三种根管器械预备弯曲根管的效果比较

目的:比较不锈钢K型锉(K-file)、手动镍钛合金锉(N i-Ti flex)和机动镍钛锉Profile(PF)预备弯曲根管时,保持原根管解剖走向的能力。方法:选择45个离体下颌单根管前磨牙,弯曲度为20°~45°,随机分为3组,分别用不锈钢K锉(SS-K锉)、手动镍钛器械(N i-Ti flex)、机动镍钛器械Profile进行根管预备。治疗前后分别拍摄可高度重叠的X线片,通过计算机扫描和放大,分析比较各组之间维持原根管形态的差异,并记录各组的操作时间和器械分离的发生率。结果:镍钛手动器械和机动器械都能较好地保持原根管解剖走向,SS器械所致的根管偏移的数目随器械号数的增大而增加,#30以上的器械,镍钛组(包括手动和机动)保持根管解剖走向能力与SS组相比有显著差异性(P<0.05),两镍钛锉之间无显著性差异。机动镍钛组有一器械分离,操作时间机动组比手动组快(P<0.01)。结论:对于弯曲根管,当根尖部预备大于#30时,镍钛锉保持根管原解剖走向的能力优于不锈钢锉,机动器械比手动器械操作时间短。     

3种器械预备弯曲根管的比较研究

目的 :比较不锈钢K型锉、镍钛合金K型锉以及镍钛合金X型锉预备弯曲根管的根尖偏移。方法 :将 4 5个 15°～ 35°的弯曲前磨牙根管按弯曲度排序后均匀分成 15个区组 ,每区组 3个根管 ,再随机分配至3个不同器械处理组。根管冠部用GG钻预处理后 ,行常规法预备根管 ,拍摄数字化X线片记录预备至不同锉号时根管器械尖端所在位置。最后 ,将根管预备前后器械尖端相应位置描记后 ,在立体显微镜下测量不同锉号根管预备后的根尖偏移。结果 :3组标本的根尖偏移均随锉号的增大而增大 ,# 35和 # 4 0不锈钢K型锉根管预备所致的根尖偏移与另外两组标本相比有显著性差异 (P <0 .0 5 ) ,另有两个标本根管侧穿 ;两组镍钛合金锉之间的根尖偏移无显著性差异 (P >0 .0 5 )。结论 :对于弯曲根管 ,用镍钛合金锉预备 ,其效果优于不锈钢锉。     

不锈钢K锉预备弯曲根管时根管不良形态形成的实验研究

目的:探讨弯曲根管预备时根管不良形态形成的特点与规律。方法:使用手用不锈钢K锉,按逐步后退法预备8个弯曲人工根管,根管预备过程中对根管及根尖孔进行微距摄影,用图像分析软件Image-ProPlus对根管的形态与位置变化进行测量、分析;实验数据采用SPSS10.0统计软件包进行统计学分析,选用配对t检验比较组间差异。结果:根管预备完毕,根管弯曲角度均值从预备前的36.21°(Schneider法)逐渐减小至21.98°,弯曲半径均值从6.28mm增大至11.35mm;根管长轴发生了偏移,与预备前原根管长轴形成2个交点,3个相交区。根管的连续锥度被破坏,并出现一系列预备缺陷。结论:弯曲根管预备时,根管器械在弯曲应力与切削力的共同作用下发生动态的根管偏移,是导致一系列根管不良形态的根本原因。     

根管冠部预处理对前磨牙弯曲根管预备效果的影响

目的:研究根管冠部预处理对预备弯曲前磨牙根管时根尖偏移的影响。方法:将60个15°～35°的弯曲前磨牙根管按弯曲度排序后分成15个区组,每区组4个根管,再随机分配至4个不同处理组。其中2组根管冠部用GG钻预处理后,分别用不锈钢和镍钛合金K锉行常规法预备根管;另2个对照组直接行常规法根管预备;记录各组根管预备至不同锉号时的根管影像及器械尖端所在位置。最后,测量比较根管预备前后弯曲度的变化和不同锉根管预备后的根尖偏移指数(ATI)。采用t检验或配对资料的符号秩和检验进行统计学处理。结果:各组根管预备前后的弯曲度之间均有显著差异(P<0.01),ATI均随锉号的增大而增大。用不锈钢锉预备根管,经过冠部预处理,根管侧穿数目明显少于对照组,且30#锉所致的根尖偏移显著低于对照组(P<0.01),与同型镍钛合金K锉所产生的根尖偏移无差异(P>0.05)。结论:对于前磨牙弯曲根管,用镍钛合金锉预备,其效果优于不锈钢锉;不论是镍钛合金K锉还是不锈钢K锉,在用常规法预备弯曲前磨牙根管时,均应进行根管冠部预处理。     

