Vitapex糊剂与氧化锌碘仿糊剂在乳牙根管充填中的疗效观察

目的观察Vitapex糊剂与氧化锌碘仿糊剂对乳牙慢性根尖周炎根管充填疗效.方法非替牙期乳前牙慢性根尖周炎120例分两组,每组各60例,分别用两种不同的糊剂根充,进行对照分析.结果随访1年后Vitapex组优于碘仿糊剂组(p＜0.05).结论Vitapex糊剂是一种较理想的乳牙根管充填材料.     

Vitapex糊剂与氧化锌碘仿糊剂在乳牙根管充填中的疗效观察

目的 观察Vitapex糊剂与氧化锌碘仿糊剂对乳牙慢性根尖周炎根管充填疗效。方法 非替牙期乳前牙慢性根尖周炎120例分两组，每组各60例，分别用两种不同的糊剂根充，进行对照分析。结果 随访1年后Vitapex组优于碘仿糊剂组（p〈0．05）。结论 Vitapex糊剂是一种较理想的乳牙根管充填材料。     

氢氧化钙糊剂预防根管预备封药后的疼痛

背景：氢氧化钙糊剂不仅可应用于直接盖髓、间接盖髓、根尖诱导等方面,目前在根管治疗过程中也得到了广泛应用。 目的：观察氢氧化钙糊剂对根管预备封药后疼痛的影响。 方法：选择中山大学附属第一医院口腔内科门诊患者752例,其中氢氧化钙组403例,在根管预备后使用螺旋输送器将氢氧化钙糊剂导入根管,氧化锌暂封;甲醛甲酚组349例,用镊子将蘸有甲醛甲酚溶液的纸尖导入根管,氧化锌暂封。1周后复诊,如出现疼痛则提前复诊并记录。 结果与结论：氢氧化钙组11例(2.73%)、甲醛甲酚组51例(14.61%)出现封药后疼痛。两组封药后疼痛发生率差异有显著性意义(P < 0.05)。说明根管预备后,采用氢氧化钙糊剂作为根管消毒剂能有效降低根管预备封药后的疼痛发生率。     

氢氧化钙制剂用于年轻恒牙根尖的诱导成形

背景：氢氧化钙糊剂制剂在对根尖发育尚未完全的年轻恒牙根尖诱导成形中取得了较满意的临床效果,具有操作简便、比例均匀、导入根管后能与牙本质及根尖牙周组织充分接触等优点。目的：验证氢氧化钙制剂用于年轻恒牙实施根尖诱导成形的临床治疗效果。方法：选择因畸形中央尖折断引起的根尖周炎患者34例,其中男18例,女16例,年龄8-12岁,均实施氢氧化钙糊剂根尖诱导成形,治疗后第 1,3,6,12,24个月拍摄X射线片,观察根尖封闭状况。结果与结论：34例中32例诱导成功,2例失败,诱导成功率为94%,其中16例在9-12个月出现根尖封闭,15例在12-15个月内完成根尖诱导,1例感染严重的患牙在18-21个月时完成诱导,2例在第24个月时没有完成诱导。随访2年内,无根尖周炎再次发作、牙齿松动、脱落、牙折及牙根进行性吸收等并发症,所有患牙出现Ⅱ型根尖封闭,未出现Ⅰ型和Ⅳ型,极少数介于Ⅱ型和Ⅲ之间,很难区分。证实在牙根尚未发育完全的年轻恒牙并发根尖周病变时,采用氢氧化钙制剂进行根尖诱导可起到保存患牙、减轻炎症的作用,诱导效果较好。中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

根管治疗术中及术后并发症原因的探讨

目的 总结牙髓病和根尖周病术中及术后发生肿胀、疼痛的原因.探讨其预防措施.方法 收集2007-2009年400例450颗根管治疗的牙齿,时病人的年龄、性别、牙位、治疗史、有无瘘管、清毒药物、根充的质量进行记录分析.结果 55颗(12.02%)发生不同程度的术中及术后疼痛;18颗(4%)发生术中及术后肿胀.其中死髓牙,无瘘型根尖周炎,后牙,超充牙,根管再治疗发生疼痛、肿胀的比例较高.应用甲硝唑、地塞米松糊剂做根管内暂封可预防根管治疗期间的疼痛、肿胀的发生.结论 对于死髓牙要有足量、柔和的根管冲洗.酌情增加复诊次数.局部性牙髓炎、外伤牙和根管恰充牙不易发生根管治疗期间的疼痛、肿胀.应用甲硝唑、地塞米松糊剂根管内暂封可减少疼痛肿胀的发生率.     

