半导体激光照射根管内壁的扫描电镜研究

目的：应用波长1320nm的半导体激光照射根管内壁,观察其扫描电镜图像改变,方法：取6颗新鲜离体上颌中切牙,随机分成A,B,C三组,A组常规根管预备加单模光纤连接波半导体激光照射5分钟;B组常规根管预备加连续波激光照射两次,每次5分钟,间隙30分钟;C组为常规根管参备对照组,三组牙齿标均进行扫描电镜观察,结果：A组部分管间牙本质熔融,呈均质状结构,玷污层大部分消失,管壁散在附着少量白色结晶样物质,牙本质小管大部分封闭,B组牙本质小管全部封闭,管壁平坦,管间牙本质熔融,呈均质状结构,玷污层消失,管壁干净无碎屑,C组根管内壁覆盖了大块不规则玷污层,可见少许牙本质小管,而且所有标本根管壁未见裂隙和碎裂现象。结论,激光照射根管内壁,可使管壁表面玷污层消除,产生熔融层,有利于根管治疗。     

不同冲洗剂对桩腔预备后牙本质清洗能力及树脂突的影响

目的比较不同根管冲洗剂对桩腔预备后根管内牙本质表面玷污层去除和牙本质小管开放的影响。方法将30个完成根管充填的上颌前牙经桩腔预备后,根据根管冲洗剂不同随机分成A、B、C 3组。A、B、C组分别使用3%过氧化氢（H2O2）、15%乙二胺四乙酸（EDTA）、15%EDTA加3%次氯酸钠（NaClO）作为冲洗剂。冲洗后每组选取8个标本通过扫描电镜（SEM）观察牙本质表面玷污层和牙本质小管开放情况,另选2个标本在粘接纤维桩后用于观察树脂突。结果A、B、C组牙本质清洁效果（Berg值）分别为3.89±0.36、1.77±0.30、1.25±0.21;牙本质小管直径分别为（2.53±0.19）、（3.11±0.23）、（3.83±0.52）μm。3组间牙本质表面清洁效果和牙本质小管开口差异均有统计学意义（P<0.05）。C组出现明显的牙本质过蚀。各组间的树脂突形成有很大差异,以B组最优。结论桩腔预备后用15%EDTA冲洗桩腔能有效去除玷污层,使牙本质小管开放,利于树脂黏固剂有效渗入牙本质小管和胶原纤维网。     

XP-endo Finisher锉对根管内壁玷污层清除效果的体外研究

目的 评估XP-endo Finisher（XPF）锉与被动超声冲洗（PUI）对根管内壁玷污层的清除效果。方法 选择60颗离体单直根管下颌前磨牙,距根尖16 mm处截冠,采用S3镍钛锉预备到3S,根据终末处理方式不同将样本随机分成6组。A组：3 mL 3%次氯酸钠溶液联合XPF处理1 min;B组：3 mL 3%次氯酸钠溶液联合XPF处理1 min,再用4 mL 17%乙二胺四乙酸（EDTA）溶液冲洗1 min;C组：3 mL 3%次氯酸钠溶液联合PUI处理1 min;D组：3 mL 3%次氯酸钠溶液联合PUI处理1 min,再用4 mL 17%EDTA溶液冲洗1 min;E组：3 mL 3%次氯酸钠溶液30号侧方冲洗针冲洗1 min;F组：3 mL 3%次氯酸钠溶液30号侧方冲洗针冲洗1 min,再用4 mL 17%EDTA溶液冲洗1 min。采用扫描电子显微镜观察玷污层形态,并比较根尖1/3区、根中1/3区牙本质小管开口数。结果 A、C、E组实验样本整个根管壁都有玷污层覆盖,A组与C组牙本质小管开口数明显高于E组（P<0.05）,而A组与C组的差异无统计学意义（P>0.05）;F组根中区、B组和D组根尖区有少量玷污层覆盖,牙本质小管开放或半开放;F组根尖区可见玷污层,牙本质小管封闭或半封闭;B和D组根中区根管壁玷污层均被有效去除;在根尖1/3区和根中1/3区,B组与D组牙本质小管开口数高于其他4组（P<0.05）,而B组和D组间的差异无统计学意义（P>0.05）。结论 XPF锉对根管内壁玷污层的清洁效果与PUI无明显差异,可用于根管预备后提高根管清洁效果。     