手用ProTaper镍钛器械预备弯曲根管的临床研究

目的:观察手用ProTaper镍钛器械预备弯曲根管的临床效果。方法:117例患者分为两组,手用ProTaper镍钛(PT)组59例,采用手用ProTaper镍钛器械预备根管,不锈钢K型根管锉(SS)组58例,采用改良双敞法预备根管。记录操作时间、器械折断情况、根管偏移发生情况、术后疼痛的发生、根管充填效果。结果:根管预备时间PT组为(5.59±1.66)min,SS组为(11.88±2.36)min;断针率PT组为3.39%,SS组为0;根管偏移率PT组为3.39%,SS组为17.24%;根充术后疼痛率PT组为5.08%,SS组为20.69%。结论:用手用ProTaper预备弯曲根管成形效果好,操作时间短,能很好地维持根管的走向和弯曲度,极少发生根管偏移等并发症,与目前较常用的K锉/改良双敞法相比有着明显的优势,可作为临床上预备弯曲根管的有效方法。但要注意预防因器械疲劳造成的折断,在形态复杂的根管中须小心操作。     

二种机用镍钛锉预备老年患者磨牙弯曲根管疗效观察

目的:比较机用镍钛锉Protaper和Hero642预备老年患者磨牙弯曲根管时,保持原根管解剖走向的能力。方法:选择2007.3～2010.3口腔科门诊年龄60-70岁牙髓病初诊病例,按Schneider测量法,选择磨牙弯曲根管(25°-30°)200例,随机分为Protaper组100例,Hero 642组100例,进行根管预备。测量主锉插针牙片和初锉插针牙片的根管弯曲度,确定根管偏移度,评价根管预备和成形效果。结果:Protaper组成功率92%,失败率8%,偏移2.8度。Hero 642组成功率99%,失败率1%,偏移1.6度。二组成功率有显著性差异(P<0.05)。结论:①Hero 642镍钛锉对于老年患者磨牙弯曲根管的成形能力明显优于Protaper镍钛锉。②联合应用二种镍钛锉,先用Hero 642扩通根管,再用Protaper成形根管,可以减少根管偏移,提高根充质量。     

弯曲根管用镍钛器械预备后根管偏移的研究

目的:研究3种镍钛根管预备器械预备后牙弯曲根管产生根管偏移的情况。方法:选择48个弯曲度>25°的下颌第一、二磨牙近中根包埋于Branmante模型中,分别用机动Hero642、Profile和手用ProTaper、不锈钢K锉进行根管预备。拍摄根管预备前后根尖、根中段横截面的影像,测定根管偏移的量、方向和轴中心率。结果:Hero642和Profile在根尖段和根中段根管的偏移显著小于不锈钢K锉,手用ProTaper仅在根尖段小于不锈钢K锉; 3种镍钛器械的轴中心率均低于不锈钢K锉,而镍钛器械组间无显著性差异;镍钛器械和不锈钢器械在根尖段根管中心偏向近中侧,而在根中段不锈钢K锉和手用ProTaper根管中心多数偏向远中侧,与Hero642和Profile有显著性差异。结论:Hero642、Profile和ProTaper在预备弯曲根管时有较小的偏移及良好的中心定位作用,尤其是Hero642和Profile对根尖和根中段成形能力较佳。     

使用三维重建技术研究不同根管预备器械的预备效果

目的：采用CT扫描结合三维重建技术,评价3种根管预备器械K-file、机用Protaper、机用Hero642的根管预备效果。方法：对离体牙进行CT扫描,建立三维数字模型,对根管预备前、后的横截面面积、根管内容积、根管内表面积及根管偏移情况进行比较分析。结果：在根管预备前后的横截面面积、根管内容积、根管内表面积差值上,Protaper组最大,手用K-file组最小;在根管预备前后根管偏移量方面：手用K-file组最大,机动Hero642组最小。结论：机动Protaper的牙本质切削能力优于机动Hero642;机动镍钛根管预备器械保持原有根管解剖走行的能力优于手用不锈钢器械。     

