根管数目和形态的识别

根管治疗是通过机械和化学的方法彻底清除根管内的牙髓组织、细菌及其代谢产物并严密充填根管，达到预防根尖周病发生和促进根尖周病愈合的目的。根管预备和根管充填是根管治疗中的两个关键步骤。根管预备和充填的效果受许多因素特别是根管解剖因素的影响。治疗时可以通过多种诊断方法确定根管的数目并判断根管形态，再根据不同的根管形态制定相应的预备和充填策略，以使患牙获得良好的治疗效果。[第一段]     

根管治疗技术规范与疗效评价标准

根管治疗术是牙髓病和根尖周病治疗的基本方法和最佳选择。根管治疗术通过彻底清除根管内的炎性牙髓和感染坏死物质,成形根管,严密充填根管,以去除根管内容物对根尖周围组织的不良刺激,防止根尖周病变发生,促进根尖周病变愈合。     

感染根管的治疗难点和对策

微生物感染是牙髓根尖周疾病发生和发展的根本原因,也是根管治疗失败的罪魁祸首.因此彻底清除根管系统内的感染物质,预防根管系统再感染,是保证根管治疗成功与否的关键.在临床根管治疗过程中,口腔环境定植细菌种类的多样性、牙髓组织环境的特殊性、根管系统解剖的复杂性以及治疗方法 的局限性,使得预防口腔微生物对根管系统的污染以及感染...     

根尖感染的控制技术

根管治疗术是治疗牙髓病、根尖周病的首选方法,其目标是彻底清除根管系统内的感染,并严密充填以防止再感染。由于根管系统解剖复杂性和感染多样化的存在,使得常规化的根管治疗常常难以彻底清除感染,尤其是根尖部（包括根管内根部1/3和根尖外组织）。根尖部的位置隐蔽,根尖分歧、根管侧支等解剖结构多,治疗器械难以达到,感染控制难度大。本文就根尖部感染的特点和难点进行总结,并对根尖内和根尖外的感染控制策略进行简要介绍,包括根尖部的预备方法,根管消毒和严密根管充填的方法等。     

电测法确定根尖孔位置的临床疗效评价

目的观察使用根尖定位仪确定根管工作长度进行根管治疗的临床疗效。方法使用Sono-explorer确定根管工作长度和X线确定根管工作长度,对慢性根尖周炎、牙髓炎的患牙进行一次性根管预备、根管充填,然后摄X线牙片检查,统计比较根充物位置差异及根管治疗后1周6、个月、1年、2年、3年疗效观察统计评价。结果使用根尖定位仪确定根管工作长度进行根管充填的病例根管治疗成功率为97.5%,通过X线片确定根管工作长度的根管治疗成功率为89.2%。结论使用根尖定位仪确定根管工作长度比X线法更准确,根管治疗成功率更高,更方便快捷。     

感染根管细菌生物膜的治疗策略

根尖周炎是发生在根尖周组织的炎症性疾病，主要由根管内的感染引起。其根管内的细菌主要以难清除的生物膜形式定植，为临床治疗带来了难题。因此，了解根管细菌生物膜的特性、掌握治疗方法对于提高感染根管治疗成功率具有重大意义。     

恒牙根尖区解剖结构对根管治疗的影响

根管治疗的目的是彻底清除根管内感染物质,并严密充填根管,从而预防或治愈根尖周病变.恒牙根尖区解剖结构复杂,形态多样的根尖孔、弯曲根管、侧副根管等会对根管治疗各步骤产生影响,增加治疗难度,影响治疗效果.本文就恒牙根尖区解剖结构对根管治疗影响的研究进展进行综述.     

感染根管细菌内毒素的致病机制与清除策略

细菌内毒素会影响牙髓根尖周疾病的发生发展及其治疗的预后。探究细菌内毒素的致病机制及清除措施对提高根管治疗的成功率及获得远期良好预后均有重要意义。本文就根管内细菌内毒素的产生、分布、致病机制以及清除策略等方面作一综述,为临床及基础研究提供新依据和新思路。     

根管内药物消毒作用的探讨

根管治疗是目前治疗各种牙髓病和根尖周病最有效的方法。通过根管预备、消毒和充填 ,防止根尖周病变的发生 ,并促进根尖周病变的愈合 ,但对根管内药物消毒的必要性有人提出质疑。本组旨在对根管内药物消毒的作用进行探讨。1　材料和方法1.1　临床资料选择门诊因各类牙髓和根尖周病需进行根管治疗的患牙 32 6个 ,其中前牙 117个 ,前磨牙 116个 ,磨牙 93个 ;牙髓有活力者 16 1牙 ,有窦道者 48牙。随机分为对照组 (16 2牙 )和实验组 (16 4牙 )。1.2　方法对 32 6例患牙均采用常规的多次法完成根管治疗。治疗中 ,对照组仅用生理盐水冲洗根管 ,消…     

