髓室底开窗术治疗根分叉区病变临床研究

目的评价髓室底开窗术治疗Ⅱ、Ⅲ度根分叉区病变的方法和疗效。方法对28例31颗根分叉区病变牙，经髓室底开窗、清除病灶，填塞羟基磷灰石等方法的处理，进行临床观察分析。结果经近三年时间临床观察成功率占90.3％，失败3例，其中2例均为选择病例不当。结论髓室底开窗术治疗Ⅱ、Ⅲ度根分叉区病变疗效是肯定的。     

A scanning electron microscopic investigation of accessory foramina in the furcation and pulp chamber floor of molar teeth

Observations of the pulp chamber floor and furcation surface of human maxillary and mandibular first and second molars were made with the scanning electron microscopic to determine the incidence, size, and location of patent accessory foramina. Accessory foramina on both the pulp chamber floor and the furcation surface were found in 36% of maxillary first molars, 12% of maxillary second molars, 32% of mandibular first molars, and 24% of mandibular second molars. Mandibular teeth had a higher incidence (56%) of foramina involving both the pulp chamber floor and furcation surface than did the maxillary teeth (48%).     

The floor of the pulp chamber following pulpotomy.

The purpose of this study was to investigate the incidence of pulpal floor damage caused by operator error in a standard pulpotomy exercise, and to determine if this damage produced significant changes in dentin morphology and thickness at the base of the pulp chamber. One hundred and fourteen primary molar teeth were utilized in this study, 61 having pulpotomies and the remainder untreated. The dentin thickness in the furcation was measured on all the teeth and the pulpal floor morphology was examined using both light and scanning electron microscopy. The difference in thickness of dentin in the furcation of pulpotomized and non-pulpotomized teeth was not statistically significant. Less than fourteen per cent of pulpotomized teeth showed damage to the pulpal floor and this damage was only minimal in all cases. This study therefore suggests that damage to the pulpal floor during preparation is unlikely to be a factor contributing to failure of pulpotomies.     

应用CBCT研究汉族人下颌第一恒磨牙髓室底与釉牙骨质界的关系

目的 应用锥形束计算机体层摄影技术(cone beam computed tomography,CBCT),研究汉族人下颌第一恒磨牙髓室底与釉牙骨质界的位置关系,为牙体牙髓病治疗提供参考依据.方法 选择汉族受试者CBCT影像男、女各210例,按年龄分为6组,15~24、25~34、35~44、45~54、55~64和65~74岁.采用配套软件处理获取的下颌第一磨牙影像资料,测量牙齿中轴线上髓室底到釉牙骨质界连线的垂直距离,进行统计学分析.结果 中轴线上髓室底至釉牙骨质界的垂直距离,颊舌向正中面男性(-1.24 ± 0.56)mm,女性(-1.31 ± 0.69)mm;近远中向正中面男性(-1.67 ± 0.63)mm,女性(-1.70 ± 0.63)mm,性别间无统计学差异(P>0.05).随年龄增长,髓室底向冠方移动,二者间距有缩小的趋势,与年龄相关性有统计学意义(P<0.01).结论 汉族人下颌第一磨牙髓室底位于釉牙骨质界连线根方3mm区间内,两者间距随年龄增加而缩小.性别间无明显差异.     

生物活性玻璃微粒修复髓室底穿孔的临床观察

目的观察生物活性玻璃微粒(Bioglass)修复髓室底穿孔的临床疗效.方法选择髓室底穿孔病例75例,患牙86个,随机分为两组,试验组采用生物活性玻璃微粒,对照组采用光固化玻璃离子修复.1年后观察临床效果.结果试验组成功率81.3%,进步13.9%,对照组成功率46.5%,进步23.3%,两组间有显著性差异(P<0.05).其疗效与穿孔直径密切相关,与穿孔原因关系不明显.结论生物活性玻璃微粒是一种良好的髓室底穿孔的修复材料.     

CBCT髓室底3D重建在牙髓根尖周疾病中的应用

目的 分析评估采用CBCT(锥形束计算机断层扫描,Cone Beam Computed Tomography)进行髓室底3D重建在牙髓根尖周疾病中的应用价值.方法 对我院口腔科于2015年11月至2016年3月所做的15例磨牙CBCT使用OnDemand 3D Dental软件进行3D髓室底重建并分析图像,与传统CBCT断层图像进行对比,观察其在临床中的作用.结果 CBCT髓室底3D重建技术能为临床医生提供直观信息,显著提高诊治效率.结论 CBCT髓室底3D重建可明确髓室底情况,确定根管口位置,为根管治疗提供优于传统CBCT断层图像的直观信息.     

