下前牙根管再治疗的临床研究

目的:经切缘开髓路径对下颌前牙根管治疗失败的病例进行再治疗,探讨下颌前牙开髓路径提高根管治疗的成功率。方法:临床收集79例下前牙因根管治疗失败后需要再治疗的患牙共计94颗,去除原根充材料,探查是否遗漏根管,采用经切缘开髓路径对患牙进行根管再治疗,治疗前后拍摄X线片,观察对比治疗前后根管的充填情况及下颌前牙根尖病变的愈合情况。结果:94颗患牙中共发现72例下前牙为双根管,其中下颌中切牙为双根管33例,下颌侧切牙为双根管19例,下颌尖牙双根管20例。所有患牙经根管再治疗后根管充填结果满意,患牙根尖病变明显好转。结论:下颌前牙切缘开髓根管路径趋于直线不仅视野良好,且能有效提高复杂根管的发现率及治疗成功率。     

利用Micro CT技术进行微创根管治疗方法的体外实验研究

目的　确定利用Micro CT技术进行恒磨牙根管口牙合面定位、保留髓顶的微创根管治疗方法的可行性。方法　选择恒磨牙100颗,随机配对分为2组;实验组通过Micro CT技术定位根管口在咬合面投影,微孔开髓,进行保留髓顶的根管治疗,对照组常规行揭髓顶根管治疗;卡方检验根管充填密合性、操作时间和咬合面硬组织损耗面积。结果　2种根管治疗方法在根管充填密合性、操作时间上没有明显差异,但利用Micro CT技术进行恒磨牙定位确定保留髓顶根管治疗方法可显著减少牙体牙合面硬组织的去除。结论　利用Micro CT技术进行恒磨牙根管口定位,从而开展保留髓顶的根管治疗方法具有可行性,利于保存更多健康牙体组织。     

Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population

Abstract The objective of this study was to determine the periapical status and the quality of root canal fillings and to estimate the endodontic treatment needs in a German population. Clinical and radiographic data and the operative procedures performed were evaluated on 323 patients coming to a dental surgery in Stuttgart, Germany, in 1993. In 182 individuals at least one tooth exhibited a root canal filling, a necrotic pulp or an irreversible pulpitis. Out of the 7897 teeth examined, 215 (2.7%) had a root canal treatment (category A), 122 being nonendodontically treated (1.5%) did not respond to the sensitivity test (category B) and 53 (0.7%) were diagnosed as having irreversible inflamed pulp tissue (category C). The prevalence of teeth associated with radiographic signs of periapical pathosis was 61 % in the group of root canal filled teeth and 88% in the group of pulpless and non-endodontically treated teeth. Using the level and the density of the root canal filling as criteria for evaluating the technical standard, only 14% of the endodontic treatments of non-apicectomized teeth were qualified as adequate. The minimal endodontic treatment need is 2.3% related to all examined teeth when the root canal filled teeth with clinical symptoms of periapical periodontitis (category A) and those of categories B and C are included. The real endodontic treatment need is suggested to be larger when considering that the technical quality of the obturation is poor in most symptomless endodontically treated teeth associated with a periapical lesion. In the case of retreatment of these teeth, the endodontic treatment need would then be calculated at 3.7%.     

经切缘开髓路径行老年患者下前牙根管再治疗的临床研究

目的:经切缘开髓路径对老年下颌前牙根管治疗失败的病例进行再治疗,探讨下颌前牙开髓路径提高根管治疗的成功率.方法:临床选取46例平均年龄为65岁的老年患者下前牙因根管治疗失败后需要再治疗的患牙共计53颗,去除原根充材料,探查是否遗漏根管,采用经切缘开髓路径对患牙进行根管再治疗,治疗前后拍摄X线片,观察对比治疗前后根管的充填情况及下颌前牙根尖病变的愈合情况.结果:53颗患牙中共发现49例下前牙为双根管,其中下颌中切牙为双根管26例,下颌侧切牙为双根管13例,下颌尖牙双根管10例.所有患牙经根管再治疗后根管充填结果满意,患牙根尖病变明显好转.结论:下颌前牙切缘开髓根管路径趋于直线不仅视野良好,且能有效提高复杂根管的发现率及治疗成功率.     

