根尖倒充填术后根尖微渗漏的影响因素

根尖倒充填术后根尖发生微渗漏是导致根尖手术失败常见的原因之一。根尖倒充填术后根尖微渗漏的影响因素有很多,包括根尖切除方法及根尖窝洞预备,对根尖牙本质表面的处理,不同的根尖倒充填材料,以及根管是否充填和pH值等。本文对此作一综述。     

根尖倒充填术微渗漏的研究进展

根尖倒充填术扩大了保留牙齿的适应证的范围,提高了患者的生活质量,但是对决定手术能否成功的关键因素—根尖倒充填微渗漏的研究结果仍然不统一。本文从根尖切除方法、根尖切除斜度、根尖切除后术区处理、根尖倒充填材料等方面加以综述。     

银汞材料与MTA材料作为根尖倒充填材料的临床效果评价

目的比较银汞材料与MTA材料作为根尖倒充填材料的不同临床疗效。方法采集既往实施根尖外科手术病例86例,按倒充填材料不同分为2组,A组47例,用MTA材料;B组39例,用银汞合金胶囊。2组均在根管显微镜下使用超声器械进行根尖倒预备。根据临床及X线片判定标准判定术后疗效,分为完全愈合、不完全愈合、不确定愈合、失败4组,统计术后1年手术成功率。结果不同的倒充填材料间成功率比较无统计学差异。结论银汞合金与MTA材料在显微超声根尖倒预备中,作为倒充填材料的临床效果无显著性差异。     

不同根尖倒充填材料临床疗效分析

目的：比较不同封闭性能的充填材料在根尖倒充填治疗中的临床疗效。方法：选择近2年因常规根管治疗无法治愈行根尖切除及根尖倒充填治疗的根尖周疾患病例69例;共72颗牙（其中上颌中切牙31颗、上颌侧切牙24颗、上颌尖牙17颗）根据选择的倒充填材料分为MTA治疗组（M组）、银汞合金治疗组（Y组）、银粉玻璃离子水门汀组（B组）,每组24颗牙,三组均肉眼下进行根尖切除、倒预备及根尖倒充治疗。术后随访24月,通过临床体征及影像学评判术后疗效,统计分析术后6月、12月、24个月临床治愈率及术后短期（1周内）局部炎症反应发生率。结果：术后2年M组临床治愈率高于Y组和B组（P〈0．05）,差异有统计学意义;Y组与B组之间有效率无明显差异（P〉0．05）;术后6个月治愈率M组与Y组、M组与B组间差异有统计学意义（P〈0．05）,Y组与B组差异无统计学意义（P〉0．05）;术后1周内M组肿痛发生率略少于Y组与B组,但经统计学处理差异无统计学意义（P〉0．05）。结论：以上三种不同根尖封闭性能的充填材料均能有效提高根尖倒充填治疗的临床效果,但MTA根尖封闭性能更好,根尖倒充填的临床治愈率更高。     

手术方法和植骨对老年人根尖周病疗效影响与分析

目的：通过2年随访观察和临床检查，分析比较手术治疗方法和治疗后植入人工骨对老年根尖周病疗效的影响。方法：选择临床需行手术治疗老年根尖周病患者67例，患牙77颗，分3组分别采用根尖刮治术，根尖切除术或根尖倒充填术。部分病例术后填入人工骨。连续2年随访观察和临床检查手术治疗方法和植骨对疗效的影响。结果：根尖切除术疗效高于根尖倒充填术和根尖刮治术，植入人工骨对根尖周病术后愈合效果好。结论：根尖切除术和术后植入人工骨有助提高根尖周病治疗后成功率。     

镓合金在根尖切除术中根尖倒充填的临床应用

目的:观察镓合金在根尖切除术中根尖倒充填的临床应用.方法:32个根管治疗后根尖周病灶未消退而施行根尖切除术的患牙,用镓合金进行根尖倒充填术,术后进行3、9、12、36个月随访观察.结果:32个患牙除2个因牙折拔除外,成功率达93.75%.结论:镓合金与骨组织界面结合紧密,对口腔黏膜及牙龈组织无刺激,无毒性,无过敏反应,是较理想的根尖倒充填材料.     

