机用镍钛锉根管预备的临床应用研究

目的：比较机用镍钛锉与手用K型锉根管预备的临床应用。方法：将牙位相同、诊断相同，全身情况类似的患者按随机配对原则分入甲乙两组，甲组为镍钛锉预备组；乙组为K型锉预备组，每组50例患者。结果：对于单根管牙齿，使用机用镍钛锉进行根管预备，所用时间与传统手用K型锉根管预备相比无显著差异，对于双根管牙及磨牙而言，采用机用镍钛进行根管预备所用时间明显少于使用传统手用K型锉根管预备，根管预备一周内，使用机用镍钛锉根管预备与传统手用K型锉根管预备术后反应无显著差异，结论：传统手用K型锉预备根管相比，机用镍锉具有省时省力的优点。     

Hero Shaper镍钛机用器械去除根管旧充填物能力的体外研究

目的　研究Hero Shaper 镍钛机用根管预备器械去除根管旧充填物的能力。方法　选取临床拔除的48 个单根管前牙, 随机分为2组, 用改良式逐步后退法进行根管预备, 牙胶尖与碧兰糊剂侧方加压充填根管。放置30 d后用不同的方法去除根管旧充填物:A组为H型锉+氯仿组;B组为Hero Shaper+氯仿组;记录操作时间。将牙根纵劈,立体显微镜下观察根管冠1/3 ,中1/3 ,根1/3的残留物情况。结果　在根管的3部分,2种方法清理后的残留物量均无统计学差异(P>0.05)。B组操作时间明显少于A组,具有统计学差异(P<0 .01)。结论　根管再治疗中,使用Hero Shaper镍钛机用根管预备器械可以减少操作时间,获得和H锉相似的清理效果。     

ProTaper机用镍钛锉根管预备的临床效果分析

目的 评价ProTaper机用镍钛锉根管预备的临床效果。方法 选择300颗患牙（638个根管）随机分为ProTaper组和K锉组,分别用ProTaper机用镍钛锉和K锉进行根管预备,采用χ2检验比较根管预备后的疼痛反应、根管充填效果及器械分离情况。结果 ProTaper组根管预备后疼痛发生率为6.00%,较K锉组的根管预备后疼痛发生率（26.67%）少（P<0.01）,ProTaper组根管恰填率为93.77%,较K锉组（88.64%）高（P<0.05）,两组间的器械分离则无统计学差异（P＞0.05）。结论 ProTaper机用镍钛锉能有效降低根管预备后疼痛的发生和提高根管充填质量,而且较为安全。     

机用镍钛锉预备根管对手感法探测根管工作长度的影响

笔者使用最新一代机用镍钛器械ProTaper预备根管，应用手感法探测根管工作长度，并对其进行观察用该器械对手感法测量根管工作长度的影响。     

ProTaper机用镍钛锉预备根管的临床评价

目的观察ProTaper机用镍钛锉的根管预备效果。方法将行根管治疗的76颗患牙共146个根管随机分为P组（38颗牙，74个根管）和S组（38颗牙，72个根管），P组用ProTaper机用镍钛锉冠根向逐步深入法预备根管，S组用手用不锈钢锉逐步后退法预备根管，观察两组在根管预备时间、锉折断、备根后患牙的疼痛发生率和根充效果的差异。结果P组根管预备时间平均为4min20s，明显少于S组的9min31s；两组的器械折断率无显著性差异（P〉0．05）；P组备根后疼痛发生率为5．3％，明显低于S组的23．7％（P〈0．05）；P组根充恰填率明显高于S组（P〈0．01），欠填率明显低于S组（P〈0．01）。结论只要掌握冠根向备根技术的要点，ProTeper机用锉比传统手用不锈钢锉更省时省力，可以有效地降低术后疼痛发生率，提高根充效果。     

机用镍钛锉ProTaper预备根管的临床观察

根管预备是根管治疗术的重要步骤之一,良好的根管预备是根管治疗成功的前提.近几年来机用镍钛锉开始应用于临床,为根管预备提供了新的手段.笔者采用机用ProTaper和不锈钢K锉对164颗磨牙进行了根管预备和临床对比观察,现报告如下:     

