一种新的根管冲洗剂——MTAD

与器械预备相伴的根管冲洗是根管预备过程的重要环节,冲洗液应当能够溶解坏死组织,有消毒杀菌作用,并且能够去除玷污层.本文将介绍一种新的根管冲洗剂--MTAD.MTAD是强力霉素、柠檬酸和清洁剂的混合物,它能有效去除玷污层,抗微生物作用强,细胞毒性小,临床使用安全.     

去除玷污层的方法对根管充填密合性的影响

目的 观察根管冲洗剂与超声根管预备法能否去除玷污层以及去除玷污层对根管充填密合性的影响。方法 75颗离体牙随机分为3组,每组25颗。A组常规根管预备,扩锉中和扩挫后用生理盐水(NS)和3％双氧水(H_2O_2)冲洗;B组根管预备同A组,扩锉完成后用15％乙二胺四乙酸(EDTA)和5.25％次氯酸钠(NaOCl)交替冲洗;C组使用超声波根管扩大锉预备根管,NS冲洗。常规根管充填后用扫描电镜观察根管内壁表面形态,并做染液渗漏实验。结果 用手持器械预备根管,NS和3％H_2O_2冲洗根管,不能去除玷污层;使用15％EDTA和5.25％NaOCl交替冲洗根管,则可完全去除玷污层;用超声器械预备根管,对去除根管玷污层具有一定的作用。去除玷污层,充填材料进入牙本质小管,根尖微渗漏显著降低(P<0.05)。结论 去除玷污层,能增强充填材料边缘密合性和根尖封闭性,根尖徽渗漏显著降低。     

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由于根管系统的复杂性。传统的根管预备器械与冲洗剂难以达到完全清理根管的目的。Er：YAG激光联合根管冲洗剂使用,既可以采取更保守的根管预备,又能增强去除玷污层、开放牙本质小管和杀菌的能力,有利于根管封闭剂和根管内黏结剂的渗透而减少微渗漏;且在一定的激光参数范围内,其不会引起冲洗剂的根尖渗出;产热作用也极小,不会引起根尖周组织损伤。因此,Er：YAG激光的应用能使根管预备过程变得简单、高效、安全。本文综述了Er：YAG激光在根管治疗中的应用研究进展。     

Er∶YAG激光在根管治疗中的应用研究进展

由于根管系统的复杂性,传统的根管预备器械与冲洗剂难以达到完全清理根管的目的。Er∶YAG激光联合根管冲洗剂使用,既可以采取更保守的根管预备,又能增强去除玷污层、开放牙本质小管和杀菌的能力,有利于根管封闭剂和根管内黏结剂的渗透而减少微渗漏;且在一定的激光参数范围内,其不会引起冲洗剂的根尖渗出;产热作用也极小,不会引起根尖周组织损伤。因此,Er∶YAG激光的应用能使根管预备过程变得简单、高效、安全。本文综述了Er∶YAG激光在根管治疗中的应用研究进展。     

5种冲洗剂组合对前牙直根管清洁效果的比较

目的：比较5种冲洗剂组合对前牙直根管的清洁效果。方法：25颗离体直根管前牙,随机分为5组,不锈钢K锉常规法预备根管．应用5种冲洗剂组合进行冲洗。第1组：根管器械预备期间和预备结束后依次用1％NaOCl和3％H2O2冲洗;第2组：根管器械预备期间用1％NaOCl冲洗,预备结束后用17％EDTA冲洗;第3组：根管器械预备期间和预备结束后依次用1％NaOCl和17％EDTA冲洗：第4组：根管器械预备期间依次用17％EDTA和1％NaOCl冲洗,器械预备结束后用17％EDTA冲洗;第5组：根管器械预备期间依次用17％EDTA、1％Triton X-100(表面活性剂)和1％NaOCl冲洗．器械预备结束后用17％EDTA冲洗。每组冲洗剂剂量和冲洗时间均为22ml和7min。将牙纵劈后进行扫描电镜观察。结果：第1组,根管壁上见典型玷污层结构和大量杂质和残屑。第2组在根管冠、中1／3能部分去除玷污层．根尖1／3残留大量玷污层。第3组虽然能有效去除玷污层．但会引起牙本质小管中度腐蚀。第5组在根管冠、中1／3能部分去除玷污层,但根管壁上黏着大量杂质和残屑．此外还存在重度腐蚀现象。第4组根管清洁效果最好,且对牙本质小管无腐蚀性。结论：在严格控制冲洗时间和顺序的情况下,联合应用17％EDTA和1％NaOCl能有效去除玷污层．且不会腐蚀牙本质小管。     

