K3镍钛锉用于塑化根管再通的效果及损伤的评估

机用器械用于通畅塑化根管的治疗简便有效，K3机用镍钛锉与其它机用镍钛系统相比，相对抗折能力较强，并且具有安全的锉尖设计，可以在一定程度上避免侧穿的发生。但是目前尚缺乏对K3机用镍钛锉进行根管再通的效果评价，以及在根管再通术中锉的损伤情况分析。本研究针对临床使用手用锉辅助酚克除于下六磨牙塑化根管再通失败的病例，采用K3机用镍钛锉进行根管再通术，     

上颌第一磨牙近颊第二根管的临床治疗体会

目的：探讨上颌第一磨牙近颊第二根管( second mesiobuccal canal, MB2)的特征及临床治疗方法。方法：选取患牙髓炎或根尖周炎的上颌第一磨牙101颗,以40岁为界分为A（≤40岁）、B（＞40岁）两组,拍摄术前X 线片,采用改良开髓洞形,利用超声器械去除根管口的钙化物,术中采用小号K锉及C先锋锉配合17%EDTA凝胶探查并疏通根管,记录根管数目、形态和类型,采用机用镍钛器械MTwo进行根管预备,热牙胶垂直加压充填技术充填根管。结果：上颌第一磨牙MB2的发现率为71.3%,扩通的MB2占65.3%,多数MB2根管细小弯曲,需用小号K锉及C先锋锉配合17%EDTA 凝胶进行探查并疏通,机用镍钛器械预备根管并使用热牙胶垂直加压充填技术充填根管未发现明显并发症。结论：上颌第一磨牙MB2的发生率高,临床医生应提高认识,采用适当的工具与方法以提高其临床疗效。     

牙髓塑化治疗后再治疗146例疗效分析

目的：通过对牙髓塑化后再治疗的患牙进行根管再治疗,总结根管再治疗的方法。方法：选取2007-02/2008-02就诊的146颗牙髓塑化治疗的患牙进行根管再治疗。结果：146颗牙髓塑化后再治疗的牙齿中136例成功打通根管顺利根充。结论：牙髓塑化后再治疗时应根据具体情况进行根管再治疗,合理地使用超声根管治疗仪及镍钛扩大针是切实有效的保留患牙的方法。     

应用C型先锋锉结合超声器械及根管显微镜处理钙化阻塞根管81例疗效观察

目的:探讨应用C型先锋锉结合超声器械及根管显微镜(DOM)处理钙化阻塞根管的临床疗效。方法:对81例钙化阻塞根管的患者采用C型先锋锉结合专用超声器械及根管显微镜进行根管疏通,统计治疗成功率。结果:本组84个根管完成治疗,成功率为82.4%,其中前牙钙化根管的治疗成功率为90.9%、前磨牙成功率为90.0%、磨牙成功率为73.5%;47.1%的根管单纯应用C型先锋锉即疏通成功,35.5%的根管需结合超声器械和根管显微镜疏通成功;均未发生根管侧穿或牙根折裂。结论:C型先锋锉结合超声器械和根管显微镜的使用,为处理钙化阻塞根管提供了行之有效的方法。     

牙科手术显微镜联合超声技术治疗阻塞根管疗效观察

目的评价牙科手术显微镜联合超声技术治疗阻塞根管的临床效果。方法显微镜下应用超声技术对因塑化治疗、根管钙化、根管治疗不完善导致根管阻塞患牙232颗417个根管行疏通治疗。结果本组疏通根管357个,阻塞根管再疏通率为85.61%;充填不完善根管疏通治疗成功率（87.97%）高于钙化根管和塑化根管所致阻塞的成功率（78.08%和78.57%）（P〈0.05）,而钙化根管治疗成功率与塑化根管比较差异无统计学意义（P〉0.05）;不同牙位阻塞根管治疗成功率从高至低依次为前牙（97.56%）、前磨牙（86.20%）、磨牙（81.94%）（P均〈0.05）。结论牙科手术显微镜联合超声技术治疗阻塞根管疗效确切,充填不完善所致的根管阻塞效果高于钙化根管和塑化根管所致。     

