根管再治疗术的临床疗效

根管治疗是治疗牙髓病和根尖周病的首选和重要方法，近年来，随着人民生活条件的改善，对牙齿功能和美容的要求也日益提高，根管治疗失败后再治疗的病人增多了，作者对2004年1月～2005年12月资料完整的根管再治疗病例进行总结，现报告如下：     

根管再治疗原因的临床分析

目的：对根管再治疗患牙的原因进行临床分析。方法：对122例需根管再治疗的患牙进行临床和X线片检查。结果：根管再治疗患牙中磨牙、前磨牙和前牙各占60％、27％和13％；出现疼痛症状占56％，冠渗漏占25％。82％根尖出现阴影或阴影较以前增大；根管欠充、超充、遗漏的比例分别为71％、9％和56％。结论：根管治疗成功率有待进一步提高。     

不同根管预备方法对老年人根管再治疗术后疼痛的影响

目的：对比ProTaper镍钛系统冠向下预备法和采用不锈钢手用锉逐步后退技术两种根管预备方法对老年人根管再治疗术后疼痛的影响。方法：选择106颗首次根管治疗失败再治疗患牙随机分为实验组与对照组,实验组使用ProTaper Universal再治疗器械（D1、 D2、 D3）去除根管内充填物后, ProTaper（F1、 F2、 F3）进行根管预备,对照组采用不锈钢手用锉去除牙胶后以逐步后退法预备根管,观察两组术后1h、6h、12h、24h、48h、7d VAS自评分值,24h与7d临床评定的疼痛发生率。结果：两组术后疼痛在6h出现,12h达到峰值,此后呈下降趋势,7d时已完全缓解;实验组在疼痛发生期间（6、12、24、48h 4个时间点）VAS自评分值均低于对照组,差异有统计学意义（P值分别为0.000、0.000、0.000、0.004, P〈0.05）;24h临床评定疼痛发生率实验组为11.1%,对照组为34.6%,差异有统计学意义（P=0.042, P〈0.05）;7d时临床评定疼痛发生率实验组为1.85%,对照组为3.85%,差异无统计学意义（P=0.807, P〈0.05）。结论：两种根管预备方法均会引起再治疗术后疼痛,使用ProTaper镍钛系统能有效降低老年人根管再治疗术后疼痛的发生。     

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。     

干髓术失败患牙的根管再治疗

目的:通过对干髓术失败患牙进行根管再治疗,探讨此类病例的特点及再治疗方法.方法:选取干髓术失败的磨牙63个,采用小号K锉配合次氯酸钠溶液和EDTA溶液探查根管并清理根管内的感染物质,封入氢氧化钙糊剂1～2周,采用机动镍钛器械Hero642进行根管预备,侧向加压技术充填根管,记录治疗过程中患牙症状的改善程度,根管疏通情况,根管预备和充填的效果.结果:62个患牙的根管疏通成功,治疗过程中症状明显缓解或完全消失,瘘管明显减小或消失,根管预备时无根管偏移、根尖阻塞、台阶等并发症发生,根管形态良好.结论:干髓术失败患牙在根管治疗时强调彻底清除根管内的感染物质,采用次氯酸钠和EDTA溶液清理根管,氢氧化钙消毒根管,机用镍钛器械进行根管预备能取得良好的治疗效果.     

左侧下颌第二磨牙根管再治疗及要点分析

下颌第二磨牙因其根管系统复杂多变,且位于牙列后部,视野较差,操作空间受限,较易出现医源性的损伤造成根管治疗失败。本文报道了一例下颌第二磨牙因根管遗漏和远中重度弯曲根管台阶形成导致根管治疗失败的病例,通过充分的术前评估、合理的计划制定以及完善的治疗,使得患牙的根尖周病变愈合,有望在口腔中长期保存。     

