根管内折断器械的取出方法及临床病例分析

目的 探讨根管内折断器械的取出方法及临床应用。方法 对56个根管内器械折断的病例,应用根管治疗显微镜和不同取出方法处理并进行分析。结果 器械折断的56个根管中,有41个取出,4个通过断针并根管充填。其中,根管上部断针5个全部取出;根管中部断针28个,25个取出;根尖部断针(包括全根管)23个,11个取出。结论 应用适当方法,根管内中上部的断针大部分可取出,根尖部的断针取出较困难。     

超声法取弯曲根管根尖部的分离器械一例

根管内分离器械阻碍根管的彻底清理充填,可能导致根管治疗的失败,然而取根管内的分离器械难度大,尤其是位于弯曲根管根尖部的分离器械,取出时极易造成根管壁过薄、穿孔等并发症.本文报道一例超声法取弯曲根管根尖部的分离器械病例,为临床中此类病例的处理提供一些参考.     

显微超声技术在折断器械取出中的临床应用

目的：评价手术显微镜下结合超声装置取出根管内折断器械的效果。方法;术前X线确诊根管内折断器械病例25例,在显微镜下使用超声装置制备直线通路和增隙,暴露器械断端,松动并取出断械。术后拍摄X线片确诊折断器械是否取出,然后完成根管治疗。结果：25例中在显微镜下取出23例,取出率82．1％。有5例未能取出,其中根管壁侧穿2例,显微镜下未能见到折断器械2例,器械部分推出根尖孔1例。结论：手术显微镜结合超声装置是根管内折断器械取出较为理想的方法。     

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目的探讨数字根尖片在术前评估根管内折断器械取出难度和根管侧穿发生中的应用价值。方法应用分角投照技术拍摄的患牙数字根尖片,对2007年4月至2008年10月于烟台市口腔医院特需门诊就诊接受显微超声取根管内折断器械的病例47例进行分析,分析其折断器械在根管内的位置与折断器械取出成功率和根管侧穿发生率的关系。结果当折断器械位于根尖1/3时,应用显微超声技术取出的成功率和根管侧穿发生率分别为36.84%和52.63%,而器械位于根管冠1/3、中1/3时取出成功率分别为90.00%、88.89%,根管侧穿发生率分别为10.00%、11.11%;当折断器械位于弯曲根管以上或以下时器械取出的成功率分别为88.46%和42.86%,根管侧穿的发生率分别为11.54%和47.62%。结论分角投照数字根尖片在术前分析根管内折断器械取出的成功率和根管侧穿的发生具有较高的参考价值,可作为根管内折断器械病例术前难度评估和预测侧穿发生的常规方法。     

显微超声技术处理根管内折断器械的影响因素及临床应用

目的用显微超声技术处理根管内折断器械并对其影响因素进行分析。方法对2003年10月—2006年10月就诊于南京医科大学附属口腔医院的47例根管内器械折断的患者进行诊断和治疗,用根管手术显微镜配合超声器械进行治疗处理。结果47例患者中有34例根管内折断器械被完全取出,取出率为72.3%。折断器械的位置与操作难度密切相关,根管弯曲前段、中段和后段内折断器械取出率依次降低;根管弯曲度小于30度者较弯曲度大于30度者其折断器械取出率高。结论手术显微镜结合超声器械是处理根管内折断器械的较有效方法。     

CBCT结合显微超声技术处理根管内折断器械的临床研究

目的：评价锥体束CT（CBCT）结合显微超声技术处理根管内折断器械的临床疗效。方法：选取济宁医学院附属医院口腔科2012年9月～2013年6月初次根管治疗中出现的器械折断病例24例,对患牙CBCT扫描,进行三维重建,对折断器械的根管进行三维定位及评估,制定临床决策,实施断械取出,计算取出率。结果：CBCT能准确定位断械所在根管,清晰显示根管形态、弯曲度、折断器械位置及周围牙本质厚度。24例断械病例中,20例选择取出治疗,其中16例成功取出,4例未能取出,成功率为80％。4例因折断器械均位于根尖部,弯曲根管下段,且周围牙本质薄弱不选择取出治疗。结论：CBCT结合显微超声技术为临床上评估及取出根管内器械折断病例提供了有效方法。     

