根尖倒充填术微渗漏的研究进展

根尖倒充填术扩大了保留牙齿的适应证的范围,提高了患者的生活质量,但是对决定手术能否成功的关键因素—根尖倒充填微渗漏的研究结果仍然不统一。本文从根尖切除方法、根尖切除斜度、根尖切除后术区处理、根尖倒充填材料等方面加以综述。     

三种根尖倒充填材料的封闭性能研究

目的:评价根尖倒充填材料iRoot BP Plus、矿物三氧化物凝聚体、玻璃离子水门汀的封闭性能.方法:收集新鲜拔除冠根完整的32颗单根管前牙及前磨牙,随机分为三个实验组和一个阴性对照组,每组8颗离体牙.所有样本离体牙在釉牙骨质界处截冠、机械预备根管、热牙胶根管充填后在根尖3mm处截根,实验组离体牙在显微镜下根尖倒预备...     

根尖倒充填术后根尖微渗漏的影响因素

根尖倒充填术后根尖发生微渗漏是导致根尖手术失败常见的原因之一。根尖倒充填术后根尖微渗漏的影响因素有很多,包括根尖切除方法及根尖窝洞预备,对根尖牙本质表面的处理,不同的根尖倒充填材料,以及根管是否充填和pH值等。本文对此作一综述。     

不同材料及根尖术式对根管封闭性的影响

目的:评价MTA、iRoot BP Plus两种根管充填材料在根管正充填与倒充填两种不同根尖术式下的根管封闭效果。方法::收集因牙周、正畸拔除并符合标准的下颌恒前磨牙40颗,根管预备后随机分为4个实验组(n=8)和2个对照组(n=4):A组(MTA正充填组)、B组(iRoot BP Plus正充填组)、C组(MTA倒充填组)、D组(iRoot BP Plus倒充填组)、M组(阳性对照组)、N组(阴性对照组)。使用印度墨汁染色技术,透明牙技术评价两种材料在根管正充填与倒充填两种不同根尖术式下的根管封闭效果。结果:各实验组根方均有不同深度的墨汁渗入,A、B组较C、D组微渗漏值稍大,但各组间差异无统计学意义(P>0.05)。结论:MTA、iRoot BP Plus在根管正充填与倒充填两种不同充填方式下能取得同样的根尖封闭效果。因此,对于部分特殊部位的根尖病变以及止血困难等行根尖倒预备、倒充填较困难的病例可以选择MTA或iRoot BP Plus正充填后再行根尖切除这一手术方式作为有效的替代方式。     

Nd：YAG激光对Dyract复合体充填微渗漏的影响

目的　观察Nd :YAG激光照射洞缘牙釉质对复合体Dyract充填微渗漏的影响。方法　新鲜拔除的完整离体牙 5 0颗 ,随机分为实验组 ( 2 6颗 )和对照组 ( 2 4颗 )。在样本牙的颊舌面制备V类洞 ,对照组常规完成Dyract充填 ,实验组用Nd :YAG激光照射洞缘牙釉质后再行Dyract充填。所有样本经冷热循环处理后 ,再进行微渗漏实验。用体视显微镜和SEM观察并拍照记录。结果　激光光蚀组充填体边缘微渗漏比对照组明显低 (P <0 .0 5 )。微渗漏实验与扫描电镜观察结果一致。结论　Nd :YAG激光的光蚀作用有助于增强复合体Dyract与牙体组织的结合 ,改善边缘封闭 ,减少微渗漏 ,有利于充填成功     

根尖倒充填材料的研究进展

根尖倒充填术的目的是严密封闭根尖孔与根尖周组织的交通，预防根尖微渗漏，常用于非手术治疗失败，不能用常规方法进行根管治疔术且要尽量保留患牙的病例。由于大量材料已应用于根尖倒充填，本文对各种以往在临床和动物实验中常用的根尖倒充填材料作一简要综述。     

