上颌第一前磨牙根管预备后根管壁厚度的研究

上颌第一前磨牙的牙根解剖形态较复杂 ,多有双分叉根、根面沟和近中凹面[1] 。所以根管预备后 ,根管壁厚度变薄 ,可能出现牙本质壁薄弱 ,甚至根折 ,将影响根管治疗术后修复效果。本实验对上颌第一前磨牙根管预备后 ,根管壁厚度进行测量研究 ,以对根外形有更多的了解。1　材料和方法10 6个上颌第一前磨牙 ,于釉牙骨质界最高点截去牙冠。然后作根管预备 ,根管工作长度距根尖 2ｍｍ[2 ] ,用ＴＲ -ＺＸ电动旋转根管锉预备根管至 # 40 ,用 3 0ｍＬ/Ｌ过氧化氢液和生理盐水交替冲洗 ,吸干 ,氧化锌丁香油糊剂加牙胶尖侧方加压充填根管 ,氧化锌丁香…     

根管侧压充填器在根管充填中的应用

根管治疗术一般有根管预备、根管消毒、根管充填三个步骤。其中根管充填常用牙胶尖和根管糊剂作根管充填剂，并用侧压充填法，即在根管内填入根管糊剂后，插入主牙胶尖，再用根管充填器将主牙胶尖推向一侧，留出空隙，再插入另一牙胶尖，再挤压再插入，直至完全充满为止。为了使根管充填完善，登士柏公司生产了根管侧压充填器，现报道用这种充填器与常规法的充填效果。     

替硝唑氢氧化钙糊剂充填根管的临床疗效观察

目的:探讨替硝唑氢氧化钙糊剂联合牙胶尖充填根管的临床疗效.方法:460例共500个牙,按就诊顺序的单双号随机分成2组.实验组:230例257个牙,根管预备后,以3%双氧水和替硝唑溶液反复冲洗根管,并用替硝唑棉捻消毒根管,将替硝唑氢氧化钙糊剂捣入根管内,置牙胶尖按侧方加压法完成根管充填.对照组:230例243个牙,根管预备后,以3%双氧水和生理盐水冲洗根管,FC棉捻消毒根管,用根管糊剂和牙胶尖按侧方加压法完成根管充填,全部病例经2年以上追踪观察.结果:实验组的临床疗效(96.11%)明显优于对照组(65.02%),两者有统计学差异(P＜0.01).结论:替硝唑氢氧化钙糊剂联合牙胶尖用于根管充填,是一种有效的治疗根尖周病的方法.     

钙化根管的根管显微镜治疗

目的:探讨应用根管显微镜治疗钙化根管的方法,并对其疗效进行评价.方法:因根管钙化进行根管治疗的患牙33个,在根管显微镜引导下,将超声预备、手动NiTi器械预备以及EDTA化学预备相结合进行治疗,记录预备时间,术后1周进行根管充填,半年后复查并进行疗效评价.结果:根管显微镜下钙化根管的治疗成功率为88.9%,平均每根根管耗时25.8 min.结论:在根管显微镜引导下,将超声预备、手动NiTi器械预备以及EDTA化学预备相结合可提高钙化根管治疗的成功率.     

Endomethasone根充糊剂用于去髓术、根管治疗术一次法的近期疗效

目的：比较Endomethasone根管充填糊剂加牙胶尖、传统根管充填剂加牙胶尖在去髓术、根管治疗术一次法根管充填术后的急性反应及近期疗效.方法：选择活髓患牙和适合行去髓术、根管治疗术一次法的患牙共678个,随机分为2组,根管预备后实验组和对照组分别采用Endomethasone糊剂加牙胶尖、根管充填剂加牙胶尖充填根管.观察2组患牙术后1周内的急性反应及术后3、6个月的疗效.结果：实验组去髓术根充后急性反应率显著低于对照组（P＜0.01）;实验组根管治疗术根充后急性反应率显著低于对照组（P＜0.05）.实验组和对照组中,单根管患牙在去髓术、根管治疗术根充后急性反应率均显著低于多根管患牙（P＜0.01）.术后3、6个月复查,实验组去髓术、根管治疗术疗效均稍高于对照组,但无显著差异（P＞0.05）.结论：在去髓术、根管治疗术一次法中,Endomethasone糊剂充填根管较根管充填剂可有效地减少术后急性反应的发生.但在近期疗效上两者无明显差异,长期疗效有待进一步观察.     