不同材料及根尖术式对根管封闭性的影响

目的:评价MTA、iRoot BP Plus两种根管充填材料在根管正充填与倒充填两种不同根尖术式下的根管封闭效果。方法::收集因牙周、正畸拔除并符合标准的下颌恒前磨牙40颗,根管预备后随机分为4个实验组(n=8)和2个对照组(n=4):A组(MTA正充填组)、B组(iRoot BP Plus正充填组)、C组(MTA倒充填组)、D组(iRoot BP Plus倒充填组)、M组(阳性对照组)、N组(阴性对照组)。使用印度墨汁染色技术,透明牙技术评价两种材料在根管正充填与倒充填两种不同根尖术式下的根管封闭效果。结果:各实验组根方均有不同深度的墨汁渗入,A、B组较C、D组微渗漏值稍大,但各组间差异无统计学意义(P>0.05)。结论:MTA、iRoot BP Plus在根管正充填与倒充填两种不同充填方式下能取得同样的根尖封闭效果。因此,对于部分特殊部位的根尖病变以及止血困难等行根尖倒预备、倒充填较困难的病例可以选择MTA或iRoot BP Plus正充填后再行根尖切除这一手术方式作为有效的替代方式。     

磨牙根尖切除术和倒充填术的临床疗效观察

目的观察根尖切除术和倒充填术在难治性磨牙牙髓病和根尖周病治疗中的临床疗效。方法选择41颗难治性牙髓病和根尖周病的磨牙,经常规根管治疗无效,进行根尖切除术和根尖倒充填术,术后随诊观察。结果本组41颗患牙,其中28颗手术治疗后无自觉症状且完全恢复功能,组织附着紧密。10颗患牙经治疗后咀嚼基本正常,瘘管消失,疼痛消失,根尖阴影缩小。临床成功率为92.68。结论根尖切除术和倒充填术在难治性磨牙牙髓病和根尖周病治疗中,具有满意的疗效。     

根管外科手术的临床疗效观察

目的 :观察根管外科手术在慢性根尖周炎治疗中的临床疗效。方法 :对 40例 42个难治性慢性根尖周炎患牙 ,分别采用根尖刮治术、根尖切除术和根尖倒充填术进行治疗 ,术后随诊观察 ,比较疗效。结果 :根尖手术成功率为 90 .47%。根尖刮治术、根尖切除术和根尖倒充填术的成功率分别为 85 .71%、90 .91%、10 0 % ,经 χ2检验三者无显著差异。结论 :根管外科手术在难治性慢性根尖周炎治疗中 ,具有满意的疗效。     

三种根尖倒充材料对人牙周膜成纤维细胞生长的影响

目的 :探讨根尖倒充填术后牙周组织修复过程中 ,3种根尖倒充填材料对人牙周膜细胞 (pe riodontalligamentcell,PDLC)生长的影响 ,从而指导材料的选择。方法 :体外细胞培养 ,MTT (噻唑蓝 )比色法 ,材料直接接触法。结果 :这 3种材料对PDLC的生长均有抑制作用 ,随时间的延长抑制作用没有明显变化 ,而 3种材料之间有显著差异。结论 :本实验的 3种根尖倒充填材料对人牙周膜成纤维细胞PDLC的生长均有抑制作用 ,使用以化学固化玻璃离子黏固剂最佳。     

Root end filling materials: a review

Abstract When non-surgical attempts prove unsuccessful or are contraindicated, surgical endodontic therapy is needed to save the tooth. The procedure usually consists of exposure of the involved area, root end resection, root end preparation and insertion of a root end filling material. Numerous materials have been suggested as root end filling materials. This article is a review of the literature on the suitability of various root end filling materials based on their leakage assessment, marginal adaptation, cytotoxicity, and usage test in experimental animals and humans.     