Er：YAG激光制备窝洞对树脂充填微渗漏的影响

目的应用离体牙比较复合树脂与Er：YAG激光及传统牙钻制备窝洞洞壁间微渗漏的差异。方法将30颗前磨牙随机分为3组,每组10颗牙,制备Ⅴ类洞：Ⅰ组牙钻预备加酸蚀处理;Ⅱ组单纯激光预备组、Ⅲ组激光预备加酸蚀处理组,经冷热循环染色后,在体视显微镜下记录微渗漏程度并应用非参数统计方法分析数据。结果各组内颈壁的染料渗透情况均比壁明显（P〈0.05）;在壁,单纯激光预备组产生的微渗漏最严重（P〈0.05）,激光预备加酸蚀处理组与牙钻预备加酸蚀处理组微渗漏无统计学差异;在颈壁,三组充填体边缘微渗漏情况无统计学差异。结论Er：YAG激光可代替牙钻备洞,结合酸蚀处理与充填体有良好的密合度。     

半导体激光照射对牙齿根尖封闭效果的研究

目的:探讨常规根管预备后使用半导体激光进行根管内照射对根尖封闭性能的影响.方法:选择新鲜拔除的单根管牙60 颗,分6 组(n=10),去除牙冠,常规根管预备.A、B组,半导体激光1 W照射20 s;C、D组,超声荡洗1 min;E、F组,不做任何处理,作为对照组.常规热牙胶垂直加压法充填6 组牙根.微渗漏实验对根充后的A、C、E组牙的根尖封闭性能进行评估,扫描电镜观察B、D、F组牙根剖面.结果:A、C、E组根管微渗漏(mm)分别为1.70±0.82、2.02±0.40和4.56±2.76(A vs E,P<0.01;C vs E,P<0.05,A vs C,P>0.05),扫描电镜观察到激光组大部分牙本质小管发生熔融、缩小或封闭,超声荡洗组大部分牙本质小管内有糊剂或牙胶进入.结论:半导体激光进行根管内照射可以显著提高根充后根尖的封闭性能.     

Nd:YAG激光对牙齿根尖封闭效应的微渗漏研究

目的 探讨Nd:YAG(掺钕钇铝石榴石)激光在牙髓病和根尖周病治疗方面的临床应用。方法 应用低能量连续Nd:YAG激光对新鲜离体牙进行不同能量及方式的照射,结合微渗漏实验对激光照射后的牙齿根尖封闭效应进行评估。结果 Nd:YAG激光无论经根管外还是于根管内照射根尖孔,均可显著减少根尖微渗漏。结论 Nd:YAG激光在促进根尖封闭方面具有显著效果,为探讨牙髓病及根尖周病的新疗法提供了理论及实验依据。     

Er,Cr:YSGG激光切割对牙根尖封闭效果影响的微渗漏研究

目的 :探讨Er,Cr:YSGG激光进行根尖切除、预备后对倒充填材料密合性的影响 ,为此激光在临床上的应用提供重要的理论及实验依据。方法 :将 32个新拔除的单根离体牙随机分成 4组。去除牙冠 ,常规根管充填。第 1组 ,不做任何处理 ,作为阳性对照组 ;第 2组 ,手机切割组 ,手机进行根尖切除、预备后 ,银汞合金倒充填 ;第 3组 ,激光照射组 ,2WEr,Cr:YSGG激光于无水条件下照射根尖区 6s;第 4组 ,激光切割组 ,4WEr,Cr:YSGG激光于喷水条件下进行根尖切除、预备后 ,银汞合金倒充填。采用微渗漏实验对此激光切割后的牙根尖封闭效果进行评估。结果 :与阳性对照组相比 ,激光照射组的染料微渗漏深度无显著改善 (P >0 .0 5 ) ;与手机切割组相比 ,激光切割组的染料微渗漏深度有所减少 ,但并无显著性差异 (P >0 .0 5 )。结论 :Er,Cr:YSGG激光进行根尖切除、预备与常规手机预备具有同样的根尖封闭效果 ,因此有望在根尖倒充填术中取代手机 ,应用于口腔临床。     

The sealing ability of an epoxy resin root canal sealer after Nd:YAG laser irradiation of the root canal

