泸州及周边地区下颌恒前牙根管系统CBCT的研究

目的 用锥形束CT(CBCT)研究下颌恒前牙的根管构型等,为临床根管治疗提供参考依据.方法 回顾泸州医学院附属口腔医院就诊的186名患者的CBCT数据,分析1026颗下颌恒前牙牙根数目、根管形态、对称性双根管下恒前牙根管分叉处至解剖型根尖的距离(双根下颌尖牙除外).结果 1026颗下颌恒前牙中,中切牙、侧切牙、尖牙的双根管发生率分别为10.71%、20.86%、4.63%.按照Vertucci的根管形态分类,所有下颌恒前牙以I型为主.下颌前牙的对称率:I型较高,其次为VI型、VII型.双根管解剖性根尖至下恒前牙根管分叉处的距离主要集中在5~8mm.结论 下恒前牙根管系统复杂多变;下恒侧切牙双根管率、双根管对称发生率最高.     

上颌侧切牙2-2型根管1例

根管治疗术目前为临床治疗牙髓病、根尖周病的主要手段,也是术后保存患牙和桩冠修复的基础。临床中根管治疗成功的关键因素之一是对于髓腔解剖的全面了解和掌握,我们在治疗中常常因遗漏变异的根管而致失败。Vertucci等[1]对2400颗恒牙的研究发现,所有的上前牙均为单根牙,根管结构通常为1-1型根管(1个根管口,1个根尖孔)。出现双根管或多根管临床上非常罕见。作者碰到根管结构为2-2型(2根管口,2个根尖孔)的上颌侧切牙伴根尖周炎1     

中国人离体第一双尖牙解剖初探

目的：旨在了解国人第一双尖牙具体统计数据、解剖特点，为临床医生提供根管治疗正畸的有关依据。方法；用游标卡尺和根管扩大针测量探查320个离体第一双尖牙的有关解剖数据。结果：发现上颌牙单根管的出现率为4.4%，而下颌牙双根管的出现率为34.65%，根尖孔至根尖距离平均为0.88mm。根尖孔并非位于根尖正中，它可偏向远、近、颊、舌侧等。而牙根可弯向远、近、颊、舌侧等。根尖孔位于根尖正中有22个牙，牙根不弯的有46个牙，而根尖孔位于正中同时牙根不弯的只有8个牙，根分叉的位置，上牙最低为11.00mm，下牙为13.85mm。结论：中国人第一双尖牙单根管的发生率远远高于以前资料，第一双尖牙根管治疗时的工作长度距真正根尖应为1.88mm左右。     

光动力疗法对侧支根管内粪肠球菌杀灭作用的实验研究

目的:观察光动力疗法(Photodynamic therapy,PDT)对离体牙侧支根管内粪肠球菌的杀灭作用。方法:选取人类单根管离体前牙60颗,随机分为3组。常规根管预备后,在牙的近远中面距离根尖孔3mm处制备15#K锉直径(锉尖直径为150μm)的人工侧支根管,建立粪肠球菌感染模型。实验组为PDT组,以40μg/ml血卟啉单     

改良根尖冷冻疗法对根管预备术后疼痛影响的研究

目的 探索改良根尖冷冻疗法对根管预备术后疼痛的影响.方法 将100例单根管、龋源性根尖周炎的患者随机均分为5组,行规范化的根管预备.对照组(C组)使用生理盐水(20℃、4ml/min、5 min)冲洗根尖区+氢氧化钙(20℃、0.1 ml)封药;经典冷冻组(T组)使用生理盐水(2.5℃、4 ml/min、5 min)冲...     

下颌前牙唇舌侧骨壁厚度的锥形束 CT 研究

目的：应用锥形束 CT(CBCT)测量下颌前牙唇舌侧骨壁厚度,为即刻种植提供临床指导。方法选取132例正常牙合个体的 CBCT 图像,对其下颌前牙进行研究。测量根尖处、根尖1/4、根中1/2、根颈1/4处的唇舌侧骨壁厚度,比较左、右侧及性别之间骨壁厚度的差异。结果下前牙左右侧同名牙相应骨壁厚度无差异。除根颈1/4处外,舌侧骨壁较唇侧厚。中切牙、侧切牙和尖牙在根颈1/4处,唇侧骨壁厚度>2 mm 的比例分别占0、0和1.51%。在根中1/4处,分别占0.76%、1.44%和3.79%。性别对舌侧骨壁厚度有影响。结论应用 CBCT 建立了正常牙合个体下颌前牙区唇舌侧骨壁厚度的参考值,为即刻种植提供临床指导依据。     

