一次法和三步法根管治疗的临床评价

目的 :探讨一次法根管治疗和三步法根管治疗的治疗效果和适应症。方法 :将 114例急性根尖周炎(包括慢性根尖周炎急性发作 )、15 2例慢性根尖周炎、90个急性牙髓炎患牙和 82个慢性牙髓炎患牙 ,随机分为 2组。观察治疗期间 ( 7d)和治疗后短期内的 ( 3个月 )临床效果。结果 :①急性根尖周炎非黏膜下脓肿期一次法比三步法的愈合时间长、疼痛分值高 ,服用抗生素时间长。②急性根尖周炎晚期 (黏膜下脓肿期 )一次法和三步法临床效果无差异。③慢性无瘘性根尖周炎一次法比三步法的愈合时间长、疼痛分值高。④慢性有瘘性根尖周炎一次法与三步法无明显差异。⑤急、慢性牙髓炎两种方法的治疗效果相同。结论 :与三步法相比 ,一次法根管治疗适用于急性根尖周炎晚期、慢性有瘘性根尖周炎和急、慢性牙髓炎。     

甲硝唑联合Vitapex辅助治疗皮肤窦道型根尖周炎的临床效果

目的探讨甲硝唑联合Vitapex辅助治疗皮肤窦道型慢性根尖周炎的临床效果。方法皮肤窦道型慢性根尖周炎患者30例,患牙30颗,根管预备后,0.5%甲硝唑注射液冲洗根管至窦道口流出,Vitapex糊剂根管充填,1个月内每2周复诊1次,若窦道未愈合给予窦道刮治术。治疗后1～3个月复诊,进行临床检查,拍根尖X线片,对根尖周暗影缩小或消失、无临床症状、窦道已完全消失的患牙,完成根管充填,牙体充填修复或全冠修复。结果 30例患者中28例经1～3次辅助治疗后皮肤窦道愈合,患牙无松动或叩痛。2例治疗后仍有窦道行窦道刮治术后愈合,患牙无松动或叩痛。治疗后1～3个月复查,无临床症状,X线片上未见根尖暗影扩大,完成根管侧压充填,牙体充填修复或全冠修复。随访6～12个月,3例复发,2例行根尖切除及窦道刮治术后愈合,1例患牙松动无功能而拔除。结论甲硝唑联合Vitapex辅助治疗皮肤窦道型慢性根尖周炎效果良好,能减少手术治疗的创伤和痛苦。     

甲硝唑-氯已定溶液治疗根尖周炎的疗效观察

目的观察甲硝唑与氯已定混合液(简称甲-氯液)治疗根尖周炎的疗效。方法选取慢性根尖周炎患牙(无瘘管)202颗,随机分为甲乙两组。甲组(102颗)用甲-氯液冲洗及棉球或捻蘸药消毒根管;乙组(100颗)用氯亚明、过氧化氢冲洗,FC消毒根管,暂封。观察根管治疗期间急症发生情况。选取急性根尖周炎患牙164颗,随机分为甲组(80颗):开髓、拔髓,甲-氯液捻或棉球消毒根管并暂封;乙组(84颗)同前乙组处理,但开放髓腔。观察急性炎症控制情况。另选取经3次或以上根管换药FC、碘仿,根管内仍有脓液的慢性根尖周炎患牙44颗,改用甲-氯液作根管冲洗及消毒,观察脓液消失情况。所得结果用四格表χ2检验作统计学分析。结果慢性根尖周炎根管治疗期间急症发生率甲组明显低于乙组;对急性根尖周炎症状的控制甲组明显优于乙组。两组间比较,均有显著性差异(P<0.05)。根管换药改为甲-氯液后,有效率达97.6%。结论甲-氯液作为根管冲洗及消毒剂,对治疗根尖周炎有良好疗效。     