乳牙根尖周病变根管治疗术的疗效观察

目的 评价乳牙根尖周病变根管治疗术的临床效果.方法 常规根管治疗术,vitapex 糊剂作为乳牙根尖周病变的根管充填剂.结果 随着根管治疗术后时间的延长,治疗成功率大大上升,经治疗的120个牙,在术后12个月的随访109个,成功率为90.8%.结论 乳牙根尖周病变用完善的根管治疗术可取得较好的临床效果.     

iRoot SP与MTA修复成年人根尖孔未闭合患牙的根尖屏障形成疗效比较

目的以无机三氧化物聚合物(MTA)修复成年人根尖孔未闭合患牙的疗效做对照,通过临床操作探讨iRoot SP治疗成年人根尖孔未闭合患牙的可行性及其临床疗效。方法选择2014年1月至2015年10月在锦州医科大学附属第二医院显微根管治疗中心因慢性根尖周炎就诊并伴根尖孔未闭合的成年患者45例(患牙45颗,前牙23颗,前磨牙22颗),其中女性22例,男性23例;年龄23~40岁,平均年龄32岁。按照随机数字表法分为2组,即iRoot SP组17例(17颗牙),MTA组28例(28颗牙)。所有患牙拍摄术前X射线片并记录患牙情况。用ProTaper手用镍钛锉联合冠向下法进行根管预备,冲洗,隔湿、干燥后测量工作长度并拍X射线片确认;iRoot SP组用iRoot SP糊剂充填至根尖(厚约4mm),MTA组用MTA糊剂充填至根尖(厚约4mm),热牙胶垂直加压法充填根管中上段;术后拍摄X射线片以查患牙充填情况并记录。术后6、12个月进行常规复诊,并拍摄X射线片记录患牙愈后情况并评价。结果在患牙治疗后第6个月进行随访观察时,因MTA组1例患者失访而立即从iRoot SP组中随机抽出1例患者撤出试验,以减小对最后统计结果的影响。最终MTA组27颗患牙,iRoot SP组16颗患牙。术后12个月iRoot SP组15颗患牙形成根尖屏障,MTA组25颗患牙形成根尖屏障;两组差异无统计学意义(P=1.0000.05)。iRoot SP组患牙形成根尖屏障所需时间为(6.600±0.737)周;MTA组所需时间为(8.800±0.726)周;两组差异有统计学意义(P=00.05)。结论两组材料根尖屏障的平均形成周期差异有统计学意义。提示临床工作者iRoot SP在治疗成年人根尖孔未闭合的患牙中能够有效促进根尖硬组织的形成,提高临床治疗效率。     

根管治疗期间急症的发生和处理

目的:总结分析根管治疗期间急症的发生原因及其治疗方法.方法:对48例根管治疗期间急症的患牙进行临床分析.地塞米松和甲硝唑根管内封存,1周后用碘仿糊剂加牙胶尖行根管充填;术后随访一年,观察其疗效.结果:根管治疗期急症的发病率为11.62%(48/413),牙髓炎组4.6%(7/150)与牙髓坏死、根尖炎组15.59%(41/463)的急症发病率有显著差异(P＜0.001),前牙和后牙发生率有显著差异(P＜0.001),随访一年后疗效评定为成功率89.58%.结论:根管治疗期间急症的发生与术前患牙的牙髓状况、牙位等有关;用地塞米松和甲硝唑行根管内封存及碘仿糊剂加牙胶尖行根管充填,治疗效果可靠.     

根尖囊肿保守治疗55例临床观察

目的：观察根管治疗对根尖囊肿的临床疗效。方法随机选择48例55个根尖囊肿患牙进行常规根管治疗，术后采用临床检查和X线牙片观察0.5~3年。结果55个牙经根管治疗后有51个痊愈或基本痊愈，有效率92.73%，前牙疗效优于后牙。结论根管治疗是治疗根尖囊肿的有效方法。     

两种根管填充材料在根管治疗乳牙牙髓病及根尖周病的疗效研究

目的:分析两种根管填充材料在根管治疗乳牙牙髓炎及根尖周病的疗效.方法:选择我院2016年1月至2021年1月乳牙牙髓炎及根尖周病患者共200例,随机分2组,每组100例,对照组的患者给予氧化锌丁香油糊剂根管治疗,观察组采用Vitapex根管糊剂根管治疗,比较两组效果.结果:观察组治疗后牙龈指数、菌斑指数、牙周探诊深度、出血指数、疼痛评分低于对照组,总有效率高于对照组(P<0.05).结论:采用Vitapex根管糊剂填充材料根管治疗乳牙牙髓炎及根尖周病的效果确切.     