左上颌侧切牙双根管1例

1　病例报告患者男 ,3 5岁。因左上颌前牙牙龈处有脓疱来诊。检查 :　 | 2　 |　 位置正常 ,色泽灰暗 ,远中牙颈部龋坏 ,穿髓 ,探痛(-) ,叩诊( ) ,唇侧根尖部牙龈可见窦道 ,挤压出脓。Ｘ线可见 　 | 2　 |　 根尖 1/ 3的近中侧有一 0 2ｃｍ× 0 5ｃｍ大小的稀疏区 ,根尖向远中弯曲 ,粗细、长短无明显改变 ,未见有侧副根管。诊断 :慢性尖周炎 (有窦道型 )。行根管治疗术。术中根管更换ＦＣ棉球 3次 ,窦道未见消失。再次检查见主根管口的腭侧有一着色点 ,探针可探入。用 15号扩孔钻可顺利扩展到原根管长度 ,继续扩根、冲洗 ,干燥根管后再封…     

光动力疗法对侧支根管内粪肠球菌杀灭作用的实验研究

目的观察光动力疗法(Photodynamic therapy,PDT)对离体牙侧支根管内粪肠球菌的杀灭作用。方法选取人类单根管离体前牙60颗,随机分为3组。常规根管预备后,在牙的近远中面距离根尖孔3 mm处制备15#K锉直径(锉尖直径为150μm)的人工侧支根管,建立粪肠球菌感染模型。实验组为PDT组,以40μg/ml血卟啉单甲醚(Hemato-porphyrin monomethylether,HMME)为光敏剂,避光孵育5 min后用激光功率为80 mW的532 nm半导体激光在根管内上下提拉螺旋照射120 s;阳性对照组为5.25%次氯酸钠冲洗组;阴性对照组为生理盐水冲洗组。各组实验牙标本(每个离体牙近中面侧支根管作为实验前标本,远中面侧支根管作为对应的实验后标本)处理前与处理后即刻用20#K锉取侧支根管内碎屑,然后将碎屑转至含5 ml TPY液体培养基的试管中,10倍递增连续稀释后厌氧培养24 h,菌落计数并推算对应的菌液浓度。结果菌落计数统计结果显示:(1)与阴性对照组(生理盐水冲洗组)比较,HMME-PDT处理组和阳性对照组(5.25%次氯酸钠冲洗组)各侧支根管内细菌量均显著下降(P<0.01);(2)HMME-PDT对侧支根管内粪肠球菌的杀灭效果(92.56%)显著优于阳性对照组(76.93%),差异有显著意义(P<0.01)。结论 HMME-PDT对侧支根管内粪肠球菌有很好的杀灭作用,将为根管消毒提供一种新的有效途径。     

不同根充方式与清洗方法对纤维桩粘接强度的影响

目的:研究不同根充方式和清洗方法对纤维桩粘接强度的影响.方法:收集因正畸治疗需要或者因牙周炎拔除的离体下颌单根管前磨牙48 颗,常规根管预备后随机分为两组,每组24颗.A组仅根充根尖1/3,B组热牙胶垂直加压充填整段根管.桩道预备后每组再根据根管清洗方法分为3个亚组(每组8颗),分别采用3 种冲洗剂及冲洗剂组合对桩道进...     

下颌尖牙双根管1例

病人,男,7 6岁.因左下前牙缺损就诊.检查:33为残冠,可探及根管口,探(-)、叩(-)、冷热刺激(-),无松动;X线牙片示:33根尖(-).初步诊断:33牙髓坏死.治疗计划:33根管治疗术.治疗中发现舌侧有第2根管,呈唇舌向直线排列,各自独立,两根管均通畅,清理扩大根管,暂封FC棉捻.1周后复诊,无自觉症状.根管糊剂加牙胶尖充填根管,复合树脂修复.术后随访,无不适.     