不同根管消毒方法对慢性根尖周炎根管内毒素 清除效果的临床研究

目的 研究Nd:YAG激光照射、超声冲洗及氢氧化钙封药等根管消毒方法对慢性根尖周炎患牙根管内毒素的清除效果.方法 选择临床诊断为慢性根尖周炎的上颌单根管前牙30颗,随机分为3组,镍钛器械常规预备后,分别采用Nd:YAG激光照射(A组)、超声冲洗(B组)及常规氢氧化钙封药(C组)等方法进行根管消毒,检测各组患牙治疗前后根管内内毒素的含量变化.结果 3组患牙治疗前内毒素含量的差异无统计学意义(P>0.05);A、B、C 3组患牙治疗前、预备后、治疗后内毒素含量差异均有统计学意义(P<0.05);治疗后3组间差异无统计学意义(P>0.05).结论 Nd:YAG激光照射、超声冲洗、氢氧化钙封药3种消毒方法均有较强清除灭活根管内毒素作用;50mjNd:YAG激光消毒1min或无菌蒸馏水超声冲洗1min可起到与氢氧化钙封药相同的根管内毒素清除效果.     

微小小单胞菌与慢性根尖周炎临床症状的相关性研究

目的：研究慢性根尖周炎感染根管中微小小单胞菌( Parvimonas micra,Pm)的检出情况以及与慢性根尖周炎临床症状、体征的关系。方法采集104名慢性根尖周炎患者的120颗患牙根管内标本,其中包括初次治疗组(A组)和再次治疗组(B组)各60颗患牙。利用16S rDNA聚合酶链反应技术检测标本中的微小小单胞菌16S rDNA的表达;用比值比( OR值)的方法,分析Pm检出率与慢性根尖周炎临床症状及体征的关系。结果慢性根尖周炎初次治疗组检出Pm 24例,再次治疗组检出Pm 3例。2组结果通过比值比分析发现,随检出Pm几率增加,慢性根尖周炎根管内出现恶臭(A组OR=3．35,B组OR=14．29)或根尖出现大于5mm的根尖病变(A组OR=2.75, B组OR=6.70)的几率随之增加,95%可信区间下限>1,结果有显著性差异(P<0．05)。结论无论在初次治疗或再次治疗的慢性根尖周炎感染根管中均有Pm 检出。 Pm 可能在该疾病的发生发展过程中发挥一定作用。     

面颊部皮瘘牙保存治疗56例报告

198 4年以来 ,我们采用一次性根管治疗患牙后 ,手术清除根尖区病变组织 ,切除皮肤瘘道 ,清创缝合创口的综合治疗方法 ,对 5 6例患牙经 1～ 3年的临床观察 ,疗效好 ,复发率低 ,患牙保存成功率高 ,报告如下。　　　一、临床资料5 6例中 ,男 38例 ,女 18例 ;年龄 12～ 5 6岁 ,病史最短 2个月 ,最长 12年 ;2 7例为第一次就诊治疗 ,36例患牙有 1次以上的治疗史伴皮肤瘘道反复流脓 ,18例瘘道口周围纤维组织增生 ,疤痕收缩 ,有比较明显的畸形 ,由瘘道口用探针多可探及患牙根尖区。根尖区病变 5 1例为慢性化脓性根尖周炎 ,5例为根尖囊肿继发感染 ,5 …     

碘仿氢氧化钙用于根管消毒的临床疗效观察

目的：评价碘仿氢氧化钙糊剂和氢氧化钙糊剂根管内消毒效果的差异。方法：将340有瘘型慢性根尖周炎患牙,在常规根管预备成形后,随机分为2组：碘仿氢氧化钙组170颗患牙,将碘仿氢氧化钙糊剂导入根管内暂封1周;氢氧化钙组170颗患牙,将氢氧化钙置入根管内暂封1周,分别复查封药1周,根充2周,根充3月后各组牙的临床症状和体征,对比根管消毒效果及封药后疼痛反应情况。结果：慢性根尖周炎患牙碘仿氢氧化钙组封药1周,根充2周,根充3月有效率分别为84.4%;86.7%;85.6%,氢氧化钙组有效率分别为77.3%,68.2%,68.2%。两组有效率的差异有统计学意义（P〈0.05）。结论：对于慢性根尖周炎患牙根管内封碘仿氢氧化钙糊剂能发挥更好的根管消毒作用。     

