牙髓腔或根管侧穿防治体会

牙髓腔或根管侧穿防治体会广东省口腔医院方加铄口腔内科中的牙体牙髓治疗是一种较为烦锁的操作性技术，术者稍微有疏忽往往易出现不良后果，如牙髓腔或根管侧穿，根管器械折断，根管器械误吞误吸等。因此要求术者工作认真细致，精神集中，才能达到治疗的预期效果，同时减...     

根管治疗护理的安全管理

目的探讨根管护理的安全管理措施。方法总结1 412例根管治疗患者的安全护理管理措施,包括患者、药物、器械等的安全管理措施,分析与根管治疗患者的安全密切相关的护理安全管理环节。结果 1 412例患者中有5例发生器械分离,其中4例将分离器械成功取出,1例因根管弯曲没有取出,向患者解释并征得同意后,器械作为根管充填材料封闭在根管内。没有发生口腔周围软组织的灼伤、损伤以及器械误吞、误吸等安全事故,无医疗纠纷发生。结论在根管治疗过程中加强对药物、器械、患者的管理,提高护理配合操作技能及护患沟通能力,有利于提高根管治疗质量与安全性。     

应用显微超声技术去除根管内折断器械的临床分析

目的：评价根管手术显微镜和超声技术去除根管内折断器械的临床疗效。方法：选择因根管内折断金属器械造成根管阻塞的患牙43个,根管47个。在根管手术显微镜下使用超声器械与IRS套管试行取出术,完成根管治疗或再治疗,统计成功率。结果：32个患牙（33个根管）内折断器械被取出并完成根管治疗,成功率74.42%（70.21%）。无一例发生根管壁侧穿或牙根折裂。结论：根管手术显微镜和超声器械及IRS套管的使用,为根管内折断器械的去除提供了有效方法。     

磁戒指在扩锉根管中的应用

磁戒指在扩锉根管中的应用河南省许昌市人民医院口腔科陈长山,郭瑞芳,娄海滨在根管治疗过程中,扩锉根管时稍有不慎容易将扩锉根管器械从手中滑脱,甚至落入气管或吞入消化道,造成严重事故。针对这一问题,我们根据磁场的磁吸特性,制作了一种磁戒指,有效地解决了这一...     

机用镍钛器械根管预备效果的研究进展

根管治疗是目前治疗牙髓病和根尖周病的主要方法,而根管预备则是根管治疗的关键步骤,良好的根管预备能有效清理根管内感染物并且能为根管充填提供良好条件。镍钛器械的研发使根管预备有了新的突破,因其记忆弹性大、抗弯曲性强、切削力大、切削效率高的特点逐步取代不锈钢器械。随着镍钛根管锉的不断革新,机用镍钛器械在临床上已经广泛使用。因此,研究机用镍钛器械不仅能够指导根管预备,而且对其创新有较大意义。本文将对机用镍钛器械的成形能力、抗疲劳性能、根管治疗后并发症等作一综述。     

不同器械去除根管充填材料的研究进展

根管治疗失败后,为了保留患牙一般应行根管再治疗或者根尖手术,而有效去除根管内原充填物是保证根管再治疗成功的关键。目前临床上用于清除根管内充填物的器械方法很多,然而任何一种器械方法都不能完全去除根管内充填物,不同的器械去除根管充填物的效率有所不同。本文就根管再治疗的重要性及不同器械去除根管充填物的效率等方面的研究进展作一综述。     

根管内器械分离后行旁路根管治疗的临床评价

目的观察根管内器械分离患牙行旁路根管治疗后的临床疗效。方法选择32颗根管内器械分离不能完全取出的患牙为试验组,采用从分离器械旁建立通路到达根尖的方法进行根管预备和充填;同时选择器械分离后不能取出也不能行旁路根管治疗的患牙13颗为对照组,未发生器械分离的常规根管治疗患牙30颗为常规治疗组。观察3组患牙2年后的临床疗效并进行评价。结果试验组2年后回访牙数25颗,根管治疗成功率为80.00%;对照组2年后回访牙数11颗,成功率为36.36％;2组失败病例均为器械分离发生在根尖1/3处的患牙。常规治疗组2年后回访牙数22颗,成功率为90.91％。结论旁路根管治疗法是器械分离后进行根管治疗的一种可行和有效的方法。     