显微超声技术在恒磨牙根管再治疗中的应用

目的：探讨牙科显微超声技术在对恒磨牙根管再治疗中的应用价值。方法：对135例需要恒磨牙根管再治疗患者的159颗恒磨牙（232个根管）用显微超声技术进行再治疗,按牙位及治疗原因分类,比较成功率。结果：159颗恒磨牙再治疗成功121颗,成功率76．1％。按治疗原因分,根充不足再治疗的成功率为88％,根管钙化再治疗成功率为68．97％,根管塑化再治疗成功率为68．42％,“C”型及遗漏根管再治疗成功率为66．67％,器械折断再治疗成功率为75．86％,根管台阶及侧穿再治疗成功率为75％。根充不足再治疗成功率分别同根管钙化,根管塑化、“C”型根管及遗漏根管再治疗成功率比较,差异均有统计学意义（P〈0．05）。按牙位分,上颌第1恒磨牙根管再治疗成功率为88．71％,下颌第1恒磨牙根管再治疗成功率为86．11％,上颌第2恒磨牙根管再治疗成功率为53．57％,下颌第2恒磨牙根管再治疗成功率为60．61％,第一恒磨牙和第二恒磨牙组内成功率无明显差异（P〉0．05）,但组间成功率有明显差异（P〈0．05）。结论：显微超声技术用于恒磨牙根管再治疗安全、有效。     

乙二胺四乙酸（EDTA）在根管疏通中的应用观察

目的研究乙二胺四乙酸（ethylene diamine tetraacetic acid，EDTA）在根管疏通中的应用效果。方法将58例根管治疗的患者62颗根管不通的患牙（计88根根管）随机分为两组，实验组用17％EDTA配合K锉疏通根管，对照组用常规冲洗液0．5％次氯酸钠配合K锉疏通根管。结果实验组与对照组根管疏通成功率分别为47．7％、18．2％，经卡方检验，两组差异有统计学意义（P〈0．05）。结论采用EDTA可提高根管疏通的成功率。     

上颌第一磨牙MB2根管100例分析

目的：探讨上颌第一磨牙MB2的特征及治疗方法。方法：用小号K锉配合15％EDTA探查上颌第一磨牙根管，记录根管数目、形态和类型；用机动镍钛器械预备根管。结果：上颌第一磨牙MB2的发现率为75．2％，多数MB2根管细小弯曲，需用小号K锉配合EDTA液疏通。结论：上颌第一磨牙MB2的发生率高，根管细小弯曲。小号K锉配合EDTA疏通根管、机动镍钛器械预备可获得良好效果。     

显微超声技术在根管内折断器械取出中的应用

目的：应用牙科显微镜结合超声根管技术对3种根管内折断器械取出方法作比较分析。方法：对37个根管内器械折断的病例，按折断器械的种类分为镍钛锉、K锉、GG钻3组，应用显微超声技术和不同取出方法处理并进行比较分析。结果：器械折断的37例根管中，有30例取出，取出率81.1%。其中镍钛锉组取出率69.2%，K锉组取出率87.5%，GG钻组取出率87.5%。其中根管壁侧穿1例。按折断部位分，折断器械在根管弯曲冠方时，取出率100%。折断器械在根管弯曲处时，取出率86.7%。折断器械在根管弯曲根方时，取出率28.6%。结论：应用显微超声技术结合适当的方法是取出根管内折断器械较为理想的方法，镍钛锉和根管弯曲下方折断器械取出率相对较低。     

两种镍钛器械去除椭圆形弯曲根管内充填物的疗效对比

将40颗离体的下额前磨牙(必须是根管呈现椭圆形,而且弯曲的)进行热牙胶垂直加压充填处理,再随机将其分为四组。分别利用ProTaper Universal(以下用PU代替)、R-Endo(以下用RE代替)、Hero642(以下用H代替),及手用H锉四种治疗方式来进行除根充物治疗。然后再对各组的操作时间和残留根充量进行测量。结果经过实验观察发现,这四组样本均出现了根充物残留的情况。其中,PU、RE、H三组的操作时间和残留量均小于手用H锉组,P<0.01。而在PU、RE、H三组之间则不存在统计学意义,P>0.05。PU、RE机动镍钛机械对椭圆形弯曲根管内充填物的祛除效果比手用器械的效果明显,而且操作时间相对较少,但是仍无法做到全部清除。     