根管偏移对充填材料封闭根管能力的影响

目的 :研究弯曲根管预备后的根管偏移对充填材料封闭根管能力的影响。方法 :选取 73颗下颌单根管前磨牙作为研究对象 ,其中弯根管牙 46颗 ,直根管牙 2 7颗。A组 2 3颗弯根管牙用Lightspeed器械预备根管 ,B组 2 3颗弯根管牙、C组 17颗直根管牙以及对照组牙用K锉预备根管 ,预备方法为逐步后退技术。使用双曝光X线技术和Ehrlich法测量根管偏移指数 (ATI)的大小。使用侧向加压技术充填所有根管后 ,用流体传输模型测量每个根管内微渗漏的量。结果 :A组中有 19%的根管发生根管偏移 ,B组中有 85 %的根管发生根管偏移 ,两组之间ATI的大小有高度显著性差异。当ATI大于 0 .3mm时 ,根管内微渗漏的发生率明显增加。结论 :弯曲根管预备中出现的根管偏移会削弱充填材料封闭根管的效果。     

两种镍钛机动器械预备根管的效果分析

目的　评价使用两种镍钛机动器械预备磨牙根管的临床疗效。方法　选取需行根管治疗的 10 0颗患有牙髓炎及根尖周炎的磨牙 ,分别使用机用镍钛器械Protaper、Hero6 4 2冠向下预备根管 ,两组均使用侧压充填法充填根管。记录根管预备时间及器械折断数量。根据治疗前、中、后的X线片计算弯曲根管的弯曲度变化 ,评价根管预备和充填的效果。结果　Protaper和Hero6 4 2预备根管时间短 ,根管锥度、流畅度好 ,术后疼痛发生少且程度轻。Protaper预备后根管弯曲度平均减小 4 0 2°,Hero6 4 2平均减小 1 72°,二者差异有统计学意义 (P <0 0 0 1)。Protaper器械折断 5支、Hero6 4 2未发生器械折断 (P <0 0 5 )。结论　镍钛机动器械Protaper、Hero6 4 2预备磨牙根管成形、根充效果好。Protaper减小根管弯曲度较Hero6 4 2明显 ,但易折断。Hero6 4 2操作简单 ,不易折断目的　评价使用两种镍钛机动器械预备磨牙根管的临床疗效。方法　选取需行根管治疗的 10 0颗患有牙髓炎及根尖周炎的磨牙 ,分别使用机用镍钛器械Protaper、Hero6 4 2冠向下预备根管 ,两组均使用侧压充填法充填根管。记录根管预备时间及器械折断数量。根据治疗前、中、后的X线片计算弯曲根管的弯曲度变化 ,评价根管预备和充填的效果。结果　Protaper和He     

Assessing the shape of root canals: an in vitro method using microradiography

The aim of this paper is to describe an in vitro method which provides clear and accurate details of root canal shape. The method utilizes the technique of contact microradiography to produce high resolution, two-dimensional, real-size images of canals in a longitudinal plane. Specimens can be accurately rotated through 90° allowing images to be produced in a bucco-lingual and mesio-distal direction. The method is simple, relatively rapid and can process large numbers of teeth without the need for complicated and expensive mounting blocks or film holders. The technique can be used to produce pre- and post-operative images of canal shape which can be superimposed to delineate the dentine removed during canal preparation. The method is thus suitable for the evaluation of the shaping ability of endodontic instruments and preparation techniques.     

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在美国牙髓病学专家Gutmann<牙髓病学解难>一书的开卷语中,引用了1884年一位英国牙髓病研究者的话:治疗前花一小会儿时间思考一下根尖病的病因,使我们理解欲达到成功目的所必须做的事;倘若病变来自感染牙髓的分解,那么将其清除,即可将多数病例治愈.     

根管钙化治疗的研究进展

根管钙化是牙髓病和根尖周病临床治疗中较为棘手的问题.了解各类钙化根管的治疗方法,对提高治疗成功率有重要意义.yynw文就根管钙化的原因、X线摄片技术、钙化根管口的寻找方法及临床治疗的研究现状作一综述.     