显微超声技术处理根管内折断器械的影响因素及临床应用

目的用显微超声技术处理根管内折断器械并对其影响因素进行分析。方法对2003年10月—2006年10月就诊于南京医科大学附属口腔医院的47例根管内器械折断的患者进行诊断和治疗,用根管手术显微镜配合超声器械进行治疗处理。结果47例患者中有34例根管内折断器械被完全取出,取出率为72.3%。折断器械的位置与操作难度密切相关,根管弯曲前段、中段和后段内折断器械取出率依次降低;根管弯曲度小于30度者较弯曲度大于30度者其折断器械取出率高。结论手术显微镜结合超声器械是处理根管内折断器械的较有效方法。     

根管初步预备器械的研究现状

根管治疗是牙髓病和根尖周病的主要治疗手段,而根管治疗成功与否很大程度上取决于根管预备的质量。在根管预备之前,首先要设计良好的髓腔入口并建立连续光滑的根管疏通通道,这个过程即为根管的初步预备。根管初步预备使清洁和成形根管的器械能够顺畅进入根管,可避免器械分离,为此专门用于建立根管光滑通道的器械应运而生。当下,根管初步预备器械凭借其独特的作用和良好的成形能力发展较为迅速,本文就根管初步预备器械的发展现状作一综述,旨在给牙髓病和根尖周病的治疗提供一些建设性的建议。     

口腔疾病治疗中异物的误吸误咽

口腔疾病治疗中难免会发生异物的误吸误咽,这种意外更容易发生在儿童。拔出的牙齿以及根管治疗器械、修复体、正畸矫治器部件等都可能被患者误吸误咽。本文简要介绍了误吸误咽发生的原因、并发症、处理方法和预防措施等方面的内容,以期指导口腔临床工作。     

Shaping and filling root canals during root canal re‐treatment

Re‐treatment of primary root canal treatment associated with post‐treatment disease has become an important component of daily endodontic practice. Basically, the management of cases requiring re‐treatment should comply with the general rules of primary root canal treatment namely accurate diagnosis, antiseptic treatment consisting of cleaning and shaping the root canals, followed by effective disinfection, canal filling, and a coronal restoration that prevents re‐infection. Nevertheless, re‐treatment represents a distinct treatment modality of its own, which in several respects differs from primary treatment of teeth with vital or necrotic pulps. The aim of this review is to present current knowledge on root canal preparation and filling during root canal re‐treatment.     

Removal of root filling materials

Safe, successful and effective removal of root filling materials is an integral component of non‐surgical root canal re‐treatment. Access to the root canal system must be achieved in order to negotiate to the canal terminus so that deficiencies in the original treatment can be rectified. Since a range of materials have been advocated for filling root canals, different techniques are required for their removal. The management of commonly encountered root filling materials during non‐surgical re‐treatment, including the clinical procedures necessary for removal and the associated risks, are reviewed. As gutta‐percha is the most widely used and accepted root filling material, there is a greater emphasis on its removal in this review.     

根管治疗术中的疼痛原因分析及疼痛控制

根管治疗是牙髓病及根尖周病的一种有效治疗方法,已在临床上广泛使用,然而在治疗过程中及治疗完成后患者可能会出现各种原因的疼痛。本文对根管治疗术中疼痛发生的原因进行分析,从而为临床医生采取相应的有效措施和治疗手段缓解患者痛苦提供参考。     

�����������о���չ

根管治疗术是牙髓病、根尖周病最有效的治疗方法。随着口腔新技术、新材料的研发和应用,其成功率不断提高。但是根管治疗失败的病例仍有发生,因此,根管再治疗成为提高患牙保存率的有效方法。本文就根管治疗失败原因、根管再治疗常用方法做一综述。     