MTAD作为根管冲洗剂的效果评价

目的探讨应用MTAD作为根管冲洗剂去除根管壁玷污层的效果,以及对根管充填后根尖微渗漏的影响。方法采集因正畸或牙周病拔除的前磨牙,截冠后统一工作长度16 mm,按照冲洗液使用的不同,随机分为A、B、C 3组,每组12颗。A:生理盐水;B:MTAD;C:5.25%NaClO+15%EDTA。采用机用Protaper镍钛根管锉进行根管机械预备,分别用相应冲洗液冲洗,根管预备后每组4颗牙齿用于制备扫描电镜标本,观察根管表面玷污层和牙本质小管暴露的情况。每组剩余8颗进行根管充填,1周后,采用液体转移法,测量各样本根管微渗漏。实验数值采用SPSS 19.0软件包进行分析。结果 A组沉积大量玷污层,牙本质小管被遮蔽,B、C组玷污层得到有效的清除,牙本质小管开放。根管充填后,A组和B组之间,A组和C组间的微渗漏值有统计学差异(P<0.05),B组合C组之间无统计学差异(P>0.05),其中A组的微渗漏值最大。结论 MTAD冲洗剂可以替代5.25%NaClO+15%EDTA联用,能有效地去除根管充填过程中产生的玷污层,增强根管充填后的根尖封闭性。     

MTAN用于桩道清洁能力的实验研究

目的:研究MTAN在桩道制备后用于去除玷污层的能力。方法:经筛选得到符合要求的40颗单根管前磨牙,于釉牙骨质界冠方2mm处截去牙冠。根管预备、根管充填、桩道制备后随机均分为5组,分别用以下溶液进行桩道冲洗。A组:10mL0.9%盐水;B组:2.5mL3%NaOCl溶液+2.5mL18%EDTA溶液;C组:5mL3%NaOCl溶液+5mL18%EDTA溶液;D组:5mLMTAN溶液;E组10mLMTAN溶液。每组冲洗后,均用10mL0.9%盐水冲洗。在场发射扫描电镜下观察桩道内壁形态,用Peters’标准进行计分,记录数据并统计分析。结果:A组未能去除玷污层,牙本质小管口全部消失。B组残留大量厚的玷污层,较多的牙本质小管被堵塞;C组残存的玷污层覆盖面积达50%,牙本质小管部分开放。D组和E组玷污层大多数被去除,牙本质小管口多数开放。结论:MTAN可有效去除桩道预备后的玷污层。     

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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目的比较5种不同方法预备根管后对根尖1／3根管壁的清洁能力。方法将2007年12月至2008年3月在大连市口腔医院颌面外科门诊拔除的60颗离体牙随机分为6组,每组10颗。各组的牙齿先使用Protaper进行根管预备,然后使用不同的方法处理根管壁,分别为：A组H2O2和生理盐水（对照组）、B组EDTA凝胶和5．25％的NACLO,C组超声波荡洗根管、D组Nd：YAG激光、E组超声波（蒸馏水）＋EDTA、F组：超声波（5．25％NAcL0）＋EDTA。完成之后将样本纵向剖开,扫描电镜观察根管壁的界面,比较根尖1／3根管壁的清洁程度和牙本质小管的状态。结果对照组（A组）牙齿根尖部被玷污层全部覆盖,未见开放的牙本质小管;各实验组（B、C、D、E、F组）牙齿根尖部根管壁玷污层不同程度被去除。B、C、D、E、F组根尖1／3玷污层的评分与A组比较,差异有统计学意义（P〈0．05）;5个实验组间根尖1／3玷污层的评分比较,D组与E组差异无统计学意义（P〉0．05）,其余各组间差异均有统计学意义（P〈0．05）。结论5种不同的方法在一定程度上可去除根尖部的玷污层,以超声波（5．25％NACLO）＋EDTA处理根管壁的效果最佳。     