感染根管致病菌及其控制方法的研究进展

细菌与牙髓以及根尖周组织炎症的发生发展关系密切,根管治疗术通过去除根管系统内的病原菌,促进根尖周组织愈合。其中通过根管预备清除根管系统内残余牙髓组织、微生物碎屑以及细菌毒素是根管治疗成功的关键,本文就近年来感染根管致病菌及其临床控制措施的研究进展作一综述。     

根尖工作宽度的研究进展

根管预备是根管治疗的关键步骤，精确测量根管根尖部初始宽度和确定根尖预备的终末工作宽度是高质量的根管预备必不可少的条件。恰当的根尖预备宽度应在尽可能保存牙体组织的前提下，彻底去除根管内的感染物质，达到根管最佳的清理和成形效果。本文对根尖预备工作宽度的观念、技术及存在的争议等作一综述。     

Dynamic recording of irrigating fluid distribution in root canals using thermal image analysis

AIM: To investigate the influence of the size and the depth of insertion of irrigating needles, and the diameter of the master apical file on flow distribution during fluid irrigation in root canals. METHODOLOGY: Stepback canal instrumentation was employed on seven extracted human single canal teeth. The size of the master apical files ranged from sizes 25, 30, 35, 40, 45, 50 to size 80 within the seven teeth, respectively. A thermal imaging system (ThermaCAM; National Instruments Co., Austin, TX, USA) was used to record the dynamic fluid distribution following root canal preparation. The dynamic fluid distribution was analysed during irrigation by insertion of different irrigating needle tips (23, 25 and 27 gauge) at various depths (3, 6 and 9 mm) from the root apex. The whole process of irrigation was recorded by a video camera and analysed by two observers separately. The success of the irrigation process was defined when the irrigant was able to flow into to the apical region immediately after injection. RESULTS: The aqueous irrigant was flushed into the apical region when a size 27 gauge irrigating needle was placed into a size 30 canal at a point 3 mm from the apical stop. When the same needle tip was placed 6 mm from the root canal apex, successful irrigation was achieved only in the canals prepared to size 50 or larger. When a size 25 gauge irrigating needle was placed 3 mm from the working length, the canal size had to be no <45 to allow for successful irrigation. When a size 23 gauge needle was placed at the same position, the canal needed to be prepared to size 50 to allow thorough irrigation of the apex. At 9 mm from the apical stop, none of the irrigating needles could achieve successful irrigation of any canal size. CONCLUSION: The flow distribution of root canal irrigation can be affected adversely by large diameter irrigating needles, by greater distances between the needle tip and the apical stop, and by narrow root canals.     

刻度牙胶尖根管充填效果的X线片观察

目的：评价刻度牙胶尖在根管治疗术中根尖处的充填质量。方法：将符合根管治疗术适应证的患牙随机分为2组，每组50例。经常规开髓拔髓、根管预备后，实验组以刻度牙胶尖为主尖充填根管。对照组以常规无刻度牙胶尖充填根管。根管充填完毕摄X线牙片，钢尺测量根管充填材料距根尖孔距离。结果：实验组有34例根管充填达理想位(距根尖孔0．5～1．0mm)，占总数68％。而对照组仅18例根管充填能达理想位，占36％。结论：使用刻度牙胶尖充填根管能提高根管充填质量、简化治疗操作步骤，有利于提高临床工作效率。     

The fundamental operating principles of electronic root canal length measurement devices

It is generally accepted that root canal treatment procedures should be confined within the root canal system. To achieve this objective the canal terminus must be detected accurately during canal preparation and precise control of working length during the process must be maintained. Several techniques have been used for determining the apical canal terminus including electronic methods. However, the fundamental electronic operating principles and classification of the electronic devices used in this method are often unknown and a matter of controversy. The basic assumption with all electronic length measuring devices is that human tissues have certain characteristics that can be modelled by a combination of electrical components. Therefore, by measuring the electrical properties of the model, such as resistance and impedance, it should be possible to detect the canal terminus. The root canal system is surrounded by dentine and cementum that are insulators to electrical current. At the minor apical foramen, however, there is a small hole in which conductive materials within the canal space (tissue, fluid) are electrically connected to the periodontal ligament that is itself a conductor of electric current. Thus, dentine, along with tissue and fluid inside the canal, forms a resistor, the value of which depends on their dimensions, and their inherent resistivity. When an endodontic file penetrates inside the canal and approaches the minor apical foramen, the resistance between the endodontic file and the foramen decreases, because the effective length of the resistive material (dentine, tissue, fluid) decreases. As well as resistive properties, the structure of the tooth root has capacitive characteristics. Therefore, various electronic methods have been developed that use a variety of other principles to detect the canal terminus. Whilst the simplest devices measure resistance, other devices measure impedance using either high frequency, two frequencies, or multiple frequencies. In addition, some systems use low frequency oscillation and/or a voltage gradient method to detect the canal terminus. The aim of this review was to clarify the fundamental operating principles of the different types of electronic systems that claim to measure canal length.     

