根管治疗期间急性发作防治的研究进展

根管治疗期间急性发作是指根管治疗期间出现不同程度的疼痛或(和)肿胀并需急诊处理者,如开放引流、口服止痛剂等。其急性发作率为1.5％～22％。众多研究认为根管治疗期间急性发作与感染根管内的厌氧菌、根尖组织中的化学介质和免疫反应密切相关。并可通过调(牙合)、Nd:YAG激光、超声技术和各种不同的药物等防治方法降低其急性发作率。     

小剂量地塞米松预防根管治疗期间慢性尖周炎急性发作的临床研究

目的 探讨小剂量地塞米松对根管治疗期间慢性尖周炎急性发作的预防作用。方法 90倒下前磨牙慢性尖周炎患者以年龄性别分层，随机化配对分成A、B、C三组：A组每日口服地塞米松1．5mg，每日2次；B组每日口服地塞米松1．5mg，每日1次；C组为空白对照。分别于根管预备后6、24、48小时记录VAS评分。结果 A、B组与C组VAS评分经方差分析，差异具有高度统计学意义。A、B组VAS评分均值t检验差异无统计学意义。结论每日口服地塞米松1．5mg可有效预防根管治疗期间慢性尖周炎急性发作。     

根管治疗期间急性发作防治的研究进展

根管治疗期间急性发作是指根管治疗期间出现不同程度的疼痛或（和）肿胀并需急诊处理者，如开放引流，口服止痛剂等，其急性发作率为1．5－22％，众多研究认为根管治疗期间急性发作与感染根管内的厌氧菌，根尖组织中的化学介质和免疫反应密切相关，并可通过调蛤Nd:YAG激光，超声技术和各种不同的药物等防治方法降低其急性发作率。     

慢性根尖周炎根管治疗约诊间急性发作时根管渗出液IL-1β定量检测

目的：探讨慢性根尖周炎根管治疗前后及约诊间急性发作时根管内渗出液中IL-1β含量的变化及意义。方法：采用ELISA双抗体夹心法,对19例根管预备后发生约诊间急性发作及20例无症状正常复诊的慢性根尖周炎患牙根管预备前后根管渗出液中IL-1β进行定量检测,采用SAS6．12统计软件包进行分析。结果：根管预备后无症状正常复诊时,根管IL-1β较预备前显著降低（P〈0．001）;而急性发作组,根管渗出液中IL-1β的含量较根管预备前显著升高（P〈0．01）。急性发作组根管预备后IL-1β亦显著高于未发作组。结论：IL-1β与慢性根尖周炎根尖组织感染有关．并与根管治疗期间急性发作显著相关。     

根管治疗期间的急症临床分析

目的 :评价根管治疗中急症发生的相关因素。方法 :收集 1997年 10月～ 1999年 2月 5 2 1例死髓牙根管治疗术中的 12 0例急症 ,分析急症发生的牙位、疼痛程度、根尖周破坏范围等因素。结果 :急症发生率为 2 3 .0 3 % ,以下前牙和上下颌磨牙居多 ;疼痛程度以老年人和女性特别是 4 5～ 5 5岁女性最严重 ;根尖周破坏范围小于 0 .5mm的牙急症发生率较高。结论 :急症的发生有其特殊性及规律性 ,根管治疗中应严格遵守操作规程 ,避免急症的发生     

老年人根管治疗期间急症的临床观察

目的为防治老年人根管治疗期间急症（EIAE）提供参考。方法选择年龄60～82岁因急性牙髓炎行多次法根管治疗的患者236例，总结和分析其EIAE发生情况。结果本组EIAE的发生率为24，20％，后牙EIAE发生率明显高于前牙，超充者EIAE发生率明显高于恰充者。结论老年人EIAE的发生率与患牙牙位及根充情况有关。     

急性根尖周炎患牙根管内厌氧菌的初步分析

目的：分析急性根尖周炎根管内细菌，为药敏试验奠定基础，方法：选择２７例急性根尖周炎患者作患牙根管内的厌氧菌分离培养和鉴定。结果：２７个感染根管内分离出厌氧菌６属，共６４株。结论：感染感染根管内的优势厌氧菌主要为类杆菌，梭杆菌，真细菌，丙酸杆菌，放线 菌和消化链球菌等。     

感染根管治疗期间急症的临床分析

目的探讨感染根管治疗期间急症发生的原因与牙位、疼痛程度、根尖周破坏范围的关系。方法分析近3年来1042颗牙髓坏死的感染根管治疗术中发生急症的200颗患牙的临床资料。结果急症发生率为19．19％,以下前牙和上、下颌磨牙居多;疼痛以老年人居多,根尖周破坏范围小于0．5mm的患牙急症发生率较高。结论急症的发生有其特殊性及规律性,根管治疗中应严格遵守操作规程,避免急症的发生。     