Quality of preparation of oval distal root canals in mandibular molars using nickel-titanium instruments

AIM: The aim of this study was to compare the preparation of oval distal root canals in mandibular molars using three different nickel-titanium (NiTi) instruments: Lightspeed (Lightspeed Inc., San Antonio, TX, USA). ProFile .04 (Maillefer Ballaigues. Switzerland) and Quantec SC (Tycom, Irvine, CA, USA). METHODOLOGY: Three groups of 20 extracted mandibular molars with oval distal root canals were embedded in a muffle system as described by Bramante et al. (1987) and modified by Hülsmann et al. (1999). Preparation of the root canals was performed with particular emphasis on the buccal and lingual extensions of the oval shape. The following parameters were evaluated: comparison of pre- and postoperative photographs with regard to the buccal and lingual extensions of the preparation, safety issues (file fractures, perforations, apical blockages, loss of working length), cleaning ability (SEM investigated using a 5-score system for remaining debris and smear layer) and working time. RESULTS: Superimposition of pre- and postoperative cross-sections in the majority of specimens revealed uninstrumented or incompletely instrumented buccal or lingual extensions (Lightspeed and Quantec SC, 56.7%; ProFile .04, 55%) For debris removal, Quantec SC achieved the best results (54.2% scores 1 and 2), followed by ProFile .04 (52.5%) and Lightspeed (46.7%). Preparation resulted in substantial smear layer covering the canal walls for every system (ProFile .04, 38.3%; Quantec SC, 36.6%; Lightspeed, 28.3%). Differences between the three systems were not significant for any of the parameters investigated. Preparation with Lightspeed resulted in two fractured instruments; with Quantec SC. two apical blockages occurred. With ProFile .04, no complications were noticed. Mean working time was shorter for ProFile .04 (261.2 s) than for Quantec SC (272.4 s) and Lightspeed (338.9 s); the differences were not significant. CONCLUSIONS: The flexibility of the NiTi instruments investigated in this study did not allow controlled preparation of the buccal and lingual extensions of oval root canals. The instruments frequently produced a circular bulge in the canal whilst the buccal and lingual extensions remained unprepared, leaving smear layer and debris.     

Root and canal morphology of the mesiobuccal and distal roots of permanent first molars in a Kuwait population--a clinical study

Aim To identify the number of roots and canal configurations in permanent first molars of the indigenous Kuwaiti sub‐population and compare them against a similar group of non‐Kuwaiti population in different age groups and gender, and to determine the frequency of a second canal in the mesiobuccal root of maxillary first molars and distal root of mandibular first molars that could be located and treated in routine practice without using magnification or special lighting conditions. Methodology A total of 220 permanent first molar teeth of patients scheduled for root canal treatment over a period of 1 year were included. Patients were identified and grouped according to their nationality as Kuwaiti and non‐Kuwaiti (which included Filipinos, Indonesian Indians, Srilankans, Egyptians, Saudi Arabians and Syrians). In both nationality groups, patients were successively distributed into four groups based on their age. The first age group included patients below 20 years, the second 21–30 years, the third 31–40 years and the fourth were over 40 years. The first three groups comprised of 15 male and 15 female patients whilst the fourth group had 10 patients of each gender. Teeth with open apices, resorptions and calcification were excluded from the study. The teeth included were both clinically and radiographically examined for number of roots, the canal configuration and the presence of the additional mesiobuccal and distal canals and recorded. The simplified classification of canal configurations proposed by Weine was utilized. Results The incidence of a second canal in the mesiobuccal (MB) root of maxillary first molars and the distal root of mandibular first molars was not influenced significantly by nationality and gender. All the 110 maxillary first molars treated had three roots; 58% of MB root had one canal and 42% had two canals. The majority of the mesial roots had Weine type II canal configuration when the second mesiobuccal canal was present. All distobuccal and palatal roots had a single or type I canal configuration. Of the 110 mandibular first molars that were treated, 96% had two roots and 4% had three roots. When present, the third root was located either buccal or lingual to the main distal root. Overall 51% of the single distal roots had one canal whilst 49% had two canals. The mesial root frequently had a Weine type II canal configuration as did the distal root when a second canal was present. Pearson’s correlation analysis of both molars revealed a significant (P < 0.05) negative correlation (r = ?0.274, r = ?0.144) between age and number of canals as well as the type of canal. Conclusions The incidence of a second canal in distal roots of permanent mandibular first molars was 49% in the Kuwaiti population and this was similar to other Asian ethnic populations. Adopting modified access and troughing procedures revealed a 42% frequency of MB2 canals in maxillary first molars. The incidence of a second canal in both mesiobuccal roots of maxillary molars and distal roots of mandibular molars decreased significantly with age; no differences were noticed amongst the nationalities and gender studied. The possibility of extra roots should be anticipated in mandibular molars.     

