联合侧向热垂直加压技术充填根管初探

目的:探索采用联合侧向热垂直加压技术充填根管以改良热连续波根充技术,通过增加根尖部的牙胶量克服该技术超充率较高,以及根尖部根管牙胶充盈率(PGFA)较低的缺点。方法:80颗离体尖牙牙根用改良双敞技术预备后,随机分为2组,分别用单纯热连续波法和侧向热垂直联合加压充填技术根充,超充样本计数;所有样本均在距根尖孔1.5mm水平截断,体视显微镜下数码拍照,计算机测定PGFA值,统计学分析。结果:实验组超充率低于对照组,差异有统计学意义(P<0.05);实验组距根尖孔1.5mm的PGFA高于对照组,差异有统计学意义(P<0.01)。结论:侧向热垂直联合加压充填技术,比单纯热连续波法具有更好的根充效果。     

单尖法和热牙胶法根管充填根尖封闭性能的比较研究

目的 比较3种封闭剂AH-Plus, iRoot SP和GuttaFlow2分别配合单尖法充填和热牙胶充填的根尖封闭性能。方法 选取近期拔除的70颗单根管前磨牙,截冠后采用Waveone gold系统预备至P#,随机分为6个实验组(每组10颗)和2个对照组(每组5颗)。分别行单尖法充填和热牙胶充填,即AH-Plus单尖法组(A1组),AH-Plus热牙胶组(A2组),iRoot SP单尖法组(B1组),iRoot SP热牙胶组(B2组),GuttaFlow2单尖法组(C1组),GuttaFlow2热牙胶组(C2组),阳性对照组(D组)和阴性对照组(E组)。将充填完成的牙齿进行染料渗透实验后,通过纵切片法检测根尖的微渗漏情况。结果 A1组微渗漏值最大,B2组微渗漏值最小,同种封闭剂下单尖法充填和热牙胶充填根尖封闭性差异无统计学意义(P>0.05),同种充填技术下3种封闭剂的封闭性差异无统计学意义(P>0.05)。结论 3种根管封闭剂均不能完全封闭根管,单尖法充填和热牙胶充填在根尖封闭效果上无显著差异。     

根管封闭剂对注射式热牙胶根管充填的影响

目的:评价注射式热牙胶根管充填中应用封闭剂对根管表面温度的变化及充填后根端微渗漏的影响.方法:18个离体单根管恒牙根管预备后,用Obtura Ⅱ高温注射式热牙胶系统以牙胶加热,温度设定在180℃充填根管.测定充填前后根管外表面温度的变化及充填后根尖微渗漏的发生情况.结果:封闭剂的使用使温度的升高减少未超过1℃,这种温度的减少及充填后微渗漏间的差异均无统计学意义(P>0.05).结论:封闭剂使用与否对减少充填时根管表面温度的升高、充填后微渗漏(P>0.05)的发生均无明显影响.     

Ultrafil-3D系统与侧压法充填根管效果的比较研究

目的：比较Ultrafil-3D系统根管充填与冷侧压充填法的根尖封闭性，同时观察不同封闭剂对根尖封闭性的影响。方法：44个人离体单、直根管前牙，在釉牙骨质界处截冠，逐步后退法预备根管，结合碘仿糊剂或Roekoseal封闭剂，分别用建立根尖屏障后的Ultrafil-3D牙胶（Firm set）充填或进行常规冷牙胶侧压充填，拍摄近中远中向和唇舌向X线片，20g/L亚甲蓝染色5d，将牙体纵劈后测量染料的线形渗漏长度。结果：①侧压充填法的X线片评价结果整体优于Ultrafil牙胶充填（Kruskal-Wallist test，P〈0．01）。②相同充填方法时，Roekoseal组的封闭性显著优于碘仿组（ttest，P〈0．01）。③采用同一种根管封闭剂时，Ultrafil-3D系统充填与侧压充填的染料渗漏无显著差异（ttest，P〉0．05），但前者小于后者。结论：建立根尖屏障后，Ultrafil-3D系统根管充填的根尖微漏略小于侧压充填法，Roekoseal封闭剂能够显著减少根尖微漏。     