根管内折断器械取出的临床研究

目的：评价采用显微超声技术去除根管内折断器械的效果。方法：收集临床器械折断病例17例,存根管显微镜下,使用超声器械取出折断器械。记录折断器械取出的成功率。记录取出的折断器械的类型及操作时间。结果：64．9％折断器械位于上下颌磨牙根管内,折断器械取出的成功率为76．47％。未能取出的4例（镍钛器械3例,K锉1例）均位于根管下段。结论：折断器械所处的牙位、根管以及在根管内的部位、器械的类型、操作者的经验等影响折断器械的取出成功率。显微超声技术有助于提高根管内折断器械的取出成功率。     

超声工作尖取根管内金属折断器械的效果评价

目的评价用超声工作尖ET20、ET40取根管内折断器械的效果.方法在肉眼或根管显微镜观察下使用GG钻或超声工作尖制备根管直线通路,用超声工作尖ET20、ET40对163根根管内折断器械进行处理.结果 163根根管内折断器械取出145个,取出率89%.其中,前牙取出率为100%,前磨牙为97%,磨牙为85%.不锈钢和镍钛扩大器械取出率为88%～90%,拔髓针取出率仅为37%.根管弯曲以下折断器械取出率为11%.直根管或根管弯曲以上折断器械因器械类型有较大差异,根管扩大器械取出率为98%、裂钻为100%,拔髓针为50%.163例中根管侧穿7例(4%),旁道形成5例(3%),折断器械出根尖孔2例(1%).结论超声工作尖ET20、ET40对大部分根管折断器械的取出有很好的效果,但对根管弯曲以下折断器械、拔髓针等取出效果较差.     

应用显微超声技术去除根管内折断器械的临床分析

目的：评价根管手术显微镜和超声技术去除根管内折断器械的临床疗效。方法：选择因根管内折断金属器械造成根管阻塞的患牙43个,根管47个。在根管手术显微镜下使用超声器械与IRS套管试行取出术,完成根管治疗或再治疗,统计成功率。结果：32个患牙（33个根管）内折断器械被取出并完成根管治疗,成功率74.42%（70.21%）。无一例发生根管壁侧穿或牙根折裂。结论：根管手术显微镜和超声器械及IRS套管的使用,为根管内折断器械的去除提供了有效方法。     

显微超声技术取根管内折断器械致根管侧穿并发症的研究

目的分析影响显微超声技术取出根管内折断器械的成功率及导致根管侧穿并发症的因素。方法45例患者,45颗患牙采用显微超声技术取出根管内折断器械,观察根管内折断器械的取出成功率以及根管侧穿发生的情况,分析影响因素。结果当折断器械位于根管冠1／3、中1／3和尖1／3时,应用显微超声技术取出的成功率分别为90．00％、94．12％和38．89％,根管侧穿发生率分别为10．00％、5．88％和50．00％,后者取出的成功率明显低于前二者（P〈0．05）,而根管侧穿的发生率却明显高于前二者（P〈0．05）;当折断器械位于直根管、中度弯曲以及重度弯曲根管内时,取出成功率分别为91．67％、85．71％和47．37％,根管侧穿的发生率分别为8．33％、7．14％和47．37％,后者的取出成功率明显低于前二者（P〈0．05）,而根管侧穿的发生率却明显高于前二者（P〈0．05）;另有2例断针推出根尖孔外。结论显微超声技术取出根管内折断器械时可能发生根管侧穿,尤其当折断器械位于根管尖1／3段或重度弯曲根管时更应该慎重。     

显微超声技术在根中下1/3取断针的疗效及策略

目的：分析在根管显微镜下应用超声技术取出根管中下1/3断针的临床效果,提出预防措施。方法：收集5年来门诊根管预备断针发生在根中下1/3的患者36例,均在显微镜下用超声根管工作尖取断针。结果：36例根管内断针取出29例,失败7例,成功率为80.5%,4例建立旁路,1例拔除,2例留内观察。结论：根管显微镜下应用超声技术取出根管内断针相对安全有效。     

Complications associated with fractured file removal using an ultrasonic technique

A technique utilizing modified Gates Glidden burs and ultrasonics has recently been advocated to remove fractured instruments from root canals. Varying extents of tooth structure are removed during this procedure, potentially leading to complications. This study evaluated the in vitro and in vivo complications associated with fractured file removal. Fractured instrument fragments were removed from three different levels (coronal, middle, or apical third) of mesiolingual canals of extracted human mandibular molars. The success rate, frequency of perforations, and root strength were recorded for each group. Perforations and unsuccessful file removal occurred only with fragments lodged in the apical third. Fracture resistance declined significantly with more apically located file fragments. A review of 60 clinical cases showed similar rates of successful file removal and rate of perforations. Removal of a fractured file fragment from the apical third of curved canals should not be routinely attempted.     