Raypex5根管长度测量仪准确性的临床及体外实验研究

目的：研究不同根管内容物（17％EDTA凝胶、生理盐水、5．25％次氯酸钠溶液）和根尖孔面积大小对Raypex5根管长度测量仪测量准确性的影响。方法：选取需要拔除的60颗单根管患牙,采用Raypex5根测仪在不同根管介质环境下,测量根管工作长度（EwLl）,拔除患牙后在体视显微镜下测得根管实际工作长度（L1）;并建立体外模型,测量不同根尖孔面积（s）、根管工作长度（EWL2）和实际根管长度（L2）,对根管在3种介质环境下Raypex5根测仪所测长度行单因素方差分析,与实际根管长度比较采用配对t检验;对根尖孔面积与Raypex5电测法测量值偏差之间的关系采用直线相关分析。结果：①．三组不同根管介质中的根管长度测量值之间差异无统计学意义（P〉0．05）。②．不同介质的根管长度测量值与根管实际长度之间的偏差无统计学意义（p〉0．05）。③．当根尖狭窄破坏后,根尖孔面积与根测仪测量值的偏差之间存在线性相关关系,（P〈0．0D。结论：Raypex5根管长度测量仪的准确性不受根管内介质的影响。当根尖狭窄被破坏后,根尖孔面积对Raypex5测量准确性有影响,临床上对根尖有吸收破坏或根尖未发育完全的患牙采用Raypex5电测法测量时,应谨慎参考根管工作长度值。     

2种根管预备终止点对术后疼痛的影响

目的 评价根管预备中2 种不同根管预备终止点对术后疼痛的影响. 方法 需做根管治疗的患者118例用Endo Pilot根测仪进行根尖定位,随机分成2组:A组(59例),根管预备终止点位于根测仪指示"弧形基线"上最高点(蜂鸣声35次/min);B组(59例),根管预备终止点位于根测仪指示"弧形基线"下最低点(蜂鸣声65次/min). 用疼痛视觉模拟评分法( visual analogue scale,VAS)的分值,记录2组患者根管预备前和术后12 h、1 d、2 d、3 d、1周疼痛情况. 结果 118颗患牙疼痛的总发生率为18. 6%,其中A组为16. 9%(10/59),B组为20. 3%(12/59),2组疼痛发生情况差异无统计学意义(P>0. 05);A、B 2组在各时间段VAS疼痛分值差异无统计学意义(P>0. 05). 结论 根管预备中2种根管预备终止点对术后疼痛无明显影响.     

Post-treatment apical periodontitis associated with a missed root canal in a maxillary lateral incisor with two roots: A case report

Missed canals can be a common cause of persistent intraradicular infection and post-treatment apical periodontitis. This article reports on a rare case of a maxillary lateral incisor with two roots exhibiting symptomatic post-treatment apical periodontitis regardless of a radiographically adequate root canal treatment. The second root, which was only revealed by cone-beam computed tomography, had passed unnoticed during the first treatment, and its missed canal was the most likely cause of symptoms and treatment failure. Reintervention including the proper management of the extra root canal and retreatment of the main canal resulted in the resolution of symptoms and periradicular tissue healing. This case report reinforces the need for three-dimensional radiographic diagnosis to search for the cause of post-treatment disease and guide the decision-making process for proper management.     

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??The most common types of pulpitis and apical periodontitis are caused by microbial infection??thus the core of endodontic treatment is infection control and the preferred method is root canal therapy. The infection variety??anatomic complexity of root canal and limitation of current technology make it difficult to control infection??and mechanochemical preparation is a critical procedure of root canal therapy. In this article??the difficulties and strategies of control for root canal infection were introduced.     

三种牙齿工作长度测量方法的比较研究

目的:研究三种牙齿根管工作长度测量方法的符合率。方法:选取临床上需进行根管治疗术的患牙153个(358个根管),使用TRI AUTO ZX根管治疗仪确定牙齿工作长度,与X线诊断丝照相法和器械探查法进行对比,研究3种牙齿工作长度测量法的符合率。结果:电测法与X线诊断丝照相法比较,符合率为92.46%,电测法与器械探查法比较,符合率为67.88%;X线诊断丝照相法与器械探查法比较,符合率为64.53%。结论:牙齿长度电测法是一种比较准确、客观的测量牙齿工作长度的方法。