取断针失败后根管充填方法的选择和评价

目的探讨取断针失败后的根管的充填方法。方法制备80颗根尖含根管断针的离体牙模型,实验组对照组各半。实验组（预备组）预备根管,制备断针取出失败时的根管模型;对照组（非预备组）将断针模型不经预备直接进行根管充填,两组都用塑化液和牙胶根充糊剂进行根管充填,使用透明牙法观察对断针的封闭效果。结果①非预备组中塑化封闭根尖效果优于糊剂牙胶充填效果（P〈0.05）②预备组塑化治疗与糊剂牙胶根尖封闭效果无明显差异（P〉0.05）。结论临床上断针且取出失败时,宜选择牙胶和根充糊剂充填根管。     

弯曲根管不同预备方法对其根管充填密封性的影响

目的 研究临床常用预备方法预备弯曲根管对其根管充填密封性的影响.方法 选取不同弯曲程度的离体单根管牙齿90颗,分别使用不锈钢K锉,机用ProTaper,Hero642进行根管预备.AH-PLUS根充糊剂加牙胶尖冷侧压法充填,染料浸泡,分光光度法定量分析微渗漏.结果 不锈钢K锉组预备出的根管,充填后根尖孔微渗量最大,显著大于其余两种镍钛器械预备出的根管(P＜0.05).不同根管弯曲程度对根管充填后根尖孔产生微渗漏的影响程度不同,随着根管弯曲程度增加,发生根尖孔染料微渗量增加(P＜0.05);不锈钢K锉预备的Ⅲ°弯曲根管充填后出现的根管微渗量最大.结论 当使用冷侧压法充填根管,镍钛器械预备的根管相比不锈钢预备的根管更有利于根管充填后根尖孔的密封,尤其对于弯曲根管.     

两种根尖屏障对Ultrafil-3D系统根管充填效果的影响

目的比较主尖法及Successfil牙胶法对Ultrafil-3D系统牙胶充填根管的根尖屏障作用及其对根管充填效果的影响。方法64颗人离体单、直根管前牙,分别以主尖法及Successfil牙胶法建立根尖屏障,用三种不同粘度的Ultrafil-3D牙胶(Endoset,Firm set,Regular set)充填根管,拍摄近远中向及唇舌向X光片,2％亚甲蓝染色5天,将牙体纵劈后测量染料的线性染色长度。结果Successfil牙胶法组根管充填效果的唇舌向X-片评价较主尖法组差(P<0．001),但其微漏显著小于主尖法组(P<0．01)。结论主尖法及Successfil牙胶法均能有效阻止热塑牙胶注射时超充,Successfil牙胶法的根管充填整体效果优于主尖法。     

刻度牙胶尖根管充填效果的X线片观察

目的：评价刻度牙胶尖在根管治疗术中根尖处的充填质量。方法：将符合根管治疗术适应证的患牙随机分为2组，每组50例。经常规开髓拔髓、根管预备后，实验组以刻度牙胶尖为主尖充填根管。对照组以常规无刻度牙胶尖充填根管。根管充填完毕摄X线牙片，钢尺测量根管充填材料距根尖孔距离。结果：实验组有34例根管充填达理想位(距根尖孔0．5～1．0mm)，占总数68％。而对照组仅18例根管充填能达理想位，占36％。结论：使用刻度牙胶尖充填根管能提高根管充填质量、简化治疗操作步骤，有利于提高临床工作效率。     