Spiral computed tomographic demonstration of C-shaped canals in mandibular second molars

OBJECTIVES: The aim of this study was to evaluate the prevalence of C-shaped canals in single rooted mandibular second molars with spiral computed tomographic imaging in detail. METHODS: One hundred and twelve single-rooted mandibular second molar samples were selected from 491 extracted mandibular second molars. The teeth were scanned by spiral computed tomographic technique to examine canal configurations. RESULTS: The evaluation criteria of the shape of roots was based on Manning's category as round, oval and C-shaped. The prevalence of C-shaped canals was found to be 8.1% in mandibular second molars. The evaluation of the root canal configurations of C-shaped mandibular second molars with single roots (40 teeth) was based on Vertucci's classification. Vertucci type I canals were most frequently seen in C-shaped mandibular second molars (40%). Additionally, we disclosed three additional canal types. CONCLUSION: Results of this study demonstrated that high resolution visualization of the root canal shape can be achieved by spiral computed tomographic imaging.     

显微超声技术治疗磨牙中上段不完全钙化根管的疗效分析

目的:评价显微超声技术在不完全钙化根管扩通治疗中的疗效。方法:采用显微超声技术对不完全钙化根管进行治疗,统计成功率。结果:70个不完全钙化根管中:44个为根管口,成功扩通43个,成功率为97.7%;20个为根中1/3处,成功扩通10个,成功率为50%;6个为根尖1/3,扩通1个,成功率为16.7%。3组间差异有统计学意义(P<0.01)。结论:显微超声技术为根管治疗提供了行之有效的方法,其中,根管口钙化疗效最好,根尖1/3处疗效最差。     

Evaluation of lingual vascular canals of the mandible with Computed Tomography

PURPOSE: To assess the anatomy of the mandibular lingual vascular canals with the use of computed tomography (CT). MATERIALS AND METHODS: Seventy consecutive patients underwent preimplantation CT of the mandible. CT images were obtained on axial plane by using a bone reconstruction algorithm and then processed with dedicated software (Dentascan). The number of lingual vascular canals, the diameter of their entrance foramina and the distance of the foramina from the symphysis menti and from the lower edge of the mandible were measured in each patient. The median superior canal (MSC), the median inferior canal (MIC), the lateral mesial canals (LMC) and the lateral distal canals (LDC) were evaluated separately. RESULTS: 0 to 5 canals were found in each patient. The MSC was found to be present in 98.6% of cases; the mean diameter of the entrance foramen was 0.85+/-0.28 mm located adjacent the symphysis menti and 11.3+/-2.6 mm from the inferior margin of the mandible. The MIC was found to be present in 32.9% of cases; the mean diameter of the entrance foramen was 0.58+/-0.21 mm located adjacent the symphysis menti and 5.5+/-2.2 mm from the inferior margin of the mandible. LMCs were found to be present in 38.6% of cases; the mean diameter of their entrance foramina was 0.60+/-0.24 mm located 5.1+/-2.5 mm from the symphysis menti and 6.3+/-3.2 mm from the inferior margin of the mandible. LDCs were found to be present in 48.6% of the patients; the mean diameter of their entrance foramina was 0.58+/-0.19 mm located 19.3+/-7.3 mm from the symphysis menti and 6.6+/-5.4 mm from the inferior margin of mandible. CONCLUSIONS: Dental CT detects the lingual vascular canals of the mandible in a high percentage of subjects and allows a good demonstration of their number, location and entrance foramen diameter. The evaluation of these canals is important in the preoperative planning of dental implants or in the planning of dental surgery in general so as to avoid bleeding due to damage of the vessels present in these canals.     

The anomalous canal between two accessory foramina on the mandibular ramus: the temporal crest canal

Objectives:

The temporal crest canal (TCC) is a variation of the bony canal with two accessory foramina that correspond to an entrance and an exit on the mandibular ramus. This study investigated the anatomical characteristics of the TCC using CBCT.

Methods:

The study population consisted 446 patients who had undergone CBCT. Sagittal, cross-sectional and three-dimensional images were evaluated for the presence of a TCC. The canals were classified into two types according to the configuration, and the location of the posterior accessory foramen of the TCC was also recorded.