地塞米松治疗根管治疗期间急症的疗效观察

目的：观察地塞米松治疗根管治疗期间急症的疗效。方法：针对根管治疗期间急症反应,采用与不同地塞米松的疗效进行分析,结果：治疗组和对照组比较经统计学检验3日、7日疗效,P值分别小于0．01和0．05,有显著性差异。结论：地塞米松可明显降低根管治疗期间急症的发生。     

氢氧化钙预防根管治疗期间急症的临床观察

目的 观察氢氧化钙根管内封药对预防根管治疗期间急症的临床疗效。方法 使用氢氧化钙及传统根管内消毒药物樟脑对氯酚、甲醛甲酚根管内封药，观察疼痛指数并比较其根管治疗期间急症的发生率。结果 氢氧化钙封药后根管治疗期间急症的发生率最低，与传统药物相比，其差异有统计学意义。结论 氢氧化钙根管内封药。对预防根管治疗期间的急症有较好的作用。     

Prevalence of yeasts in saliva and root canals of teeth associated with apical periodontitis

AIMS: To determine: (i) the relative prevalence and diversity of yeasts in salivary and root canal samples from the same patients; and (ii) the clinical factors associated with their presence in saliva and root canals. METHODOLOGY: Sixty root canal samples from teeth associated apical periodontitis and the corresponding whole unstimulated saliva samples were obtained from 55 patients. The medical history including antibiotic therapy and clinical/radiographic data on the teeth were recorded. The samples were serially diluted and cultured on yeast & fungi-selective sabouraud dextrose agar. Isolates were characterized and speciated by the germ tube formation test, hyphal morphology and a commercial biochemical test kit (Rapid ID32C(R) system). RESULTS: Twenty-three yeast isolates were recovered from 19 saliva samples and eight isolates from six root canal samples. Candida albicans (17/23 & 3/8) and Rodotorula mucilaginosa (2/23 & 4/8) were the most prevalent isolates from saliva and root canal samples. It was significantly (13.8 times) more probable that yeasts would be recovered from root canals when they were also present in the saliva (P = 0.021). The effect of coronal restoration leakage (P = 0.08) and previous root canal treatment (P = 0.123) were equivocal. The history of antibiotic therapy had no association with the presence of yeasts in saliva (OR = 1.1). CONCLUSIONS: Yeasts occurred relatively infrequently (10%) in root canals. Their presence in root canals was significantly associated with their presence in saliva. The role of yeasts in the initiation and perpetuation of periapical disease remains to be determined.     

慢性根尖周炎根管中8种厌氧菌检出分析

目的应用16SrRNA-PCR技术检测慢性根尖周炎患牙根管内8种厌氧菌的定植情况,分析根管细菌与患牙临床症状的关系。方法采集23例慢性根尖周炎患牙根管样本,提取样本细菌DNA,用细菌16SrRNA引物通过PCR扩增细菌基因片段检测细菌种类。结果23例样本均检出有细菌存在,待检细菌检出率达73.91%(17/23)。其中检出率最高的是中间普氏菌(39.13%),其次是牙龈卟啉菌(30.43%)和福赛斯类杆菌(21.74%),变黑普氏菌、齿垢密螺旋体和啮蚀艾肯氏菌均为13.04%,伴放线放线杆菌有1例检出,直肠弯曲杆菌未检出。中间普氏菌在有自发痛症状组检出率高于无自发痛症状组(P<0.05),其他细菌检出率组间比较差异无显著性。结论慢性根尖周炎患牙根管内以厌氧菌感染为主;根管内中间普氏菌感染与患牙自发痛症状相关。     

Molecular characterization of the microbial flora residing at the apical portion of infected root canals of human teeth

Introduction

This study investigated the bacterial communities residing in the apical portion of human teeth with apical periodontitis in primary and secondary infections by using a culture-independent molecular biology approach.

Methods

Root canal samples from the apical root segments of extracted teeth were collected from 18 teeth with necrotic pulp and 8 teeth with previous endodontic treatment. Samples were processed for amplification via polymerase chain reaction and separated with denaturing gradient gel electrophoresis. Selected bands were excised from the gel and sequenced for identification.

Results

Comparable to previous studies of entire root canals, the apical bacterial communities in primary infections were significantly more diverse than in secondary infections (P = .0003). Interpatient and intrapatient comparisons exhibited similar variations in profiles. Different roots of the same teeth with secondary infections displayed low similarity in bacterial composition, whereas an equivalent sample collected from primary infection contained almost identical populations. Sequencing revealed a high prevalence of Fusobacteria, Actinomyces species, and oral Anaeroglobus geminatus in both types of infection. Many secondary infections contained Burkholderiales or Pseudomonas species, both of which represent opportunistic environmental pathogens.

