����������е���ٴ�Ӧ��

机用镍钦器械的发展与应用,为临床医生创造了获得最佳根管预备效果的可能性,是根管预备技术的一场革命.机用镍钛器械从螺纹设计、几何外形到锥度,与传统标准器械存在很大差别.这些改变不仅提高了根管预备的效率,也最大限度减少了根管的移位和变形,但同时临床医生也面临着机用镍钛器械折断的风险.本文对根管镍钛器械的特点以及目前常用机用镶钦器械的操作方法、操作原则等方面加以阐述.     

���Ѹ�����е�۶ϵ����ͼ�Ԥ��

镍钛根管器械在临床上得到越来越广泛的应用,但它较不锈钢器械更易折断.镍钛根管器械的折断在长轴观上可分为扭转折断和弯曲疲劳折断,根据其断面的显微特征可分为剪切折断和疲劳折断.临床使用中可通过控制剪切力或疲劳因素来降低镍钛器械折断的风险.本文重点对镍钛根管器械折断的预防要点进行了较为全面的阐述.     

��׼������е����ʹ��

提要：牙拔除术是口腔科医生必须掌握的一种基本治疗技术。如何规范地选择和使用拔牙器械,减少因拔牙对患者造成的损伤与并发症,是口腔颌面外科医生必须具备的一项基本技能。本文简要叙述了标准拔牙器械及其使用要点,特别强调了微创拔牙器械的优点与普及的必要性。     

������ת������еԤ���������ܵ��ٴ�Ч���о�

目的    对比研究3种旋转镍钛器械ProFile、ProTaper和Mtwo在弯曲根管预备中的应用。方法    选择2008年2月至2010年2月在沈阳市口腔医院牙体牙髓病科就诊的69例有弯曲根管的牙髓炎或根尖周炎患者的72颗患牙,随机分为4组,分别采用ProFile、ProTaper、Mtwo和不锈钢K锉预备根管,侧方加压法充填。评价根管预备和充填的效果。结果    3种旋转镍钛器械均能较好地维持根管的弯曲度及走向,根管的锥度及流畅度佳,无根管偏移、台阶形成等并发症;术后疼痛少且程度轻;ProTaper和Mtwo的操作时间比ProFile短。结论    机用镍钛器械ProFile、ProTaper和Mtwo预备弯曲根管成形效果好,ProTaper和Mtwo比ProFile更快速高效;临床操作须注意预防器械折断。     

��Ĥ��������е����ʴ��Ӱ���ٴ��о�

??Objective    To electrochemically evaluate corrosion resistance and longevity of nickel-titanium endodontic instruments after modifided by surface coating. Methods    A total of eight sets of new Mtwo NiTi instruments??size 10??size 15??size 20??size 25 in each set??were randomly divided into four groups??A1??A2 and B1??B2??. The instruments of group B1 and B2 were exposed to multi-arc plating machine to create a coating of a TiZrNO layer??and the files of group A1 and A2 were not coated. Scanning electron microscopes??SEM??were used to examine surface morphology of NiTi instruments with and without coating. Moreover??X-ray energy dispersive spectroscopy analysis??EDX??was performed before and after coating to evaluate the effect on the chemical composition. The following irrigation solutions were used??in group A1 and B1 files 5.25% NaOCl was used. In groups A2 and B2 2.5% NaOCl was used. Files were used to prepare single-rooted extracted human teeth. The procedure was repeated to prepare10 canals. Files were used for a cycle of preparation and sent to autoclave. The instruments were sent for corrosion assessment. Results    Scanning electron microscopes showed that surface morphoology has been improved compared with uncoated NiTi instruments. Electrochemical measurements indicated that coated instruments were significantly higher in corrosion resistance  than uncoated instruments. Conclusion    Corrosion resistance and surface morphology of coated NiTi files are significantly higher than that in uncoated files.     

���Ѹ���Ԥ����е�о���չ

??Root canal preparation is one of the difficulties in endodontic therapy process. Compared with stainless steel instruments??the instruments made in nickel-titanium alloys have good shaping ability and corrosion resistance which can acquire satisfactory shaping and cleaning effect and also have good clinical application prospect. The purpose of this review is to summarize current understanding of the types??phase transition of the metal??shaping ability and factors of separation of nickel-titanium instruments.     

������е�����Ӱ�����ؼ����β���

??Instruments separation is one of the most troublesome complications during root canal therapy. A separated instrument may hinder the effectiveness of shaping and cleaning procedures??which may adversely affect the prognosis. Thus??the nickel-titanium instruments separation has always been a key point of clinical discussion. In this article??influencing factors and preventive strategies of the nickel-titanium instruments separation were introduced.     

��Ӳ�����׶Ի�е�������������ƶ���Ӱ�켰���û���

??Sclerostin/SOST??mainly expressed in osteocytes??is a negative regulator of bone formation and is regulated by mechanical stimulus??which plays an important role in orthodontic tooth movement. Wnt and BMP are two important signaling pathways in bone metabolic regulation. SOST can regulate osteoblastic differentiation and bone formation by binding type ??or??receptors and co-receptor LRP5/6 to inhibit BMP and Wnt signaling pathways. This review covers the effect of Sclerostin/SOST on orthodontic tooth movement after mechanical loading and its mechanism??and the clinical significance as well as prospect of Sclerostin/SOST in clinical application.     

