利用超声波预备阻塞根管的临床研究

用国际先进的ＯｄｏｎｔｏｓｏｎＭ超声波机对３２例患者４６个阻塞根管进行预备再通，成功４２个根管，失败４个根管，成功率为９１．３％，再通成功的病例中仅１例发生术后疼痛。说明用超声波进行阻塞根管的预备再通，成功率高、术后疼痛反应少，与传统的手工器械预备法相比，是一种高效而实用的新方法     

牙根管阻塞的治疗进展

临床上常遇到阻塞根管，导致根管无法扩通，根管的治疗无法彻底，这是临床医生最棘手头痛的事情。传统的治疗是用小号扩管锉耐心地钻通，目前随着社会科技的发展，越来越多新的设备技术应用于临床．阻塞根管的治疗有了新的方法。本文就牙根管阻塞的治疗进展作一综述。     

微镜下对根管治疗失败临床再治疗的体会

目的：通过手术显微镜和超声器械对根管治疗失败病例的再治疗，探讨牙本质领和髓室钙化物在根管治疗失败中的影响。方法：临床收集再治疗病例中，因根管治疗术后长期咬合不适，以及根管内器械折断、常规治疗根管不通、根管侧穿、髓室底穿的患牙385例，X线片结合手术显微镜和超声器械，探寻原始根管口查找失败原因并进行治疗。结果：再治疗病例中因遗漏根管187例；器械折断53例；根管台阶和侧穿98例；底穿32例（医源性26例）；牙髓钙化56例；共计426例患牙。发现牙本质领或髓室钙化物未祛除的患牙231例，占再治疗病例54．2％。结论：牙本质领和髓室钙化物能使根管口狭窄、偏移或阻塞，造成遗漏根管、增大根管弯曲度，从而增大根管台阶、侧穿及断针的几率。而应用手术显微镜和超声器械能在清晰的视野下准确地祛除牙本质领和髓室钙化物，降低根管治疗失败率，也是再治疗得以成功的保证。     

牙科手术显微镜联合超声技术治疗阻塞根管疗效观察

目的评价牙科手术显微镜联合超声技术治疗阻塞根管的临床效果。方法显微镜下应用超声技术对因塑化治疗、根管钙化、根管治疗不完善导致根管阻塞患牙232颗417个根管行疏通治疗。结果本组疏通根管357个,阻塞根管再疏通率为85.61%;充填不完善根管疏通治疗成功率（87.97%）高于钙化根管和塑化根管所致阻塞的成功率（78.08%和78.57%）（P〈0.05）,而钙化根管治疗成功率与塑化根管比较差异无统计学意义（P〉0.05）;不同牙位阻塞根管治疗成功率从高至低依次为前牙（97.56%）、前磨牙（86.20%）、磨牙（81.94%）（P均〈0.05）。结论牙科手术显微镜联合超声技术治疗阻塞根管疗效确切,充填不完善所致的根管阻塞效果高于钙化根管和塑化根管所致。     

应用C型先锋锉结合超声器械及根管显微镜处理钙化阻塞根管81例疗效观察

目的:探讨应用C型先锋锉结合超声器械及根管显微镜(DOM)处理钙化阻塞根管的临床疗效。方法:对81例钙化阻塞根管的患者采用C型先锋锉结合专用超声器械及根管显微镜进行根管疏通,统计治疗成功率。结果:本组84个根管完成治疗,成功率为82.4%,其中前牙钙化根管的治疗成功率为90.9%、前磨牙成功率为90.0%、磨牙成功率为73.5%;47.1%的根管单纯应用C型先锋锉即疏通成功,35.5%的根管需结合超声器械和根管显微镜疏通成功;均未发生根管侧穿或牙根折裂。结论:C型先锋锉结合超声器械和根管显微镜的使用,为处理钙化阻塞根管提供了行之有效的方法。     

显微超声根管技术处理根管阻塞的临床护理

常规根管治疗过程中,多种因为可导致根管阻塞,如治疗过程中的器械分离,根管内修复体(根管桩和固位钉等)、钙化物以及金属充填物、牙胶、黏固剂等多种物质均可使根管阻塞.临床处理阻塞根管存在一定的困难,笔者配合医生应用牙科手术显微镜结合超声根管技术处理根管内阻塞物,取得了一定的效果.现介绍如下.     

显微超声技术处理由增龄性变化所致根管阻塞的临床评价

目的 总结牙科手术显微镜和超声联合应用技术处理由于增龄性变化所导致根管阻塞的临床应用效果.方法 选取由于增龄性变化导致根管阻塞且常规方法未能顺利疏通根管的患牙57颗共76个根管,采用显微超声联合技术疏通根管阻塞.结果 76个根管阻塞中,有63个顺利扩通并完成根管治疗,总体成功率为82.89%.前牙、前磨牙和磨牙的阻塞根管分别为15个、22个和39个,应用显微超声技术寻找、疏通的根管数分别为14个、19个和30个,成功率分别为93.33%、86.36%和76.92%.结论 牙科手术显微镜和超声器械联合应用可作为临床上处理由于老年人增龄性变化所导致根管阻塞治疗的有效方法.     

