影像学检查结果进行统计分析。结果 在所收集病例中,失败原因包括根管欠充、遗漏根管、牙周牙髓联合病变、牙折、冠渗漏、根管超充及根管侧穿。结论 根管欠充、遗漏根管是导致根管治疗失败的主要原因,牙周损害则是后期处理的疑难因素。CBCT可为病因的确定提供有力参考依据,且对后期治疗方案的制定起关键作用。     

乳磨牙根管治疗失败原因分析

目的探讨乳磨牙根管治疗失败的原因。方法收集2004年1月~2006年6月在广东省口腔医院儿童牙科就诊的乳磨牙根管治疗失败的病例128例,共136颗患牙,分析治疗失败的原因。结果失败患牙中因充填物脱落根管系统暴露再感染53颗(38.97%);遗漏根管52颗(38.24%);根管充填不密合、欠填21颗(15.44%);其它原因10颗(7.35%)。结论因充填物脱落造成髓腔暴露发生再感染和遗漏根管是造成乳磨牙根管治疗失败的主要原因。     

根管治疗失败1例分析

根管治疗术是治疗牙髓病和根尖周病的首选方法。随着根管治疗术在临床中的逐步推广和完善,使许多患牙得以保留。然而,根管治疗有6%～34%的失败率,其失败的原因是多方面的。笔者对临床中1例由根管治疗失败而导致患牙被拔除的病例进行全面分析,以期为临床中如何避免医方因素导致根管治疗失败及根管治疗失败后治疗方案的选择提供警示。     

两种根充材料治疗乳牙感染根管的临床疗效评价

目的:观察新型注射式根管糊剂作为乳牙根管充填材料的疗效.方法:设碘仿氧化锌丁香油糊剂作为对照组,共对224个乳牙行根管治疗观察3个月、1年后的疗效.结果:注射式新型根管糊剂与碘仿氧化锌丁香油糊剂远期疗效有显著差异(t=0.025,P＜0.05),尤其在乳磨牙治疗效果更为显著(t=0.02,P＜0.05);实验组超充和适充疗效无显著性差异(X2=0.28,P＞0.05),与欠充之间有显著性差异(X2=6.04,P＜0.05).结论:新型注射式根管糊剂更适合临床作为常规乳牙根管充填材料.     

重度牙周炎病例牙周牙髓联合治疗与单纯牙周治疗的临床对比研究

目的：本研究比较了重度牙周炎病例牙周牙髓联合治疗法与单纯牙周治疗法治疗效果的差异，旨在探讨牙髓状态对牙周治疗效果的影响。方法：半年随访重度牙周炎病例14例，共计试验牙20颗，随机进入实验组(牙周牙髓联合治疗组)12颗，对照组(单纯牙周治疗组)8颗。于治疗后3个月、6个月通过牙周袋探诊深度(probing pocket depth，PDD)、相对附着水平(relative attachment level，RAL)，影像学指标釉牙骨质界到骨缺陷底的距离(cementum enamal junction to bottom of born，defects，CEJ-BD)，釉牙骨质界到牙槽嵴顶的距离(cementum enamal junctioa to alveolar crest，CEJ-AC)及计算机辅助骨密度影像分析值(computer assisted densitometric image analysis，CADIA)对比两组治疗效果的差异。结果：观察期内临床指标PPD、RAL及CEI-AC未出现显著性差异，而CEJ-BD及CADIA于治疗后3个月，6个月出现显著性差异。结论：重度牙周炎病例选择牙周牙髓联合治疗法较单纯牙周治疗法更有利于牙周骨组织的再生。     

Dens Invaginatus: Clinical Implications and Antimicrobial Endodontic Treatment Considerations

Dens invaginatus or dens in dente is a developmental dental anomaly resulting from an invagination of the enamel organ into the dental papilla during odontogenesis. Radiographically, it is usually seen as a radiolucent invagination surrounded by a radiopaque area (enamel) limited to the tooth crown or extending into the root. Because the invagination is opened to the oral cavity, it can retain saliva, food remnants, and bacteria. In conditions where the enamel lining of the invagination is naturally absent or lost because of caries, bacterial cells and products can diffuse from the invagination through the dentin tubules to reach the pulp and cause disease. Management of teeth with dens invaginatus includes preventive sealing or filling of the invagination, or if the pulp is affected, therapeutic options include vital pulp therapy, nonsurgical root canal treatment, apexification or regenerative endodontic procedures, periradicular surgery, intentional replantation, or extraction. It is recommended that the invagination be always approached, regardless of the type of dens invaginatus. The root canal should be treated whenever the pulp is irreversibly inflamed or necrotic. Endodontic management of teeth with dens invaginatus is often tricky because of its anatomic complexity, and special and customized strategies should be devised. This review discusses the endodontic implications of this anomaly and the current treatment recommendations based on anatomic, pathological, and technologic considerations.     