The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide

Abstract— Calcium hydroxide (CH) is often used as a routine interappointment dressing during the endodontic treatment of teeth with apical periodontitis. However, it fails to consistently produce sterile root canals. The present study was set up to find out whether an antimicrobial strategy including the use of CH could be made more effective if: 1) canals were pretreated with 5% iodine potassium iodide (IPI), and 2) the dressing period was extended up to 2 months. Fifty human teeth, with radiographically verified apical periodontitis, were microbiologically sampled. After chemomechanical preparation the canals were pretreated with IPI for 3–7 days. Teeth where microorganisms persisted were then treated with CH for 2 months. Following instrumentation and dressing with IPI, 43 bacterial strains were recovered in 22 of the teeth. Samples obtained after the CH dressing period disclosed growth of 13 facultative and two strict anaerobic strains in 10 teeth. Enterococcus faecalis was identified in two specimens. In conclusion, the present study gave no evidence for an increased antimicrobial effect of CH if it was left for longer periods in the root canal. Although pretreatment with IPI from a quantitative point of view did not seem to add antimicrobial power, it might reduce the frequency of persisting strains of E. faecalis .     

钙化根管治疗的研究进展

根管钙化是临床进行根管治疗术时的多见现象。了解各类钙化根管的治疗方法，对提高治疗成功率有重要意义。本文对钙化根管治疗技术的研究现状进行了综述。     

2种侧压器进入弯曲根管的深度及充填质量的比较

目的 比较镍钛（NiTi）侧方加压器和不锈钢（SS）侧方加压器进入不同程度弯曲根管的深度和根充质量。方法 选择40颗离体弯曲单根管的下颌前磨牙,依据根管弯曲度将其分为小于等于20°和大于20°。采用机用镍钛ProFile器械预备根管,测定2种侧压器进入有主牙胶尖根管的深度,并采用冷牙胶侧方加压充填技术充填根管,在距根尖2 mm和4 mm处对根管作水平片切,记录图像并分析根管中牙胶面积的百分比（PGP）。结果 在弯曲度大于20°的根管中,NiTi侧压器进入根管的深度及根尖2 mm处PGP均大于SS侧压器（P<0.05）;在弯曲度小于等于20°的根管中,二者的差异无统计学意义（P>0.05）。采用不同侧压器充填的根管距根尖4 mm处的PGP的差异均无统计学意义（P>0.05）。结论 NiTi侧压器在严重弯曲根管中较SS侧压器能获得较好的进入深度及充填质量。     

老年患者钙化根管的预备

目的：观察老年人根管钙化情况,总结高校社区医院对老年患者钙化根管的治疗方法。方法：选择60-72岁老年患者的148个钙化根管,在EyeMag放大镜下,分别采用低速球钻或超声器械去除髓室内钙化物, C型先锋锉蘸取Glyde凝胶进行根管疏通,术中记录根管钙化情况和疏通效果,最后完成根管预备、消毒和充填。结果：老年人钙化根管多见于上颌第一磨牙,前牙、前磨牙、磨牙疏通成功率分别为：91.67%,72.73%,60.80%,前牙组疏通成功率高于磨牙组（χ2=4.50, P＜0.05）;根管冠方1/3和根中1/3较易发生钙化,且钙化的疏通成功率明显高于根尖1/3（χ2=19.33, P＜0.05）。结论：针对老年人钙化根管的治疗,临床医生要有足够的细心、耐心和信心,灵活的综合运用现有的各种治疗器械和设备,能够取得较好的治疗效果。     

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迄今为止,根管治疗术仍是治疗牙髓和根尖周疾病最有效的方法,近二十多年来的发展,使根管治疗不仅在基础研究方面取得了长足的发展,而且根管治疗的预备器械、预备方法也有了很大的改进.根管充填材料和方法的进一步完善以及根管手术显微镜的使用,使根管治疗的临床成功率可达90%以上.