AIM: To evaluate ex vivo the effect of Nd:YAG laser irradiation with and without black ink on instrumented root canal walls, and the degree of both coronal and apical microleakage of filled root canals. METHODOLOGY: Seventy-two single-rooted teeth were instrumented up to a size 40 K-file, and then divided into six groups of 10 teeth: groups 1 and 4 remained unlased and acted as control groups, groups 2 and 5 were treated with a Nd:YAG laser (Fidelis Plus, Herzele, Belgium), groups 3 and 6 were treated with a laser and black ink; the remaining 12 teeth served as positive and negative controls. The laser was operated at 1.5 W, 15 Hz, four times for 5 s with a 20-s interval. Groups 4-6 were filled using cold lateral condensation of gutta-percha and AH26. After storage in water for 48 h at 37 degrees C, through-and-through leakage (L in microL day-1) was measured for 48 h under a pressure of 1.2 atm using a fluid transport model and recorded as L=0 (L1), 010 (L3). After the assessment of leakage with the fluid transport model, the teeth were immersed in rhodamine B solution for 48 h at 37 degrees C. Apical and coronal dye leakage was scored after longitudinal splitting of these teeth. All teeth of groups 1-3 were split longitudinally and observed under SEM for evaluation of remaining smear layer. RESULTS: Through-and-through leakage was only observed in the group lased with black ink (two samples-L2). Apical and coronal dye leakage was observed in all groups; there were no statistically significant differences amongst the three experimental groups. The through-and-through leakage, measured with the fluid transport model in two teeth of group 6, was confirmed in the dye leakage test (rhodamine B dye was observed along the total length of the root filling). There was evidence of melted and ablated root canal dentine in the laser-treated groups. These findings were more obvious in root canals lased in association with black ink. All apical foramina in the lased group remained patent. CONCLUSIONS: Nd:YAG laser irradiation with black ink increased the amount of melted and ablated dentine areas compared with that without black ink. Nd:YAG lasing in association with black ink did not result in a reduction of either coronal or apical microleakage in root filled teeth.     

Nd:YAG激光在牙齿漂白中的应用效果分析

目的评价532nm Nd:YAG激光在牙齿漂白技术中的临床应用效果。方法选择因氟斑牙、四环素牙、增龄因素导致的牙色暗黄的着色牙患者256例,采用连续输出的532nm Nd:YAG激光,功率设置为1W,照光时间设置为30秒,对不同类型着色牙进行漂白,并与托盘漂白术相对照,通过VITA比色分别就氟斑牙、四环素牙、增龄性黄牙漂白术前及术后的色度变化、术后3个月疗效、术中及术后牙本质过敏发生情况进行比较。结果对氟斑牙、四环素牙及增龄性黄牙532nm Nd:YAG激光漂白法即刻疗效均优于药物托盘漂白法(P<0.05)。而激光漂白组和托盘漂白组在3个月后复查,两者之间治疗上仍有统计学上的差异(P<0.05)。对术中或术后过敏情况进行比较,激光漂白法显著少于较托盘漂白法(P<0.05)。结论532nm Nd:YAG激光漂白法脱色效果显著,较少发生术中或术后过敏。     

Nd:YAG激光对不同充填材料牙本质边缘微渗漏的影响

目的 评价Nd:YAG激光对不同充填材料与牙本质之间边缘微渗漏的影响。方法 选用人离体前磨牙36颗,制备V类洞,随机分为激光组和对照组,激光组使用80 rnJ、10 Hz脉冲Nd:YAG激光照射后,分别用全酸蚀粘接树脂、自酸蚀粘接树脂和玻璃离子充填洞型,对照组不使用激光,同样用如前所述的3种材料充填洞型。将所有标本浸泡在2%亚甲基蓝溶液中24 h后,用金刚砂片从颊舌向通过充填物中央纵向切开牙体,显微镜下观察龈壁染料渗透的深度。采用SAS8.0软件对数据进行统计学处理。结果 经Nd:YAG激光照射后尽管3种材料与牙本质之间微渗漏程度均有降低趋势,但只有玻璃离子组激光照射后较未照射组微渗漏降低具有统计学意义(P<0.05)。结论 脉冲Nd:YAG激光照射牙本质壁,在一定程度上可能会减少玻璃离子充填材料与洞壁的微渗漏。     

The sealing ability of amalgam used as a retrograde root filling in endodontic surgery

A dye penetration technique was used to investigate the sealing ability of amalgam retrograde root fillings in vitro. A factorial design was employed to determine the effect of amalgam fillings of 1, 2 and 4 mm in length with and without prior filling of the canals with gutta-percha. The results were compared with a group of teeth filled with laterally condensed gutta-percha alone and another with laterally condensed gutta-percha plus root resection but with no retrograde filling. It was concluded that increasing the length of the amalgam filling did not improve the seal, that prior filling of the canal did not improve the seal, that retrograde root fillings were no worse than laterally condensed gutta-percha alone and that root resection of teeth filled with laterally condensed gutta-percha without retrograde filling was no worse than those filled with laterally condensed gutta-percha without root resection or retrograde root filling.     