Removal of separated files from root canals with a new file-removal system: Case reports

There have been many different devices and techniques developed to retrieve instruments fractured during endodontic procedures, but none of them can consistently remove separated instruments from root canals. Iatrogenic accidents such as perforation and canal destruction have been reported during the removal of separated instruments. The file removal process becomes even more difficult when breakage occurs in a curved canal or in the apical third of the canal. Four cases requiring removal of separated files from the apical third of curved canals are presented. All were successfully treated using a newly designed system and technique.     

In vivo study of apical cleaning

This study sought to evaluate the efficiency with which debris is removed in the clinical environment by evaluating 53 teeth that had undergone in vivo root canal therapy and were extracted for various reasons, including fractures, pain, caries, and financial considerations. The teeth were cross-sectioned 1.0 mm from the apical constriction and 120 canals were evaluated for residual debris based on photographs taken at a magnification of 50x. Of the canals evaluated, 82% had residual debris. Canals treated with the crown down (with apical gauging) technique and/or the step-back technique were free of debris 1.0 mm from the apical constriction only 18% of the time. These techniques prematurely gauged the correct apical canal size because the gauging file bound either in the tangent of the curves or in the narrower dimension of the typical oval canal. All of the canals instrumented to a round shape were free of debris 1.0 mm from the apical constriction. Of the canals treated with tapered instruments, 48% were transported. Of the canals cleaned with the LightSpeed technique (that is, engaging the canal), 100% were free of debris 1.0 mm from the apical constriction.     

Ultrasonic removal of broken instruments in root canals

Summary. A method to remove broken instruments in root canals was developed employing a new ultrasonic device for root canal treatment. The results, using extracted teeth, showed that broken instruments locked tightly in round root canals were more difficult to remove compared with those in irregularly shaped root canals. This method was applied in 39 clinical cases, and in 26 of these the fragment was removed successfully while in six cases it was possible to bypass a file alongside the fragment. Therefore, in 32 out of the 39 clinical cases with broken instruments, it was possible to instrument to the apex.     

超声法取根管内折断器械对根管壁损伤的体外研究

目的比较不同弯曲度根管用显微超声技术取折断器械时对根管壁的损伤程度。方法体外建立不同弯曲度根管内根尖1／3器械折断模型30例,手术显微镜辅助下超声法取根管内折断器械,通过图像分析软件对术前、术后根管横截面积的变化进行分析比较。结果根管内折断器械取出后的横截面积变化经过多因素方差分析,直根或轻度弯曲组与中度弯曲组根管横截面积增加值的差别无统计学意义（P〉0．05）;重度弯曲组与直根或轻度弯曲组、中度弯曲组之间根管横截面积的增加值差别具有显著性意义（P〈0．05）;重度弯曲组与轻度弯曲组和中度弯曲组间的差别主要在4、6mm的位置,在2mm和8mm处的差别无统计学意义（P〉0．05）。结论用超声法取位于重度弯曲根管内根尖1／3的折断器械时,对根管壁损伤较大,损伤最大部位为根管中部,易造成此处侧穿,故位于重度弯曲根管根尖1／3的折断器械不建议用超声法取出。     

根管内折断器械显微超声取出效果的临床观察

目的 探讨显微超声技术处理根管内折断器械的效果及提高取出成功率的有效方法.方法 对常规方法不能处理的96例患者,共计101个根管内折断器械.在根管显微镜下使用专用超声工作尖进行处理,统计患牙的治疗成功率.结果 显微镜下顺利完成78例,成功率82.2%,共计83支折断器械.结论 对下颌磨牙的根管治疗及折断器械取出应提高警惕;牙科显微镜结合超声技术,采用合理的操作方法、合适的工作尖,对处理大部分根管内折断器械有较理想的治疗效果.