Conclusions

Certain microorganisms exhibit similar prevalence in primary and secondary infection, indicating that they are likely not eradicated during endodontic treatment. The presence of Burkholderiales and Pseudomonas species underscores the problem of environmental contamination. Treatment appears to affect the various root canals of multirooted teeth differently, resulting in local changes of the microbiota.     

Effectiveness of different endodontic files for preparing curved root canals: a scanning electron microscopic study

Abstract In this study, the effect of using four endodontic files from different manufacturers on the final shape of 80 prepared curved root canals of extracted single-rooted teeth were comparatively analyzed with scanning electron microscopy. The instruments tested were Tri-files, Flex-R files, Flexofiles and conventional K-type files. All files were used with in and out linear movements with a circumferential motion starting with a size 15 file. Final preparation of the apical thirds was performed with a size 30 file. Shaping effectiveness of the tested files was qualitatively evaluated in terms of respect for conservation of the apical constriction and the presence or absence of ledging, specially in the apical third of the root canals. A well-centered and tapered preparation without apical transportation or ledging was detected when Tri-file or Flex-R files were used. Conversely, the use of Flexofile or conventional K-type files resulted in frequent alteration of the initial pattern of the root canals, showing an hourglass preparation with alteration of the apical constriction and ledge formations.     

一次性和多次性根管治疗应用于根尖周炎的临床评价

目的评价根管治疗一次法和多次法对无症状根尖周炎疗效的影响,探讨一次性根管治疗的适应症。方法选取无症状根尖周炎的患牙160颗,分层随机法分为两组,分别采用一次法和多次法完成根管治疗。所有患牙均使用镍钛机动根管器械预备,牙胶冷侧方加压法充填根管。比较两组术后疼痛发生情况,根据患者主观症状、临床表现和术前术后X线片评价疗效。结果一次法和多次法在术后疼痛、根管治疗效的差异上没有统计学意义。结论一次性根管治疗应用于无症状根尖周炎的患牙是可行的,但要注意控制适应症。     

Comparative in vivo analysis of the sealing ability of three endodontic sealers in post-prepared root canals

AIM: To compare the sealing ability of the endodontic sealers AH Plus, Sealer 26 and Endofill in premolar teeth of dogs exposed to the oral cavity after post-preparation. METHODOLOGY: Forty teeth with two canals each underwent root canal cleaning and shaping. Before filling, the canals were randomly distributed into three groups according to the sealer to be used: Group 1 - AH Plus; Group 2 - Sealer 26; and Group 3 - Endofill (Dentsply, Indústria e Comércio Ltda.). Immediately after filling, the gutta percha and sealer were partially removed from the canals, leaving material only in the apical third of the root. The teeth were temporarily sealed with glass ionomer sealer for 72 h to ensure setting. The coronal seal was then removed and the canals were exposed to the oral cavity for 45 days. The animals were euthanased and their mandibles and maxillae were removed. After abundant irrigation with distilled water, the canals were dried and filled with India ink. The teeth were sealed again for 96 h before extraction. The roots of the extracted premolars were separated and stored in labelled test tubes. The roots were cleared and the extent of dye penetration was measured with a 20x stereoscopic magnifying lens. RESULTS: Statistical analysis revealed that there were significant differences between the sealers studied (P < 0.001). Means for the extent of dye penetration for AH Plus, Endofill and Sealer 26 were, respectively, 0.13, 2.27 and 3.08 mm. CONCLUSIONS: After 45 days exposure to the oral cavity, none of the sealers was capable of preventing leakage and coronal dye penetration. There were significant differences between the sealers studied, in terms of mean dye penetration.     

吸烟与非吸烟者慢性牙周炎龈下福赛类杆菌的检测

目的：利用聚合酶链反应（PCR）检测吸烟与非吸烟者龈下福赛类杆菌（Bf）水平,通过Bf的检出率进一步探讨吸烟与牙周炎的关系。方法：健康者与慢性牙周炎伴吸烟与非吸烟患者共75例,用纸捻法提取每位观察者龈沟液,PCR检测。结果：慢性牙周炎组Bf检出率（59．5％）高于健康组（24．2％）,具有显著性差异（P〈0．01）;吸烟者慢性牙周炎组Bf检出率（72．0％）高于非吸烟者健康组、吸烟者健康组、非吸烟者慢性牙周炎组（15．8％、35．7％、41．2％）,P〈0．05。结论;Bf与吸烟及慢性牙周炎有密切关系。