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目的探讨Vitapex糊剂在根尖周囊肿非手术治疗中的疗效。方法选择2011年6月至2012年3月在开滦总医院康复医院确诊为根尖周囊肿10例患者,共计19颗患牙,经充分根管引流、根管预备及根管消毒后,封入Vitapex糊剂并超出根尖孔至囊肿内,待囊肿范围减小或病变区骨密度增高后,行严密根管充填。术后定期拍摄X线牙片观察6～12个月。结果10例中1例患者（1颗患牙）因自身原因退出,失败1例（2颗患牙）,其余8例（16颗惠牙）有效,有效率达88．9％。结论Vitapex糊剂根管封药加根管充填可应用于根尖周囊肿的非手术治疗。     

根管治疗诊间疼痛的原因分析

目的回顾分析根管治疗术中诊间痛的发生原因。方法通过对记录在案400例450颗施行根管治疗术的患牙进行临床观察。结果 60颗牙(11.1%)出现约诊间疼痛反应,其中中年女性患者、无窦型根尖周炎牙齿、后牙疼痛发生率较高。结论根管治疗约诊间疼痛与年龄、性别、牙位及牙髓状况有关,因此,采取个性化的防范措施,可降低诊间痛发生率。     

A histobacteriological assessment of nonvital teeth after ultrasonic root canal instrumentation

Abstract The purpose of this study was to evaluate and discuss the bactericidal effect of ultrasound when applied in the root canal of teeth with necrotic pulp and periapical lesions. Twenty newly extracted teeth were instrumented with an ultrasonic unit and K-files using 0.5% sodium hypochlorite as irrigating solution. Compacted debris and micro-organisms were frequently observed in the apical region and in dentinal tubules of the root canal wall. Overinstrumentation that sometimes occurred led to contamination of the periapical lesions with micro-organisms and debris from the root canal.     

Microbial causes of endodontic flare-ups

LITERATURE REVIEW: Inter-appointment flare-up is characterized by the development of pain, swelling or both, following endodontic intervention. The causative factors of flare-ups encompass mechanical, chemical and/or microbial injury to the pulp or periradicular tissues. Of these factors, microorganisms are arguably the major causative agents of flare-ups. Even though the host is usually unable to eliminate the root canal infection, mobilization and further concentration of defence components at the periradicular tissues impede spreading of infection, and a balance between microbial aggression and host defences is commonly achieved. There are some situations during endodontic therapy in which such a balance may be disrupted in favour of microbial aggression, and an acute periradicular inflammation can ensue. Situations include apical extrusion of infected debris, changes in the root canal microbiota and/or in environmental conditions caused by incomplete chemo-mechanical preparation, secondary intraradicular infections and perhaps the increase in the oxidation-reduction potential within the root canal favouring the overgrowth of the facultative bacteria. Based on these situations, preventive measures against infective flare-ups are proposed, including selection of instrumentation techniques that extrude lesser amounts of debris apically; completion of the chemo-mechanical procedures in a single visit; use of an antimicrobial intracanal medicament between appointments in the treatment of infected cases; not leaving teeth open for drainage and maintenance of the aseptic chain throughout endodontic treatment. Knowledge about the microbial causes of flare-ups and adoption of appropriate preventive measures can significantly reduce the incidence of this highly distressing and undesirable clinical phenomenon.     