Vitapex糊剂治疗根尖周炎疗效观察

目的探讨Vitapex糊剂治疗慢性根尖周炎疗效与氧化锌丁香性糊剂疗效观察。方法将255例根尖患牙随机分成2组。Vitapex实验组135例。根管内注入Vitapex糊剂后加牙胶尖致密充填;常规治疗组氧化锌丁香油糊剂 牙胶尖致密充填。结果治疗总有效率实验组91.85%,对照组82.5%。两组疗效有显著差异(P<0.05)。结论Vitapex糊剂在治疗慢性根尖周炎患牙疗效优于氧化锌丁香油糊剂     

急性根尖周炎患牙治疗前后前列腺素E-2水平的变化

目的　检测急性根尖周炎患牙治疗前后根管渗出液中前列腺素E2水平的变化。方法　用同位素放射免疫法测定25例急性根尖周炎患牙治疗前后根管内渗出液中前列腺素E2含量的变化。结果　急性根尖周炎患牙治疗前后前列腺素E2的含量明显不同,治疗前明显高于治疗后。结论　前列腺素E2水平的变化与根尖周炎临床表现之间有着密切的关系,根管渗出液中前列腺素E2浓度反映出根尖周炎的活动性。     

空管法治疗根尖周病伴瘘管八例报告

一九八六年以来,我们用空管法治疗八例根尖周病伴瘘管,疗效显著。八例共10颗患牙,患者年龄最大者42岁。最小者25岁.患牙均有不同程度叩痛,多数牙有变色,其中4例伴牙瘘,1例伴皮瘘。均为“急(慢)性根尖周炎”。用空管法治疗.方法:常规处理根管,根管内封入 F、C 棉捻,五日后取出,     

Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients

BACKGROUND/AIMS: The presence of selected bacteria (Enterococcus faecalis, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, Treponema denticola) in infected root canals was studied using polymerase chain reaction (PCR) assays, and the association of bacteria with clinical signs of endodontic disease was assessed. The null hypothesis, that no difference could be observed between clinical signs of apical periodontitis and a specific bacterial strain, was tested. METHODS: Microbial samples were obtained from 62 teeth in 54 patients with endodontic disease. For each tooth, clinical data including patient symptoms were collected. Teeth were categorized by diagnosis as having acute apical periodontitis (AAP, teeth with clinical symptoms but no periapical radiolucency, n=22), chronic apical periodontitis (CAP, teeth with radiolucency but no clinical symptoms, n=15) or exacerbated apical periodontitis (EAP, teeth with symptoms and radiolucency, n=25). Seventy-one percent of cases were primary endodontic infections, and 29% were recurrent ('secondary') endodontic infections (failing cases). PCR assays were used to detect the presence of the selected bacteria. RESULTS: T. denticola and E. faecalis were each detected in 15 of 62 samples (24%), P. gingivalis in 8 samples (13%), P. intermedia in 5 samples (8%), and T. forsythensis in 4 samples (7%). T. denticola was detected in 56% of teeth with EAP. E. faecalis was found in 60% of teeth with CAP and in 72% of teeth with secondary infection. Statistical analysis demonstrated an association of CAP and secondary endodontic infection with the presence of E. faecalis. (P<0.01). EAP was associated with the presence of T. denticola (P<0.01). CONCLUSION: T. denticola was associated with symptomatic endodontic disease in the presence of apical bone resorption. E. faecalis was associated with treatment failures. We suggest that these species may play critical roles in endodontic pathology.     

MTA应用于显微根尖手术治疗慢性根尖周炎的效果观察

目的 观察三氧化矿物凝聚体(mineral trioxide aggregate,MTA)应用于显微根尖手术治疗慢性根尖周炎的效果.方法 无法行常规根管再治疗的慢性根尖周炎患者64例91颗患牙,随机分为观察组和对照组.观察组患者32例48颗,行显微根尖手术,应用MTA进行倒充填治疗.对照组患者32例43颗,行传统外科根尖手术联合银汞合金充填治疗.术后每隔3个月定期复诊,随访12个月,通过临床和X线检查评估根尖周病损愈合情况,进行疗效判定.结果 观察组痊愈27颗,改善17颗,成功率91.67%(44/48);对照组痊愈19颗,改善12颗,成功率72.09%(31/43).观察组治疗成功率明显高于对照组(x2=5.997,P=0.014).结论 MTA应用于显微根尖手术治疗慢性根尖周炎效果满意.     

