根管逆充填材料

根管逆充填材料广东佛山市口腔医院口腔内科史久成广东佛山第一人民医院口腔科彭国光综述。西安第四军医大学口腔医学院史俊南上海第二医科大学口腔医学院王晓仪审校在牙髓、根尖周病的治疗中,对根管不通,不能进行常规根管治疗术或有些慢性根尖周病变经根管治疗术失败,...     

老年患者根管充填GuttaFlow的临床观察

目的：评价常温流动牙胶GuttaFlow根管充填的疗效。方法：65名老年牙髓病患者,83颗患牙,165根根管。镍钛旋转器械根管预备成0．06锥度根管,采用常温流动牙胶GuttaFlow配合主牙胶尖技术根管充填。根管充填后即刻根尖片按照评价标准评分,并随访术后反应。结果：A级97根;B级52根;C级16根;术后胀痛15例。结论：常温流动牙胶GuttaFlow配合主牙胶尖技术根管充填具有充填效果好、不良反应小、操作省时的特点,是一种非常适合老年牙髓病患者的充填方法。     

根管治疗中根管抗折性的研究进展

根管治疗是目前牙髓病和根尖周病最有效和最根本的治疗方法。根管的抗折性与根管预备的器械和预备方法、根管冲洗剂的选择、根管充填方法以及根管充填材料有着密切的联系。本文对在根管治疗过程中各个环节对根管抗折性的的影响作一综述。     

牙体牙髓临床治疗Ⅰ.C形根管的形态、识别和治疗

20世纪初，美国学者John Ston提出了“牙髓病学”（endodonties）的术语。1958年，在第二届国际牙髓病学会上，Ingle建议统一根管器械和材料的设计标准，促进了牙髓病学的发展。自20世纪50年代至80年代中期，根管治疗器械、充填材料及根管预备技术进一步规范化。根管标准预备法、逐步后退法和逐步深入法在临床上已广泛应用；根管侧方加压充填技术进一步完善。80年代以后，镍钛合金开始应用于根管器械制造，设计开始向非ISO模式方向发展。随着镍钛器械的使用，根向预备技术（crown-down pressureless preparation）逐渐应用于临床。手术显微镜的使用使根管治疗可视化；第四代根尖定位仪、数字化牙片技术、超声根管冲洗技术和垂直加压充填技术的应用使根管治疗的成功率不断提高。近年来，我国一些大专院校的中青年医师不断学习和引进牙髓病临床治疗前沿技术，迅速掌握这些高新技术并在国内推广，使我国牙髓病治疗上了一个新台阶。许多院校的牙髓病治疗已达到国际先进水平。本系列讲座将重点介绍近年来牙髓病临床治疗的新思想、争论及相关技术，旨在进一步用新的理论指导临床，推动我国临床牙髓病学的发展。[编者按]     

书籍名称：《实用补牙技术》

内容简介： 《实用补牙技术》一书详细介绍了口腔内科中常见的牙体牙髓病、牙周病等。重点介绍了根管治疗技术．并对根管治疗所用器械、操作步骤及注意事项都作了详细说明。考虑到《实用补牙技术》的读者群是基层口腔医师，书中还对牙体牙髓疾病的诊断和鉴别诊断作了介绍。     

疑难根管治疗术病因分析

目的：找到疑难根管发生的原因，以便为其预防提供依据。方法：本文分析了2004-01-2004-03在北京大学口腔医院门诊部显微门诊就诊的疑难根管病例114例。结果：钙化的细小根管和根管再治疗是主要病因，分别占门诊病例的38．60％和34．21％，且以磨牙为主；其次是遗漏根管，占13．16％；根管内器械折断占5．26％。结论：磨牙根管治疗是一难点。临床医师如能做到熟悉磨牙解剖形态，制备充足的开髓洞形，治疗钙化细小根管时注意操作手法，选择合适的器械，将会有助于减少疑难根管病例的发生。     

机用镍钛根管器械用于根管治疗术一次法的近远期疗效

目的：观察机动镍钛根管器械用于根管治疗治疗术一次法治疗根尖周炎的近远期效果，并探讨其临床适应症。方法：300例病人随机分成两组，实验组150例297个牙，进行根管治疗术一次法，以ProTaper机用镍钛器械预备根管；常规组150例304个牙，采用常规法完成根管治疗术。术后3d复诊，评估术后疼痛情况；术后1年、2年复查并评估治疗效果。结果：根管充填术后疼痛率实验组为4．38％，常规组为4．28％；术后2年根管治疗术成功率实验组为95．18％，常规组为94．58％。两组近远期疗效均无显著性差异（P〉0．05）。结论：机动镍钛根管器械用于根管治疗术一次法术后反应少，有较为可靠的远期疗效，适应于非急性期的各类根尖周病。     

乳牙根管治疗术疼痛的临床分析

目的：探讨乳牙根管治疗疼痛的发生率及其与临床因素之间的关系。方法：对牙髓病、根尖周病、牙髓坏死的乳磨牙230例进行根管预备，FC消毒，用氧化锌丁香油糊剂根充，术后拍X线片，如果欠填，则重新充填。结果：乳牙根管预备后疼痛的发生率为7．83％，根充后疼痛的发生率为10．43％。根吸收、病种、超填与疼痛有明显的关系。结论：规范无菌操作、避免器械和根充剂超出根尖孔，可预防乳牙根管治疗的疼痛反应。     

