慢性根尖周炎感染根管内粪肠球菌和白色念珠菌的检测

目的检测未经治疗和根管再治疗的慢性根尖周炎感染根管内粪肠球菌和白色念珠菌,探讨粪肠球菌和白色念珠菌与慢性根尖周炎发病的关系。方法选取未经根管治疗和需根管再治疗的慢性根尖周炎病例各30例,采集根管内细菌样本,提取DNA,分别设计粪肠球菌和白色念珠菌的引物进行PCR检测。结果所有根管内均可检测到细菌。粪肠球菌在慢性根尖周炎根管再治疗病例中检出率为53.3%(16/30),慢性根尖周炎未经根管治疗病例的根管为10%(3/30)。白色念珠菌仅检出2例,均在慢性根尖周炎根管再治疗病例中检出(6.67%),而未经根管治疗病例的检出率为0。结论粪肠球菌和白色念珠菌在原发的慢性根尖周炎感染根管中检出率较低,在再治疗根管中检出率增高,可能与根管治疗时再感染有关。     

根管再治疗中去除牙胶后根管内残留物量的体外评价方法

根管再治疗是指在初次根管治疗失败后患牙仍旧持续或再次出现感染症状时,需去除原充填物重新进行的根管预备、消毒和充填。根管内残留物是指根管再治疗过程中彻底清理根管后根管内残余的牙胶、碎屑和玷污层,去除原充填物已成为根管再治疗成功的关键。随着各种现代化再治疗器械的问世,根管再治疗中根管内残留物量的评价已经成为衡量它们对根管系...     

运用现代根管治疗技术去除根管内充填物的研究进展

根管再治疗是指初次根管治疗失败,患牙的感染仍旧持续或再次出现感染症状时需去除原充填物,重新进行的根管预备、消毒和充填.彻底去除根管内充填材料是根管再治疗成功的关键,而再治疗过程中去除根管充填材料非常困难.随着现代根管治疗技术的发展,去除根管充填物的技术方法也在不断丰富和完善,通过使用各种根管锉系统、有机溶剂、超声器械和根管显微镜等现代技术,以求达到最大的清洁效果.本文就现代根管治疗技术去除根管内充填物的研究现状作一综述.     

应用显微超声技术进行根管再治疗的临床评价

目的探讨牙科手术显微镜结合超声工作器械进行根管再治疗的临床效果。方法选取需要进行根管再治疗的111例患者的124颗患牙164个根管为研究对象,使用显微超声技术进行再治疗,统计根管再治疗的成功率。结果124颗患牙中,103颗完成了根管再治疗并获得临床成功,其成功率为83.06%;按根管数计算,164个根管有136个治疗成功,成功率为82.93%。按根管数计算,去除根管钙化物和取根管内塑化物的成功率分别为85.29%和83.33%,寻找遗漏根管和去除根管桩的成功率分别为86.67%和100%,取根管内分离器械和去除根管内台阶的成功率较低,均为66.67％。结论显微超声技术在牙髓病治疗中的应用为根管再治疗提供了有效的治疗手段。     

不同器械去除根管内充填材料的研究进展

根管再治疗是指患牙经过根管治疗，感染持续存在或再次出现感染症状，需去除根管内原充填物，重新进行根管预备、消毒和充填的治疗方法。根管再治疗成功的关键是彻底去除根管内原充填材料，扩通阻塞根管。再治疗过程中去除根管内原充填材料非常困难。本文就不同器械去除再治疗根管内充填材料的效果、时间及安全性的研究现状进行综述。     

显微超声技术在根管再治疗中的临床应用

目的:评价根管显微镜(dental operating microscope,DOM)联合超声技术在根管再治疗中的应用.方法:对临床常规治疗方法失败的患牙113颗(根管134个),在DOM下,采用超声根管锉疏通根管后,用机用镍钛ProTaper完成根管预备,热牙胶充填根管,观察并评价疗效.结果:疏通了70个钙化根管,取根管内断械12个,去根管桩12个,寻找遗漏根管11个,修补根管侧壁穿孔8个,根管内吸收1个,根尖封闭12个,成功完成126个根管再治疗.结论:显微超声技术是根管再治疗的有效的手段.     

28例后牙根管治疗后失败的探讨

目的 探讨根管治疗后失败的原因。方法采用根管再治疗、根尖手术和牙周手术的方法对失败病例进行再治疗。结果28例后牙根管治疗后失败的病例中,根内感染11例,冠渗漏7例,牙根纵折裂7例,牙周感染3例。结论根管内感染是根管治疗失败的主要原因,而牙根纵折裂也是不容忽视的因素。     

201例患者根管再治疗的临床分析

目的 评价根管再治疗的临床现况.方法 随机选择需行根管再治疗的201例患者的254颗患牙为研究对象,分析根管再治疗的就诊情况和疗程情况.结果 254颗需行根管再治疗的患牙中,前牙65颗,占25.59%;前磨牙64颗,占25.20%;磨牙125颗,占49.21%.根管内充填物为牙胶尖/AH糊剂者 208颗,曾做过干髓术者29颗,塑化治疗者0颗,根管内单纯糊剂允填者8颗,根管内存在器械分离者9颗.平均疗程为2～7次,2次完成者89颗;3次完成者150颗;4次完成者5颗;5次及以上完成者10颗.结论 254颗患牙其根管于治疗情况复杂,根管再治疗的疗程较首次根管治疗延长.     