Results:

6 TCCs were present in 4 of 446 patients (0.90% of the total population). All of the TCCs were observed in males, and all of the posterior foramina were located superior to the mandibular foramina on the medial aspect of the mandibular ramus. There were five noticeably curved and increasingly narrow canals (Type 1) and one slightly curved and uniformly wide canal (Type 2).

Conclusions:

Precise knowledge of the TCC is clinically important for suitable local anaesthetic nerve block and the planning of surgical procedures that involve the mandibular ramus. Three-dimensional images of CBCT data are particularly effective for confirming the presence of this variation.     

Mandibular lingual vascular canals (MLVC): Evaluation on dental CTs of a case series

Purpose

The aim of this study was to assess the anatomy of the mandibular lingual foramen (MLF) and its linked canals (mandibular lingual vascular canals - MLVC), describing their frequency, diameter, location, and course.

Materials and methods

One hundred and fourteen computed tomography (CT) images of the mandible (57 male and 57 female; mean age 44.70 ± 12.53; age range 13-75 years, were evaluated. The CT sections were obtained on axial plane by using a bone reconstruction algorithm and then processed with dedicated software (Dentascan), with a standard protocol.

Results

103 patients (90.35%) had at least one lingual vascular canal and 52 (45.61%) had multiple (two or three) canals. The typical locations of MLVC were the midline of the mandible (median lingual canal [MLC]). The mean diameter of the lingual canals in the midline (MLC) was 0.8 mm ± 0. The direction of MLC progresses in an anterior and slightly caudal sense.

Conclusions

Dental CT examination easily demonstrates the presence, position, direction and size of the lingual foramen and of the lingual vascular canals of the mandible. Radiologists and oral surgeons should be aware of these canals and their importance, in order to prevent bleeding complications during implants placement and other surgical procedures.     

Canal pretreatment using cold atmospheric argon plasma,chitosan and Chlorine p6 activated by photodynamic therapy with EDTA as a final irrigant on the pushout bond strength of fiber post

AimsTo evaluate the effect of contemporary root canal irrigants i.e., Cold atmospheric argon plasma (CAAP), Chlorine p6 (Clp6), and chitosan on the push-out bond strength (PBS) of glass fiber post (GFP) and marten hardness (MH) of root canal dentin compared to NaOCl+EDTA.Materials and methodsThe anatomic crown of sixty human mandibular premolars was removed by transversal section till cement-enamel junction (CEJ). Root canals were prepared and canals were dried and obturated using gutta-percha points and AH plus sealer. Post space was prepared and specimens were arbitrarily divided into four groups based on the post-space irrigation. (n = 15) Group 1: 5.25% NaOCl + 17% EDTA, Group 2: CAAP + 17% EDTA, Group 3: Chitosan + 17% EDTA and Group 4: Clp6 + 17% EDTA. For MH evaluation five samples from each disinfected group were taken and MH was assessed with the help of an ultra microhardness tester. GFP was cemented using self-etch dual cure cement on the remaining 10 samples from each group. Samples were vertically planted in acrylic resin blocks 1 mm thick slices were subjected to push-out testing and failure mode analysis using a universal testing machine and Stereomicroscope. ANOVA and Tukey multiple comparison tests were used to compare the means of bond integrity attained (p = 0.05).ResultsThe maximum values of PBS and MH were displayed in group 1 (5.25% NaOCl + 17% EDTA) specimens. However, group 3 exhibited the minimum values of bond strength and MH scores. Intergroup comparison analysis revealed that group 2, group 3, and group 4 displayed comparable outcomes of PBS and MH (p > 0.05). The cervical and middle third of group 1 specimens displayed a cohesive type of failure. However, the apical section of group 1 and other tested groups exhibited the adhesive type of failure.ConclusionCanal irrigation with 5.25% NaOCl and 17% EDTA appears to be better in terms of improving the bond integrity of fiber posts with no compromise in MH of the dentin as compared to the contemporary irrigant used.     