氢氧化钙糊剂与根管内感染控制

感染控制对根管治疗的成功至关重要。尽管随着器械及设备的进步，对根管的清理及成形取得了很大的进展；然而，由于根管系统解剖结构错综复杂，使得获取清洁根管面临各种问题。例如：机械预备的宽度有限，不能彻底清理感染牙本质；冲洗技术的运用虽然可以去除根管器械预备后形成的玷污层，但对细菌内毒素的清除还是难以达到理想的效果，而残留的微生物、毒素等若得不到清除可能会在根尖周组织形成持续感染。因此，除外机械预备和冲洗，根管封药也是感染根管治疗过程中的重要步骤。氢氧化钙糊剂以其高效的抗菌作用在临床得到广泛使用。文章将对根管封药的必要性、氢氧化钙的作用机制及临床应用做一介绍。     

根管冲洗剂QMix冲洗性能的研究进展

根管预备时,采用单纯机械预备方法无法完全去除根管内感染,化学冲洗是消除根管内感染不可或缺的步骤。理想的根管冲洗剂应具备彻底清除玷污层、润滑根管、有效杀菌、对组织无毒性且不损伤牙齿结构的特点。现有的根管冲洗剂尚不能同时满足上述所有要求。QMix是由乙二胺四乙酸（EDTA）、氯己定（CHX）和表面活性剂混合组成的根管冲洗剂。QMix能够有效去除玷污层,杀菌性强且有持续的抗菌作用,细胞毒性小且生物相容性好,对牙本质的着色浅,对牙本质微硬度的影响小。此外,QMix还可以提高根管封闭剂的润湿性且不影响其粘接性能。本文比较QMix与其他常用的根管冲洗剂（如次氯酸钠、CHX、EDTA、SmearClear、MTAD等）在去除玷污层、对牙本质作用、对根管封闭剂的影响、细胞毒性、抗菌作用等方面的作用特点,将目前对QMix的研究成果作一综述。     

牙体牙髓临床治疗Ⅱ.根管预备的工作长度、宽度和锥度

根管预备主要是通过器械切削和药物冲洗等方法，去除根管内的微生物及其代谢产物、感染的牙髓组织及牙本质碎屑，形成与特定根管充填物和充填方法相适应的形态。根管预备是根管治疗中重要且难度较大的步骤之一，其难点主要体现在以下几个方面：工作长度的确定；工作宽度的确定；根管预备锥度的确定。     

根管冲洗方法的研究进展

根管预备是根管治疗的关键步骤,由于根管系统的复杂性,单纯机械预备难以达到彻底清理的目的,因此根管冲洗是根管预备不可缺少的步骤。目前常用的冲洗方法是使用针头冲洗或合并超声振荡冲洗,根管刷、Rinsendo、EndoVac及EndoActivator系统仍处于研究阶段,极少应用于临床。本文将就这些根管冲洗方法作一综述。     

根管手术显微镜下上颌第二前磨牙的根管再治疗

目的：探讨运用根管手术显微镜和现代根管治疗技术对上颌第二前磨牙进行根管再治疗的疗效。方法：选择临床上需行根管再治疗的上颌第二前磨牙63颗，利用根管手术显微镜去除初次治疗的失败因素，小号K锉疏通根管，镍钛机用根管锉冠向下法预备主根管，显微镜下使用超声与K锉预备峡区，1％NaCIO超声冲洗根管系统，热牙胶垂直加压充填根管。记录初次治疗失败原因，根管再次探查和疏通的效果、再治疗根充效果及半年随访效果。结果：63颗上颌第二前磨牙初次治疗失败的主要原因为根管预备不充分和根管充填不完善。再治疗三维适填达86％。半年随访成功率达85％。结论：峡区、根尖分叉和根尖弯啦是上颌第二前磨牙根管治疗失败的主要解剖原因。显微根管再治疗可以获得理想的疗效，值得临床推广使用。     

Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment

Extrusion of intracanal debris as well as irrigants is a common occurrence during root canal treatment, and no instrument or technique has thoroughly solved this problem. Because flare‐ups may arise with any irritation directed towards periapical tissues, a shaping or irrigation technique should minimize the risk of apical extrusion, even though it may not be prevented. There has been a rapid evolution of root canal instruments and irrigation systems through the last decade, and many have been assessed for their debris extrusion potential. The purpose of this review was to identify publications regarding the evaluation of debris, bacteria and irrigant extrusion during root canal treatment. A PubMed, Ovid and MEDLINE search was conducted using the keywords “apical extrusion”, “debris extrusion” and “endodontic treatment”. The literature search extended over a period of more than 30 years up to 2012. Content of the review was limited to apical extrusion of debris and irrigants, extrusion of liquid by irrigation methods and bacterial extrusion. Issues relevant to apical extrusion were obtained by further search in the reference sections of the retrieved articles. The review provides an update on the current status of apical extrusion.     