RADIOGRAPHIC STUDY OF THE PREVALENCE OF APICAL PERIODONTITIS AND ENDODONTIC TREATMENT IN THE ADULT POPULATION OF S?O LUíS,MA, BRAZIL

This study investigated the prevalence of apical periodontitis (AP) and its association with endodontically treated teeth in residents of São Luís, MA, Brazil. Two-hundred complete series of periapical radiographs taken over a 10-year period (1993-2003) were retrieved from the files of four prosthesists and five periodontists. The Periapical Index (PAI) was used and the age range, sex, tooth groups, location and association with endodontic treatment (ET) were also analyzed. The Cohen Kappa and Chi-square tests were used for statistical analysis. Out of 200 patients, 135 presented at least one case of AP, which corresponds to a prevalence of 67.5%. Of the 5008 teeth examined, 296 had AP and 553 had ET. Therefore, considering the total number of teeth, AP and ET prevalences were 5.9% and 11%, respectively. Of the 553 endodontically treated teeth, 235 (42.5%) were associated with AP. Chi-square test showed a strong correlation between AP and ET (p<0.05). The 40-year-old age group was significantly the most prevalent (p<0.05). There was no association between AP and patient''s sex (p>0.05). The maxillary incisors were the most affected group of teeth (p<0.05). AP had predilection for the maxilla and was strongly associated with endodontically treated teeth (p<0.05). The prevalence of apical periodontitis and endodontically treated teeth with AP was high and similar to the results of studies performed in other countries.     

两种镍钛器械预备根管的临床研究

目的比较两种机用镍钛器械Twisted Files（TF）和Protaper预备根管的临床效果。方法患牙髓炎或根尖周炎需进行根管治疗的患牙60颗,随机分为2组,分别使用TF锉（TF组）和Protaper锉（P组）采用根向技术预备根管,2组均采用热牙胶垂直加压充填根管。比较2组根管预备的成形效果、预备时间、预备前后工作长度、预备术后疼痛评分。结果 2组均能形成较好的根管流畅度,预备前后的锥度评价比较,差异无统计学意义（χ2=1.381,P=0.240）;预备时间P组为12.24 min,TF组为8.69 min,TF组的预备时间短于P组（F=60.18,P〈0.001）;两组预备前后工作长度差值P组为（0.09±0.46）mm,TF组为（0.20±0.33）mm,差异无统计学意义（t=1.06,P=0.29）,预备后2组疼痛评分差异无统计学意义（Z=-0.72,P=0.47）。结论 TF锉和Protaper锉均有良好的根管预备能力,TF锉预备时间较短,切割效率较高。     

根管治疗慢性根尖周炎5年预后及影响因素分析

目的:探讨慢性根尖周炎经根管治疗后的牙生存率、拔除原因、根尖愈合率及预后影响因素.方法:回顾性队列研究纳入由同一名医师完成根管治疗的102例根尖周炎患者.主要预测变量为根管治疗难度系数(difficulty assessment of root canal therapy,DARCT),即根据牙根长度、牙根弯曲度、根管...     

碘复用于感染根管冲洗消毒的细菌学观察

目的：观察碘复冲洗消毒感染根管的抗菌效果。方法：共收集３５例感染根管标本,实验组２０例用０．５ｇ／Ｌ碘复冲洗根管然后封５ｇ／Ｌ碘复原液,对照组１５例用过氧化氢液和生理盐水冲洗根管,封ＦＣ于根管,分别在用药前后进行细菌标本采样、培养、分离与鉴定,观察ＣＦＵ变化及细菌检出情况。结果：使用０．５ｇ／Ｌ碘复冲洗根管的抗菌作用明显优于临床用Ｈ２Ｏ２和生理盐水联合冲洗的效果;用５ｇ／Ｌ碘复封药消毒根管的杀菌作用与ＦＣ相当。结论：碘复对感染根管内厌氧菌有良好的抗菌效果。     

根管治疗期间疼痛问题的临床观察

目的 探讨根管治疗期间疼痛发生的原因。方法 对330例临床病人366颗根管治疗的牙齿进行临床观察。结果37颗牙（10.1％）发生了不同程度的根管治疗术后疼痛,其中死髓牙、后牙、根尖阴影小的牙和近期有过疼痛史的牙齿发生疼痛的比例较高。结论 与根管治疗术后疼痛发生关系较为密切的因素有牙髓坏死、牙位、根尖阴影和疼痛史等,确切原因尚有待于进一步研究。     

Maillefer Profile 机用根管器械预备磨牙根管的近期效果分析

目的了解临床应用Maillefer Profile镍钛合金机用根管锉在预备前磨牙和磨牙根管的根管预备效果.方法Maillefer Profile机用根管器械采用逐步深入法预备前磨牙和磨牙根管共62个牙;手用根管器械采用逐步后退法预备前磨牙和磨牙根管共60个牙;并通过术前、术后的X线牙片和近期临床症状(疼痛发生率等)对比分析.结果Maillefer Profile镍钛合金机用根管锉预备牙根管的时间短、根管偏移率和近期临床效果亦优于手用根管器械.结论Maillefer     

Effects of Endodontic Infections on the Maxillary Sinus: A Case Series of Treatment Outcome

This article shows the follow-up of several cases of maxillary sinusitis of dental (usually endodontic) origin, with different manifestations, diagnostic challenges, and outcomes.Cases from 14 patients from 3 countries and treated by 7 different endodontists are presented, all of them with inflammatory sinus changes represented by mucositis, osteoperiostitis, and/or partial/full obstruction. All cases showed dental and/or sinus signs/symptoms that resolved after dental management. In 13 cases, the sinus condition had an endodontic origin, 4 of them concurrently with periodontal involvement. In 1 case, sinusitis was caused by trauma to the face. All cases but 1 had a satisfactory response of the periradicular tissues and maxillary sinus to treatment that consisted of root canal therapy, root amputation, extraction, or trauma management.The successful management of most cases reported in this article emphasizes the importance of endodontics as a specialty engaged in saving teeth and promoting health not only in the oral cavity but also in other areas that may be affected by infections of endodontic origin, including the maxillary sinus.