显微超声技术取根管内折断器械致根管侧穿并发症的研究

目的分析影响显微超声技术取出根管内折断器械的成功率及导致根管侧穿并发症的因素。方法45例患者,45颗患牙采用显微超声技术取出根管内折断器械,观察根管内折断器械的取出成功率以及根管侧穿发生的情况,分析影响因素。结果当折断器械位于根管冠1／3、中1／3和尖1／3时,应用显微超声技术取出的成功率分别为90．00％、94．12％和38．89％,根管侧穿发生率分别为10．00％、5．88％和50．00％,后者取出的成功率明显低于前二者（P〈0．05）,而根管侧穿的发生率却明显高于前二者（P〈0．05）;当折断器械位于直根管、中度弯曲以及重度弯曲根管内时,取出成功率分别为91．67％、85．71％和47．37％,根管侧穿的发生率分别为8．33％、7．14％和47．37％,后者的取出成功率明显低于前二者（P〈0．05）,而根管侧穿的发生率却明显高于前二者（P〈0．05）;另有2例断针推出根尖孔外。结论显微超声技术取出根管内折断器械时可能发生根管侧穿,尤其当折断器械位于根管尖1／3段或重度弯曲根管时更应该慎重。     

显微超声技术去除磨牙根管内折断器械的临床应用

目的：评价牙科显微镜结合超声技术处理磨牙根管内折断器械的临床疗效。方法：门诊收集发生器械折断的磨牙81例,采用显微超声技术进行治疗,统计患牙折断器械取出成功率。结果：81个根管器械折断成功取出39个,成功率48．1％;根管冠1／3成功率为100％,根管中1／3成功率为51．7％,根管下1／3成功率为28．2％;不锈钢锉取出成功率为55．6％,镍钛锉取出总成功率42．2％;折断器械位于冠1／3时,二者成功率均为100％;根中1／3,不锈钢锉组取出成功率为61．5％,镍钛锉组43．8％;根下1／3,不锈钢锉组取出成功率为35．3％,镍钛锉组22．7％。结论：显微超声技术是处理磨牙根管内折断器械的一种安全有效的方法,但在处理磨牙根管下1／3时有很大局限性。     

根管内折断器械显微超声取出效果的临床观察

目的 探讨显微超声技术处理根管内折断器械的效果及提高取出成功率的有效方法.方法 对常规方法不能处理的96例患者,共计101个根管内折断器械.在根管显微镜下使用专用超声工作尖进行处理,统计患牙的治疗成功率.结果 显微镜下顺利完成78例,成功率82.2%,共计83支折断器械.结论 对下颌磨牙的根管治疗及折断器械取出应提高警惕;牙科显微镜结合超声技术,采用合理的操作方法、合适的工作尖,对处理大部分根管内折断器械有较理想的治疗效果.     

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。     

根尖区机用镍钛器械折断的临床治疗体会

目的：探讨机用镍钛器械在根尖区折断的特点及临床治疗经验。方法：收集根尖区机用镍钛器械折断患者18例,记录折断器械的种类,型号,患者的年龄,牙位及其治疗结果。结果：18例折断器械中,发生于前牙3例,前磨牙3例,磨牙12例;其中ProTaper锉11例,Waveone锉5例,Mtwo锉1例,S3锉1例。折断器械成功取出10例,成功率55.6%。其中显微超声技术取出8例,成功率为44.5%;显微镜下加压冲洗法2例,成功率11.1%;保留作为根管充填物5例,旁路通过术2例,显微根尖手术1例。1年根管治疗成功率77.8%。结论：镍钛器械折断好发于磨牙细小根管及复杂根管,折断器械取出的难度大,有效预防器械折断及选择合适的治疗方案是提高根管治疗成功率的关键。     

显微超声技术在折断器械取出中的临床应用

目的：评价手术显微镜下结合超声装置取出根管内折断器械的效果。方法;术前X线确诊根管内折断器械病例25例,在显微镜下使用超声装置制备直线通路和增隙,暴露器械断端,松动并取出断械。术后拍摄X线片确诊折断器械是否取出,然后完成根管治疗。结果：25例中在显微镜下取出23例,取出率82．1％。有5例未能取出,其中根管壁侧穿2例,显微镜下未能见到折断器械2例,器械部分推出根尖孔1例。结论：手术显微镜结合超声装置是根管内折断器械取出较为理想的方法。     