Mtwo镍钛系统去除根管内充填物的效果评价

目的 评估Mtwo镍钛再治疗系统去除椭圆形根管内充填物的效果.方法 选择30颗椭圆形根管的下颌前磨牙经ProTaper Universal预备、侧方加压法充填后随机分为2组,分别采用Mtwo再治疗器械(Mtwo镍钛组)、手用不锈钢器械(手用器械组)去除根管内充填物.采用Image Proplus软件比较2组根管内管壁充填物的残留量百分比,纪录器械操作所需的时间.结果 2组根管内均残留有充填物.整个管壁充填物残留量百分比,Mtwo镍钛组(0.39±0.12)%与手用器械组(0.41±0.13)%差异无统计学意义.根管内各部分充填物的残留量百分比:冠部1/3,手用器械组(0.04±0.02)%少于Mtwo镍钛组(0.09±0.04)%;中1/3,Mtwo镍钛组(0.10±0.05)%少于手用器械组(0.20±0.08)%.2组根尖部充填物的残留量百分比均高于根中及冠部.Mtwo镍钛组的操作时间(5.68±0.74)min明显低于手用器械组(11.32±1.01)min,且差异有统计学意义(t=27.9,P=0.001).结论 Mtwo器械较手用器械可减少操作时间,2组器械均无法完全去除椭圆形根管内充填物.     

镍钛预备系统的运动模式对去除根管充填物效果影响的研究现状

根管治疗失败后,非手术根管再治疗是最基本的治疗手段。尽可能彻底地去除根管内原有的充填材料是根管再治疗的首要问题。镍钛预备系统已经被证实可用来去除根管充填材料,但其运动模式的不同也会在治疗过程中产生差异。本文将针对不同运动模式镍钛预备系统去除根管充填物的效果以及过程中产生的问题进行比较。     

手用ProTaper镍钛锉与不锈钢H锉根管预备的临床疗效

目的比较手用ProTaper镍钛锉与标准手用不锈钢H锉根管预备的临床疗效。方法选择100例患者需作根管治疗的120颗患牙随机分为实验1组和实验2组,每组60颗患牙。实验1组使用标准手用不锈钢H锉和逐步后退法预备根管;实验2组使用手用ProTaper镍钛锉和冠向下预备技术预备根管。根管治疗完成后,随访3个月,观察临床疗效。结果实验2组根管治疗后疗效明显优于实验1组,其差异有统计学意义(P<0.05)。结论手用ProTaper锉系统柔韧性好,治疗成功率高,值得临床推广应用。     

镍钛机用器械根管预备

自1988年Johnsen发明Profile后,镍钛机用器械逐渐成为根管预备的主要器械,医师可以借助机动器械对根管进行安全处理,引发了根管治疗的技术革命。1.镍钛机用器械概述目前国内使用的系统主要有:Profile(Dentsply)、ProTaper(Dentsply)、Hero642(Micro-Mega)、Hero Shaper(Micro-Mega)、K3(Sybronendo)、Flexmaster(VDW)、Race(FKG)、GT(Dentsply)和Light Speed(LigthSpeedUSA)等,这些系统有一定的相似性,也有各自的特点。镍钛机用系统的共同特点:①镍钛金属材料的成分基本雷同;②大锥度的设计;③均为螺旋设计,器械在根管中能方…     

R-Endo镍钛系统在根管再治疗中的应用

目的评价R-Endo镍钛机用器械在离体牙根管再治疗中的应用性能。方法收集根尖孔发育完成的单根管恒牙,根据根管弯曲度分层随机分组。使用牙胶或RealSeal树脂充填,而后分别使用Gates-Glidden钻＋K锉、HERO 642镍钛机动和R-Endo镍钛机动再治疗。记录再治疗时间及从根尖孔推出的碎屑重量,并拍摄术后X线片,AutoCAD 2008软件分析残余充填材料与根管壁的面积比。结果 R-Endo镍钛系统再治疗时间较长（P＝0.003）;推出根尖孔碎屑量较Gates-Glidden钻＋K锉少（P＝0.001）,与HERO 642镍钛系统相比差异无统计学意义（P＝0.239）;根管内残余充填材料与根管壁的面积比低于其他两组,但差异无统计学意义（P＝0.157）。 RealSeal充填组再治疗时间（P＝0.001）和推出根尖孔碎屑（P＝0.028）均低于牙胶充填组,两者间差异均具有统计学意义（P＜0.05）。结论 R-Endo机动镍钛系统是根管再治疗的有效方法,其根管清理性能优于手动器械,对根尖周组织激惹度较传统手动器械小,但器械的安全性有待提高。     

