新型机用镍钛锉去除不同弯曲度的椭圆形根管充填物的效果研究

目的:评价新型机用镍钛锉Waveone Gold和Reciproc Blue在不同弯曲度的椭圆形根管中去除根充物的效果.方法:选取150颗单根管离体前磨牙,根据弯曲度分为3组:直根管组、中度弯曲组、重度弯曲组,每组各50颗牙.完善根管预备和充填后,各组再随机分为5组(n=10):手用H锉组、Protaper Universal Retreatment锉组、Mtwo R锉组、Waveone Gold锉组、Reciproc Blue锉组,分别去除根充物,记录时间及并发症,计算根管侧壁残留量.结果:不同弯曲度的椭圆形根管,H锉组所用操作时间及根管总体残留量明显高于其他机用锉组,差异有统计学意义(P<0.05),各机用锉组间比较差异无统计学意义.中度弯曲组Mtwo R锉组发生器械分离1例,重度弯曲组中Mtwo R组发生器械分离2例.结论:Reciproc Blue锉和Waveone Gold锉均能有效清除根管充填物,且在弯曲椭圆形根管中表现出较好的安全性.     

不同往复运动镍钛锉根管预备后冲洗效果的比较

目的:比较3种不同往复运动单支镍钛锉进行根管预备后根管形态对冲洗效果的影响。方法:将30个树脂模拟弯曲根管随机分成3组(n=10),M-wire Reciproc组(MR组)、Reciproc Blue组(RB组)和WaveOne Gold组(WG组)。分别使用对应镍钛锉按照厂商推荐方式进行根管预备。使用注射器配以侧方开口冲洗针头将1 mL墨水均速地注入树脂根管内,将20^#锥度0.04的牙胶尖置于根管内上下提拉以排除气泡。使用3 mL 0.9%氯化钠水溶液作为冲洗液,对充满墨水的根管进行冲洗。使用牙科显微镜在针头进入根管但尚未注墨时以及完成根管冲洗后分别拍照,测量针头到根尖孔的距离,以及最终根尖部残留未得到冲洗的墨水长度。结果:RB组和WG组测得的针尖到根尖孔距离相似[(6.43±1.06)mm和(6.52±0.83)mm](P>0.05),但都明显短于MR组[(7.43±0.82)mm](P<0.05)。完成根管冲洗后,MR组和WG组根尖部残留的墨水长度相似[(4.85±1.63)mm和(4.46±0.47)mm](P>0.05),而RB组[(...     

机用镍钛锉去除根管旧充填物能力的体外研究

目的研究0.04锥度的镍钛锉去除根管旧充填物的能力.方法将30颗单根管前牙分成A、B、C三组,每组10颗.用K型锉行根管颈备、牙胶尖+氧化锌侧压法充填.放置30天后用不同的方法去除根管旧充填物A组为K型锉+氯仿组;B组为镍钛锉+氯仿组;C组为单纯应用镍钛锉组.记录操作时间、氯仿用量.将牙根纵劈,立体镜下观察牙根整体及其不同水平的残留物情况,将结果进行统计学分析.结果对于根管整体的残留物量,C组少于A组,存在显著性差异(P=0.007),其余的实验组间无显著性差异(P＞0.05).对于操作时间,B、C两组均少于A组(P＜0.05),B、C两组间无显著性差异(P＞0.05).B组的氯仿用量少于A组(P＜0.05).结论同K型锉相比,机用镍钛锉去除根管旧充填物更为完善且操作时间显著减少.     

根管再治疗中根管充填物去除方法及其新进展

根管治疗术已成为现如今牙髓及根尖周疾病公认的最常见、最主要的治疗手段。因其治疗效果较好,被临床医生广泛使用。由于根管解剖复杂性、器械限制、充填物吸收、医生操作不当等原因,伴随而来的一些问题也逐渐显现,导致根管治疗存在一定的治疗失败的风险。对于该类患牙,临床通常首选施行根管再治疗术达到彻底治疗的目的。施行根管再治疗术的第一步便是去除旧的根管充填物,旧充填物的去除效果,直接决定后续治疗的进行可否并影响最终治疗效果。本文将针对根管再治疗中牙胶充填物的常用去除方法及其新进展进行概述。     

2种镍钛器械对根管充填物清除效率比较

目的:比较Mtwo R再治疗锉、Reciproc锉与手动器械在根管再治疗过程中对根管内充填物的清除效率.方法:取45颗离体下前牙,清理根管后,预备至40#.牙胶尖和AH Plus糊剂以冷侧压法充填根管.随机分为3组,分别用手用器械、Mtwo R和Reciproc去除根管内充填材料,收集推出根尖孔的碎屑,称重,记录所用时间.样本沿长轴颊舌向劈开,显微镜下进行观察、评分.采用SPSS 13.0软件包对数据进行统计学分析.结果:3种方法碎屑推出量和管壁清洁度无显著差异(P＞0.05),Mtwo R组和Reciproc组用时更少(P＜0.05).结论:镍钛器械并不能完全清除根管充填物,但可以提高效率.     