再治疗根管粪肠球菌毒力因子gelE表达与临床表现的关系研究

目的:比较再治疗根管内粪肠球菌(enterococcus faecalis)毒力因子gelE表达情况,分析gelE表达与临床表现的关系。方法:采集临床需要根管再治疗病例的根管内细菌样本53例,利用Real Time Quantitative PCR技术来检测gelE的表达情况。统计学分析gelE表达与患者临床表现之间的关系。结果:再治疗根管内粪肠球菌毒力因子gelE在有临床症状或体征和有根尖暗影的病例中表达增强(P<0.05)。结论:再治疗根管内粪肠球菌毒力因子gelE的表达增强与临床症状或体征的出现有关系。     

不同器械去除根管充填材料的研究进展

根管治疗失败后,为了保留患牙一般应行根管再治疗或者根尖手术,而有效去除根管内原充填物是保证根管再治疗成功的关键。目前临床上用于清除根管内充填物的器械方法很多,然而任何一种器械方法都不能完全去除根管内充填物,不同的器械去除根管充填物的效率有所不同。本文就根管再治疗的重要性及不同器械去除根管充填物的效率等方面的研究进展作一综述。     

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。     

Efficient and effective root canal retreatment without chloroform

A root canal retreatment technique is described which eliminates the need for chloroform as a gutta percha solvent. This technique utilizes the gutta percha softening actions of both a self-heating instrument and the heat-potentiated solvent action of eucalyptol. In addition, sonics/ultrasonics and/or Gates-Glidden drills are suggested as useful adjuncts to canal debridement during re-preparation of the canal system. Given the controversy regarding the toxicity of chloroform, both for dental patients and dental personnel, practitioners may wish to consider using this retreatment technique to eliminate chloroform from endodontic retreatment procedures, while still achieving effective, efficient root canal retreatment.     

根管内牙胶充填材料去除方法和效果

根管治疗术是目前牙髓病及根尖周病最为有效的治疗方法,在临床上广为应用。但根管治疗失败仍时有发生,这就需要去除原有充填材料,重新进行根管预备、消毒和充填。牙胶是目前应用最为普遍的充填材料。文章将对根管再治疗过程中原有牙胶充填材料去除的方法、效果及安全性做一概述。     

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??The root canal therapy is the most effective treatment for pulpal and periapical disease??but failure occurred occasionally. Root canal retreatment is the best choice to save the teeth at this moment. The success of root canal retreatment depends highly on complete removal of previous root filling material and infection tissue??and formation of tight three-dimensional closure. This paper will discuss the method and effectiveness of intracanal gutta-percha removing.     

根管显微镜下上颌第二磨牙根管的再治疗

目的：总结应用根管显微镜和超声器械对上颌第二磨牙根管再治疗的临床疗效。方法：收集上颌第二磨牙初次治疗失败病例80例,显微镜下记录初次治疗失败原因,应用根管显微镜和超声技术疏通根管,机用镍钛锉冠向下法预备根管,侧方加压和垂直加压法充填根管,拍X线牙片记录再治疗成功率。结果：80个患牙再治疗成功71个,成功率88.7%。半年后随访,成功率88.2%。结论：上颌第二磨牙因其根管存在融合、变异、根管过弯等因素,易导致初次治疗时根管遗漏、台阶形成、器械折断、根管侧穿以及根管钙化,造成初次根管治疗失败。应用根管显微镜和超声技术对其进行再治疗能获得满意的疗效,但应正确使用超声器械,避免根管侧穿的发生。     

塑化根管再治疗中显微超声技术的临床应用

目的探讨显微超声技术在塑化治疗后根管再治疗的临床应用。方法选取临床上已行根管塑化治疗但因各种原因需要进行根管再治疗的患者168例,前磨牙187颗（239个根管）,分成两组,分别运用常规手动K锉和显微超声技术去除根管内的塑化物后进行根管预备和充填,并记录根管再治疗的疗效和根管充填的效果。结果166个根管（69．45％）疏通获得成功,其中运用显微超声技术对上颌前磨牙根管再通畅成功率为83．82％,常规方法的下颌前磨牙的再通畅率为60．00％。统计结果显示这两种方法有着显著性差异。结论塑化治疗后的根管再治疗中运用显微超声技术能够取得比较好的临床效果。     

Efficacy of removing glass ionomer cement, zinc oxide eugenol, and epoxy resin sealers from retreated root canals.