间接法铸造金属桩核修复体对根管充填效果的影响

目的 研究间接法铸造金属桩核修复体对根管充填效果的影响.方法 对完善根管治疗的牙进行牙体预备,硅橡胶取根管及牙体印模,间接法制做铸造金属桩核,黏固于根管后,通过测量和观察封闭根管下段根充物的长度、是否将根充物推出根管外、桩核黏固后根充物与桩最下端的间隙,了解铸造桩核对修复预后的影响.结果 102例共185个铸造桩核未发现根充物被推出根管外,未出现根尖周炎,也无修复体松脱.结论 只要病例选择合适,操作规范,间接法铸造金属桩核不会对根充效果产生不利影响.     

根管侧壁穿孔的修补及桩冠的临床探索

对２０例，２１个有根壁侧穿，并伴有根周脓肿或窦道的患牙，重新进行根管清理、预备、消毒，达到根充指征时，即采用氢氧化钙加碘仿糊剂修补侧壁穿孔，同时加牙胶尖进行根充，３～４周后，采用铸造基底背板桩行桩冠修复患牙，取得了较为满意的效果。     

Cortisomol糊剂用于老年人根管充填术后反应的近期临床观察

目的：观察Cortisomol糊剂加牙胶尖充填老年人根管后的反应并与氧化锌丁香油糊剂加牙胶尖根充后反应作对比。方法：将140颗需进行根管治疗术的患牙随机分为2组，常规根管预备、根管消毒后，分别用Cortisomol糊剂（以下称Cortisomol组）和氧化锌丁香油糊剂（以下称ZOE组）加牙胶尖进行根管充填，观察术后反应。结果：Cortisomol组与ZOE组在无痛、2d自愈以及7d自愈的发生率差异均有显著性（P〈0．05）。Cortisomol组根充后疼痛发生率和持续时间均明显低于ZOE组。结论：Cortisomol糊剂加牙胶尖充填根管可以明显减少老年人根充后疼痛的发生。     

3种根管治疗方法的临床效果比较

目的：观察Profile机动镍钛针根管预备器械预备根管，热融胶针充填根管与传统根管治疗方法的临床效果。方法：将患者随机分为3组，A组：Profile预备根管，热融胶针充填根管。B组：Profile预备根管，碘仿糊剂牙胶尖根充。C组：手工法不锈钢扩大针预备根管，碘仿糊剂牙胶尖根充。结果：经X线片和临床对比观察．A组优于B组．B组优于C组。结论：Profile机动镍钛针预备根管，工作效率高，根管预备形态好，省时省力。热融胶针充填根管恰充率明显高于其他方法。经过Profile预备的根管，使用国产材料根充同样可以达到满意效果。手工预备根管和传统侧压法根充较费时费力，恰充率低于机动预备和热融胶针根充组：     

弹溢式根管充填尖的研制及根管充填效果

目的对弹溢式根管充填尖的根充情况进行研究。方法以弹溢式根管充填尖分别作离体牙实验及临床试验,通过与糊剂组、牙胶尖组进行充填比较,观察弹溢式根管充填尖的充填效果。结果弹溢式根管充填尖在离体牙根管连续充填3、4次的完善率达100%;在临床试验中,使用弹溢式根管充填尖的恰填率达69.56%,明显高于糊剂组、牙胶尖组恰填率,且统计学分析有显著性差异。治疗成功率97.44%。结论弹溢式根管充填尖具有相当完善的根管封闭作用,操作简单方便,无需附加器械,是一种值得临床应用推广的根管充填尖。     

The imaging of root canal obturation using micro-CT

AIM: To examine the potential and accuracy of micro-computed tomography (micro-CT) for imaging of filled root canals. METHODOLOGY: The root canals of five extracted maxillary teeth were shaped manually with K-files. After irrigation and drying, the root canals were filled by lateral condensation using gutta-percha cones and AH plus (Dentsply Maillefer, Ballaigues, Switzerland) as sealer. The filled root canals were examined by micro-CT at resolutions <11 microm. Three-dimensional reconstructions of the root canal fillings were made. The roots were sectioned histologically and standard photographs of the sectioned surfaces were taken. Digitized photographic images and the corresponding micro-CT sections were correlated qualitatively by superimposition. Quantitative morphometric data were obtained with respect to the surface area of the root canal filling and the individual gutta-percha points of the histological and the micro-CT sections. Pearson correlation coefficients were calculated. RESULTS: There was a good qualitative correlation between the images from the histological and the micro-CT sections. The fillings were clearly differentiated from the root canal walls. Individual gutta-percha cones and sealer were discernable. Pearson correlation coefficients showed a highly significant correlation between the two methods (P < 0.001) with respect to the area of the complete root canal filling (r = 0.992) and the gutta-percha cones (r = 0.968). CONCLUSIONS: The micro-CT technique was a highly accurate and nondestructive method for the evaluation of root canal fillings and its constituents. Qualitative and quantitative correlation between histological and micro-CT examination of root canal fillings was high.     