Thermafil根管充填技术的临床评价

目的 :研究Thermafil根管充填技术的效果。方法 :选择牙髓病或根尖周病患者 60例 ,按就诊顺序随机分为 2组。即Thermafil根管充填组 (TC组 )和冷牙胶侧方加压充填组 (LC组 )。对 2组的根管充填时间、术中疼痛情况和根管充填效果进行比较。术后 3个月和 6个月进行复查 ,并拍摄X线片。结果 :以牙为单位 ,TC组适充 18颗 ,超充 11颗 ,欠充 1颗 ;在LC组中 ,适充 2 7颗 ,超充 3颗 ,无欠充 (P <0 .0 5)。TC组术中不适 4颗 ,LC组 2颗 (P >0 .0 5)。以根管为单位 ,根管充填时间Thermafil充填技术组平均 3 6.6s/根管 ,LC组平均 2 47.4s/根管 (P <0 .0 1)。结论 :Thermafil充填技术临床操作简便省时 ,但容易造成超充     

根管糊剂在ObturaⅡ充填技术中对根尖微渗漏的影响

目的:探讨在Obtura Ⅱ注射式热熔牙胶充填中,不同根管糊剂对根尖微渗漏的影响。方法:40颗单根管牙随机分为4组,采用Obtura Ⅱ注射式热熔牙胶进行根管充填,A、B、C组分别以ZOE、Vitapex、AHplus作为根管糊剂,D组未用糊剂。充填后行墨汁渗透实验,制作透明标本,使用体视显微镜和显微照相系统观测染料渗透的长度。结果:染料自根尖孔渗入根管的长度,D组最长,为4.56±2.72mm,与A、B、C组间差异均有显著性(P<0.05)。在使用糊剂的实验组中,染色线的长度由小到大依次是AHplus1.70±0.82mm、Vitapex1.87±0.56mm和ZOE2.02±0.40mm,但3组之间没有统计学差异(P>0.05)。结论:根管糊剂的使用能显著降低Obtura Ⅱ根管充填后根尖的微渗漏。     

An evaluation of .06 tapered gutta-percha cones for filling of .06 taper prepared curved root canals

AIM: To compare the area occupied by gutta-percha, sealer, or void in standardized .06 tapered prepared simulated curved canals and in mesio-buccal canals of extracted maxillary first molars filled with a single .06 gutta-percha point and sealer or lateral condensation of multiple .02 gutta-percha points and sealer. METHODOLOGY: Simulated canals in resin blocks with either a 30 degrees curve and radius of 10.5 mm (n = 20) or a 58 degrees curve and 4.7 mm radius (n = 20) and curved mesio-buccal canals of extracted maxillary first molars (n = 20) were prepared using .06 ProFiles in a variable tip crown-down sequence to an apical size 35 at 0.5 mm from the canal terminus or apical foramen. Ten 30 degrees and 58 degrees curved resin canals and 10 canals in the extracted teeth group were obturated with .02 taper gutta-percha cones and AH 26 sealer using lateral condensation. The time required to obturate was recorded. The remaining canals were obturated with a single .06 taper gutta-percha cone and AH 26 sealer. Excess gutta-percha was removed from the specimens using heat and the warm mass vertically condensed. Horizontal sections were cut at 0.5, 1.5, 2.5, 4.5, 7.5 and 11.5 mm from the canal terminus or apical foramen. Colour photographs were taken using an Olympus 35 mm camera attached to a stereomicroscope set at x40 magnification, and then digitized using a flatbed scanner. The cross-sectional area of the canal contents was analysed using Adobe PhotoShop. The percentage of gutta-percha, sealer or voids to the total root canal area were derived and data analysed using unpaired Student's t-test and the Mann-Whitney U-test. RESULTS: In the 30 degrees curved canals the levels had between 94 and 100% of the area filled with gutta-percha with no significant difference (P > 0.05) between the lateral condensation and single cone techniques. In the 58 degrees curved canals the levels had 92-99% of the area filled with gutta-percha, with the single cone technique having significantly (P < 0.05) more gutta-percha fill at the 2.5 mm level only. In the mesio-buccal canals of the teeth the levels had between 72 and 96% of the area filled with gutta-percha with no significant difference (P > 0.05) between the lateral condensation and single cone technique. The time for obturation was significantly (P < 0.05) greater for lateral condensation compared with the single cone technique in all groups. CONCLUSIONS: The .06 taper single cone technique was comparable with lateral condensation in the amount of gutta-percha occupying a prepared .06 tapered canal. The .06 single cone technique was faster than lateral condensation.     