��ͬ����Ԥ����е�Ը��������мӰ��������о�

??To compare the amount of apically extruded debris from root canals when different nickel-titanium instruments were used. Methods    Sixty-eight healthy single-rooted premolar teeth extracted for orthodontic purpose were induded in the study. The teeth were randomly divided into the control group??hand ProTaper??and 3 experimental groups. Three kinds of nickel-titanium instruments were used??rotary ProTaper??Waveone and Mtwo??n = 17??. Debris extruded from the apical foramen after root canal preparation was collected into tubes and the amount of apically extruded debris was determined and analyzed. Results    The OD values of apically extruded debris??in the control group it was 68.65 ± 11.47??in rotary ProTaper group it was 62.66 ± 11.17?? in Waveone group it was 58.49 ± 12.96??in Mtwo group it was 47.70 ± 10.28. Waveone group and Mtwo group had less extruded debris??which was significantly different from the control group??P < 0.05??. Mtwo group had the least of extruded debris??which was significantly different from the other groups??P < 0.05??.  Conclusion    Mtwo nickel-titanium instruments produce obviously less apically extruded debris than ProTaper and Waveone.     

三种器械预备弯曲根管成形效果的比较

目的：评价K锉、Safesiders锉和HERO Shaper锉预备离体牙弯曲根管的成形效果。方法60颗根管弯曲的离体下颌前磨牙随机分为3组,分别用K锉、Safesiders锉和HERO Shaper锉进行根管预备,根管预备前后分别往根管内注入复方泛影葡胺并拍摄X线片,分析根管预备后根管弯曲内外侧壁牙本质去除量、中心定位能力及根管直化角度。结果在根管弯曲内外侧壁所有观测点,Safesiders锉组和HERO Shaper锉组牙本质去除量均少于K锉组（P均＞0.05）。 Safesiders锉组牙本质去除量多于HERO Shaper锉组,但仅在根管弯曲内侧壁3和4 mm观测点处差异有统计学意义（3 mm：t＝3.72,P＜0.05;4 mm：t＝7.62,P＜0.05）。在距根尖孔5 mm以下观测点,Safesiders锉组和HERO Shaper锉组中心定位能力优于K锉组（1 mm：F＝7.45,P＜0.05;2 mm：F＝10.20,P＜0.05;3 mm：F＝7.75,P＜0.05;4 mm：F＝23.45,P＜0.05;5 mm：F＝10.91,P＜0.05）;而在所有观测点上,Safesiders锉组与HERO Shaper锉组差异均无统计学意义（P均＞0.05）。 Safesiders锉组和HERO Shaper锉组根管直化角度均小于K锉组（F＝58.95,P＜0.05）,但Safesiders锉组与HERO Shaper锉组间差异无统计学意义（P＞0.05）。结论 K锉、Safesiders锉和HERO Shaper锉预备离体牙弯曲根管均有不同程度的根管偏移,其中Safesiders锉和HERO Shaper锉根管偏移较少,具有较好的根管成形效果。     

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。     

两种根管再治疗镍钛器械去除椭圆形弯曲根管内充填物的效果评价

目的:评价2种根管再治疗镍钛器械去除椭圆形弯曲根管内充填物的效果。方法:离体的80颗根管呈椭圆形且弯曲的下颌前磨牙经Hero642预备、热牙胶垂直加压充填后随机分为4组,分别用ProTaper Universal、R-Endo、Hero642和手用H锉去除根充物,测量各组根充物的残留量百分比和操作时间。结果:4组样本均有根充物残留,ProTaper Universal、R-Endo和Hero642组根充物残留量百分比、操作时间均少于手用H锉组(P<0.01),前3组间的差异无统计学意义(P>0.05)。结论:ProTaper Universal、R-Endo机动镍钛器械对椭圆形弯曲根管内充填物的清除效果优于手用器械,且可减少操作时间,但仍不能彻底清除根充物。     

MTWO���Ѹ���Ԥ��ϵͳ��ĥ�����������е�Ӧ�÷���

目的评价MTWO镍钛根管预备系统在磨牙根管治疗中的应用效果。方法选取2008年1月至2009年2月解放军第463医院口腔科门诊收治的需做根管治疗的患者110例(126颗患牙),随机分成2组,试验组72颗,对照组54颗;分别采用MTWO镍钛根管预备系统和不锈钢K锉行根管预备,次氯酸钠溶液和EDTA凝胶疏通并清理根管内感染物质,采用侧向加压技术行根管充填;根据临床操作时间、术后X线片及疼痛情况评价根管预备和充填的效果。结果试验组根管预备平均时间为4min10s,明显少于对照组的10min50s;试验组无根管偏移及台阶形成,能较好地保持根管的解剖初形,对照组中2例有台阶形成;试验组适充率(94.4%)明显高于对照组(81.5%)(P<0.01),术后3d疼痛的发生率(4.2%)明显低于对照组(13.0%)(P<0.01)。结论用MTWO镍钛根管预备系统预备根管能很好地维持根管解剖形态,减少术后疼痛,并且省时、高效,提高了根充效果。     