Hero Shaper镍钛机用器械去除根管旧充填物能力的体外研究

目的　研究Hero Shaper 镍钛机用根管预备器械去除根管旧充填物的能力。方法　选取临床拔除的48 个单根管前牙, 随机分为2组, 用改良式逐步后退法进行根管预备, 牙胶尖与碧兰糊剂侧方加压充填根管。放置30 d后用不同的方法去除根管旧充填物:A组为H型锉+氯仿组;B组为Hero Shaper+氯仿组;记录操作时间。将牙根纵劈,立体显微镜下观察根管冠1/3 ,中1/3 ,根1/3的残留物情况。结果　在根管的3部分,2种方法清理后的残留物量均无统计学差异(P>0.05)。B组操作时间明显少于A组,具有统计学差异(P<0 .01)。结论　根管再治疗中,使用Hero Shaper镍钛机用根管预备器械可以减少操作时间,获得和H锉相似的清理效果。     

两种根管再治疗镍钛器械去除椭圆形弯曲根管内充填物的效果评价

目的:评价2种根管再治疗镍钛器械去除椭圆形弯曲根管内充填物的效果。方法:离体的80颗根管呈椭圆形且弯曲的下颌前磨牙经Hero642预备、热牙胶垂直加压充填后随机分为4组,分别用ProTaper Universal、R-Endo、Hero642和手用H锉去除根充物,测量各组根充物的残留量百分比和操作时间。结果:4组样本均有根充物残留,ProTaper Universal、R-Endo和Hero642组根充物残留量百分比、操作时间均少于手用H锉组(P<0.01),前3组间的差异无统计学意义(P>0.05)。结论:ProTaper Universal、R-Endo机动镍钛器械对椭圆形弯曲根管内充填物的清除效果优于手用器械,且可减少操作时间,但仍不能彻底清除根充物。     

四种机用镍钛器械预备磨牙根管的临床效果分析

目的:比较镍钛器械M3-L Platinum、HyFlex EDM、WaveOne Gold和Reciproc Blue磨牙根管预备的临床效果。方法:选择牙髓炎或根尖周炎需要根管治疗的磨牙144颗,随机分为4组,M组使用M3-L顺时旋转预备根管;H组使用HyFlex EDM顺时旋转预备根管;W组使用WaveOne Gold往复运动预备根管;R组使用Reciproc Blue往复运动预备根管。均使用热牙胶垂直加压技术充填根管。比较4种镍钛器械根管预备时间,术后疼痛,根管预备及根充效果,器械折断情况。结果:M组预备时间最短,R组预备时间最长,差异有统计学意义(P<0.05);4组在预备后均能形成锥度及流畅度好的根管形态,术后疼痛及根充效果均无统计学意义(P>0.05)。M组使用中出现变形,H组、W组、R组均有器械折断。结论:M3-L、HyFlex EDM、WaveOne Gold和Reciproc Blue在预备磨牙根管时,均能使根管获得良好的预备形,出现较轻的术后疼痛,使用时都需注意器械折断的发生,M3-L预备磨牙根管更加省时。     

3种不同根管治疗器械对根管充填物清除效果的比较研究

目的比较G钻+手动K锉、Protaper再治疗镍钛锉、Reciproc单只锉在根管再治疗中对牙胶的清除效果及推出根尖孔碎屑量。方法选择60颗离体单根管牙进行根管预备、充填、玻璃离子封闭30 d,随机分成3组,每组20颗,分别用G钻+不锈钢手动K锉(A组)、Protaper再治疗锉(B组)及Reciproc单只锉(C组)去除根管充填物,采用根尖X线片和扫描电镜的方法评估根管内的充填物去除的情况,比较3组样本牙根管充填物的清除效果;记录去除充填物所用的操作时间;用称量的方法计算每组推出根尖孔的牙胶碎屑的量。结果 3组样本牙根管壁均有残留的充填物,B,C两组根管壁残留的充填物明显低于A组(P<0.05),C组清除效果优于B组(P<0.05)。和A组相比,B,C组均可以减少再治疗时间(P<0.05)。推出根尖孔的碎屑量A组最多,其次是B组,C组最低(P<0.05)。结论镍钛器械无论是在清除效果、操作时间、推出根尖孔碎屑量上都优于手动器械;Reciproc单只锉优于Protaper再治疗锉。     