慢性牙髓炎根尖炎一次性根管治疗的临床疗效观察

目的评价慢性牙髓炎、根尖炎一次性根管治疗术的，临床效果。方法选择170例牙髓炎根尖炎患者，分别采用分次性根管治疗和一次性根管治疗，记录患牙术后3d疼痛反应，评价1年后根管治疗效果，计算术后3d疼痛率和1年后治疗的成功率。结果170例患牙中，术后3d轻微疼痛和严重疼痛的发生率A组分别为8％和4％，B组分别是11％和4％，两组差异均无统计学意义。术后1年，156例随访患者，分次根管治疗纽87例，一次性根管治疗组69例，治疗成功率分别为92％、86％，治疗效果两组差异均无统计学意义。结论一次性根管治疗术治疗慢性牙髓炎、根尖炎，术后3d疼痛发生率及术后1年治疗效果与分次根管治疗无差异，并能减少患者复诊次数，减轻医生工作量，值得在临床推广使用。     

两种不同方法在弯曲根管治疗效果中的比较

目的：评价根管治疗和塑化治疗在弯曲根管治疗中的疗效比较。方法：随机选择门诊确诊为牙髓炎和根类周炎的118例患牙分为根管治疗组和塑化治疗组，采用手用镍钛根管锉备根进行治疗，2年后统计结果，有96例复查。结果：根管治疗成功率96．2％；塑化治疗成功率79．1％，提示对于弯曲的根管，用弹性大的器械，根管治疗效果更好。     

弯曲根管的塑化治疗和根管治疗疗效对比观察

目的：评价弯曲的根管，塑化治疗和根管治疗的疗效。方法：选择临床诊断为牙髓炎或根尖周炎的病例中的弯曲根管118例随机分为塑化治疗组和根管治疗组，采用手用镍钛根管锉备根进行治疗。2年后统计结果．有96例复查。结果：根管治疗成功率96．2％；塑化治疗成功率79．1％，提示对于弯曲的根管。用弹性大的器械，根管治疗效果更好。     

Three years of clinical evaluation of endodontically treated teeth by 15 F CO2 laser microprobe: in vivo study

OBJECTIVE: Evaluation of the efficiency of 15 F CO2 laser microprobe, in cases of periapical lesions. The elimination of the pathological reaction caused by certain species of bacteria by reduction of reinfection and stimulation of osteogenesis. SUMMARY BACKGROUND DATA: Until now, no suitable delivery fiber existed for CO2 laser endodontic radiation in the apical region where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, Sharplan Lasers designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal, thus favorably increasing the thermal effects. METHODS: The study was conducted on 900 teeth, corresponding to 1512 root canals, divided in two groups. Four hundred sixty-eight were new cases, carefully selected according to strict parameters such as wide periapical translucency over 1 mm, supported by digital x-ray, with a lesion of 3 mm and more. All root canals were mechanically prepared in the conventional method up to size 35, Physiological saline solution served as rinsing solution and the root canals were treated by 15 F CO2 laser microprobe for 60 pulses repeatedly. The temperature at the surrounding tissue of the root did not exceed 38 degrees C. RESULTS: Filling of the canal was possible at the same appointment, without antibiotic treatment. Four hundred thirty-two of the cases, which were referred to us by other dentists after an unsuccessful treatment according to the classic therapy, were treated by the same laser therapy. Follow-up was performed by clinical examination, and a digital x-ray was taken, during and after treatment as well as after 3, 6, 9, and 12 months. CONCLUSIONS: There is a 98% success rate in both study groups, according to objective criteria for successful treatment including reduction of apical translucency after 2-6 months, freedom from clinical complaints, and no need for periapical surgery.     

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.     

四手操作在显微超声技术疏通钙化根管的应用效果

目的评估四手操作在显微超声技术疏通钙化根管的应用效果。方法便利抽样法选取选2011年1月至2012年6月在深圳市龙岗中心医院口腔科治疗的钙化根管患者110例为研究对象,按就诊时间先后将其分为观察组和对照组,每组55例。观察组患者实施显微超声技术疏通钙化根管,采用四手操作方法医护配合;对照组患者患者采用传统护理方式。比较两组患者的平均治疗时间及满意度情况及满意率。结果观察组患者平均治疗时间为(33±8.45)min,对照组患者为(57±9.42)min,工作效率提高42.10%,两组患者平均治疗时间的差异有统计学意义(t=-50.556,P0.001)。观察组患者的满意率为94.54%,高于对照组的52.72%,差异有统计学意义(P0.05)。结论四手操作在显微超声技术疏通钙化根管治疗过程中,能提高工作效率和患者的满意度。     

铸瓷高嵌体修复经根管治疗后前磨牙牙体缺损的临床效果

目的探讨铸瓷高嵌体修复经根管治疗后前磨牙牙体缺损的临床效果。方法选取2015年1月至2017年12月我院口腔科收治的70例经根管治疗后前磨牙牙体缺损患者,共81颗患牙(前磨牙牙体缺损均涉及邻牙合面),将患者随机分为A组(35例,40颗患牙)和B组(35例,41颗患牙)。A组采用纤维桩加钴铬烤瓷冠修复,B组采用铸瓷高嵌体修复。修复后1年患者入院复诊,比较两组的患牙修复成功率。结果A组、B组的患牙修复成功率分别为92.5%、95.1%,组间比较,差异无统计学意义(P>0.05)。结论铸瓷高嵌体修复经根管治疗后前磨牙牙体缺损短期内效果较好,并在美学、生物学方面具有良好性能。     