Difference in the periapical status of endodontically treated teeth between the samples of Croatian and Austrian adult patients

Aim. To compare the periapical status of endodontically treated teeth between Austrian and Croatian adult patients and determine its relation to age, sex, position of teeth, and length of root canal filling. Methods. The study was conducted from 2007 to 2009 at two university dental clinics and included 163 Croatian (412 teeth) and 101 Austrian (430 teeth) patients. We assessed the periapical status of endodontically treated teeth by using the periapical index system and determined its relation to age, sex, position of teeth, and length of root canal filling. Results. Austrian patients had a greater number of diseased endodontically treated teeth than Croatian patients (P=0.001). In the age group 31-40 years, Austrian patients had apical periodontitis significantly more often (22.1% vs 12.2%, P<0.001) than Croatian patients. In relation to sex and position of teeth, no significant difference was found between the two groups. In Croatian patients, apical periodontitis was significantly more often present in molar than premolar (46.2% vs 29.7%, P=0.022) and front teeth (46.2% vs 24.1%, P<0.001). In Austrian patients, apical periodontitis was significantly more often present in molar and premolar than front teeth (molar-front teeth: 38.2% vs 25.5%, P=0.011; premolar-front teeth: 36.3% vs 25.5%, P=0.029). Croatian and Austrian patients with AP significantly differed in the number of adequately filled and underfilled teeth (both P<0.001). Conclusion. Apical periodontitis was significantly more present in endodontically treated teeth in Austrian patients. The difference in the periapical status between Croatian and Austrian patients was most related to age and length of root canal filling.     

Scanning electron microscopy of the apical structure of human teeth

The objective of this research was to evaluate, by scanning electron microscopy, the apical structure of extracted human permanent teeth with different degrees of pulp and periapical pathology. A total of 25 teeth were extracted: 5 teeth with vital pulp (group I); 10 teeth with pulp necrosis without radiographically visible periapical lesion (group II); 10 teeth with pulp necrosis with radiographically visible periapical lesion (group III). The root apex was sectioned and processed for scanning electron microscopy. In groups I and II, fibers covered the root cementum and there was no cementum resorption or microorganisms. There were areas of cementum resorption in group III with microorganisms on the root apex surface (biofilm) and no fibers. The authors conclude that the presence of chronic periapical lesions causes severe changes in the apical structure with a destruction of fibers and different degrees of cementum resorption forming lacunae in which bacterial biofilm persisted.     

根尖微渗漏影响因素的研究

根管治疗术是牙髓病和根尖周病首选的、最有效的治疗方法,根管的消毒、扩大成形以及根尖区的严密封闭是其重要的操作步骤,彻底清除根管内感染源并防止根管再感染是其基础和目标。根尖微渗漏是根管治疗术后根管因再感染而出现根尖周炎症的危险因素,是根管治疗失败的主要原因。根尖微渗漏的产生是多个因素协同作用的结果,研究根管治疗过程中根尖微渗漏的影响因素,为降低和防止根尖微渗漏的发生提供指导,对提高根管治疗成功率具有重要作用。本文就根管治疗过程中根尖微渗漏影响因素的研究进展作一综述。     

矿物三氧化物凝聚体根尖屏障后的根尖微渗漏

BACKGROUND: Because of its good sealing property and biocompatibility, mineral trioxide aggregate can promote the regeneration of bone tissue, induce the differentiation of periodontal cells. and reduce the apical micro-leakage. OBJECTIVE: To compare the micro-leakage of hot gutta-percha filling after mineral trioxide aggregate apical barrier and continuous hot gutta-percha filling techniques. METHODS: Totally 36 in vitro single root canal molars were selected and randomly divided into experimental and control groups. In the experimental group, mineral trioxide aggregate apical barrier was conducted, and then hot gutta-percha root canal filling was conducted after operation. Continuous wave of hot gutta-percha root canal filling was conducted in the control group. The apical micro-leakage was detected by glucose oxidase method. RESULTS AND CONCLUSION: The root canals were successfully and tightly sealed in these two groups. The apical micro-leakage gradually increased with the time. In the experimental group, the apical micro-leakage values at 1, 7, 14, 21 and 28 days of filling were all significantly lower than those in the control group (P < 0.05). These results demonstrate that hot gutta-percha root canal filling has a relatively good apical sealing effect after the mineral trioxide aggregate apical barrier, and can significantly reduce micro-leakage.       