3种器械去除椭圆形根管内充填物的效果研究

目的：研究两种镍钛器械和手用不锈钢器械去除椭圆形根管内充填物的效果。方法：45颗具有椭圆形根管的下颌前磨牙经逐步后退法预备、热牙胶垂直加压充填后随机分为3组,分别用ProTaper再治疗器械和ProTaper器械,Mtwo再治疗器械和Mtwo器械,手用H锉和K锉去除牙胶。测量各组中充填物的残留量及各个器械使用的时间。结果：手用器械组充填物的残留量百分比明显低于ProTaper组和Mtwo组,但操作时间高于ProTaper组和Mtwo组。结论：椭圆形根管内,使用机用镍钛器械可以减少操作时间,但是残留的根管充填物较多。     

机用镍钛器械预备弯曲根管的临床应用

目的　研究机用镍钛器械ProFile、ProTaper和Hero 642在弯曲根管预备中的临床应用。方法　选取有弯曲 根管的牙髓炎或根尖周炎患牙80颗,分为A、B、C、D 4组,分别用ProFile、ProTaper、Hero 642和不锈钢K锉预备根管, 全部患牙均采用侧向加压法充填根管。根据X线片评价根管预备和充填的效果。结果　3种机用镍钛器械均能很 好地维持根管的弯曲度和走向,根管的锥度和流畅度佳,无根管偏移、根尖阻塞、台阶形成等并发症发生;术后疼痛 发生少且程度轻;ProTaper的操作时间比ProFile和Hero 642短;有2例镍钛器械折断。结论　机用镍钛器械ProFile、 ProTaper和Hero 642预备弯曲根管成形效果好,极少有根管内并发症发生,ProTaper比ProFile和Hero 642更快速高 效;临床操作中须注意预防器械折断。     

3-dimensional Ability Assessment in Removing Root Filling Material from Pair-matched Oval-shaped Canals Using Thermal-treated Instruments

IntroductionThe purpose of this study was to evaluate the ability of the XP-endo Shaper instrument (FKG Dentaire, La Chaux-de-Fonds, Switzerland) during the removal of root fillings from oval-shaped canals. M-Wire Reciproc and Reciproc Blue systems (VDW, Munich, Germany) were used as reference instruments for comparison, and micro–computed technology was used as an analytical tool.MethodsThirty mandibular incisors with oval-shaped canals were matched based on similar anatomic features of the canal (eg, volume, aspect ratio, and 3-dimensional configuration) after scanning procedures. The canals were prepared with M-Wire Reciproc R25 instruments and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the continuous wave of condensation technique. Then, the sample was allocated into 3 experimental groups (n = 10) according to the retreatment protocol used: M-Wire Reciproc, Reciproc Blue, and XP-endo Shaper. M-Wire Reciproc R25, Reciproc Blue R25, and XP-endo Shaper instruments were used to remove the root fillings. Apical enlargement was performed with M-Wire Reciproc R40, Reciproc Blue R40, and BioRace BR5 (FKG Dentaire) instruments. Each sample was scanned after each endodontic procedure. The volume of remaining root filling material was quantified before and after apical enlargement. The percentage volumes of root filling reduction in relation to the instrumented canals at both time points (before and after apical enlargement) were calculated and considered for statistical analysis. Data were analyzed statistically with a significance level of 5%.ResultsReciproc Blue presented significantly lower removal of filling material compared with the XP-endo Shaper (Tukey test, P < .05). No difference was detected either between M-Wire Reciproc and Reciproc Blue (Tukey test, P > .05) or M-Wire Reciproc and XP-endo Shaper (Tukey, P > .05). The increase of apical enlargement significantly improved the removal of root fillings from the root canals (P < .05); this effect was similar for all systems (time point × file system, P > .05).ConclusionsThe XP-endo Shaper instrument showed a higher percentage of root filling removal, but no differences were observed comparing M-Wire Reciproc with the XP-endo Shaper or Reciproc Blue. The increase of apical enlargement improved the removal of root fillings in all groups. None of them was able to render root canals completely free from root fillings.     