Er：YAG激光预备及酸蚀处理对复合树脂充填体微渗漏的影响

目的 研究Er∶YAG激光备洞及酸蚀处理对复合树脂充填体微渗漏的影响.方法 将40颗离体前磨牙随机平均分为5组制备洞型：A组,高速牙钻预备加酸蚀;B组,Er∶YAG激光预备;C组,Er∶YAG激光预备加酸蚀;D组,高速牙钻预备加Er∶YAG激光蚀刻;E组,高速牙钻预备加Er∶YAG激光蚀刻后酸蚀.所有样本经复合树脂充填后交替放置于5℃与55℃水中各1 min,间隔45 s,共2000个周期进行冷热循环,然后用0.2％亚甲基蓝染色后颊舌向劈开,体视显微镜下观察剖面,记录其微渗漏情况,并进行统计学分析.另选6颗离体前磨牙,随机分为3组,按上述A、B、C三组方法制备,扫描电镜下观察其牙本质界面的结构.结果 在（牙合）壁与龈壁,B组染料渗入严重,到达洞底,微渗漏最大,与其他各组相比有统计学差异（P＜0.05）,A、C、D、E组染料渗入表浅,微渗漏程度之间没有统计学差异（P＞0.05）.扫描电镜下,A组牙本质表面较平整,无玷污层存在,牙本质小管口开放.B组牙本质表面不平整如鳞片状,无玷污层,牙本质小管口开放,直径小于酸蚀组.C组牙本质小管口开放,无玷污层存在,管周牙本质脱矿明显.结论 单纯Er∶YAG激光预备比传统牙钻制备结合酸蚀处理洞型更易发生微渗漏,若Er∶YAG激光预备结合酸蚀剂处理可以使微渗漏程度减小,Er∶YAG激光蚀刻可以达到和酸蚀剂类似的效果.     

Nd:YAG激光照射根管后的形态学观察

目的：了解感染根管管壁牙本质的病变特点，根管预备及Nd：YAG激光照射对感染根管的作用。方法：选用单根患牙60颗，随机分为5组：对照组（治疗前感染根管）、根管预备组（用手用器械根管预备）、3个激光组（在常规根管预备后，采用3种不同能量参数照射1min），做扫描电镜观察。结果：对照组：感染根管牙本质小管形态不规则，排列紊乱。根管预备组：能去除病变的牙本质层，形成玷污层。50mj 10Hz激光组不能封闭牙本质小管。100mj 10Hz、150mj 10Hz激光照射1min根管壁呈熔融状态，去除了玷污层，牙本质小管封闭和半封闭。结论：激光剂量在100mj 10Hz或在此以上时，能有效清洁根管壁玷污层和封闭牙本质小管。     

4组冲洗剂对桩道清洁效果的对比研究

目的：比较4组冲洗剂组合清洁桩道管壁玷污层的能力。方法：收集20颗新鲜无龋前磨牙，常规根充、桩道预备后随机均分为4组，A组：1％次氯酸钠溶液＋3％双氧水溶液；B组：1％次氯酸钠溶液＋1％Tritonx-100；C组：17％EDTA溶液＋1％次氯酸钠溶液；D组：17％EDTA溶液＋1％TritonX-100；每组冲洗后，再用10mL生理盐水冲洗，在扫描电镜下观察各组根管内壁情况，并用Berg分级法进行评价。结果：A组和B组均未有效去除玷污层，牙本质小管口堵塞。C组、D组可有效去除桩道预备后根管内壁形成的玷污层，达到Ⅱ级甚至更好效果，C组达到I级效果，残屑极少。结论：C组、D组组合均可有效去除桩道预备产生的玷污层，且效果由桩道上部向下部逐渐减弱。     

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??Objective    To study the effect of different irrigation regimens and methods of activation on smear layer removal in root canals. Methods    Thirty-two mandibular premolar roots were divided into 4 groups??with 8 teeth in each . In group A??the teeth were instrumented and irrigated by lateral opening syringe. In group B??irrigation was done using passive ultrasonic irrigation??PUI?? system. In group C RinsEndo root canal irrigation system was used and in group D??Vibringe sonic irrigation system. Scanning electron microscope evaluation was done for assessment of smear layer removal in the coronal??middle??and apical thirds. Results    In each group??there was a smear layer covering the dentinal tubule in apical thirds??and the score was higher than that in the coronal and middle ??P??0.05??. The scores of B??C and D groups were lower than those in group A??P??0.05??. Among A??B??C??D groups in the area of the root canal wall??difference of smear layer score was not statistically significant. Conclusion    Better removal of smear layer of the middle and apical thirds of root canal can be achieved by using RinsEndo??Vibringe and PUI system than by lateral opening syringe.     

