显微根尖手术治疗39例慢性根尖周炎病例的临床疗效

目的评价显微根尖手术治疗39例慢性根尖周炎病例的临床疗效。方法对39例慢性根尖周炎病例进行显微根尖手术治疗．包括在牙科手术显微镜下借助显微外科器械对患牙进行根尖刮治、根尖切除、根尖倒预备和MTA倒充填。术后每3个月复诊．通过临床和X线片检查评价术后1年的疗效，分为愈合、好转和无效病例。结果39例慢性根尖周炎病例1年后随访的治疗成功率为94．9％，其中治愈病例为82．1％．好转病例为12．8％。结论显微根尖手术对治疗慢性根尖周炎病损具有良好疗效。     

数字化导板辅助显微根尖手术精确性的临床对照研究

目的 研究数字化导板辅助显微根尖外科手术的精确性.方法 选择就诊于我院需进行显微根尖手术的受试者20例,术前行CBCT扫描,按照随机对照原则分为两组,试验组进行根尖周病变的可视化三维模型建模、手术模拟并设计打印手术导板,在导板引导下手术,对照组进行常规手术评估设计完成手术.两组手术均由同一治疗小组完成.术后拍摄小视野C...     

Detection of antibiotic resistance genes in samples from acute and chronic endodontic infections and after treatment

Objective

The purpose of this study was twofold: survey samples from acute and chronic endodontic infections for the presence of genes encoding resistance to beta-lactams, tetracycline and erythromycin, and evaluate the ability of treatment to eliminate these genes from root canals.

Design

DNA extracts from samples of abscess aspirates (n = 25) and root canals of teeth with asymptomatic apical periodontitis (n = 24) were used as template for direct detection of the genes blaTEM, cfxA, tetM, tetQ, tetW, and ermC using real-time polymerase chain reaction (PCR). Bacterial presence was determined using PCR with universal bacterial primers. Root canals of the asymptomatic cases were also sampled and evaluated after chemomechanical procedures using NiTi instruments with 2.5% NaOCl irrigation.

Results

All abscess and initial root canal samples were positive for bacteria. At least one of the target resistance genes was found in 36% of the abscess samples and 67% of the asymptomatic cases. The most prevalent genes in abscesses were blaTEM (24%) and ermC (24%), while tetM (42%) and tetW (29%) prevailed in asymptomatic cases. The blaTEM gene was significantly associated with acute cases (p = 0.02). Conversely, tetM was significantly more prevalent in asymptomatic cases (p = 0.008). Treatment eliminated resistance genes from most cases.

Conclusions

Acute and chronic endodontic infections harboured resistance genes for 3 classes of widely used antibiotics. In most cases, treatment was effective in eliminating these genes, but there were a few cases in which they persisted. The implications of persistence are unknown. Direct detection of resistance genes in abscesses may be a potential method for rapid diagnosis and establishment of proactive antimicrobial therapy.     

三维打印导板辅助下的微创根尖手术新方法

目的:探讨数字化术前诊断设计、三维打印技术及手术导板在显微根尖手术中应用效果。方法:选取根管治疗失败患者1例。术前拍开口位锥形术CT,硅橡胶印模、模型灌注及模型扫描,CBCT与扫描数据整合;软件分析、模拟设计及输出导板的STL数据;3D导板打印制作;并在3D导板指引下,行微创根尖外科手术。结果:微创根尖手术精准切除了根尖病变区,最大程度地减少对骨组织的损伤,缩短了术中治疗时间,提高了患者的满意度和舒适度。结论:采用数字化技术、三维打印导板能有效实现根尖手术可视化、微创化、精确化、快速化、简单化,并降低技术敏感性。     

生物陶瓷材料iRoot BP Plus在显微根尖手术中应用的疗效分析

目的 评价生物陶瓷材料iRoot BP Plus作为根管倒充填材料在根尖手术中的临床疗效.方法 选择临床符合纳入标准的慢性根尖周炎患牙,进行显微根尖手术治疗,对患牙进行根尖切除、超声器械根尖倒预备和iRoot BP Plus根管倒充填.术后1年复查,通过临床检查和X线片评定结果,分析临床疗效.结果 2013年2月至2014年2月期间完成显微根尖外科手术59例,共80颗患牙.术后1年有效回访53例,72颗患牙,术后1年治疗成功率达94.4％(68/72).患者性别、年龄、牙位、根尖周病变范围大小、根尖周病变类型、有无窦道等因素对疗效的影响均无统计学差异(P＞0.05).结论 iRoot BP Plus作为根尖手术倒充填材料,有良好的临床效果.     