Mineralization patterns in the dentine of the floor of the pulp chamber of porcine molars

The relationship between the arrangement of the matrix fibre bundles and the shape of the mineralization front (mineralization pattern) were observed in the dentine of the subpulpal wall of porcine molars. The observations were made using mainly light microscopy and scanning electron microscopy on the primary dentine excluding the secondary dentine. The results obtained shows that the dentine of the subpulpal wall consists of two parts, a surface layer and the circumpulpal dentine. The surface layer can be divided into two sublayers according to the arrangement of it's matrix fibres. The mineralization pattern was also observed to have another two sublayers which did not correspond with the two fibrous subdivisions. Adjacent to the dentine-cement junction, there is a layer, measuring about 3 microns in thickness, in which the matrix fibres run parallel to the junction. The second layer is characterized by two types of fibre bundles which run perpendicularly to the dentine-cement junction. These outer radially oriented fibres are about 1-2 microns in diameter, and the inner radially oriented fibre bundles are coarse, 10 microns in diameter. In the outermost 10 microns, mineralization begins as an aggregation of mineral granules, and forms a hypermineralized layer which overlays the junctional region between the fibres which are oriented parallel and perpendicular to the dentine-cement junction. Except for the most-superficial layer, mineralizing cones surround the radial fibre bundles at the mineralizing front. The circumpulpal dentine, which forms the floor of the pulp chamber, can also be divided into two layers by the differences in their fibrous matrix. The fibres of both of these layers lay in the plane of the predentine surface. However, in the outer layer the fibres of the matrix are randomly arranged around and between the dentinal tubules, whereas in the inner layer the fibres have a preferred orientation extending radially from a central region between the roots. In the outer layer, calcospherites, which are the units of the mineral aggregation, appear at the mineralizing front. In the inner layer, at the mineralizing front, ridges, measuring approximately 10-15 microns in width, 10 microns in height and 100 microns in length, also have a preferred orientation, 90 degrees to the fibre direction. Microradiographs show that a higher mineralized "lamellae-like' region exists in the center of each ridge-crest. X-ray diffraction indicates two preferred crystallite orientation, one is parallel to the matrix fibres and the other perpendicular to the predentine surface. The latter seems to be situated in the highly mineralized lamellae. In the circumpulpal dentine, therefore the mineralizing units have a spheritic shape in the outer layer, and a columner shape in the inner layer. As far as the author is aware the columnar mineralization unit in mammalian dentine has not been described before.     

C-shaped canal system in mandibular second molars Part III: The morphology of the pulp chamber floor

The purpose of this study was to investigate the morphology of pulp chamber floors in mandibular second molars with a C-shaped canal system. Forty-four extracted mandibular second molars with C-shaped roots were collected from a native Chinese population. After the teeth were scanned by the micro-computed tomography (microCT), the pulp chamber floors were reconstructed three-dimensionally using three-dimensional software. The reconstructed images were classified into four types based on the shape of the pulp chamber floor and the location of the dentin fusion between the peninsular-like floor and the pulp chamber wall. Of the 44 reconstructed pulpal floors, 38 (86.37%) were C-shaped (peninsula-like floor) in which 8 (18.18%) had a continuous C-shaped orifice (type I); 16 (36.37%) had a dentin fusion between the peninsula-like floor and buccal pulp chamber wall, forming one or two mesial orifice(s) and a distal orifice (type II); and 14 (31.82%) had a dentin fusion between the peninsula-like floor and the mesial pulp chamber wall, forming a large mesiobuccal-distal (MB-D) orifice and a small mesiolingual orifice (type III). Six (13.63%) teeth did not have a C-shaped floor configuration (type IV). The number and configuration of the canals at different levels below the orifices were analyzed. The results suggested that most teeth in this study with C-shaped roots also have a C-shaped pulpal floor and that a new classification of pulpal floor anatomy would be helpful in locating the C-shaped canals.     

磨牙修复体与磨牙根分叉病变

目的：调查冠类修复体，邻面修复体与磨牙根分叉病变的相关性。方法：收集44个患者，有无修复体均可，调查内容包括：修复体状况、有无牙髓治疗、有无根分叉病变、松动度和牙周附着水平。结果：修复组的根分叉患病率以及牙周附着丧失水平均明显高于未修复组。结论：做过冠修复，邻面洞修复的磨牙更易形成根分叉病变及牙周附着水平丧失。     

乳磨牙髓室底穿孔治疗方法的探讨

目的:探讨乳磨牙髓底穿孔后,保留患牙的治疗方法。方法:清除穿孔处炎性感染物质后,常规根管治疗,用复方抗生素糊剂覆盖髓底穿孔处,双层基底封闭髓室底。结果:该方法有效地控制了炎症,保存了患牙。治疗成功率92.96%。结论:去除局部炎性组织后,运用复方抗生素糊剂覆盖髓底穿孔,能够有效地保留患牙,达到乳恒牙顺利替换的目的。     

锥形束CT研究上颌磨牙根尖与上颌窦底壁的解剖关系

目的采用锥形束CT,观测上颌磨牙根尖与上颌窦底壁的解剖关系,并进行分类,为治疗方案的制定和操作风险评估提供解剖学依据。方法从宿迁口腔医院影像科数据库中筛选出60位成年人,120侧上颌磨牙区锥形束CT影像,对其进行重建,测量磨牙根尖与上颌窦底壁的距离,并按照Shahbazian M分类法进行分析。结果上颌第一磨牙远中颊侧根距离上颌窦底壁的距离最小。分类中出现最多的为Ⅰ型(41.67%),最易引起上颌窦炎的Ⅳ型约占总数的19.85%,且上颌第一磨牙的远颊侧根出现Ⅳ型最多(29.17%)。结论上颌磨牙根尖与上颌窦底壁的关系个体差异较大。因此临床上,涉及该区域的治疗,需个性化的制定治疗方案,增加治疗的成功率且减少医源性问题。