根管内折断器械的超声取出方法

根管内器械折断是根管治疗的常见并发症,随着显微根管治疗技术的发展,大部分根管折断器械可以通过超声技术取出。本文对根管内器械折断的原因、超声技术取根管内折断器械的方法及应用中可能出现的问题进行介绍,强调超声法取根管内折断器械时建立直线通路的重要性,对超声振动过程中有水或无水下操作、工作尖是否需要旋转以及是否需要根管显微镜辅助等问题进行讨论,对临床医师预防和处理根管器械折断具有指导意义。     

超声工作尖取根管内金属折断器械的效果评价

目的评价用超声工作尖ET20、ET40取根管内折断器械的效果.方法在肉眼或根管显微镜观察下使用GG钻或超声工作尖制备根管直线通路,用超声工作尖ET20、ET40对163根根管内折断器械进行处理.结果 163根根管内折断器械取出145个,取出率89%.其中,前牙取出率为100%,前磨牙为97%,磨牙为85%.不锈钢和镍钛扩大器械取出率为88%～90%,拔髓针取出率仅为37%.根管弯曲以下折断器械取出率为11%.直根管或根管弯曲以上折断器械因器械类型有较大差异,根管扩大器械取出率为98%、裂钻为100%,拔髓针为50%.163例中根管侧穿7例(4%),旁道形成5例(3%),折断器械出根尖孔2例(1%).结论超声工作尖ET20、ET40对大部分根管折断器械的取出有很好的效果,但对根管弯曲以下折断器械、拔髓针等取出效果较差.     

CBCT结合显微超声技术处理根管内折断器械的临床研究

目的：评价锥体束CT（CBCT）结合显微超声技术处理根管内折断器械的临床疗效。方法：选取济宁医学院附属医院口腔科2012年9月～2013年6月初次根管治疗中出现的器械折断病例24例,对患牙CBCT扫描,进行三维重建,对折断器械的根管进行三维定位及评估,制定临床决策,实施断械取出,计算取出率。结果：CBCT能准确定位断械所在根管,清晰显示根管形态、弯曲度、折断器械位置及周围牙本质厚度。24例断械病例中,20例选择取出治疗,其中16例成功取出,4例未能取出,成功率为80％。4例因折断器械均位于根尖部,弯曲根管下段,且周围牙本质薄弱不选择取出治疗。结论：CBCT结合显微超声技术为临床上评估及取出根管内器械折断病例提供了有效方法。     

不同弯曲度根管中两种分离器械取出成功率对比研究

目的：体外对比分析不同弯曲度根管中分离的镍钛器械和不锈钢器械取出的成功率。方法：取新鲜拔除的离体人牙60颗,随机分为镍钛器械组和不锈钢器械组,每组30颗牙,分别将机用镍钛根管锉和不锈钢K锉分离于三种不同弯曲程度的根管内,根管显微镜下超声法取出分离器械,计算取出成功率并统计学分析。结果：不锈钢器械取出率高于镍钛器械,但差异无统计学意义（P〉0．05）。直根管和轻度弯曲根管中两种分离器械的取出成功率差异无显著统计学差异（P〉0．05）。重度弯曲根管中两种分离器械的取出成功率明显低于直根管和轻度弯曲根管的取出成功率,差异有显著统计学意义（P〈0．05）。结论：显微超声法可有效取出不同弯曲度根管内分离的镍钛和不锈钢器械。根管弯曲度是根管内分离器械取出的关键因素,对于重度弯曲根管内分离器械的取出进行术前的合理评估。     

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目的评价根管显微镜和超声联合应用技术对疑难根管处理的临床应用效果。方法总结2007年4月至2008年3月于滨州医学院附属烟台口腔医院特需门诊就诊并接受显微超声联合根管治疗的疑难病例177例资料,共210个根管,包括折断器械、根管内水门汀样充填物和根管内塑化物、根管钙化、根管侧穿。结果应用根管显微镜超声联合技术处理折断器械、根管内原充填物、根管钙化、根管侧穿的成功率分别为82.35%、82.14%、76.32%、100%;重度弯曲根管侧穿的发生率为35.14%。结论根管显微镜联合超声技术可以使许多疑难根管得到完善的治疗;各种原因导致的重度弯曲根管的阻塞在应用显微超声技术时应注意避免根管侧穿的发生。     

显微超声技术在根中下1/3取断针的疗效及策略

目的：分析在根管显微镜下应用超声技术取出根管中下1/3断针的临床效果,提出预防措施。方法：收集5年来门诊根管预备断针发生在根中下1/3的患者36例,均在显微镜下用超声根管工作尖取断针。结果：36例根管内断针取出29例,失败7例,成功率为80.5%,4例建立旁路,1例拔除,2例留内观察。结论：根管显微镜下应用超声技术取出根管内断针相对安全有效。     