144例显微根尖外科手术疗效观察及分析

目的通过对显微根尖手术后患者临床随访评估,探讨显微根尖手术的成功率以及相关预后影响因素,为无法行根管治疗的复杂根尖周病的治疗提供参考。方法对2012—2014年底在我院行显微根尖手术的144例患者进行1年随访,收集患者主观症状、临床检查以及拍摄根尖X线片相关资料,综合评估显微根尖手术疗效,并统计分析性别、年龄及牙位预后影响因素。结果对144例患者共190颗患牙相关资料进行分析,1年有效率达92.63%(176颗),无效率为7.37%(14颗)。统计学分析结果显示患者的性别、年龄及牙位分布对显微根尖外科手术的预后无明显影响。结论显微根尖外科手术可以有效治疗复杂根尖周病变的有效方法,值得临床推广。     

Local injection of Benadryl® for the prevention of iatrogenic endodontic flare-ups

Abstract Endodontic flare-ups often occur within 24 h of root canal debridement, during which time a small amount of antigen in the form of necrotic pulp tissue and bacteria within the root canal, may be inadvertently extruded through the apical foramen. Subsequently, preformed mediators such as histamine are released into the tissue, causing symptoms of pain and swelling. The IgE-mast cell mechanism conceivably plays an important role in this development. A rationale for using local injection of Benadryl® prior to canal debridement of infected teeth is given, along with an indication of a lack of adverse reactions and side effects following such treatment.     

未经治疗和根管治疗失败的慢性根尖周炎的细菌学研究

目的:比较未经治疗和根管治疗失败的慢性根尖周炎患牙根管内的感染状态并分析临床表征与特殊细菌之间的关系.方法:收集临床诊断为慢性根尖周炎的病例90 例,包括未治疗患牙和根管治疗失败患牙各45 例,根据临床症状分为疼痛组、窦道组和无症状组.详细记录患牙的临床表征并拍摄X线片.经根管内取样、接种、培养后检测根管内的细菌种类并...     

1例桥基牙根尖手术后的固定桥修复

目的: 通过个性化的综合诊疗,实现右上中切牙慢性根尖周炎疾病控制、美观调整与功能恢复。诊治经过： 主诉患牙为旧固定桥的基牙,拆除旧固定桥后,对进行了显微根管治疗。8个月后,仍存在根尖病变,通过显微根尖手术纠正根充超填、囊肿样变化及可能存在的根外感染。期间进行了定期的牙周基础治疗,其他楔状缺损患牙的复合树脂直接粘接修复。通过功能适合性美学诊断蜡型进行美学调整和功能适应。针对修复环节,患者综合考虑疗程、费用、美观、功能及预后,选择了固定桥修复。结果： 控制了 的根尖周炎症,良好地恢复了牙体缺损及牙列缺损的功能与美观。结论： 通过一站式的个性化综合诊疗,可降低患者转换不同专业的沟通成本和转诊次数。     

54例持续性根尖周炎的显微根尖外科手术1年疗效观察

目的评价显微根尖手术治疗54例持续性根尖周炎病例的短期临床疗效。方法对54例持续性根尖周炎病例进行显微根尖手术,包括翻瓣、去骨、根尖周刮治、根尖切除,使用超声器械倒预备,三氧化矿物凝聚体（MTA）作为倒充填材料,术后定期复查,通过临床和X线片检查和测量,评价术后疗效。结果54例持续性根尖周炎病例术后1年随访,治愈者31例（57.41％）,改善者19例（35.19％）,失败者4例（7.41%）。根据患者性别、年龄、牙位分布、根尖周暗影的最大直径和根尖周病变组织病理分类分别统计显微根尖手术的疗效,组间差异均无统计学意义（P>0.05）。结论显微根尖手术明显提高持续性根尖周病变的治疗成功率。     

Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population

The present epidemiological study is derived from a random sample of 322 residents of the Porto area, aged 30-39 years. Prevalence of apical periodontitis and results of endodontic treatment were evaluated from orthopantomograms, available from 179 of a total of 197 individuals attending for examination. The results indicated a prevalence of apical periodontitis in 27% of this population. The quality of a majority (54%) of the 69 root fillings observed were found to be inadequate, (i.e. short and/or poorly condensed), but only 15 (22%) of the endodontically treated teeth presented with apical periodontitis.     