Root-end filling materials in apicoectomy--a review

An integral component of apicoectomy procedure is the placement of a root end filling material. In this 20 years literature review we identified at least 19 different materials that have been used as root end filling materials. Unfortunately, the ideal material for this purpose is yet to be found. Amalgam is the most frequently used material in apicoectomy procedure and can lead to satisfying results in many cases. IRM, super EBA and MTA are more suitable materials, and give better results in apicoectomy procedures than Amalgam. IRM and super EBA are both ZOE cements. Super EBA is less cytotoxic than IRM, suggesting that the decreased eugenol in Super EBA allows it to be less irritating. MTA gives better results when tested for leakage and biocompatibility than IRM and Super EBA, and has the ability of induction of hard tissue. A possible disadvantage that prevents MTA from being acceptable as "the ideal root-end filling material" is a long setting time that may lead to dislodgment or deformation from root end preparation. Yet, in most cases MTA serves as the best choice for a root end filling material.     

Adaptation of mineral trioxide aggregate to dentine walls compared with other root‐end filling materials: A systematic review

This systematic review analysed the literature comparing marginal adaptation of mineral trioxide aggregate (MTA) with other filling materials in root‐end cavities. The PubMed, Ovid, Web of Science, SCOPUS, and Cochrane library databases were searched using appropriate keywords related to root‐end filling materials and adaptation. Of 38 articles assessed, 20 met the inclusion criteria. No in vivo study was identified. In 10 studies, MTA gave the best marginal adaptation results, but no significant differences were found between MTA and any of the tested filling materials in seven studies. There was great variability in the study designs including analysed surface, unit of gap measurement and magnification amount during analysis. On the basis of available evidence, MTA presented good marginal adaptation to dentine walls. This review identified the need for the development of standardised methods to evaluate the adaptation property of root‐end filling materials in ex vivo studies as well as in clinical studies evaluating outcome.     

A systematic review of in vivo retrograde obturation materials

Purpose The aim of this study was to answer the question: For patients requiring apicoectomy (apicectomy/root‐end resection) and retrograde (root‐end) obturation (filling), which retrograde obturation (root‐end filling) material(s) is/are the most effective, as determined by reduction in periapical radiolucency and elimination of signs and symptoms? Materials and methods A MEDLINE and a Cochrane search (two specified searches) were conducted to identify randomised (RCT) and nonrandomised controlled clinical trials (CCT), cohort studies (CS) and case‐control studies (CCS), published between 1966 and 2002, October week 4, conducted on humans, and published in English, German and French language, relating to retrograde obturation materials following apicoectomy. Results The MEDLINE and the Cochrane search identified 324 and 21 published articles, respectively. The Cochrane search identified three additional articles to the MEDLINE‐search articles. Fourteen studies met the inclusion criteria: two were RCTs, six were CCTs, none was a CS and six were retrospective CCSs. Nine of the 14 studies compared a new retrograde (root‐end)‐filling material to amalgam, 4 of the 14 studies compared orthograde root canal fillings to retrograde (root‐end) amalgam and the fourteenth study compared variations of a resin composite (Retroplast) when used in combination with the bonding agent Gluma (Bayer AG, Gluma 1 and 2). The two RCTs indicated that glass ionomer cement appeared to be equivalent to amalgam. The six CCTs indicated that orthograde filling with gutta‐percha and sealer was more effective than amalgam retrograde (root‐end)‐filling (one trial). Similarly, retrograde (root‐end)‐filling with (i) composite and Gluma (Bayer AG, Leverkusen, Germany) as bonding agent (one trial), (ii) reinforced zinc oxide eugenol cement (EBA cement) (Stailine, Staident, Middlesex, England; one trial) and (iii) gold leaf (one trial) appeared to be better than amalgam retrograde (root‐end)‐filling. Finally, gutta‐percha retrograde (root‐end)‐filling appears to be less effective than amalgam (one trial) and Retroplast with ytterbium trifluoride is better than Retroplast with silver, when they are both used with Gluma as bonding agent (one trial). Conclusions For the highest level of evidence (RCT) retrograde (root‐end)‐filling with glass ionomer cement is almost as effective as amalgam. However, there was a significant caveat as there were only two RCTs. At the next highest level of evidence (CCT), and given the additional caveat that there was only one controlled trial for each material, retrograde (root‐end) EBA cement, composite with Gluma and gold leaf, as well as orthograde gutta‐percha, may be more effective than retrograde (root‐end) amalgam filling. In conclusion, these results suggest that additional validating CCTs and RCTs are needed.     