碘仿氢氧化钙糊剂注射根管充填的微渗漏实验研究

目的 :了解碘仿氢氧化钙糊剂 (iodoform -calciumhydroxideICH)注射根管充填对根尖孔的封闭性能。方法 :5 0颗离体单根牙随机分为实验组和对照组。两组分别用注射型ICH和氧化锌丁香油糊剂组单尖充填根管 ,采取染料渗入法检查根尖孔微渗漏 ,在解剖显微镜下测量染料渗入距离。结果 :ICH组微渗漏值平均 0 .60 2mm ,氧化锌丁香油糊剂组微渗漏值平均 1.2 3 6mm ,经t检验 ,P <0 .0 5 ,两组渗漏值具有显著性差异。结论 :注射型碘仿氢氧化钙糊剂对根尖孔的封闭性优于氧化锌丁香油糊剂     

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.     

Quality of cold and warm gutta-percha fillings in oval canals in mandibular premolars

AIM: The aim of this study was to determine the quality of cold and warm gutta-percha fillings in oval canals. METHODOLOGY: Two groups of mandibular premolars with oval canals were selected after bucco-lingual and mesio-distal radiographs indicated an internal long: short diameter of > or =1.6 at a level 5 mm from the apex. After instrumentation they were obturated, respectively, by cold lateral compaction of gutta-percha cones (cold GP) and vertical compaction of warm gutta-percha (warm GP). Leakage along apical root fillings was measured using a fluid transport model. After the leakage test, horizontal sections were cut 2 and 4 mm from the apex. The area of the canal and gutta-percha in cross-sections was measured using an image analysis program. The quality of root fillings was evaluated by calculating the percentage of gutta-percha-filled canal area (PGP). RESULTS: No significant difference in leakage was found between the two groups (P = 0.570). The warm GP group produced significantly higher PGPs than the cold GP group 4 mm from the apex only (P = 0.522 at 2 mm: P = 0.000 at 4 mm). CONCLUSIONS: The percentage of gutta-percha-filled canal area using warm GP was greater than that of the cold GP in oval canals.     

玷污层及封闭剂对Ultrafil-3D系统根尖封闭的影响

目的:观察有无玷污层及不同类型的封闭剂对Ultrafil-3D系统根管充填封闭性的影响。方法:64颗人离体单、直根管前牙预备后,将其中的60颗分为有玷污层与无玷污层组,各组分别采用3种封闭剂(AH-plus、Roekoseal、CRCS)并以Ultrafil-3D牙胶(Firmset)充填根管,其余4颗作为对照。所有标本在2%亚甲蓝中浸染5d,将牙体近远中向纵劈后,测量染料的线性染色长度。采用SAS6.04软件包进行方差分析及t检验。结果:(1)无论玷污层去除与否,CRCS组的微漏均显著大于AH-plus及Roekoseal组(P<0.05);(2)去除玷污层前后,使用3种封闭剂的染料微漏均无显著差异(P>0.05)。结论:AH-plus及Roekoseal与Ultrafil-3D牙胶联合使用,能增加根管充填的密合性,去除玷污层不能明显减少微漏的发生。     

Comparison of cold lateral condensation and a warm multiphase gutta-percha technique for obturating curved root canals