3种根管治疗器械根管再治疗的临床效果比较

目的：比较3组器械在根管再治疗中的临床应用效果,探讨其中2种镍钛器械的应用特点。方法选择173例因根充不实或欠填需根管再治疗的177颗第一恒磨牙作为研究对象,84颗患牙均有叩痛,经首次根管治疗后出现自觉症状,随机分为3组（TF1组、Protaper D1组和不锈钢锉1组）,每组各28颗;93颗无叩痛患牙,也随机分为3组（TF2组、Protaper D2组和不锈钢锉2组）,每组各31颗。预备时间组间比较采用方差分析;预备后无痛率或缓解率和器械损伤情况组间比较采用卡方检验。结果预备时间TF组明显少于Protaper D组和不锈钢锉组（P=0.00）;TF组的无痛率和缓解率明显高于不锈钢锉组（P<0.01）;60支TF锉发生螺纹损伤;1支ProtaperD发生折断。结论在临床根管再治疗中使用TF机用镍钛锉比不锈钢锉更能减少术中疼痛,节省用时,更适合弯曲根管的使用,但其易发生螺纹损伤,值得注意。     

镍钛旋转锉在老年人根管治疗中应用

目的:探讨机用镍钛器械ProTaper在老年患者根管治疗中应用的临床效果。方法:选取临床上因牙髓炎及根尖周炎需要进行根管治疗的老年患者46例,患牙56颗(94个根管),运用冠向下技术,采用机用镍钛器械ProTaper进行根管预备,热牙胶垂直加压技术充填根管。记录根管预备所需要的时间及器械折断的数量,根据治疗前、中及根充后的X线片评价预备及根充效果。结果:所有患者的根管预备锥度流畅度好,根管形态及工作长度无改变,无1例发生器械分离。结论:在老年患者的根管治疗中,使用机用镍钛器械ProTaper进行根管预备,可以获得比较好的临床效果。     

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。     

两种镍钛器械联合预备弯曲根管的效果评价

目的：评价联合使用K3和TF两种不同镍钛器械预备弯曲根管的效果。方法：选择离体下颌前磨牙及磨牙各40颗,依根管弯曲度分为轻度及中重度弯曲组,每组再随机分为两组,分别采用K3联合TF、单独K3进行根管预备。记录并分析各组单根管预备时间、并发症、根管直化角度、器械中心定位能力。结果：轻度弯曲组采用K3联合TF进行根管预备仅预备时间明显短于K3组（P<0．05）;中重度弯曲组采用K3联合TF进行根管预备,预备时间、术中并发症、根管直化角度、自根尖孔1～4 mm观测点的器械中心定位能力与K3组相比均有统计学差异（ P<0．05）。结论：K3联合TF预备弯曲根管,可节省操作时间,减少并发症,更好地维持根管原有形态,尤其适用于中重度弯曲根管的预备。     

2种机用镍钛器械磨牙根管预备效果的临床观察

［摘要］ 目的比较2种机用镍钛器械Reciproc和Mtwo用于磨牙根管预备的效果。方法 选取因牙髓炎或根尖周炎需治疗的磨牙62例,随机分成R、M两组,其中R组32例,选用Reciproca进行根管预备,M组30例,选用Mtwo进行根管预备,采用热牙胶垂直加压充填技术进行充填。评价器械损耗、预备时间、预备效果。 结果 Reciproc无折断,Mtwo折断2支。预备时间：R组(15.45±3.16）min,M组(20.31±2.32) min,差异有统计学意义（P＜0.05)。两组均未发生根管偏移,无根尖阻塞、台阶及侧壁穿孔等并发症。 结论 两种机用镍钛器械Reciproc和Mtwo用于磨牙根管预备,均能达到良好的效果,但Mtwo时间略长,并且要预防器械折断。     

不同根管预备器械对根管充填后冠方微渗漏影响的实验研究

目的:比较不同根管预备器械对根管充填后冠方微渗漏的影响。方法:选择60个单根管前磨牙(弯曲度为10～20°)随机分为6组,分别以不锈钢K锉、VDW K锉、手动Protaper、机用Protaper、Hero642、Mtwo预备根管。采用冷侧压法进行根管充填,染色法比较不同根管预备器械对根管冠方封闭性能的影响。结果:不同根管预备器械对充填后根管冠方微渗漏影响不同,其中Hero 642预备组、Protaper预备组、VDWK锉组冠渗漏长度少于不锈钢K锉组,且差异有统计学意义(P<0.05),Hero 642预备组产生的冠方微渗漏最小。结论:不同根管预备器械预备根管后对冠渗漏影响不同,镍钛旋转器械预备根管后产生的冠方微渗漏较小,不锈钢K锉根管预备后产生的冠方微渗漏较大。