登士柏机用镍钛根管锉在磨牙弯曲根管治疗中的临床应用

目的 观察登士柏机用镍钛根管器械磨牙弯曲根管预备的临床应用效果.方法 选择435颗磨牙1 566个根管随机分为3组,机用PT组镍钛根管锉预备根管,手用PT组镍钛根管锉预备根管,两组均使用冠根向深入法预备技术,K型组不锈钢K锉(ISO标准型)预备根管,使用逐步后退法预备技术.3组均采用侧压法充填根管.比较每组根管预备操作时间,及根管充填恰填率.结果 机用PT组每个根管预备操作时间明显少于其他两组(P＜0.05),机用PT组与手用PT组在根管治疗中根管充填效果差异无统计学意义(P＞0.05).手用PT组根管预备操作时间明显少于不锈钢K型组(P＜0.05),手用PT组根管适充率明显高于不锈钢K型组(P＜0.05).结论 机用 ProTaper在磨牙弯曲根管预备中有明显的优越性,成行更快速高效,省时省力,能获得良好根管成行效果,在临床上得到越来越广泛地青睐认可,提高了口腔根管治疗水平,值得临床普及推广,临床操作中须预防器械折断.     

Study on removal effects of filling materials and broken files from root canals using pulsed Nd:YAG laser

OBJECTIVES: The aims of this study were to investigate the capability of removing the filling materials or broken files from root canals with pulsed Nd:YAG laser irradiation at three parameters, and to evaluate the temperature rises on root surfaces and morphological changes of root canal walls in vitro. SUMMARY BACKGROUND DATA: There has been no report on removing the filling materials and broken instruments from root canals with laser irradiation. MATERIALS AND METHODS: Thirty-six extracted human incisors were divided into two groups of 18 each. Eighteen root canals were shaped and obturated with gutta-percha and root canal sealer. In another 18 specimens, 3-mm long fractures of files were performed intentionally during root canal preparation. A pulsed Nd:YAG laser irradiation was performed repeatedly at three parameters of 1, 2, and 3 W to remove the filling materials or file fragments. Temperature rises on root surfaces during laser irradiation were measured by thermography, and the remaining of obturated materials and morphological changes of root canal walls were evaluated by stereoscopy and scanning electron microscopy. RESULTS: In more than 70% of the teeth, the obturated materials were completely removed by laser, and in more than 55% of the teeth, the broken files were successfully removed. Temperature rises ranging from 17 degrees C to 27 degrees C were measured from 6 to 11 repeated times. CONCLUSION: These results demonstrated that a pulsed Nd:YAG laser irradiation has the capability of removing the obturated materials in root canals and is useful for removing the broken files in same if the counter-measure reducing the temperature rise is performed.     

机用 ProTaper 器械预备磨牙重度弯曲根管对根管工作长度的影响

目的：观察机用 ProTaper 器械预备磨牙重度弯曲根管对根管工作长度的影响。方法选择磨牙根管弯曲度在25＆#176;~45＆#176;的牙髓炎、根尖炎患者307颗牙386个重度弯曲根管,随机分为对照组和实验组,对照组151颗磨牙186个根管使用 GG 钻联合手用不锈钢 K 锉采用逐步后退法预备根管,分别测量预备前、后根管长度;实验组156颗牙200个根管使用机用 ProTaper 器械预备根管,分别测量预备前和 SX、S1、S2、F1、F2、F3预备后根管长度,将数据进行统计学分析。结果对照组和实验组组预备前后根管长度变化比较,差异有统计学意义（ t ＝14.28,P 〈0.01）,实验组内 SX、S1、S2、F1、F2、F3预备后根管长度变化差异无统计学意义（P 〉0.05）。结论机用 ProTaper 器械预备磨牙重度弯曲根管后对根管工作长度影响小,根管预备效果好。     