Critical analysis of leakage studies in endodontics

Incomplete filling of the root canal is one of the major causes of endodontic failure. Endodontic filling techniques and materials which perfectly seal the canal are essential for the success of endodontic treatment. Different in vitro tests are being used to test the sealing efficiency of endodontic filling techniques and materials. A large amount of these tests are leakage tests which measure the penetration of a tracer along the root canal filling. Tracers mainly are dyes, radio-isotopes, bacteria, bacterial metabolites, fungi and others. Apart from the tracer penetration techniques there are also other techniques. The electrochemical technique measures electrical current passing through the void along the root canal filling. The fluid transport method evaluates through-and-through voids along the canal filling. With this technique pressure on the water at the coronal side of the root canal filling is increased. In case of leakage, this will be registered based on the movement of an air bubble in a capillary attached to the end of the root. All of the described methods have their limitations. The largest limitations are the low reproducibility of some of the methods and the absence of standardization. Capillary flow porometry, a method well-known from the industry, has recently been applied in dentistry. With this method through pores can be evaluated in a standardised and reproducible way. Voids which do not extend along the entire root canal filling still have to be evaluated with other methods. Despite of the shortcomings of the in vitro leakage tests, they remain useful as an initial screening of new materials and techniques for canal obturation.     

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part II: other clinical applications and complications

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root‐end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium‐enriched mixture cement, Endo‐CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick‐Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root‐end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.     

Removal of root filling materials

Safe, successful and effective removal of root filling materials is an integral component of non‐surgical root canal re‐treatment. Access to the root canal system must be achieved in order to negotiate to the canal terminus so that deficiencies in the original treatment can be rectified. Since a range of materials have been advocated for filling root canals, different techniques are required for their removal. The management of commonly encountered root filling materials during non‐surgical re‐treatment, including the clinical procedures necessary for removal and the associated risks, are reviewed. As gutta‐percha is the most widely used and accepted root filling material, there is a greater emphasis on its removal in this review.     

Root‐end management: resection,cavity preparation,and material placement

Current protocols for root‐end management in apical microsurgery are described. The dramatic increase in light and magnification as the advent of the surgical operating microscope (SOM) for use in endodontic apical surgery has caused a renewed examination of the rationale, indications, techniques, instrumentation, and materials for root‐end procedures. Additional research and increased use of the SOM in endodontic surgery have elucidated many shortcomings of previous techniques. Root‐end resection, root‐end bevel, root‐end preparation, and root‐end filling are discussed. The steps necessary to achieve a predictable result in performing surgical root‐end procedures using the enhanced vision of the SOM are presented.     

Root‐end filling materials: rationale and tissue response

The requirements of an ideal root‐end filling are reviewed, before the demise of amalgam is considered. The focus is on tissue response to newer alternative materials: zinc oxide–eugenol cements, Mineral Trioxide Aggregate, glass ionomer cements, composite resins, compomers, and Diaket. The conflicting findings of in vitro and in vivo studies are analysed, as well as whether a root‐end filling is necessary. The ‘apical seal’ is revisited with support for the concept of a ‘double seal’ that is physical and biological.     

Surgical endodontic and retrograde procedures.

This article reviews the recent literature on endodontic surgery and root end filling materials. Root end filling materials have been studied extensively during the period of this review. The materials that have proved to consistently seal the apex in both leakage and success studies are the reinforced zinc oxide-eugenol cements such as IRM (The L.D. Caulk Co., Milford, DE) and SuperEBA (Harry J. Bosworth Co., Skokie, IL) cement. Articles on treatment planning and surgical armamentaria are also reviewed. Two textbooks and 21 journal articles are cited.