机用镍钛Hero642预备磨牙弯曲根管的临床研究

目的探讨机用镍钛器械Hero642应用于磨牙弯曲根管预备的效果。方法选择根管弯曲的磨牙86颗,先采用小号K锉疏通根管,将根尖部预备至15号后,再以机用镍钛器械Hero642完成根管预备,侧向加压充填根管,根据治疗前后的x线片评价根管预备和充填效果。结果86颗磨牙共有274个根管,264个根管形态良好,无台阶、根尖堵塞、根管偏移及侧壁穿孔等并发症发生。根充恰填256个,8个根管超充,10个根管未能完全扩通,无法到达根尖孔而欠充或做塑化治疗。结论手用锉疏通弯曲根管的根尖段后再以机用镍钛器械Hero642完成根管预备,可获得良好的成形效果且较少产生并发症。     

Mtwo机用镍钛锉根管预备的临床效果观察

目的探讨Mtwo机用镍钛锉预备根管的临床效果。方法选取拟行根管治疗的患牙80颗,随机分为试验组和对照组,每组40颗,试验组采用Mtwo机用镍钛锉及改良逐步后退法进行根管预备,对照组采用手用不锈钢K锉和逐步后退法进行根管预备,2组均采用侧向加压法充填根管。比较2组的根管预备时间、根管预备术后疼痛反应和根管充填质量。结果试验组根管预备时间平均为（5.81±0.95）min/根,对照组平均为（13.45±1.08）min/根,试验组明显短于对照组,差异有统计学意义（t=17.15,P〈0.05）;试验组根管预备术后疼痛发生率明显低于对照组,且差异有统计学意义（χ2=4.45,P〈0.05）;试验组根管适充率96.6%,对照组根管适充率85.2%,2组差异有统计学意义（χ2=5.79,P〈0.05）。结论Mtwo机用镍钛锉预备根管快速有效,根管成形、根管充填效果好,并发症少,值得临床推广。     

Evaluation of Two Trephine Techniques for Removal of Fractured Rotary Nickel-titanium Instruments from Root Canals

IntroductionThe aim of this in vitro study was to evaluate the effects on root dentin of 2 trephining techniques using an ultrasonic tip or a trepan bur in the mesial canals of mandibular molars during attempts to remove fractured file fragments using micro–computed tomographic imaging.MethodsTwenty-one teeth with a similar anatomic configuration in mesial (buccal and lingual) canals were selected. A 4-mm apical segment of K3 file size 25/.06 was fractured in each mesiobuccal and mesiolingual canal 5 mm apically from the canal orifice. A staging platform was prepared at the coronal aspect of the broken instrument followed by either ultrasonics or a new trepan bur technique to expose a 1- to 1.5-mm length of the fragment. If the broken instrument could not be removed by exposing it either by ultrasound or the trepan bur, a microtube device was used to attach to and withdraw the fragment. Micro-CT scanning was performed before and after removing the broken instrument. Canal volume, diameter, and furcal root dentin thickness were measured by using image analysis software. The time required for the removal of the instrument fragments was recorded. The result was statistically analyzed using the paired t test.ResultsThe trepan bur technique had significantly less impact on canal volume, diameter, and furcal root dentin thickness change than the ultrasonic technique (P < .001). The time consumed for successful removal of the fragments was significantly less in the trepan bur group (8.9 ± 3.5 minutes) than in the ultrasonic group (25 ± 11.9 minutes) (P < .001).ConclusionsA new small-sized trepan bur technique was superior to the use of ultrasound with regard to the amount of dentin removed and the speed in the removal of fractured instruments from root canals.     

镍钛机动器械预备弯曲根管的研究进展

弯曲根管的预备是根管治疗中的难点，镍钛合金制制成的根管机动预备器械具有良好的成形能力和抗腐蚀性能，在弯曲根管预备中。京能取得满意的成形和清理效果。临床应用前景良好，但是，镍钛器械的折断仍为亟待解决的问题。     

ProTaper手动锉预备弯曲根管的临床评价

目的评价ProTaper手动锉预备弯曲根管的临床疗效。方法将40颗具弯曲根管需行根管治疗的患牙随机分为两组：试验组用ProTaper手动锉及冠根向技术预备根管，对照组用K锉及逐步后退技术预备根管。两组均采用侧向加压充填法充填根管，用X线片评价根管预备的效果。结果ProTaper手动锉组无根管偏移、根尖堵塞、台阶形成、器械折断等并发症发生，能维持根管的弯曲度和走向，根管锥度和流畅度佳；操作时间短，且术后疼痛发生率低。结论ProTaper手动锉预备弯曲根管快速、安全、有效，临床应用价值较高。