疑难根管再治疗中显微超声技术的临床应用

目的：评价显微超声技术在疑难根管再治疗中的应用。方法：选取需要根管再治疗的前牙56颗,62个根管,在根管显微镜下,采用超声根管锉,顺利疏通根管后,常规完成根管预备和根管充填,观察并评价临床疗效。结果：62个根管中,疏通了21个钙化根管,取根管内断械6个,去除根管桩7个,寻找遗漏根管11个,修补根管侧壁穿孔6个,发现根管内吸收1个,根尖封闭10个,成功完成56颗患牙（62个根管）再治疗。结论：显微超声技术在疑难根管再治疗中可以提供有效的治疗手段,提高临床治疗成功率。     

根管再治疗中根管消毒的研究进展

对初次根管治疗及再治疗根管消毒的差异进行探讨,对再治疗病例中的微生物是否比初次感染者更加耐药提出了质疑,同时对再治疗过程中充填物的去除及冲洗方法的研究进展进行综述。     

左上第一磨牙牛牙症根管再治疗1例

本文汇报1例左上颌第一磨牙牛牙症的根管再治疗以及冠部修复。通过分析牛牙症的解剖变异特点,强调CBCT术前检查的必要性,以及其对于根管治疗过程中完善感染控制的重要指导作用。同时结合牛牙症特殊的解剖结构特点,分析术后冠部修复方式的差异,从而为此类患牙的临床诊疗提供参考。     

显微超声技术在根管再治疗中的临床应用

目的:评价根管显微镜(dental operating microscope,DOM)联合超声技术在根管再治疗中的应用.方法:对临床常规治疗方法失败的患牙113颗(根管134个),在DOM下,采用超声根管锉疏通根管后,用机用镍钛ProTaper完成根管预备,热牙胶充填根管,观察并评价疗效.结果:疏通了70个钙化根管,取根管内断械12个,去根管桩12个,寻找遗漏根管11个,修补根管侧壁穿孔8个,根管内吸收1个,根尖封闭12个,成功完成126个根管再治疗.结论:显微超声技术是根管再治疗的有效的手段.     

Apical accuracy of two apex-locating handpieces in root canal retreatments of root-end resected teeth

We aimed to evaluate the accuracy of 2 apex locator integrated endodontic motors during retreatment of root-end resected teeth by using 40 extracted incisor teeth. The apical 3 mm of the roots were resected, and the root lengths were recorded as resected length of the roots. Forty roots were randomly divided into 2 groups of 20 to evaluate the 2 handpieces, Tri Auto ZX and TCM Endo V. The working lengths measured during the auto reverse function and during the electronic apex locator function with Tri Auto ZX and TCM Endo V were recorded and compared with resected length of the roots. The repeated measures analysis of variance was used for statistical analyses. Electronic apex locator functions of both devices might be used for apical accuracy, but the auto reverse functions might not be useful to 0.0-mm accuracy in retreatment procedures of root-end resected teeth.     

201例患者根管再治疗的临床分析

目的 评价根管再治疗的临床现况.方法 随机选择需行根管再治疗的201例患者的254颗患牙为研究对象,分析根管再治疗的就诊情况和疗程情况.结果 254颗需行根管再治疗的患牙中,前牙65颗,占25.59%;前磨牙64颗,占25.20%;磨牙125颗,占49.21%.根管内充填物为牙胶尖/AH糊剂者 208颗,曾做过干髓术者29颗,塑化治疗者0颗,根管内单纯糊剂允填者8颗,根管内存在器械分离者9颗.平均疗程为2～7次,2次完成者89颗;3次完成者150颗;4次完成者5颗;5次及以上完成者10颗.结论 254颗患牙其根管于治疗情况复杂,根管再治疗的疗程较首次根管治疗延长.     