Probability of removing fractured instruments from root canals

Aim To evaluate in a clinical case series the location of fractured instruments, how many of them could be removed and to compare these findings with the results of a similar study. Methodology Within an 18‐month period all referred endodontic cases involving fractured instruments within root canals were analysed. The protocol for removal of fractured instruments was: create straight‐line access to the coronal portion of the fractured instrument, attempt to create a ditched groove around the coronal aspect of the instrument using ultrasonic files and/or to bypass it with K‐Files. Subsequently, the fractured instrument was vibrated ultrasonically and flushed out of the root canal or an attempt was made to remove the instrument with the Tube‐and‐Hedström file‐Method or similar techniques. The location of the fractured instrument and the time required for removal were recorded. Successful removal was defined as complete removal from the root canal without creating a clinically detectable perforation. Results In total, 97 consecutive cases of instrument fracture were included in the time period. In all, 84 instruments (87%) were removed successfully. There was a significant correlation between the time needed to remove fractured instruments and a decrease in success rate. Curved canals had significantly more fractured instruments than straight canals (P < 0.05). Rotary instruments fractured significantly more often in curved canals (P < 0.05) compared with other instruments. Half of all instrument fractures occurred in mesial roots of lower molars and most often when using rotating instruments. There was no statistically significant difference in the success rate with respect to the location of the fractured instrument (tooth/root type), the type of fractured instrument or the different methods of instrument removal. Conclusions Curved canals are a higher risk for instrument fracture than straight canals. In curved canals rotary instruments (including lentulo spirals) fractured more often than other instruments. In all, 87% of the fractured instruments were removed successfully. A decrease in success rate was evident with increasing treatment time. The use of an operating microscope was a prerequisite for the techniques used to remove the fractured instruments.     

The clinical treatment of complicated root canal therapy with the aid of a dental operating microscope

Objectives: To evaluate the clinical application of the dental operating microscope (DOM) in the management of complicated root canal therapy. Methods: 345 teeth with 546 root canals which could not be successfully managed by conventional methods received therapy under the DOM with ultrasonic instruments by the same endodontists. The aetiology of the canals included calcification, broken instrument, missed canal and canal perforation. The teeth and canals successfully managed were then calculated. Results: 406 canals were successfully managed with a rate of 74.4%; 246 teeth were successfully managed with a rate of 71.3%. The rates in each category of the complicated root canals were: 74.0% for calcified canals, 72.3% for canals blocked by broken instruments, 82.5% for missed canals and 72.7% for canal perforations. Conclusions: The clinical application of the DOM is an effective way of managing complicated root canal therapy.     

根管内折断器械处理方法的临床研究

目的 探讨根管内折断器械的处理方法及影响取出因素分析。方法对86个根管内器械折断的病例。应用不同取出方法处理，总结根管内折断器械的取出效果。结果使用非手术方法，在器械折断的86个根管中，全根管和根管上部的折断器械38例，全部取出；折断器械位于根管中部的20个，13个取出；折断器械位于根尖部的28例中，6例取出。在使用非手术方法未能取出的29例中，18例通过折断器械建立旁路根管充填；11例行根尖手术取出并根管倒充填。结论应用适当的非手术方法，根管中上部的折断器械大部分可取出，根尖部的折断器械取出较困难，根尖部的折断器械可以通过根尖手术的方法取出。     

Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: an experimental study

The use of nickel-titanium rotary instruments in endodontic practice is increasing. One frequently mentioned problem is fracture of an instrument within the root canal. To date, there is no consistently safe and successful technique for removing these fractured instruments. This study evaluates the use of an ultrasonic technique to remove fractured rotary nickel-titanium instruments from narrow, curved canals in both simulated (resin blocks) and mesiolingual canals of extracted mandibular first molars. A technique using ultrasonic tips, combined with the creation of a "staging platform" and the use of the dental operating microscope, was consistently successful and safe at removing fractured rotary nickel-titanium instruments from curved root canals, when some part of the fractured instrument segment was located in the straight portion of the canal. When the fractured instrument segment was located entirely around the curve, the success rate was significantly decreased and major canal damage often occurred.     

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目的 评价显微超声技术配合K锉取出法取出根管内折断器械的临床效果.方法 对2005年3月至2010年6月在北京大学深圳医院口腔科就诊的根管内折断器械患者49例,应用显微超声技术结合K锉取出法取出折断器械,并时不同部位的根管内折断器械的取出情况进行分析.结果 49例根管内折断器械共取出37例,取出率75.5%;折断器械在根管上、中、下1/3的取出率分别为100%、87.5%、44.4%.结论 显微镜下应用超声技术结合K锉取出法是根管内折断器械取出较为理想的方法,根管下1/3折断器械取出率相对较低.