正畸治疗对根管治疗牙及对侧同名活髓牙根吸收影响的Meta分析

目的    分析正畸治疗对根管治疗牙及对侧同名活髓牙根吸收的影响。方法    计算机检索Cochrane Library、PubMed、Embase、Google Scholar、中国知网、万方等数据库,查找研究根管治疗牙经正畸治疗后牙根吸收情况的相关文献。应用Meta分析比较正畸治疗对根管治疗牙及对侧同名活髓牙根吸收的影响。结果    纳入了10篇相关文献。Meta分析结果发现,正畸治疗患者根管治疗牙根吸收情况与对侧同名活髓牙比较,差异无统计学意义（P > 0.05）。在男性正畸治疗患者中,根管治疗牙牙根吸收量小于对侧同名活髓牙,差异有统计学意义（P < 0.05）;而女性正畸治疗患者两侧牙根吸收量比较,差异无统计学意义（P > 0.05）。正畸治疗方式（拔牙矫治与非拔牙矫治）和牙位（前牙与后牙）对正畸治疗患者根管治疗牙及对侧同名活髓牙根吸收的影响比较,差异均无统计学意义（均P > 0.05）。结论    正畸治疗过程中移动根管治疗后的牙齿是一种相对安全的操作。     

Complete Healing of a Large Cystic Lesion Following Root Canal Treatment with Concurrent Surgical Drainage: A Case Report with 14-Year Follow-Up

We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment.     

根管初步预备器械的研究现状

根管治疗是牙髓病和根尖周病的主要治疗手段,而根管治疗成功与否很大程度上取决于根管预备的质量。在根管预备之前,首先要设计良好的髓腔入口并建立连续光滑的根管疏通通道,这个过程即为根管的初步预备。根管初步预备使清洁和成形根管的器械能够顺畅进入根管,可避免器械分离,为此专门用于建立根管光滑通道的器械应运而生。当下,根管初步预备器械凭借其独特的作用和良好的成形能力发展较为迅速,本文就根管初步预备器械的发展现状作一综述,旨在给牙髓病和根尖周病的治疗提供一些建设性的建议。     

根管治疗期间急症的相关因素及防治

目的　探讨根管治疗期间急症(EIE)的临床相关因素及防治方法。方法　544颗患牙分为3组:①常规治疗组　392颗患牙按常规步骤行根管治疗;②口服药物组　91颗患牙在根管预备后给予患者地塞米松口服,余同常规治疗组;③开放引流组　61颗患牙初诊时预备根管后开放引流2~3 d,余同常规治疗组。记录各相关因素,统计各组EIE发生率和急性发作指数(FUI)。比较各因素与EIE关系以及不同实验组EIE的差异。结果　常规治疗组中,19·1%的患牙发生EIE;根管预备超出根尖孔的患牙EIE发生率和FUI值均显著高于根管预备长度欠和恰的患牙;患者的年龄、性别及患牙的牙位、病变程度与EIE发生率无明显关系。口服药物组较常规治疗组FUI值显著降低。开放引流组与常规治疗组比较,其EIE发生率和FUI值均无显著差异。结论　操作因素与EIE发作有显著关系,药物等预防措施可能减少EIE发作。     

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。     

前牙牙冠外伤性冠折一次性根管治疗的体会

目的 探讨一次性根管充填治疗恒前牙外伤性冠折的疗效.方法 选择因外伤致冠折的115例患者的131颗牙齿为研究对象.68例患者的76颗冠折牙为试验组进行一次性根管治疗;47例患者的55颗冠折牙为对照组进行常规根管治疗.所有患牙均在治疗后12个月复查,根据疗效评价标准,评价治疗效果.结果 试验组76颗牙齿均治疗成功,其治疗成功率为100%;对照组55颗牙齿中54颗治疗成功,其治疗成功率为98.2%.结论 一次性根管治疗外伤性恒前牙冠折的临床疗效良好.     

乳牙根管治疗术疼痛的临床分析

目的：探讨乳牙根管治疗疼痛的发生率及其与临床因素之间的关系。方法：对牙髓病、根尖周病、牙髓坏死的乳磨牙230例进行根管预备，FC消毒，用氧化锌丁香油糊剂根充，术后拍X线片，如果欠填，则重新充填。结果：乳牙根管预备后疼痛的发生率为7．83％，根充后疼痛的发生率为10．43％。根吸收、病种、超填与疼痛有明显的关系。结论：规范无菌操作、避免器械和根充剂超出根尖孔，可预防乳牙根管治疗的疼痛反应。     