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根管冲洗对根管的消毒和清理起着重要作用,冲洗液可以通过冲洗碎屑、溶解组织和消毒根管系统而提高机械预备的效力。次氯酸钠（NaClO）是目前世界范围内临床上使用最广泛的根管冲洗液之一。本文就NaClO的作用及相应机制、提高使用效率的方法、不良反应、与其他冲洗液联合应用等方面做一综述。     

根管内动能冲洗技术及应用策略

从根管系统中彻底清除牙髓组织、微生物、毒素及坏死组织是根管治疗成功的关键.但由于根管系统解剖结构的复杂性,如峡部和侧支根管的存在,使得根管的清理与成形具有挑战性.机械预备会在根管壁形成玷污层,而残留的牙髓组织、微生物、毒素及坏死组织可能会导致根尖周组织的持续感染.因此,单纯的机械预备并不能达到理想的根管清理效果,还需结...     

Irrigation in endodontic treatment

The primary endodontic treatment goal is to optimize root canal disinfection and to prevent reinfection. Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal system. In this review of the literature, various irrigants and the interactions between irrigants are discussed and new delivery systems are introduced.     

In vitro cleaning ability of root canal irrigants with and without endosonics

A variety of methods have been used to evaluate the cleanliness of root canals after endodontic preparation and irrigation. Few irrigation agents other than sodium hypochiorite (NaOCl) have been tested in conjunction with endosonics. The purpose of this study was to examine the cleaning ability of water, NaOCl, Hibiscrub and a biological washing liquid when used as intracanal irrigants, with and without endosonics. Two methods of evaluation were employed to assess the root canal cleanliness after endodontic preparation. A total of 56 teeth, divided into eight groups, were prepared manually using the step-down technique. Each irrigating agent was used in two experimental groups, with and without endosonics. Two additional teeth which received neither instrumentation nor irrigation served as the controls. The teeth were split longitudinally and the state of cleanliness of the root canal was assessed by scoring the amount of stained organic debris and smear layer. It was demonstrated that the results of debris and smear layer scoring were significantly influenced by the type of irrigant and whether endosonics had been used. All agents exhibited similar cleaning ability when introduced manually. With endosonics, NaOCl yielded significantly less stainable debris (P < 0.05) than the other groups which showed no significant difference. The ability to remove the smear layer was enhanced, but at some distance short of the working length, by endosonics for all irrigants tested. None of the solutions tested was able to produce a canal wall that was free of smear layer.     

Update on endodontic irrigating solutions

Bacteria have long been recognized as the primary etiological factor in the development of pulp and periapical lesions. Successful root canal therapy depends on thorough debridement of pulpal tissue, dentin debris, and infective microorganisms. Currently, it is impossible to eradicate intraradicular infection with mechanical instrumentation alone. Therefore, irrigants are required to complete this task. In this article, the different actions and interactions of the most commonly used irrigants are discussed. The aim of this review is to analyze the relevant literature on root canal irrigants.     

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.     

不同冲洗液对根尖溢出碎屑的影响

目的： 比较根管预备后不同冲洗液对根尖溢出碎屑的影响。方法：58颗正畸拔除的单根牙随机分为4组,常规根管预备后,采用不同冲洗液冲洗,对照组(A组)：7颗、蒸馏水冲洗;实验组每组17颗,B组：1% NaOCl冲洗;C组：2.5% NaOCl冲洗;D组：17% EDTA冲洗。收集冲洗后的冲洗液,通过紫外可见分光光度计检测吸光度（OD）值,比较其根尖溢出碎屑的含量。采用SPSS 13.0软件包对结果进行统计学分析。结果：冲洗前、后的OD差值分别为对照组A组0.012、B组0.122、C组0.393、D组0.021,B、C、D 3组冲洗前、后的差值与对照组相比,均有显著差异（P<0.05）。其中,C组最高,与B、D 2组相比,均差异显著（P<0.05）。结论：冲洗液能增加根尖溢出碎屑的含量,2.5%NaClO冲洗液产生较多的根尖溢出碎屑,1% NaOCl、17%EDTA溶液是临床上较理想的冲洗液。