显微根尖手术探查根管治疗失败的可能原因分析

目的 通过显微根尖手术直接探查,分析以往根管治疗失败的可能原因。方法收集2006年1月—2014年1月因根管治疗失败需行根尖手术的患牙289颗,其中238个牙根被纳入研究。所有根尖手术都在显微镜下完成,手术过程中将被切除的根尖或牙根断面进行亚甲蓝染色后,放大26倍,观察先前的根管治疗情况。采用SPSS19.0软件包,应用Fisher精确检验法进行统计学处理。结果在238个牙根的根尖手术病例中,根管治疗失败的可能原因包括根管渗漏（29.41%）、遗漏根管（15.55%）、根管欠充（15.55%）、根尖部解剖结构复杂（7.98%）、根管超充（4.20%）、根尖骨开窗（4.20%）、医源性因素（3.36%）、根尖结石（2.52%）、根尖裂纹（1.68%）和未知原因（15.55%）,根管治疗失败的发生率在不同牙位差异显著（P<0.001）。结论显微根尖手术能更好地探查根管治疗失败的可能原因,为提高根管治疗成功率提供保障。     

CBCT在牙根尖周炎源性上颌窦黏膜炎根管治疗疗效评价中的应用

目的　通过CBCT检查患根尖周炎的上颌后牙,探讨牙根尖周源性上颌窦黏膜炎的特点及根管治疗后黏膜及骨质的改变。方法: 对25例患上颌后牙根尖周炎患者上颌窦进行CBCT扫描重建,确诊为黏膜炎后,根管治疗3个月后CBCT扫描明确黏膜炎消退程度,6个月后扫描通过根尖周指数评估根尖骨质愈合情况。结果: 剔除2例上颌窦炎,14例上颌窦表现为黏膜炎（61％),根管治疗3个月后,黏膜炎完全消退5例（35.7％）;部分消退6例（42.9％）;3例无明显改变（21.4％）。6个月后,3颗牙齿愈合（21.4％）,4颗牙齿好转（28.6％）,7颗牙齿未愈合（50％）。结论:上颌后牙根尖周炎易引发上颌窦黏膜炎,根管治疗是该疾病有效的治疗方法,CBCT影像能精确反映根管治疗前后上颌窦黏膜炎消退及骨质愈合情况,具有重要的临床参考价值。     

Intracanal Cryotherapy Reduces Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Multicenter Clinical Trial

Introduction

A prospective, multicentered, randomized clinical trial was designed to assess if controlled irrigation with cold saline could result in less incidence and intensity of postoperative pain in patients presenting with pulp necrosis and symptomatic apical periodontitis.

正畸在牙周病治疗中的应用及其效果的评价

目前,正畸已被广泛应用于牙周病的治疗,从最初的排齐整平牙列到正畸牵引患牙,其治疗方法也逐渐增多。但是,临床上对于真正适合于评价牙周病正畸后临床效果的指标并不统一。本文分别从牙周指标和正畸相关指标两方面,对牙周病经正畸治疗前后效果的评价作一综述。     

Clinician-centered Outcomes Assessment of Retreatment and Endodontic Microsurgery Using Cone-beam Computed Tomographic Volumetric Analysis

Introduction

Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases.

Changes in endodontic status 1973–1993 among 35-year-olds in Oslo, Norway

Epidemiological investigations from Scandinavia have documented high prevalence of apical periodontitis and inferior quality and results of endodontic treatment performed in general practice. The present investigation is part of a 20-year follow-up study on oral health in 35-year-old Oslo citizens focusing on endodontic con-ditions. The results indicate reduced prevalence of apical periodontitis and statistically significant improvement in endodontic status compared with results from a similar study performed in 1984.     

Endodontology – epidemiologic considerations

Abstract The limited information available from endodontic epidemiologic research indicates an increase in prevalence of apical periodontitis with increasing age. Furthermore, apical periodontitis seems mainly to be present in connection with already endodontically treated teeth. This finding should be of particular concern since there is a discrepancy between the quality and results of endodontic therapy performed in general practice compared with the results obtained in specialty clinics. Pulpitis and acute apical periodontitis are main reasons for seeking emergency treatment and affect many people. Dental trauma frequently involving the dentin/pulp organ are likewise prevalent, affecting 30% of children and adolescents. Most information available regarding endodontic treatment is derived from well-controlled clinical studies performed by specialists. Epidemiologic data should be considered a necessary complement to this source of knowledge regarding etiologic factors and proper treatment procedures in order to improve the results of endodontic practice.     

林可霉素治疗慢性根尖炎的对照分析

采用林可霉素治疗慢性根尖周炎131例,并作随机对照,结果表明1周窦道消失率前牙、前磨牙、磨牙均明显优于对照组（P<0.05）,治疗各组叩痛及不适改善情况与对照各组无明显差异（P>0.05）,治疗半年窦道消失率及叩痛不适好转率、X线片根尖骨愈合率治疗组前牙与对照组前牙无明显差异（P>0.05）,前磨牙及磨牙治疗组明显优于对照组。说明林可霉素治疗慢性根尖周炎对窦道消失有明显帮助,对长期前磨牙、磨牙窦道消失,叩痛、不适治愈及根尖骨质修复有明显疗效。