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目的探讨前牙钙化根管治疗的可行性。方法2003年1月至2005年12月,对郑州市中医院口腔科收集的前牙钙化根管患者22例,通过寻找根管口,行根管治疗术,进行术前、术后X线片观察研究。结果20例患者顺利完成根管治疗术,2例因根管完全钙化行根尖手术。结论前牙钙化根管的治疗关键在于根管口的寻找,并进行常规根管治疗术,避免根尖手术或牙拔除术。     

前牙髓腔完全钙化的临床研究

目的：探讨完全钙化根管行根管治疗术的可行性。方法：对26例完全钙化前牙根管行根管治疗术，进行术前术后X线片对比研究。结果：24例顺利完成根管治疗术，2例因根管口完全钙化行根尖手术。结论：完全钙化的前牙根管X线片上显示为根管闭锁，临床上可通过寻找根管口，逐步扩大根管完成根管治疗术，以避免根尖手术或牙拔除术。     

Root canal morphology of maxillary permanent first molar teeth at various ages

The root canal anatomy and pulp chamber morphology of 216 maxillary permanent first molar teeth of known age was examined using a radiographic technique after infusion of the root canal system with a radiopaque sodium iothalontate gel. This technique proved to be a rapid and effective method for the examination of root canal morphology and is recommended when root canal anatomy needs to be examined before further investigations are carried out. Over 95% of palatal and disto-buccal roots contained a single root canal. The mesio-buccal root was more complex. All types of configurations were seen. Only 26% of mesio-buccal roots showed a single canal. The pulp canal in all roots appeared to narrow at an early age. In the mesio-buccal root, a definite two-directional calcification pattern was apparent in most teeth by the age of 10. The rate of progress of root formation was very variable. There was no apparent relationship between the type of canal system in the mesio-buccal root and the type of canal orifice present. The transverse cross-sectional shape of the pulp chamber was trapezoidal in 81% of teeth.     

Differences in the confluence of mesial canals in mandibular molar teeth with three or four root canals

Aim  To investigate the correlation between number of root canals and their confluence in mandibular molar teeth.
Methodology  A total of 553 first and 383 second mandibular molars were root filled between the beginning of 1997 and the end of 2006. Access cavities were prepared and the pulp chamber floors were carefully inspected with an endodontic explorer under magnification of 4×. After negotiating the root canal system, the 'straightest' canal of each root was instrumented. A gutta-percha cone was placed in the canal and a small file (08 or 10) was inserted to working length and then removed in all other canals. The gutta-percha cone was removed and inspected for notches indicating the presence of confluences. If it was not possible to probe completely one or more canals, the canal confluences were classified as 'not determined' (ND) if there was no sign of confluence; if a notch was present canals were considered confluent. For each tooth, the number of root canals and the presence of confluences were recorded. To test whether there was a difference in frequency of confluences between teeth with three and four root canals the chi-squared analysis with Yates' continuity correction was performed.
Results  The frequency of a confluence in mesial canals of first molars was 56% in teeth with three root canals and 34% in teeth with four canals. In second molars, it was 67 and 41%, respectively. Differences in the frequency of confluences in teeth with three and four root canals were statistically significant both in first and in second molars.
Conclusions  A greater incidence of confluent canals occurred in teeth with three rather than with four root canals both in first and second mandibular molars.     

老年人磨牙根管治疗变异法的临床疗效分析

目的 :研究老年人变异根管治疗法治疗慢性根尖周炎的疗效。方法 :对 83例慢性根尖周炎的老年病例在接受常规根管治疗、变异法根管治疗或牙髓塑化治疗 2年后的 85个磨牙进行复查 ;并以同期治疗的 79例青年病例 82个同类牙作对照。采用根尖周指数 (periapicalindex ,PAI)评定X线片并结合临床检查 ,对疗效进行评价。结果 :变异根管治疗法组与常规根管治疗组疗效差异无显著性 (P >0 .0 5 ) ,牙髓塑化治疗组与常规根管治疗组疗效差异有显著性 (P <0 .0 5 )。结论 :变异根管治疗法治疗老年人慢性根尖周炎的远期疗效是肯定的。对老年人磨牙按照不同的根管形态采用不同的方法充填是合理的。