AIM: The aim of this project was to evaluate and compare the radiographic quality and sealability of root fillings in extracted human teeth using lateral condensation of gutta-percha or multiphase gutta-percha obturation (Alphaseal). METHODOLOGY: A total of 108 freshly extracted human, mature single-rooted teeth were divided into two identical groups of 54 teeth on the basis of root canal shape. The canals were prepared to a minimum 0.055 taper and enlarged to size 35 at the apex. All root canals were flushed with 17% EDTA solution and 2.5% NaOCl to remove the dentinal smear layer. The canals of one group were obturated using cold lateral condensation of gutta-percha and the canals of the other group were filled using a warm multiphase gutta-percha obturation technique. The extrusion of sealer and/or gutta-percha through the apex of the teeth was recorded using a simple yes/no scheme. The sealability of each technique was assessed by a dye penetration method. The radiographic quality of obturation was determined for each canal using a four-point scale. RESULTS: Root canals filled by multiphase obturation had significantly more extrusion of sealer (P < 0.001) and gutta-percha (P < 0.001) than canals filled by lateral condensation. Canals filled by multiphase gutta-percha obturation had significantly less apical dye leakage than those obturated by lateral condensation (P < 0.05). Lateral condensation achieved significantly better scores for radiographic quality than multiphase obturation from the bucco-lingual view (P < 0.01). CONCLUSIONS: Under laboratory conditions multiphase gutta-percha had better sealability but poorer radiographic quality than lateral condensation.     

Sealer distribution in root canals obturated by three techniques

AIM: The aim of this study was to observe sealer distribution in root canals filled by different root filling techniques. METHODOLOGY: AH26 (0.05 mL) dyed with carbon black powder was placed into the prepared root canals of maxillary central incisors using a lentulo spiral. Thereafter the canals were obturated using three different gutta-percha root-filling techniques. Horizontal sections were cut in the apical and middle portions of the filled canals. Images of the cross sections were scanned and the percentage of sealer coated canal perimeter (PSCP) was measured using a computer digital imaging system. RESULTS: At 3 mm from the apex, the PSCP after lateral condensation was similar to that after vertical condensation (P > 0.05). At 6 mm from the apex, however, the PSCP was significantly higher after lateral condensation than after vertical condensation (P < 0.05). At both levels the PSCP was significantly higher after single cone (no condensation) than after the other two condensation techniques (P < 0.0001). CONCLUSIONS: Sealer may be removed from the canal wall by the condensation procedures.     

5种根管充填糊剂的根管封闭能力的比较

目的：比较5种根管充填糊剂的根管封闭能力。方法：选择75个直根管的恒牙,经开髓拔髓,Mtwo镍钛根管器械预备后反复冲洗后随机分为5组,分别采用实验组1：氧化锌丁香油糊剂,实验组2：Endomethasone根管充填糊剂,实验组3：Cortisomol根管充填糊剂,实验组4：Vitapex糊剂,实验组5：AH-plus糊剂,加牙胶尖严密充填。将所有离体牙置于37℃,100%湿度的恒温箱3d后选用透明牙染色法测量微渗漏深度。结果：实验组1：（2.35±0.768）mm,实验组2：（1.78±0.548）mm,实验组3：（1.54±0.322）mm,实验组4：（3.22±0.452）mm,实验组5：（0.98±0.536）mm。各组微渗漏深度值差异有显著性（P〈0.05）。其中实验组4的微渗漏值显著高于其他各组（P〈0.05）,实验组5的微渗漏值显著低于其他各组（P〈0.05）,实验组2的微渗漏值稍高于实验组3,结果无显著差异。结论：在Mtwo镍钛器械预备下,AH-Plus糊剂充填根管可有效的减少根管微渗漏的发生,但长远疗效有待进一步的观察。     

不同封闭剂对根管壁抗折力的影响

目的:比较经过完善预备后的根管选用不同封闭剂根充对管壁抗折力的影响。方法:将30颗人尖牙随机分为二个实验组和一个对照组,每组10颗。从牙颈部截去牙冠后进行根管预备。组1以Ultra为封闭剂;组2以Endofil为封闭剂,均采用冷侧压方法充填。组3根管预备后不充填。所有标本进行抗剪切强度试验。结果:组3与其它二组间有显著性差异(P<0.01),抗折应力值最低(126.1819MPa);组1和组2之间有显著性差异(P<0.01),其抗折应力值最大(153.4974MPa)。结论:预备后不充填的根管抗折力,明显低于完善根管治疗组;使用Ultra封闭剂根充后的管壁抗折力,明显强于Endofil组。     

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.