Electronic root canal length measurement before and after experimentally induced pulpitis and apical periodontitis in dogs

The aim of the study was to examine the influence of the state of the pulp and apical periodontium on the results of electronic root canal length measurement (ERCLM) with a resistance measuring device in dogs. Pulpitis and apical periodontitis were induced by pulp exposure and contamination by the oral flora in the premolar teeth of six mongrel dogs, comprising four experimental groups (36 root canals). In a control group, measured lengths of teeth with uninfected pulps were performed on the first experimental day (44 root canals). In all animals the ERCLMs were performed on teeth with healthy pulps, and at the end of the experimental period (20, 35, 50 and 65 days) following pulp exposure. The point of measuring canal lengths was the anatomical obstacle above the apical delta. Electronically measured lengths (EML) were compared between each other and with the root canal length established by tactile-sense measurement verified radiographically. The EMLs were less accurate in teeth with healthy pulps and teeth with pulpitis in the third experimental group (dif = 2.27 × 2.65 mm²; t test, p < 0.05), while they were most precise after 65 days in teeth with completely necrotic pulp and established chronic apical periodontitis (dif = 0.54 × 1.36 mm²; t test, p > 0.05). These results suggest that the state of the pulp and periapical tissue may have an influence on the ERCLM.     

Alveolar bone remodeling in the early stage of experimental apical periodontitis in the rat mandible.

Apical periodontitis was surgically induced in the mandibular first molar of rats and chronological changes in the periapical bone tissue were observed by histochemistry and electron microscopy. On the second postoperative day (Day 2), tartrateresistant acid phosphatase (TRACPase)-positive cells emerged on the bone surface facing the inferior alveolar nerve, whereas alkaline phosphatase (ALPase)-positive cells proliferated on the bone marrow surface of the mandibular canal wall. On Day 3, the active resorption of the mandibular canal wall appeared on the surface facing the inferior alveolar nerve. The bone of the upper wall of the canal was completely resorbed. On Day 4, however, numerous ALPase-positive cells emerged over the bone surface facing the inferior alveolar nerve intermingled with TRACPase-positive cells. On Day 5, repair of the upper wall of the mandibular canal by new bone progressed. Bone formation was also observed on the bone surface facing the inferior alveolar nerve. On Day 6, the upper wall of the mandibular canal was remodeled by the new bone, whereas TRACPase-positive cells had already migrated over the bone surface in the vicinity of ALPase-positive cells. From Days 2 to 5, active trabecular bone formation continued in the bone marrow cavity close to the mandibular canal, while TRACPase-positive cells were found only on Day 6. These demonstrate that inflammatory stimuli activate bone formation coupled with bone resorption, as well as direct trabecular bone formation without a bone resorption phase. A rapid bone turnover in the early stage of apical periodontitis is also suggested. We conclude that bone defects in apical periodontitis are not the result of sole bone resorption but rather, active bone remodeling.     

利用三维有限元分析根尖切除对上颌中切牙生物力学性能的影响

目的研究根尖切除手术后牙体及牙周应力分布的变化以及牙齿的位移,为临床医师实施根尖手术提供数据支持,提高根尖手术治愈率。方法基于Micro CT图像数据建立正常上颌中切牙及其牙周组织的三维有限元模型。在此基础上仿真根尖周炎和根切治疗手术,并建立根尖周炎及不同根切长度(3、4、5、6、7、8 mm)上颌中切牙及其支持组织的三维有限元模型,施加咬合力,通过三维有限元仿真分析,研究术后愈合牙齿的生物力学行为特性,对比分析手术修复的生物力学效果,得到最佳的根尖切除长度。结果根尖切除手术术后,愈合模型降低患牙的应力水平(26.8%)及牙齿动度(7.3%);随着根切长度的增加,根切达8 mm时,牙齿颈部和牙周膜的应力分别增加11.14%和29.27%,牙槽骨的应力增加83.11%,切面形成的新的根尖处应力相较于正常牙齿相同部位整体上升;牙齿沿长轴的位移也逐渐增大,当根切超过5 mm时,位移水平明显增大(18.39%)。结论根尖切除手术对于难治性根尖周炎患牙的生物力学特性有明显改善,建议临床手术中根尖切除长度范围为3～5 mm,冠根比不低于0.84。     

