四手操作根管治疗中应用橡皮障的护理体会

橡皮障隔离技术是现代根管治疗的必要步骤,在根管治疗方面具有许多优势,争取患者配合、防止渗漏及保持患者呼吸通畅等是该项技术应用是否成功的关键因素。笔者在四手操作根管治疗中应用橡皮障隔离技术已有近10年,医护间配合积累了丰富的临床经验,在本文中总结了如何在患者使用前准备、防止渗漏并保持患者呼吸通畅等方面配合医生的护理体会及使用过程中注意的事项。     

四手操作技术在根管治疗中的应用效果体会

目的 探讨四手操作技术对一次性根管治疗工作效率和术后疼痛反应的影响。方法 选择磨牙108颗,随机分为2组,分别采用四手操作(实验组)和传统配合操作(对照组)进行一次性根管治疗,记录2组治疗所用时间以及治疗结束后1～7 d患牙的疼痛反应,并对结果进行分析。结果 四手操作组治疗所需时间较传统独立操作组短,二者之间具有显著性差异(P<0.05)。一次性根管治疗后1周疼痛发生率四手操作组低于独立操作组,但2组之间差异无显著性(P>0.05)。结论 四手操作能够提高一次性根管治疗的工作效率。?     

根管再治疗的四手操作护理配合

目的探讨根管再治疗中的四手操作护理体会。方法 278例患者278颗患牙行根管再治疗,术前做好患者的心理辅导和用物准备,术中平稳、迅速地传递冲洗液和各种类型、型号的锉,使用酚克除或丁克除时,要对患者的口腔黏膜、眼睛、皮肤做好预防保护及应急处理准备。在进行显微操作时,正确传递器械,随时引导和校正术者手中器械的方向。结果随访3个月,治疗总有效率为87.77%（244/278）,其中塑化再治疗的有效率为85.44%（176/206）,根管治疗后再治疗的有效率为94.44%（68/72）。无1例酚克除或丁克除造成的意外损伤及医疗投诉和纠纷。结论根管再治疗四手操作中,护士应熟练掌握其操作过程及所用药物、器械及仪器的性能和使用中的注意事项,提供优质的护理保障和支持。     

根管预备过程中的四手操作评价

目的：评价四手操作在根管治疗中的应用价值。方法：将门诊30～50岁患有牙髓病,根尖周病患者180例随机分为实验组和对照组各90例。实验组采用四手操作法进行根管预备,对照组按传统医护配合进行根管预备。按单根管,双根管,三根管及四根管进行分类,分别记录实验组和对照组根管预备所用时间并进行统计学分析。结果：单根管预备时间两组间无显著性差异,双根管,三根管及四根管预备时间经统计学处理有显著性差异。结论：四手操作在根管预备中提高了医生的工作效率,减轻了医生的工作压力和强度。提高了牙科护士的专业护理水平,还有效防止了交叉感染的发生,增加患者的舒适感与安全感,使治疗依从性提高。     

四手操作在根管充填治疗中的应用效果

目的:评估四手操作在根管充填治疗中的应用效果。方法:将160例做根管充填治疗患者分为四手操作组和对照组各80例,对2组患者治疗所需时间和对医护人员的满意度进行测评,作χ2检验。结果:2组根管充填时间、患者满意度比较,P值均<0.01,差异有统计学意义。结论:通过运用四手操作可提高医生的工作效率和患者的满意度。     

显微超声技术治疗阻塞根管的四手操作护理体会

目的探讨口腔门诊显微超声治疗中,如何实施规范标准的四手护理操作技术,从而更好地为患者和术者服务。方法 52例患者的52颗根管阻塞患牙在四手操作下行显微超声治疗,护理人员做好术前环境、器械及患者的准备工作,遵循无菌显微操作原则,始终保持术者视野清晰,在器械的传递方向、传递区域、器械工作头的朝向、衔接技巧等方面加强配合,缩短手术时间,提高手术成功率。结果 52例患者行显微镜下阻塞根管疏通术后,50例获得满意的治疗效果。结论显微超声治疗阻塞根管是一项精细的工作,护理人员在器械传递方向、传递区域、衔接技巧方面需经过特殊的操作技巧培训后才能高效率地配合医生完成治疗。     

根管治疗术中根管充填的护理

目的探讨根管治疗术中根管充填的护理方法,以提高根管治疗的效率和质量。方法对112颗进行根管充填的患牙进行护理配合,总结根管充填护理的要点。结果112颗牙根管充填后均取得满意的疗效,无欠填或超填,全冠修复112颗。根管充填后1年无继发疼痛和牙折裂。结论无菌护理、默契配合、器械管理、护患沟通是根管治疗术中根管充填的护理要点。     

根管手术显微镜在根管治疗术中的应用

根管解剖结构复杂,根管手术显微镜因其良好的光源和适当的放大倍数,无疑能在根管治疗术中发挥重要的作用。该文就根管手术显微镜的组成、特点及其在根管治疗术中的应用作一综述。     

超声波在根管治疗术中的应用

本文回顾了超声波在根管治疗中的历史;对近十年来,超声波根管杀菌作用和清理能力的实验室研究作了综合分析,并对它在根管治疗术中的各种应用作了介绍;评价了其临床应用的可行性。     

The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care

Objectives

The aim of this study was to evaluate clinical and radiological findings and the role of periapical infection and antecedent dental treatment of infected focus teeth in odontogenic maxillofacial abscesses requiring hospital care.