Strengthening and restoration of immature teeth with an acid-etch resin technique

Abstract Endodontic treatment with subsequent restoration of 3 immature incisors with horizontal fractures in the cervical region is described. In 1 tooth the fracture occurred supragingivally, whereas in 2 others the fracture was such that the root margins were between 1 and 2 mm subosseous. In these teeth proper access to the roots was established by means of orthodontic extrusion and/or periodontal surgery. After endodontic treatment, the gutta-percha was removed from the root canals to a level 2 to 3 mm apically to the osseous crest. The root canal dentin was acid-etched and a post to retain a crown was cemented into the canal with a composite resin. The resin will then penetrate into the dentinal tubules of the root canal walls and strengthen the root to such a degree that it becomes restorable. Semipermanent composite resin crowns and, in one instance, a more permanent porcelain crown were used to restore the teeth.     

恒前牙根中部以下折断临床修复体会

目的：探讨根中部以下折断的恒前牙保存活髓或经根管治疗后进行功能修复的临床效果。方法：收集近5年来恒前牙根中部以下折断60位病例共178颗牙,根据情况进行保存活髓或根管治疗后加用根管钉或联冠形式进行功能修复。结果：经以上治疗,患牙均可收到较好的功能修复。结论：牙根中部以下折断应及时准确复位,定期监测牙髓活力,死髓牙应尽早作根管充填诱导硬组织屏障形成,经合适治疗后绝大部分患牙均可行使咀嚼功能。     

三种根管糊剂在离体牙热牙胶充填中根尖封闭效果的比较研究

目的:以直接热牙胶充填后的根管密封性为标准,比较并评估cortisomol(碧兰)、vitapex、AH-plus三种不同根管糊剂在热才胶系统中充填根管后根尖封闭效果及差异.方法:选取62个离体单根管恒牙,截除牙冠,冠向下法根管预备后,其中56个随机均分为4组(每组14个):A组不使用根管糊剂,B、C、D组分别使用co...     

In vivo performance of the new non-instrumentation technology (NIT) for root canal obturation

AIM: The aim of this in vivo study was to compare the radiographic quality of root fillings performed by the NIT-obturation method versus conventional mechanical obturation. METHODOLOGY: Sixty-six patients needing root canal treatment participated in this study. The treatments were performed by three private practitioners. The root canals were instrumented with K-Flexofiles to a master apical file between sizes 25 and 60, followed by step-back flaring up to size 70. Copious irrigation was used throughout the instrumentation procedure with NaOCl (3%). The teeth were obturated either by lateral condensation, the McSpadden technique (control) or by the new non-instrumentation technology (NIT) with and without using gutta-percha points. In the NIT method, a low pressure was created within the tooth, and AH 26 sealer was sucked into the root canal system. Radiographs of the root-filled teeth were analysed and the length of the root filling, the presence of voids and the area of any other fillings determined. RESULTS: The root canal fillings of the control group (0.1 +/- 0.1 mm) and those of the NIT/gutta-percha group (0.3 +/- 0.1 mm) were both overextended when taking the apical constriction as a reference point. Root canal fillings of the NIT/gutta-percha group were statistically (P < 0.05) significantly longer than those of the NIT without gutta-percha group. The latter showed slightly underextended root canal fillings (-0.14 +/- 0.1 mm). CONCLUSIONS: The present investigation demonstrated the performance of the NIT-obturation method in vivo. Root canals filled by the reduced-pressure-method using sealer combined with gutta-percha cones exhibited equivalent radiographic quality compared to conventionally filled canals.     

A comparison of root fracture resistance using two root canal sealers

AIM: The aim of this study was to compare in vitro root fracture resistance following root canal filling with either Ketac-Endo or Roth's root canal sealer. METHODOLOGY: The roots of 40 teeth with single canals were instrumented and placed randomly into four groups of 10 teeth. The prepared canals were obturated with lateral compaction using gutta-percha and Roth's 801 sealer, lateral compaction and Ketac-Endo sealer or with a single cone and Ketac-Endo sealer; the fourth group acted as unfilled controls. The roots were stored for 2 weeks in 100% humidity prior to being mounted in acrylic resin blocks. A steel tipped rod attached to an Instron testing machine was positioned against the canal opening and a slowly increasing force was applied until root fracture occurred. The results were subjected to statistical analysis using Kruskal-Wallis one-way ANOVA. RESULTS: There were no significant differences between the groups in terms of force required to vertically fracture the roots. CONCLUSIONS: Under the conditions of this study, the use of Ketac-Endo sealer in conjunction with lateral compaction or single-cone obturation techniques does not increase the fracture resistance of root-filled teeth.     