2种镍钛再治疗器械清理根管内充填材料效果比较

目的:比较Protaper Universal、R-Endo镍钛根管再治疗器械和手用H锉等3种器械在再治疗根管中对牙胶的清理能力。方法:选取60个单根管的离体下颌前磨牙,截去牙冠部统一工作长度,使用Hero 642镍钛器械预备至30#,侧方加压法完成牙胶尖和糊剂充填。样本随机分为3组,分别使用手用H锉,Protaper Universal和R-Endo清理根管内充填材料,记录操作过程引起的堵塞、台阶、穿孔等并发问题以及操作时间。随后从颊舌和近远中2个角度拍数码X线照片,使用图像分析软件分析根管壁的清洁度。结果:所有样本均有充填物残留,手用器械组管壁充填物的残留量明显低于机用镍钛2组(P<0.05),Pro-Taper Universal和R-Endo两者之间差异无显著性。和手用H锉比较,Protaper Universal和R-Endo均可减少再治疗的时间(P<0.05)。结论:所有器械均会残留根管充填物,机用镍钛器械残留的充填物较多,但可以明显减少操作时间。     

A comparison of the relative efficacies of four hand and rotary instrumentation techniques during endodontic retreatment

AIM: The purpose of this study was to quantify the amount of remaining gutta-percha/scaler on the walls of root canals when two engine-driven instruments (Quantec and ProFile) and two hand instruments (K-file and Hedstr?m file) were used to remove these materials. The amount of apically extruded debris and the time required for treatment were also recorded. METHODOLOGY: One hundred extracted mandibular premolars were prepared using a modified step-back, flare technique and obturated with the lateral condensation technique. After repreparation with the test instruments, the specimens were cut transversally at the cervical, middle and apical thirds with steel discs and the three sections were split longitudinally. The amount of residual debris on the canal walls in each section was examined using a stereomicroscope. RESULTS: In all groups the cervical and middle thirds showed no debris. In the apical third, obturating material was observed in some specimens. No statistically significant difference was found between the two groups for incidence of debris, although the Hedstr?m group showed a greater number of samples with remaining gutta-percha/sealer. When analysing dirty specimens only, there was a statistically significant difference between the four groups (P < 0.01) with the Hedstr?m group having significantly less length of canal wall with remaining obturation material than the Quantec group. There was no significant difference amongst the groups for weight of extruded debris. However, there was a significant difference amongst the groups for mean treatment time with the Hedstr?m file group requiring significantly less time than the Quantec group (P < 0.001); no significant differences were found between the other groups. Six instruments fractured in the Quantec group, four in the ProFile group, two in the Hedstr?m group and two in the K-type group. CONCLUSIONS: The results showed that overall, all instruments may leave filling material inside the root canal. During retreatment there is a risk of instrument breakage, especially rotary instruments.     

两种旋转镍钛器械根管预备效果的临床观察

目的对比评价两种设计特点不同的旋转镍钛器械Hero642和Pro Taper的临床成形效果。方法随机选择需要做根管治疗的磨牙100例，分为两组，分别采用两种旋转镍钛器械Hero642和ProTaper预备根管，采用冠向下预备方法。冷侧压方法充填。评价器械损耗、预备时间及成形效果。结果ProTaper器械折断3支，Hero642折断1支；Hero642组预备时间稍短于ProTaper组，两组均能形成较好的根管流畅度（P〉0．05），但ProTaper预备后根管锥度优于Hero642组（P〈0．05），根尖止点清楚。结论ProTaper用于磨牙根管预备的成形效果优于Hero642。但Hero642具有成本低、安全性好、操作易掌握的优点。     

K3根管预备系统根管预备后发生约诊间痛的临床分析

目的：采用K3根管预备系统进行根管预备,观察约诊间痛的情况,探讨发生约诊间痛的影响因素。方法临床选取因龋病或隐裂引起牙髓炎的患者共138例,其中男65例,女73例,年龄18~66岁。随机分成2组,分别采用大锥度K3机用镍钛器械（实验组）和02锥度手用不锈钢K锉（对照组）预备,比较2组根管预备后,患牙约诊间痛（EIAP）发生的情况。结果采用K3机动预备系统预备的患牙约诊间痛发生率显著低于K锉常规法（P=0.02）,两组差异有统计学意义。其中,多根管患牙在2组的差异具有统计学意义（P〈0.05）,单根管患牙无统计学意义（P〉0.05）。结论与手动不锈钢K锉相比,K3机动根管预备系统可以降低根管预备后约诊间疼痛的发生率。     

FlexMaster镍钛机用器械根管再治疗清理效果的体外研究

目的研究FlexMaster镍钛机用器械根管再治疗清理的效果。方法选取临床拔除的40颗单根管前牙,用改良式逐步后退法进行根管预备,牙胶尖与碧兰糊剂侧方加压充填根管。放置30d后随机分为两组,A组用H型锉去除根管内旧充填物,B组用FlexMaster镍钛机用器械去除充填物。分别记录操作时间。然后,将牙根纵劈,立体显微镜下观察根管冠1/3、根中1/3和根尖1/3段的残留物情况。结果在根管冠1/3处两种方法的根管清理效果无统计学差异（P〉0.05）。在根管的中段和根尖段,B组的残留物量较A组少,两组间存在显著性差异（P〈0.05）。B组操作时间明显少于A组,两组间也有显著性差异（P〈0.01）。结论与手用H型锉相比,FlexMaster镍钛机用根管预备器械去除根管旧充填物效果更好,且操作时间显著减少。     