Cleaning of the root canal using Nd:YAP laser and its effect on the mineral content of the dentin

OBJECTIVE: To compare the efficacy of root canal cleanliness with and without Nd:YAP laser and to assess the effect of the laser on the mineral content of the dentin. BACKGROUND DATA: A high degree of cleanliness of the canal when using Nd:YAG laser has been shown while the laser had been in contact with the canal wall. A new Nd:YAP laser has been studied recently, which is considered to be superior to Nd:YAG with regard to antibactericidal ability due to its 1.34-mu wavelength, which is in the infra red range. This wavelength is absorbed better in water that of Nd:YAG. MATERIALS AND METHODS: Fourteen extracted single rooted premplars were divided into two groups. In group 1, canals were cleaned, instrumented and shaped with K files. In group 2, initial preparation was done using K files and completed with a Nd:YAP laser. Teeth were then split longitudinally and submitted to SEM. RESULTS: The cleanliness of the laser treated teeth was significantly greater than teeth treated with K files alone (p<0.05). No difference in Ca and P content was detected when the use of K files was compared to the use of laser. CONCLUSIONS: It appears that Nd:YAP laser improves the cleanliness of the root canal. However, since Nd:YAP laser serves as an addition to K files, its clinical value for replacing conventional root canal instrumentation remains to be determined.     

Cleaning of the root canal using Nd:YAP laser and its effect on the mineral content of the dentin

OBJECTIVE: The aim of this study was to compare the efficacy of root canal cleanliness with and without Nd:YAP laser and to assess the effect of the laser on the mineral content of the dentin. BACKGROUND DATA: A high degree of cleanliness of the canal when using the Nd:YAG laser has been shown while the laser is in contact with the canal wall. A new Nd:YAP laser has been studied recently, which is considered to be superior to the Nd:YAG with regard to antibactericidal ability due to its 1.34 micro m wavelength, which is in the infra-red range. This wavelength is absorbed better in water than that of Nd:YAG. MATERIALS AND METHODS: Fourteen extracted single rooted premplars were divided into two groups. In group 1, canals were cleaned, instrumented, and shaped with K files. In group 2, initial preparation was done using K files and completed with a Nd:YAP laser. Teeth were then split longitudinally and submitted to scanning electron microscopy. RESULTS: The cleanliness of the laser-treated teeth was significantly greater than teeth treated with K files alone (p < 0.05). No difference in Ca and P content was detected when the use of K files was compared to the use of laser. CONCLUSION: It appears that the Nd:YAP laser improves the cleanliness of the root canal. However, since the Nd:YAP laser serves as an addition to K files, its clinical value for replacing conventional root canal instrumentation remains to be determined.     

Protaper机用镍钛器械在前牙根管预备中的应用

目的：评价Protaper机用镍钛器械在前牙根管预备中的临床效果。方法：选择38例牙髓炎或根尖周炎患者40颗患牙，均为单根管前牙，随机分成两组。A组（n=20）采用机用镍钛器械Portaper预备根管，B组（n=20）采用K锉常规法预备根管，两组均采用侧向加压充填法充填根管。比较两组根管预备时间，并根据治疗前后X线牙片评价根管预备和充填效果。结果：A组根管预备时间明显短于B组（P〈0．001），A组1例欠充0．5mm，B组3例欠充1．0mm，两组充填的锥度、流畅度从X线牙片上看在根尖1／3，A组连续锥形比B组更为明显些。结论：Protaper机用镍钛器械快速、安全、成形效果好，在前牙根管预备中完全可以代替传统的不锈钢K锉。     