年轻恒前牙感染根管内血管再生的动物实验研究

目的通过建立根尖周炎模型观察年轻恒前牙根管内血管再生的组织学状况。方法选择4个半月龄杂种犬1只,建立上颌未发育完成的恒前牙根尖周炎模型,将6颗上颌恒前牙随机分组,对照组3颗采用根尖诱导成形术,实验组3颗采用根管内血管再生术。将术后1、4、8周的X线片分别与术前X线片进行对比,观察牙根继续发育及根尖炎症的愈合情况。术后8周处死动物,利用苏木精-伊红（HE）染色观察根尖闭合情况及根管内容物的构成。结果X线观察,术后1、4周,2组牙根的根尖孔大小及根尖透射区范围未见明显改变。术后8周,实验组根尖透射区范围缩窄较明显,并出现根尖孔缩窄的趋势,但管壁厚度无明显变化;而对照组根尖透射区变化不一。组织学检查,实验组管腔内可见肉芽组织,其中包含有大量的不规则的类牙本质、类牙骨质和类骨质样钙化物,钙化物以根尖部和管腔内侧壁尤为明显。对照组管腔未见软组织,根尖部有少量的硬组织沉积。结论血管再生术可促使年轻无髓恒前牙的慢性根尖周炎症消退,根管内再生的肉芽组织中有硬组织沉积。     

Endodontic management of immature teeth with spontaneous apical closure and periapical lesions: case series and review of the literature

Spontaneous apical closure in non‐vital immature teeth has been rarely encountered and outcome of non‐surgical endodontic treatment of related teeth associated with periapical lesions has not yet been adequately elucidated. The aim of this article was to report endodontic management of spontaneous apical closure of infected untreated immature teeth with periapical lesions and to review previously proposed mechanisms for the development of spontaneous hard tissue barrier. Three patients were referred at different time intervals to the endodontic clinic for treatment of their maxillary anterior incisors with acute or chronic apical periodontitis . Dental histories indicated that related teeth had been subjected to trauma approximately 12–18 years previously. Radiographically, the involved teeth exhibited incomplete root formation with spontaneous apical closure and were associated with an apical radiolucency. After biomechanical preparation, calcium hydroxide paste was applied and was changed once or twice within 3 months. All canals were then filled with gutta‐percha and AH Plus and the follow‐up period was 16–50 months; both clinical and radiographic examinations revealed adequate function, the absence of clinical symptoms and significant healing of the periapical radiolucency.     

CGF联合根尖刮治术及单一根尖刮治术治疗慢性窦道型根尖周炎的比较

目的 探讨血小板浓缩生长因子(CGF)联合根尖刮治术及单一根尖刮治术治疗慢性窦道型根尖周炎的临床疗效.方法 选择80例慢性窦道型根尖周炎患者为研究对象,分成CGF组和对照组.对照组采取根尖刮治术治疗,CGF组在对照组基础上给予CGF覆盖根尖区创面治疗.结果 CGF组治疗后总有效率95.00％显著高于对照组77.50％....     

尖周病变患者循环血中产黑色素普里沃氏菌等细菌抗体水平

对１８名健康人、２０例慢性尖周炎、１８例慢性尖周炎急性发作患者循环血清中的产黑色素普里沃氏菌等抗体进行了检测。发现正常人血清存在一定效价的中间型普里沃氏菌抗体，在尖周炎阶段该菌抗体水平明显上升，急性尖周炎患者血清中牙龈卟啉菌抗体效价明显高于慢性尖周炎，而正常人血清牙龈卟啉菌抗体效价极低。     