Chlorhexidine gluconate

The aim of root canal treatment is to eliminate bacteria from the infected root canal and to prevent reinfection. Biomechanical cleaning and shaping greatly reduces the number of bacteria. Nevertheless, due to anatomical complexity of the root canal system, residues and bacteria cannot be removed completely. Therefore, various substances have been used during canal preparation to remove debris, necrotic tissue, bacteria and smear layer. The most common irrigant of choice is sodium hypochlorite (NaOCI): it is an effective antimicrobial agent and tissue solvent. However, NaOCI can be toxic. Chlorhexidine gluconate (CHX) is a broad-spectrum antimicrobial agent. As a root canal irrigant and intracanal medicament, CHX has an antibacterial efficacy comparable to that of NaOCI, and is effective against resistant bacterial strains. CHX may result in residual antimicrobial activity of the dentine surface after prolonged exposure of the root canal to CHX. CHX also has a low grade of toxicity. In this review CHX will be discussed in detail.     

有瘘型根尖周炎的氩离子激光手术及一次程根管充填的临床疗效观察

目的 :探讨 Ar+激光手术加一次程根管充填治疗有瘘型根尖周炎的处理方法及疗效 ,为临床提供一种新的根管消毒法 .方法 :应用 Ar激光技术及一次程根管充填术对 87例有瘘型根尖周炎患牙进行治疗和临床观察分析 .结果 :成功 70例 ,进步 9例 ,总有效率达 90 .8% .结论 :证实了 Ar+激光临床根管治疗的有效性、安全性和实用性 ,不失为一种新的临床根管消毒方法 ,在临床具有应用前景。     

A review of the prognostic value of irrigation on root canal treatment success

The aim of this review is to discuss the requirements for effective irrigation of the root canal system and its role in treatment outcome. A review of the literature regarding irrigants, methods of irrigation and regimens was undertaken. It indicates that irrigation is comprised of a multitude of factors, and that effective irrigant delivery and agitation achieves mechanical, chemical and microbiological functions, which are prerequisites for obtaining a clean canal system. However, most studies are ex vivo and assess intermediate outcome values rather than treatment success. Additionally, there is an absence of high‐level evidence evaluating the effect of irrigation on the outcome of root canal treatment. Therefore, citing irrigation as a significant factor that affects root canal treatment success cannot be done. This highlights the need to further investigate the prognostic value of irrigation on root canal treatment success.     

��������Լ�����ʹ�ķ������Ƽ�Ԥ�����Ʋ���

??Endodontic interappointment pain is one of the common complications of root canal therapy. It arises from microbial??mechanical and chemical stimuli to root apical tissue during the root canal treatment??which can cause acute inflammation of the root apical tissue??and the clinical manifestations are local pain and swelling. With the development of science and technology??a great many nickel-titanium rotary instruments are widely used??so that it is possible to reduce the endodontic interappointment pain in patients in the process of treatment. This paper introduced the research status of occurrence mechanism and preventive control approach during the treatment of the root canal therapy.     

���������г�������ʧ��2�� ——������©

提要：根管治疗中如遗漏根管则会导致根管系统不能彻底清理和严密充填，引起根管治疗失败。因此，根管遗漏既是根管治疗中的操作失误之一，又是影响根管治疗预后的重要因素之一。本文主要介绍根管探查中的操作失误——根管遗漏，旨在为临床医生提供理论和实践参考。     

Critical evaluation of root canal transportation by instrumentation

Proper chemomechanical disinfection of the entire root canal system is required for a successful treatment outcome. Various techniques of mechanical root canal preparation have been introduced and described. Preservation of the integrity of the root canal anatomy and especially of the location of the apical foramen is important during mechanical root canal preparation. Despite the introduction of flexible nickel–titanium instruments and torque‐limited devices, root canal preparation of severely curved canals is still challenging and canals may be transported and/or other procedural errors may occur during preparation procedures. There are several aspects that influence the performance of root canal instruments with respect to their shaping ability. This article elucidates different parameters having an impact on canal transportation and discusses the impact of canal transportation on treatment outcomes.