根管治疗失败原因的临床分析

目的：探讨根管治疗失败的原因。方法：按纳入标准选取206名患者，分析根管治疗失败患牙215颗，根据初次治疗情况、临床检查、术前X线片以及术中对患牙根管系统的探查等判断原治疗失败的原因。结果：失败病例中慢性根尖周炎患牙最多，占67．9％，其次是无根尖暗影、但因欠充要求再治疗的患牙，以及存在冠渗漏的患牙；X线片显示84．2％的患牙欠充，多数后牙根管锥度欠佳；遗漏根管多见于上颌第一磨牙和前磨牙；18．1％的患牙存在台阶、根管偏移等并发症。结论：因预备和充填不当等造成的根管清理不彻底、封闭不严密使根管系统再感染是根管治疗失败的主要原因，遗漏根管、冠部渗漏等也可造成治疗失败。     

Survival of first-time nonsurgical root canal treatment performed in a dental teaching hospital

OBJECTIVE: The purpose of this study was to use survival analysis to evaluate the long-term treatment outcome of first-time, nonsurgical root canal therapy performed in a dental teaching hospital and to identify factors that might affect that outcome. STUDY DESIGN: One-tenth of all teeth treated between 1989 and 1994 were sampled. Patients were invited to return for a recall and were examined both clinically and radiographically. Any teeth that had been extracted or retreated or that were associated with a periapical radiolucency or presented with clinical signs and symptoms were deemed to have failed. An adjusted date of failure was calculated in the survival analysis by means of the Kaplan-Meier method. Ten covariables were further analyzed with the Cox regression model by using a backward stepwise regression method. RESULTS: Of 550 sampled teeth, 251 were examined. The mean observation period was 74 months. The failure rate was 44% (n = 111), with a median survival time of 113 months (mean, 91 months). Use of the Cox Regression model revealed that tooth type was significant in affecting the survival time of the treatment. Radiographic presence of voids in the apical and middle thirds of root canal fillings was associated with a significantly lower mean survival time than the presence of voids found in the coronal third or no void at all. The use of a calcium hydroxide dressing after initial treatment was associated with a longer survival time than failure to use medication or dressing with Ledermix alone. CONCLUSION. Simple calculation of percentages did not provide sufficient information on the treatment prognosis. The survival of first-time root canal therapy was significantly influenced by the tooth type, radiographic location of voids in the root canal filling, and the intracanal medicament used.     

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目的评价ProTaper机用镍钛锉用于根管治疗术一次法的临床效果。方法选择2008年7月至2010年7月广州医学院第一附属医院口腔科就诊患者206例(206颗患牙),随机分为两组。试验组的106颗患牙用ProTaper机用镍钛锉预备根管,对照组的100颗患牙用不锈钢K型锉预备根管,两组均以常规侧方加压法进行根管充填。拍摄牙片以了解根管数目形态、确定根管工作长度及判断治疗效果,并观察根管预备及充填后1～2周的术后反应。结果试验组患牙根管充填成功率(88.7%)高于对照组患牙(64.0%),试验组患牙根管预备及充填术后急性反应发生率(1.9%)明显低于对照组(14.0%),差异均有统计学意义(P<0.05)。结论 ProTaper机用镍钛锉用于根管治疗术一次法的根管充填成功率较高,且能明显减少术后根尖不良反应的发生,近期疗效可靠。     

氢氧化钙碘仿糊剂用于根管消毒的临床分析

根管消毒是完成根管治疗的关键步骤之一，根管消毒的彻底性直接影响着根管治疗的远期效果。目前用于根管消毒的药物种类较多，国外根管消毒选用氢氧化钙制剂川，国内传统的根管消毒药物是酚醛类制剂，其中以甲醛甲酚为代表。本文对氢氧化钙碘仿糊剂、甲醛甲酚合剂用于根管消毒的效果进行比较。     

Endosseous implants versus nonsurgical root canal therapy: a systematic review of the literature

For this article, the authors identified and reviewed the current literature, addressing two treatment options for endodontically involved teeth: root canal therapy and restoration versus extraction and the placement of a dental implant. The literature was evaluated as a basis for making treatment decisions. PubMed was queried for all studies that compared nonsurgical root canal therapy (NSRCT) and restoration with the extraction of teeth and placement of a dental implant. This search was supplemented by searching the bibliographies of these studies to ensure that all relevant studies were included. A total of 38 studies were found that directly compared NSRCT and restoration with extraction and placement of a dental implant. The literature is discussed in terms of outcomes for both treatment options, considerations in treatment plan decision-making, or the opinions of the authors.