碧兰根充糊剂一次性根充窦道型慢性根尖周炎疗效观察

目的：观察碧兰根充糊剂一次性根充窦道型慢性根尖周炎的疗效,并与传统的氧化锌碘仿根充糊剂进行比较。方法：选择窦道型慢性根尖周炎患者160例,随机分为实验组（碧兰糊剂）80例,对照组（氧化锌碘仿糊剂）80例,同时在局麻下于窦道开口处实施彻底根尖刮治术,用3％双氧水生理盐水交替冲洗病变区,窦道清刮术后,视情况于窦道内置碘仿细纱条,用碧兰糊剂加牙胶尖（实验组）和氧化锌碘仿糊剂加牙胶尖（对照组）进行根管充填。结果：术后7d内,实验组87．5％患者无不适感,对照组37．5％无不适感,实验组疗效显著高于对照组（P〈0．05）。1年的连续观察评价临床疗效,实验组治疗后有效率100％,对照组治疗后有效率96．3％,近期疗效明显高于对照组,远期疗效无显著性差。结论：碧兰根充加根尖刮治治疗窦道型慢性根尖周炎治疗效果满意,临床值得推广。     

Guided Endodontics: Use of a Sleeveless Guide System on an Upper Premolar with Pulp Canal Obliteration and Apical Periodontitis

Guided endodontics has been used for the treatment of anterior teeth with a successful outcome. This approach is not only limited to anterior teeth because it can also be used for the treatment of premolars and molars. However, in such cases, space may be a limitation because a long bur has to be used in addition to the guide being placed on top of the teeth. The aim of this case report was to present a novel guided endodontics technique using a sleeveless 3-dimensional–printed guide. This design can reduce vertical space, allowing an open view of the tooth and irrigation during drilling. A 46-year-old female patient consulted the endodontic department with intermittent pain around tooth #5. Tooth #5 presented pain upon percussion and responded negative to a cold test. The initial periapical radiograph revealed an apical radiolucency with pulp canal obliteration. Clinically, there was no sinus tract. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. Guided endodontic treatment was performed with a sleeveless 3-dimensional–printed guide and long neck carbide bur with a head diameter of 1 mm to drill a minimally invasive access cavity up to the root canal. A completely healed apical area of tooth #5 was visible after 1 year on periapical radiographs. This technique seems to be a promising alternative in comparison with the conventional guided endodontic guide design for the negotiation of pulp canal obliteration in cases in which vertical space is limited.     

超声冲洗对感染根管内毒素的灭活及清除作用

目的探讨超声冲洗对感染根管内毒素的灭活及清除作用。方法选择因严重慢性根尖周炎拔除的具有双根管的离体上颌前磨牙10颗,常规开髓,用改良双敞法预备根管,将3％过氧化氢溶液30 μL注入根管,行超声振荡,每根管振荡2 min,分别于根管预备后和超声振荡后取样,测量内毒素活性。另外在临床患者中选择患有慢性根尖周炎的双根管上颌前磨牙10颗,采用相同的方法进行根管预备,预备后以无菌蒸馏水为介质进行超声冲洗,每根管均冲洗2 min,分别于根管预备前、根管预备后和超声冲洗2 min后根管取样,测量内毒素活性。内毒素活性的测定采用动态浊度法鲎试验,并对超声处理前后根管内毒素活性的差异进行分析。结果离体牙超声振荡前,根管内毒素的活性平均为4.069 EU·mL-1,超声振荡后为16.410 EU·mL-1,二者差异有统计学意义（P<0.01）,超声振荡后内毒素活性明显升高。临床样本中,根管预备前、根管预备后和超声冲洗后根管内毒素的平均活性分别为44.860、4.099、0.116 EU·mL-1,根管预备前与根管预备后内毒素活性的差异有统计学意义（P<0.01）,根管预备后内毒素活性明显下降;根管预备后与超声冲洗后内毒素活性的差异也有统计学意义（P<0.01）,超声冲洗后内毒素活性明显下降。结论在模拟临床操作的条件下,采用口腔科超声根管治疗仪进行超声冲洗可以明显增强根管冲洗液清除感染根管内毒素的作用,但不能增强根管冲洗液灭活感染根管内毒素的作用。