Materials and methods

In this retrospective cohort study, we evaluated medical records and panoramic radiographs during the hospital stay of patients (n?=?60) admitted due to odontogenic maxillofacial infection originating from periapical periodontitis.

Results

Twenty-three (38 %) patients had received endodontic treatment and ten (17 %) other acute dental treatment. Twenty-seven (45 %) had not visited the dentist in the near past. Median age of the patients was 45 (range 20–88) years and 60 % were males. Unfinished root canal treatment (RCT) was the major risk factor for hospitalisation in 16 (27 %) of the 60 cases (p?=?.0065). Completed RCT was the source only in 7 (12 %) of the 60 cases. Two of these RCTs were adequate and five inadequate.

Conclusions

The initiation of inadequate or incomplete primary RCT of acute periapical periodontitis appears to open a risk window for locally invasive spread of infection with local abscess formation and systemic symptoms. Thereafter, the quality of the completed RCT appears to have minor impact. However, a considerable proportion of the patients had not received any dental treatment confirming the importance of good dental health. Thus, thorough canal debridement during the first session is essential for minimising the risk for spread of infection in addition to incision and drainage of the abscess. If this cannot be achieved, tooth extraction should be considered.

Clinical relevance

Incomplete or inadequate canal debridement and drainage of the abscess may increase the risk for spread of endodontic infection.     

The role of intracanal medication in root canal treatment

The role of intracanal medication as a root canal dressing is re-examined. In pulpectomy and some root canal treatments, where the root canal contains vital pulp tissue, it is doubtful whether a routine intracanal medicament is needed. In infected root canals, intracanal medication has been advocated for many purposes. An intracanal medicament is used to: (i) eliminate any remaining bacteria after canal instrumentation; (ii) reduce inflammation of periapical tissues and pulp remnants; (iii) render canal contents inert and neutralize tissue debris; (iv) act as a barrier against leakage from the temporary filling; (v) help to dry persistently wet canals. However, most of the indications for intracanal medicaments are questionable. Intracanal medicaments should only be used for root canal disinfection as part of controlled asepsis in infected root canals, and their role is secondary to cleaning and shaping of the root canal. Thorough canal debridement and adequate canal preparation are more pertinent, and their importance is emphasized. Bacteriological sampling may be necessary if a tooth does not respond to treatment, to help in the choice of intracanal medicament.     

Lubrication during root canal treatment

Lubrication is involved in all root canal treatment phases, from dental dam placement to canal obturation. Most often associated with instrumentation, lubrication is required to facilitate the mechanical action of hand/rotary files and to help emulsify and suspend the debris produced. Aqueous irrigation solutions such as sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA) should be regarded as lubricants, but paste‐type substances are marketed specifically for this purpose. As more patients demand the retention of challenging teeth with narrow and curved root canals, the importance of lubrication in all aspects of root canal treatment must be acknowledged.     

根管治疗过程中影响牙根纵裂的因素

牙根纵裂最常发生于根管治疗之后且临床症状不具有明显的特异性,常常症状不明显,早期诊断较为困难,常出现漏诊和误诊。本文从病因学的角度出发,针对根管治疗过程中的每个步骤,就牙根纵裂的影响因素作一综述,以供临床操作参考。     

Biologic perspectives to support clinical choices in root canal treatment

Some of the most keenly debated issues in endodontics have revolved around the where to end the root filling, as well as cleaning and shaping and obturation techniques. In some respects, original scientifically-based concepts have been abandoned in favour of clinical techniques that may provide aesthetically pleasing radiographs, but do not necessarily support tissue regeneration around the root apex following obturation. Recently advocated obturation techniques supporting the use of resin-based and bonded materials have not had the same extensive evaluation that gutta-percha, when in contact with the periradicular tissues, has had. Further studies are necessary so that evidence-based data can support the confident use of these innovative materials.     

Pain during and after root canal treatment

Toothache can be prevented or remedied with a root canal treatment. Unfortunately a root canal treatment can also be the cause of pain. During a root canal treatment pain can be suppressed by local anesthesia, the use of the airotor, the attitude of the dentist and his communication with the patient. Afterpain has three causes: damage and iatrogenic apical periodontitis, pulpitis and continuing apical periodontitis. In this article the possible treatment of pain by a root canal treatment are extensively discussed.     

Disinfection of the root canal system during endodontic treatment

In this article an overview is given of the disinfectants used in root canal therapy. The different properties of anti-microbials and their effect on the endodontic microflora are discussed. A clinical guideline for effective disinfection is included.     

Disinfection of the root canal system during root canal re-treatment

In this narrative review, the differences between primary root canal treatments and re-treatments are explored in view of optimal disinfection of the root canal system. A critical appraisal of the literature raises doubt as to whether the microbiota found in re-treatment cases per se is more resistant to antiseptics than the counterpart found in primary infections. In reality, primary, refractory, and persisting endodontic infections are all biofilm-related; their microbial composition is dictated by local ecological factors rather than treatment history. Furthermore, their resistance to antimicrobials is most likely similar. The true difficulty in disinfecting root canal systems during re-treatment cases is to achieve access to the infected areas. Iatrogenic alterations in canal anatomy and the presence of root filling material hamper the diffusion of disinfectants to these target areas. Consequently, cleaning the canal systems of foreign material and creating a canal shape that can properly be disinfected should be the initial aims. Ways of achieving these goals are discussed. Subsequently, the disinfection regimen can be similar to that in primary root canal infections. However, time is a crucial factor in re-treatments, and thus a multiple-visit approach is preferable in more complex cases in order to ensure more complete disinfection has been achieved.