Novel laser activated photoacoustic streaming for removing pulp remnants from round root canals after single file reciprocating instrumentation

Background: This study evaluated the efficacy of a new laser-assisted irrigation system, the shock wave enhanced emission photo-acoustic streaming (SWEEPS) technique in removing pulp tissue from single-rooted premolars.Methods: Freshly extracted mandibular premolars with round root canals (n = 40), scanned using cone beam computed tomography, were randomly divided into control and four experimental (according to the irrigation technique used) groups (n = 8/group). Groups 1, 2, and 3 were instrumented using Reciproc Blue (RB25/0.06) followed by final irrigation protocol (FIP), activated by SWEEPS, ultrasonically activated irrigation (UAI), and conventional irrigation (CI), respectively. In these groups, 7 mL 3% NaOCl in total was used during instrumentation; for FIP, 3% NaOCl (60 s), ethylenediaminotetraacetic acid (60 s), and 3% NaOCl (30 s). In group 4, SWEEPS activation of 3% NaOCl for 6 × 30 s alone was performed. The untreated control group specimens were processed for histological evaluation of remaining pulp tissue (RPT) in each canal third. The results were analyzed using the Mann-Whitney U test (α = 0.05).Results: Significant differences were observed between the control group and the experimental groups (p<0.05). In the middle third, the UIA and SWEEPS showed similar efficacy (p = 0.171), superior to CI and SWEEPS without instrumentation (p<0.05). In the apical third, SWEEPS was the most efficient (p = 0.002), and UIA and CI showed no difference (p = 0.643).Conclusion: SWEEPS was superior to UIA and CI in removing RPT in the apical region of round canals after single instrument root canal preparation; SWEEPS without instrumentation was inefficient in removing pulp tissue.     

C形先锋锉联合EDTA在下颌后磨牙钙化根管疏通中的应用

 目的 探讨C形先锋锉联合乙二胺四乙酸(ethylene diamine tetraacetic acid,EDTA)在下颌后磨牙钙化根管疏通中的应用。方法 选取2014-10至2017-10在解放军总医院口腔医学中心口腔内科就诊的患者78例共89颗下颌后磨牙,共284个钙化根管随机分为两组,治疗组采用C形先锋锉联合EDTA进行根管疏通,对照组采用普通K锉联合EDTA进行根管疏通,比较两组根管疏通成功率,根管偏移、根管侧穿、器械分离发生率。结果 治疗组根管疏通成功率为84.72%,根管偏移发生率为12.50%;对照组根管疏通成功率为65.71%,根管偏移发生率为11.43%,治疗组根管疏通成功率高于对照组,差异有统计学意义(P＜0.01),两组根管偏移发生率差异无统计学意义。结论 C形先锋锉联合EDTA能够提高钙化根管疏通率,值得在临床中推广。     

Microanatomical and histological assessment of the content of superior genial spinal foramen and its bony canal

OBJECTIVES: To assess histologically the true content of the superior genial spinal foramen and to match these findings to the microanatomical canal content observed using high-resolution magnetic resonance images of the same region. METHODS: Ten human mandibular specimens were imaged using a 9.4 Tesla MRI unit. Afterwards, eight specimens were decalcified, embedded in paraffin and serially sectioned (7 microm) for histological examination; the remaining two were embedded in methylmethacrylate and sectioned (50-60 microm). All sections were examined using routine light microscopy to inspect the superior genial spinal foramen region and its content. RESULTS: Histological observations of the superior genial spinal foramen confirmed the presence of a well-defined neurovascular bundle, with branches of the lingual nerve and lingual artery. The canal had an average diameter exceeding 1 mm and could thus be considered significant. CONCLUSIONS: The present study confirms the existence of a true superior genial spinal foramen's bony canal with neural and blood vessel content. These findings imply that surgical procedures should consider a proper preoperative assessment of the neurovascular trajectory of the superior genial spinal foramen.     

两种新型根管充填法在下颌第二恒磨牙C形根管中的应用比较

目的 比较常温流动牙胶与热牙胶垂直加压充填法在下颌第二恒磨牙C形根管中的临床应用效果.方法 将67例诊断为C形根管的患者随机分为A、B两组,A组采用常温流动牙胶充填,B组采用热牙胶垂直加压充填,比较两组的根充质量、疼痛程度及1年后的疗效.结果 两组患者的根充质量、疼痛程度及1年后的疗效比较均无显著性差异.结论 常温流动牙胶与热牙胶垂直加压充填法对下颌第二恒磨牙C形根管的充填短期内均有较好疗效.