Epstein-Barr virus infection induces bone resorption in apical periodontitis via increased production of reactive oxygen species

Chronic inflammatory processes in periapical tissues caused by etiological agents of endodontic origin lead to apical periodontitis. Apart from bacteria, two herpesviruses, Epstein-Barr virus (EBV) and Human cytomegalovirus (HCMV) are recognized as putative pathogens in apical periodontitis. Although previous reports suggest the involvement of EBV in the pathogenesis of apical periodontitis, its exact role in periapical bone resorption has not yet been fully elucidated. We hypothesize that EBV infection in apical periodontitis is capable of inducing periapical bone resorption via stimulation of reactive oxygen species (ROS) overproduction. Increased levels of ROS induce expression of receptor activator of nuclear factor kappa B (NF-κB) ligand (RANKL). RANKL binding to receptor activator of nuclear factor κB (RANK) present on the surface of preosteoclasts induces their maturation and activation which consequently leads to bone resorption. The potential benefit of antiviral and antioxidant-based therapies in periapical bone resorption treatment remains to be assessed.     

空管疗法治疗药物性根尖周炎的临床疗效观察

目的 药物性根尖周炎的治疗。方法 采用空管疗法治疗药物性根尖周炎的患牙62颗。结果 40颗牙齿愈,治愈率达到90％。结论 空管疗法治疗药物性根尖周炎疗程短,治愈率高,方法可行。     

Prevalence of apical periodontitis and quality of root canal fillings in population of Zagreb, Croatia: a cross-sectional study

Aim

To determine the prevalence of apical periodontitis and assess the quality of endodontic fillings in the population of the city of Zagreb, Croatia.

Methods

A total of 1462 orthopantomograms from new patients at 6 different dental practices was analyzed during 2006 and 2007. The presence of periapical lesions was determined by using the periapical index score (PAI). The quality of endodontic fillings was assessed according to the filling length and homogeinicity. Data were analyzed using t test and ANOVA with Scheffe post-hoc test.

Results

There were 75.9% of participants with endodontically treated teeth and 8.5% of all teeth were endodontically treated. Only 34.2% of endodontically treated roots had adequate root canal filling length, while 36.2% of root canal fillings had homogenous appearance. From the total number of teeth with intracanal post, 17.5% had no visible root canal filling. Using PAI 3 as a threshold value for apical periodontitis, periapical lesions were detected in 8.5% of teeth. Adequate quality of root canal fillings was associated with a lower prevalence of periapical lesions.

Conclusion

We found a large proportion of endodontically treated teeth with apical periodontitis and a correlation between the quality of endodontic filling and the prevalence of periapical lesions. This all suggests that it is necessary to improve the quality of endodontic treatment in order to reduce the incidence and prevalence of apical periodontitis.Apical periodontitis (AP) is a result of microbial contamination of periapical tissues that originates from a necrotic dental pulp or inadequately treated root canals (1-3). Diagnostic criteria for AP include the presence of symptoms and clinical signs during clinical examination and analysis of radiographs (periapical or panoramic). Radiographic analysis is important because AP in its chronic form is often overlooked and left untreated. Despite the relatively low risk of exacerbations (less than 5%), the influence of AP on remote organs and tissues persists even in its sub-acute chronic form (4). The outcome of endodontic therapy is assessed radiographically (5), but due to high availability and reliability, radiographs are also suitable for epidemiological studies. The prevalence of AP among adults in different populations is well documented in the literature, especially in the Scandinavian countries (6-11). The prevalence of AP positively correlated with age and this tendency will presumably increase because of an increase in dentate population (6). Multi-rooted teeth have a higher prevalence of AP than single-rooted teeth, especially molars (12). Factors that determine the outcome of endodontic treatment are length and quality of endodontic filling and post-endodontic restoration of the tooth (13-15). Nevertheless, epidemiological studies performed worldwide show that AP is present in 22-65% of root-filled teeth (14-17). The crucial factor for a successful healing of the periapical region is adequate root canal therapy with complete obturation of the root canal less than 2 mm from the external apical foramen (14-17). Another factor influencing the prevalence of AP is the quality of coronal restorations. Teeth with inadequate restorations were associated with greater occurrence of AP (8,18-20). So far, many studies on the prevalence of AP and its association with various factors have been done worldwide, but not one has been conducted in this part of Europe. Since epidemiologic data are essential for population health assessment, future health care planning, and funding, the aim of this study was to assess the prevalence of AP and the quality of root canal fillings in the population of the city of Zagreb, Croatia.