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。     

Influence of smear layer on depth of penetration of three endodontic sealers: an SEM study

Abstract— The purpose of this study was to examine the effect of the smear layer on the penetration depth of Sealapex, Roth 811, and CRCS root canal sealers into the dentinal tubules. Forty recently extracted, human single-rooted teeth were used. The crowns were cut and removed at the cemento-enamel junction level and the root canals were prepared to a #60 K-file. The teeth were then randomly divided into two groups of 20, group A and group B. The smear layer was removed from all teeth in group A with EDTA and NaOCl. The smear layer remained in all teeth in group B. Two roots in each group were used as controls. Six roots from each group were obturated with Roth 811 sealer and gutta-percha through lateral condensation. The same process was repeated using sealers CRCS and Sealapex. Each root was then divided in two and prepared for scanning electron microscope observation. The removal of the smear layer allowed penetration of all three sealers into the dentinal tubules to a depth of between 35 μm and 80 μm. Although the CRCS sealer penetrated only up to the 35 mm point, it offered better or complete obturation of the dentinal tubules. The presence of smear layer at the root canal walls obstructed the penetration of all sealers into the dentinal tubules.     

不同冲洗方法与机用镍钛锉结合应用对根管壁的清洁作用

目的 应用扫描电镜来观察四种不同冲洗方法与机用镍钛锉结合预备根管，对根管壁的清洁效果。方法 将40颗前牙分成4组，采用不同的冲洗方法：A组：生理盐水．B组：2．5％次氯酸钠；C组：Glyde File Prep和2．5％次氯酸钠交替冲洗；D组：2．5％次氯酸钠冲洗，预备完成后，用无菌纸尖蘸上次氯酸钠和Glyde File Prep交替处理根尖区。在根管的三个不同深度采用扫描电镜记录牙本质碎屑、玷污层和牙本质小管情况。结果 A、B组与C、D比较组存在着明显的增厚的玷污层，开放的小管数目也明显减少，A组样本与其它冲洗方法组有统计学差异。结论 Glyde File Prep与机用镍钛锉合用预备根管能获得良好的术前清洗效果。     

Effect of Er:YAG laser treatment on the root canal walls of human teeth: an SEM study

Abstract— The purposes of the study were to observe the morphological changes on root canal walls after instrumentation and irrigation, and assess the efficacy of conventional cleansing procedures and the effectiveness of Er:YAG laser in removing debris and smear layer from the root canal walls. Thirty-six endodontically treated human mandibular incisor teeth with single root canals were bisected longitudinally and divided into three groups of 12 teeth. Group 1 (Gl) was left unlased as a control. The teeth of group 2 (G2) and group 3 (G3) were irradiated by Er:YAG laser (laser parameters were set at 1 W, 100 mJ/pulse and 10 Hz) for 3 s and 5 s. The teeth were prepared for scanning electron microscope study. Control specimens showed debris and heavy smear layer obscuring the dentinal tubules at all levels in the canals. The root canal walls irradiated by Er:YAG laser were free of debris, with an evaporated smear layer and open dentinal tubules. These results suggested that Er:YAG laser irradiation had an efficient cleaning effect on the prepared root canal walls.     

Effect of Different Irrigation on Smear Layer Removal after Post Space Preparation

The purpose of this study was to evaluate the effect of different irrigating solutions on smear layer removal and dentinal tubule opening on root canal surfaces after post space preparation and to study whether additional ultrasonic irrigation has any effect on smear layer removal. Forty-eight anterior teeth were treated endodontically. After post space preparation, they were assigned to six groups: group 1, EDTA; group 2, EDTA with ultrasonic activation; group 3, sodium hypochlorite (NaOCl); group 4, NaOCl with ultrasonic activation; group 5, sodium chloride (NaCl); and group 6, NaCl with ultrasonic activation. Specimens were examined under a field-emission scanning electron microscope and scored for debris removal and dentinal tubule opening at the coronal, middle, and apical thirds of the root canal. The results showed that EDTA performed significantly better than NaCl and NaOCl in smear layer removal and dentinal tubule opening. Additional ultrasonic irrigation did not improve smear layer removal significantly.