Removal of gutta-percha and various sealers was assessed during retreatment of the root canal system. Sixty root canals were prepared and obturated with gutta-percha and Ketac-endo, Roth's 801 cement, or AH26. After 14 days, the canals were retreated by hand or ultrasonic technique and the retreatment time was recorded. The roots were split and the amount of debris that remained on the canal walls in three separate levels was recorded by use of a dissecting microscope. The mean scores were compared by one-way and two-way ANOVA. The total score was significantly the highest for Ketac-endo (p less than 0.04), followed by AH26 and Roth's 801 cement. The largest amount of debris was consistently found in the apical third, and generally it was comparable for both retreatment techniques. The ultrasonic technique was significantly faster than the hand technique for all sealers tested (p less than 0.0004, p less than 0.0003, p less than 0.02, respectively). Hand retreatment of Ketac-endo was the slowest, whereas ultrasonic retreatment of Roth's 801 cement was the fastest. The results indicated that Ketac-endo endodontic sealer can be effectively removed from the root canal by ultrasonic instrumentation.     

微焦点CT技术评价镍钛再治疗器械去根管内充填材料的效果

目的：利用微焦点CT技术定量比较两种镍钛再治疗器械与手用不锈钢器械去根管内充填材料的效果。方法：30颗离体前牙经逐步后退法预备根管后行冷侧方加压充填,随机分为3组,分别使用K锉、ProTaper D和Mtwo R去根管内充填物。再治疗前后分别对实验牙进行微焦点CT扫描,CT图像处理软件处理图像,计算根管内中1/3段和尖1/3段充填材料体积并比较其残留充填材料体积百分数。结果：在根管中1/3段,Mtwo R组根管残留充填材料体积百分数均数最小,与其他两组根管中1/3段间存在显著性差异（P〈0.05）。结论：在本实验条件下,K锉、Mtwo R和ProTaper D这3种器械在去根管内充填材料时,Mtwo R组清理效果最好。     

显微超声技术应用于根管再治疗中牙胶去除的体外评价

目的评价显微超声技术应用于根管再治疗中牙胶糊剂去除效果。方法 30颗下颌前磨牙,经Pro-Taper镍钛器械预备及牙胶糊剂侧方加压充填,保存2周。先用ProTaper镍钛再治疗器械去除根管内充填物,结束后拍摄数字化牙片(radiovisiography,RVG)。再在根管显微镜下用根管超声锉继续去除根管内的残留物,治疗结束后再次拍摄RVG。分别计算颊舌侧及近远中侧根管壁充填物残留量的百分比,比较显微治疗前后管壁的清洁度。结果 ProTaper镍钛再治疗器械去除后管壁的残留物百分比颊舌侧为26%,配合显微超声治疗后为9%;近远中侧为21%,配合显微超声治疗后为7%;显微治疗前后颊舌侧及近远中侧管壁清洁度均有统计学意义上的改变(P<0.05)。结论根管再治疗的牙胶去除过程中,显微超声技术有助于提高效率。     

Il ruolo della strumentazione meccanica nei ritrattamenti endodontici

Objectives

Endodontic retreatments are performed when endodontic therapy fails and the tooth is considered restorable. They include orthograde, surgical, and combined approaches. The primary objective of orthograde retreatment is the complete removal of the old filling material from the root canal. The purpose of this paper is to describe an orthograde endodontic retreatment technique performed with specific mechanical instruments made of nickel-titanium (NiTi).

Materials and methods

For retreatment, the root canal filling can be removed with traditional methods, such as heat carriers, Largo or Gates burs, and hand-held steel instruments, or newer methods, such as ultrasonic inserts, laser tips, and NiTi files (manual or mechanical). The orthograde retreatment technique presented here uses specific NiTi endodontic rotary instruments (Mtwo R^®). We describe its use in two cases involving retreatment of teeth 4.6 and 2.5, whose root canals had been filled using thermoplastic gutta-percha, plastic carrier and endodontic sealer, and a single gutta-percha point.

Results and conclusions

The success of orthograde endodontic retreatment depends on many factors, including correct and complete removal of old filling material from the root canal. The specific NiTi endodontic rotary instruments (taper .05) we used are very sharp at the level of the blades and the tip, and they allow rapid, safe removal of commonly used endodontic filling materials, even in the presence of a plastic carrier. As illustrated by the two cases presented, we used NiTi endodontic rotary instruments specifically designed for retreatment in the coronal two thirds of the canal, manual instruments in the apical third, and simultaneous technique after the filling material had been removed. This approach allowed acceptable preservation of the original anatomy of the canal and effective sealing by the new filling material.