Detectability of residual Epiphany and gutta-percha after root canal retreatment using a dental operating microscope and radiographs--an ex vivo study

AIM: To compare the detectability of residual Epiphany and gutta-percha after root canal retreatment using a dental operating microscope and radiographic examination with the residual area measured after rendering the roots transparent. METHODOLOGY: Sixty extracted single-rooted maxillary central incisor teeth were enlarged to apical size 40. Thirty canals were filled using vertically compacted Epiphany, the remainder were filled with vertically compacted gutta-percha and AH Plus sealer. After re-instrumentation to apical size 50, radiographs of the roots were taken in buccolingual and mesiodistal direction. Residual filling material was categorized by three observers using the radiographs and a dental operating microscope. The area of remaining material that was made visible by radiographs was measured with the aid of a computer image analysis programme. After clearing the roots, areas of residual filling material on the root canal wall were measured using a microscope. RESULTS: Computer image analysis of the radiographs showed significantly smaller areas of remaining gutta-percha and Epiphany compared with the analysis of the transparent teeth that revealed only one absolutely clean root (Epiphany). Especially in the gutta-percha group, the scores determined by the observers using radiographic examination gave an over-optimistic impression of cleanliness compared with the scores determined by the visualization through the microscope. CONCLUSION: Especially for remaining gutta-percha, the operating microscopes provided better detection of residual root filling material in retreated maxillary incisor teeth.     

显微超声技术在老年人下颌前磨牙扁根管预备中的应用

目的：利用牙科手术显微镜对老年人下颌前磨牙扁根管的预备。方法：因龋坏、颈部楔状缺损和牙合面重度磨损所致牙髓炎或根尖周炎以及因固定修复要求进行根管治疗的共69例,82颗下颌前磨牙。k锉或protaper镍钛锉常规根管预备后,再使用显微镜超声根管工作尖处理扁形根管,以完成预备。结果：常规根管治疗后显微镜观察扁根管并超声处理54颗牙齿,28颗常规根管预备后未见根管壁有遗留,其中5颗第一下颌前磨牙为双根管。结论：利用显微镜并使用超声根管工作尖ED20、ED40能有效地预备根管壁而去除遗留的坏死组织和感染的牙本质,完善根管预备,有助于提高根管治疗的成功率。     

单根管与多根管铸造桩核用于磨牙残冠修复的比较研究

目的比较单根管与多根管铸造桩核冠修复磨牙残冠的临床效果。方法选择140例患者的153颗磨牙残冠,在修复前行完善的根管治疗,其中92颗采用单根管整体铸造桩核冠修复,61颗采用插销式铸造的多根管桩核冠修复。对修复后两年的复查结果进行临床效果评价。结果单根管固位修复体桩核松动1个,其余桩核X线片显示桩核与根管结合紧密,修复效果良好。多根管分体插销式铸造桩核冠无松动。修复的临床效果无显著性差异(P>0.05)。结论采用单根管铸造桩核修复磨牙残冠不仅制作简单,而且与多根管分体桩核修复无显著性差异,同样可取得良好的临床效果。     

口腔锥形束CT在下颌第二磨牙C形根管诊治中的应用

目的探讨口腔锥形束CT(cone-beam computed tomography,CBCT)在根管治疗中诊断治疗下颌第二磨牙C形根管的临床应用。方法选取初次根管治疗失败的下颌第二磨牙62颗,根尖片不能确定根管解剖形态以及可疑遗漏根管,患牙采用CBCT进行扫描三维重建。结果使用CBCT确定下颌第二磨牙中52颗为C形根管,C形根管发生率达83.87%,C形根管中28颗为C1型变异根管(53.84%),18颗为C2型变异根管(34.62%),6颗为C3型变异根管(11.54%)。52颗患牙除2颗因根管侧穿导致根管治疗失败外,其余50颗患牙通过热牙胶充填与垂直加压技术将软化的牙胶充入不规则的根管系统,达到严密充填根管,根管再治疗后患牙成功治疗的有50颗(96.15%),均无不适症状。CBCT在根管治疗中辅助定位变异根管,定位准确率较高。结论 CBCT影像精密度高,可从三维角度分析根管,在根管治疗中诊断治疗下颌第二磨牙C形根管具有临床指导意义。