ProTaper镍钛系统去除根管内充填物的效果评价

比较ProTaper镍钛系统去除不同充填方法的根管内充填物的效果。A组:侧方加压法充填;B组:热牙胶垂直加压法充填。2组均采用ProTaper Universal再治疗器械(D1,D2,D3)+ProTaper Universal(F2,F3,F4)去牙胶及根管再预备,测量镍钛器械操作时间及根管内充填物的残留量。B组根管壁充填物残留量低于A组,镍钛器械所需时间高于A组。2组中牙胶残留物均主要位于根尖三分之一区域。ProTaper镍钛系统去除垂直加压法充填的牙胶管壁清洁度较高。     

不同根管再治疗器械与氯仿联合使用去除根管充填材料效果的比较研究

目的:评价不同再治疗器械与氯仿联合使用去除根管内充填物的效果.方法:选取下颌单根前磨牙60个,逐步后退法预备根管,AH-plus糊剂+牙胶尖冷侧压充填4周后随机分为6组;分别用手用器械和R-endo、Mtwo R机用镍钛再治疗锉在不使用和使用氯仿情况下去除根管内充填材料,记录到达工作长度的时间(T1)、预备完成所用总时间(T2);称重法比较各组推出根尖孔的碎屑量;矢状劈开样本体视显微镜下以BettiLV计分法评价根管壁清洁度.结果:不用氯仿时Mtwo R组T1和T2最短(P＜0.05),使用氯仿时R-endo组T1和T2最短(P＜0.05).镍钛器械用氯仿组T1和T:明显少于不用氯仿组(P＜0.05),手用器械T1用氯仿组较少(P＜0.05),T:氯仿组与无氯仿组差异不显著(P＞0.05).两种镍钛器械推出根尖孔碎屑的量均显著少于手用器械组(P＜0.05),两种镍钛器械用氯仿时推出根尖孔碎屑量均明显少于不使用氯仿组(P＜0.05),而手用器械组用氯仿时碎屑量明显大于不用氯仿组(P＜0.05).各组器械使用与不使用氯仿根管壁清洁度无显著差异(P＞0.05).结论:根管再治疗时配合使用氯仿可提高机用镍钛器械工作效率,减少推出根尖孔碎屑的量,但不能提高根管壁的清洁度.     

Decision making process by senior residents of Saudi Board in restorative dentistry for nonsurgical endodontic retreatment: A retrospective study

BackgroundDespite the general guidelines for retreatment, differences in decision making exist for secondary endodontic treatment and may be related to many factors including education, clinical experience, dentist specialty, patient preferences and economic resources. Aim of the study was to evaluate the decision making of the Saudi Board in Restorative Dentistry (SBRD) senior residents in the endodontic retreatment of molar teeth as per the scientific guidelines of the American Association of Endodontists (AAE) and also to identify the causes of retreatment and measure how far they become deviated from their taught retreatment principles and inter-individual variability.Materials and methodsCase histories have been obtained from the files of cases treated in the SBRD Resident Comprehensive Case Archives in the SCHS from 2003 to 2015 in Riyadh region. The cases were only confined to Complex I and Complex II cases according to RDITN (Restorative Dental Index of Treatment Need), and seen by R3 and R4 residents only. Residents’ diagnosis was recorded as well as their treatment plan and any given notes regarding their decisions to retreat. Differences between the two groups (R3 and R4) residents and within the same group, regarding endodontic retreatment decisions and reasons for their treatment options were analyzed using Chi-Square test and Fisher’s Exact test.ResultsThe majority of residents in both R4 and R3 groups followed the recommended guidelines. R3 residents preferred to retreat all cases while R4 chose ‘no to retreat’ in few cases. Although R4 residents preferred nonsurgical retreatment more than R3 residents, the difference was insignificant. R4 residents preferred ‘no therapy’ or ‘follow up’ more frequent than R3 residents. Members of the R3 residents agreed more or less with each other as did those of the R4 residents without significant inter-individual variations within each group regarding the choice of retreatment).ConclusionsR4 residents appeared more likely, although not significant, to choose no retreatment or follow up than R3 residents. Conventional nonsurgical retreatment had the highest selection by both R3 and R4 residents. No significant inter-individual variations within each group regarding the choice of retreatment. There is a need to establish evidence based guidelines for more uniform management of failed root treated teeth.