脉冲Nd：YAG激光对牙周袋壁作用的研究

目的：观察脉冲Ｎｄ：ＹＡＧ激光去除牙周袋内壁上皮衬里和其他病理组织的效果，以及组织损伤的情况。方法：选择２８个患牙，颊、舌侧均有４ｍｍ～８ｍｍ牙周袋，随机分成两组，每组１４个牙。照射后切除颊、舌侧全层袋壁组织，常规包埋、切片，光学显微镜下观察。结果：２８个患牙中有２３个牙（８２．１４％）完全去除袋内上皮衬里，部分去除病理肉芽组织，但不能全部去除整个袋壁的炎症浸润。结缔组织层内未见凝固坏死。结论：脉冲Ｎｄ：ＹＡＧ激光可用于治疗牙周炎，在某些病例可替代牙周手术治疗。临床应用的能量参数可选择脉冲频率２０／ｓ，能量１００ｍＪ，功率２．０Ｗ     

脉冲Nd:YAG激光照射牙本质后对光固化树脂充填体边缘微渗漏的影响

目的研究脉冲Nd：YAG激光照射牙本质后对光固化树脂充填体边缘微渗漏的影响，以探讨脉冲Nd-YAG激光在龋病治疗中的临床应用意义。方法选用正畸要求拔除的正常双尖牙30颗，随机分为A。B，C三组，每组10颗，用高速裂钻备洞（洞长、宽为3mm；洞深为2mm），A组为对照组，常规酸蚀树脂充填；B，C两组分别用50mJ，10Hz和100mJ，10Hz的脉冲Nd：YAG激光能量照射窝洞牙本质壁30s后树脂充填，分别用体视显微镜和扫描电镜观察充填体边缘和洞壁结合情况。结果．体视显微镜下观察：A组的牙本质洞壁与光固化树脂充填体间染料渗入较多，着色较深；B、C组的牙本质洞壁与光固化树脂充填体间染料渗入较少，着色较浅。扫描电镜下观察：B、C组的牙本质洞壁与光固化树脂充填体间裂隙明显小于未经激光处理的对照组。结论脉冲Nd：YAG激光处理牙本质后进行光固化复合树脂充填，可以减少充填体微渗漏，有利于充填的成功．     

In vitro study of the sealing ability of four retrograde filling materials

Abstract This in vitro study utilized India ink dye after clearing to evaluate the extent of apical microleakage following reverse filling procedures. Forty single-rooted human teeth divided into 4 groups were chemomechanically prepared and obturated, using the lateral condensation technique with gutta-percha and Grossman sealer. Following obturation, an apicoectomy was performed and retrograde cavities were filled with 4 different materials: Group A: amalgam and varnish; Group B: EBA cement; Group C: Ketac-cem®; Group D: hot-burnished gutta-percha. All teeth were immersed in India ink, decalcified, cleaned, examined through a stereomicroscope, and the depth of linear dye penetration was measured. Statistical analysis showed significantly less dye penetration with EBA cement and amalgam with varnish than with Ketac-cem and hot-burnished gutta-percha.     

Effects of the Nd:YAG laser, air-abrasion, and acid-etchant on filling materials

The purpose of this study was to determine any inadvertent effects of the neodymium: yttrium-aluminium-garnet (Nd:YAG) laser, air-abrasion, and ortho-phosphoric acid on some conventionally used dental filling materials [amalgam, composite resin, compomer, glass-ionomer cement (GIC), and ceromer], when they were used for purposes of margin etching and assessed according to standard enamel etching parameters using a total of five fillings. The surfaces of the filling materials were polished. One sample from each material group was exposed to laser (at 0.75 J, 15 pps) and air abrasion (with Al-oxide powder, 60 psi) for 2 s and to the 37% ortho-phosphoric acid for 60 s. The exposed materials were examined under Scanning Electron Microscopy (SEM). After laser treatment most specimens showed recrystallized areas, the GIC surface being the most affected. There were some pores and cavities on the amalgam surface following laser treatment. The abraded surfaces showed mechanical abrasions. The acid etchant showed the least effect. During the application of laser or air-abrasion, the adjacent tooth or filling surface must be protected or the dentist must be careful.