机动镍钛器械Hero 642预备后牙弯曲根管的临床评价

目的评价机动镍钛器械Hero642预备后牙弯曲根管的临床疗效。方法将64颗具有中、重度弯曲根管的患牙随机分为两组,试验组使用机动镍钛器械Hero642以冠向下技术预备根管,对照组使用手动K锉以逐步后退法预备根管,两组均以侧向加压方法完成充填。根据治疗前、中、后的数字牙片评价根管预备和充填效果。结果试验组无根尖阻塞,根管预备后的锥度和流畅度好,操作时间短,术后疼痛发生率低(P<0·01)。有2例器械折断;对照组有1例器械折断。结论机动镍钛器械He-ro642预备后牙弯曲根管成形效果好、快速、使用方便,术后疼痛发生率少。可视为临床上预备弯曲根管的有效方法。     

Histopathological changes in dental pulp irradiated by Er:YAG laser: a preliminary report on laser pulpotomy

OBJECTIVE: The effects of Er:YAG laser irradiation on the pulp tissue during a pulpotomy procedure were evaluated histopathologically. BACKGROUND DATA: The effects on pulp tissue during laser pulpotomy using Er:YAG laser irradiation are not clear. MATERIALS AND METHODS: Sixty mesial root canals of mandibular first molars in rats were divided into four groups. In three of these groups, root canals were irradiated using an Er:YAG laser at 2 Hz and 34, 68, and 102 mJ/pulse for 15 sec. Non-irradiated canals served as controls. The effects of laser irradiation on the remaining pulp tissue and periodontal tissues were evaluated at 0 days, 2 days, and 1 week after irradiation under light microscopy. RESULTS: At 1 week after treatment, no inflammation or resorption was observed in any cases in the control or 34 mJ/pulse-irradiated groups. However, moderate to severe inflammation was observed in 9 of 10 cases (90%) in the 68 and 102 mJ/pulse-irradiated groups. CONCLUSION: These results suggest that effects on pulp tissues during a pulpotomy procedure by Er:YAG laser irradiation are minimal, if appropriate parameters are selected, and this is a potential therapy for pulpotomy of human teeth.     

一次性根管治疗对老年人感染根管的疗效

目的观察老年人感染根管一次性根管治疗的短期疗效。方法选择临床诊断为牙髓坏死、慢性根尖炎的病例60例,平均年龄(70.4±5.9)岁。随机分为一次治疗组30例,1次完成根管预备和根管充填;两次治疗组30例,疗程间氢氧化钙根管封药。临床观察指标为术后疼痛及术后2年的临床评定治愈率。结果术后患者疼痛率一次组为36.7%,两次组40.0%,差异无统计学意义(P>0.05);术后两周患者疼痛率一次组为10.0%,两次组33.3%,差异有统计学意义(P<0.05)。6个月临床治愈率分别为58.3%、56.0%,2年的临床治愈率分别为80.0%、72.7%,两组间差异无统计学意义。结论老年人感染根管一次性根管治疗可减少激惹术后疼痛的机会,具有临床可行性。     

间接数字化成像技术分析208颗山东地区汉族人恒前牙根管的弯曲情况

背景:熟悉根管解剖形态,了解其弯曲程度,可以在一定程度上预防根管预备时的并发症,提高根管治疗的成功率.目的:了解山东地区汉族人恒前牙根管弯曲的情况.方法:采用间接数字化X射线成像技术,对收集的离体208颗前牙进行颊舌向和近远中向拍摄,采用改良的Schneider测量方法,分析根管弯曲情况.结果与结论:山东地区汉族人前牙根管多为Ⅰ型根管,且半数以上存在弯曲,弯曲部位多集中在根尖1/3,尤以上颌尖牙根管弯曲发生率最高,除上颌中切牙外,其余牙位均有S形弯曲根管,下颌前牙在唇舌方向上弯曲半径明显高于近远中方向.提示山东地区汉族人恒前牙根管形态复杂,弯曲率较高.     

隐裂磨牙的诊治分析

目的:观察145颗隐裂磨牙的治疗效果,探讨隐裂磨牙的治疗方法。方法:对136例患者共145颗隐裂磨牙进行治疗,其中9颗行充填、调□治疗,26颗在复合树脂充填后行全冠修复,110颗在根管治疗后行全冠修复。对所有患者进行2年以上跟踪观察,分析并比较治疗效果。结果:男性患磨牙隐裂的比例高于女性,其好发年龄为35～54岁,以上颌第一恒磨牙最为好发,好发隐裂类型为近远中向。145颗患牙治疗后总成功率为85.52%。结论:根管治疗后行全冠修复能有效地保留隐裂的磨牙。