乙二胺四乙酸凝胶在弯曲根管预备中的应用效果评价

目的评价弯曲根管预备中应用乙二胺四乙酸(EDTA)凝胶的临床效果。方法将155例患者的189颗患牙分为三组,A组67颗患牙行不锈钢K锉结合手用镍钛锉+EDTA凝胶根管预备,0.5%次氯酸钠及生理盐水交替冲洗;B组59颗患牙行不锈钢K锉结合手用镍钛锉根管预备,0.5%次氯酸钠及生理盐水交替冲洗;C组63颗患牙行不锈钢K锉结合手用镍钛锉根管预备,3%双氧水及生理盐水交替冲洗。评价各组间根管预备情况、根管充填效果及约诊间疼痛的差异。结果 A组在弯曲根管预备过程中预备时间及器械折断率均明显低于B、C两组,根管充填成功率高于B、C两组,差异均有统计学意义(P<0.05);三组约诊间疼痛的发生率差异无统计学意义(P>0.05)。结论在弯曲根管的预备过程中应用EDTA凝胶,能有效提高根管预备的效率及根管的预备质量。     

镍钛手用根管锉ProTaper用于磨牙弯曲根管治疗的临床与影像学评价

目的:观察手用ProTaper锉预备磨牙弯曲根管的疗效。材料与方法:选取有弯曲根管的牙髓炎和根尖周炎的82颗磨牙随机分为P组41颗和S组41颗,P组用手用ProTaper锉冠向下逐步深入法预备根管,S组用不锈钢K锉逐步后退法予备根管,两组均用侧向加压充填法,根管治疗前中后的X线片评价两组在根管预备的效果。结果:P组无根管偏移,根尖阻塞,台阶形成等并发症形成,能维持根管的弯曲度,根管成形效果,充填效果好。结论:手用ProTaper锉架起了机用冠向下预备法与手用逐步后退法的桥梁,根管成形及根充效果好,临床应用价值高。     

根管手术显微镜在疑难根管治疗中的应用研究

目的比较根管手术显微镜(DOM)与传统根管治疗在疑难根管治疗中的疗效,以寻找疑难根管的有效治疗方法。方法随机选取牙髓炎患者346例,按照治疗方法将其分为显微镜组(运用DOM治疗,n=182)和传统组(运用传统根管治疗,n=164),比较2组治疗成功率。结果显微镜组对于钙化根管、器械折断根管、近中第二颊根(MB2)根管、"C"型根管、失败再治疗根管的成功率均显著高于传统组(P<0.01)。结论 DOM对复杂疑难根管的治疗具有可视性及可操作性,效果优于传统根管治疗。     

不同热牙胶旁路充填牙根表面的温度变化

背景：热牙胶充填可以实现完善的三维根管充填效果,但由于扁根管结构的特殊性,特别是在旁路预备过程中,部分牙体组织被过度切削造成局部区域牙体组织薄弱与不规则,同时分离器械为导热良好的金属,那么热牙胶在操作过程中产生的热量是否会烧伤牙周组织？目的：利用红外成像仪分析两种热牙胶充填方法在扁根管内器械分离行旁路充填牙根表面的温度变化。方法：选取40颗扁根管离体人下颌第一前磨牙,将新的15#不锈钢K锉分离在距根尖3 mm处,分离长度3 mm。在根管手术显微镜下采用TF镍钛锉进行根管旁路预备,随机分为2组,每组20颗,分别运用Thermafil热牙胶充填方法与E＆Q plus热牙胶垂直加压充填方法进行根管旁路充填。采用红外成像仪测定根管充填前后离体牙牙根表面的温度变化。结果与结论：两种热牙胶充填方法在扁根管内器械分离行旁路充填,均引起牙根表面温度升高,但均小于10℃：Thermafil热牙胶充填组温度变化范围为3.2-8.1℃,平均4.97℃;E＆Q plus热牙胶垂直加压充填组变化范围为5.5-9.8℃,平均为7.35℃,两组温度变化值比较差异有显著性意义（P 〈0.05）。表明Thermafil热牙胶充填方法在扁根管内器械分离行旁路充填时会导致牙根表面温度升高,但不会烧伤牙周组织,其充填安全性优于E＆amp;Q plus热牙胶垂直加压充填法。