根管治疗中器械折断原因分析及防范措施

根管治疗是治疗牙髓病和根尖周病首选和重要的方法[1]。包括根管预备、根管消毒和根管清洁三个环节。根管预备过程中可能会发生拔髓针、扩大针、扩孔钻、镍钛锉、螺旋充填器等器械折断,从而阻塞根管,影响根管通畅和成型困难,造成根管治疗的失败。因此,减少或避免器械折断,提高根管治疗的成功率是临床口腔医护人员关注的焦点。现就根管治疗过程中出现器械折断情况的原因及预防措施进行综述,以期为临床工作中更好的养护器械     

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。     

上海市髓病治疗方法临床应用现状调查

目的：了解上海市髓病治疗方法临床应用现状。方法：对上海市3个类别共计42所医院、136位医生对干髓术、塑化术和根管治疗术治疗成人恒牙的临床应用情况进行问卷调查,主要内容包括3种方法的临床应用范围及比例、适应证的选择、疗效评价以及应用前景。采用SAS6．04软件进行卡方检验以及Kruskal—Wallis检验。结果：（1）干髓术与根管治疗共存并占有一定比例,塑化术几乎不被采用,3个类别的医院采用干髓术的比例有显著差异（P〈0．001）：（2）干髓术主要被用于急或慢性牙髓炎,尤其是活髓磨牙的牙髓病治疗;（3）远期疗效是医生选择治疗方法的首要考虑因素：（4）根管治疗的良好疗效得到充分肯定,干髓术用于急或慢性牙髓炎的疗效不定。结论：上海市髓病治疗方法与国际上还存在一定差距。但总体而言,根管治疗将进一步推广普及,干髓术将逐步淘汰。     

根管治疗失败原因的临床分析

目的：探讨根管治疗失败的原因。方法：按纳入标准选取206名患者，分析根管治疗失败患牙215颗，根据初次治疗情况、临床检查、术前X线片以及术中对患牙根管系统的探查等判断原治疗失败的原因。结果：失败病例中慢性根尖周炎患牙最多，占67．9％，其次是无根尖暗影、但因欠充要求再治疗的患牙，以及存在冠渗漏的患牙；X线片显示84．2％的患牙欠充，多数后牙根管锥度欠佳；遗漏根管多见于上颌第一磨牙和前磨牙；18．1％的患牙存在台阶、根管偏移等并发症。结论：因预备和充填不当等造成的根管清理不彻底、封闭不严密使根管系统再感染是根管治疗失败的主要原因，遗漏根管、冠部渗漏等也可造成治疗失败。     

A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia

The purpose of this study was to evaluate the practice and depth of knowledge of root canal treatment by general dental practitioners working in private dental centers in different cities within the Kingdom of Saudi Arabia. A questionnaire was distributed to 400 general dental practitioners. Completed questionnaires were analyzed in term of simple summary statistics. A total of 252 (63%) practitioners responded. The majority of the respondents were Syrians (59%) and Egyptians (32%). Ninety-one per cent of the respondents indicated that they performed root canal treatment. Amongst those who carried out root canal treatment, only seven practitioners (3%) used rubber dam for isolation. More than half of the respondents (55%) used saline to irrigate canals during treatment. Forty-six per cent of practitioners used formocresol as an inter appointment medicament. The standardized and step-back preparation techniques were the method of choice for the majority of the respondents (91%). Ninety-seven per cent of the practitioners used stainless steel hand instruments to prepare root canals and the majority (92%) used gutta-percha for obturation. Seventy-four per cent of the respondent used cold lateral condensation. The average number of radiographs routinely taken for root canal treatment was four. Ninety-three per cent indicated that they usually completed a root canal treatment of molar teeth in three or more visits. Eighty-eight per cent of the practitioners preferred waiting for 1 or 2 weeks to restore the teeth permanently. Results of this study confirm that many general dental practitioners are not following quality guidelines for endodontic treatment.     

机动镍钛器械预备根管治疗术的护理

目的：探讨机动镍钛器械预备根管的护理要点及注意事项。方法：对206例患者的机动镍钛器械预备根管进行护理配合,问卷调查以追踪医生及患者的满意度,评价其护理效果。结果：206例患者根管预备的效果良好,调查表结果显示,100％的医生和97．58％的患者对护理配合满意。结论：正确熟练的护理配合能缩短医生的治疗时间,提高患者的依从性,减少治疗过程中不必要的伤害,从而提高工作效率和疗效。     

医师操作水平对根管预备疗效的影响

目的：观察医师操作水平对根管预备疗效的影响.方法：选择164颗患牙,其中活髓牙66颗,感染根管牙98颗,随机分为2组,分别由2位不同年资的医师用ProTaper机用镍钛锉行根管预备,采用SAS6.2软件包进行统计学处理,x2检验比较2组患牙的器械折断率、根管治疗期间痛（EIP）发生率及根管充填成功率,分析医师操作水平对根管预备疗效的影响.结果：2组磨牙间的根管预备器械折断率有显著性差异（P＜0.05）;2组EIP发生率有高度显著性差异（P＜0.01）;在低年资医师组中,活髓牙和感染根管牙间有显著性差异（P＜0.05）;2组根管充填成功率有显著性差异（P＜0.05）,尤其是在感染根管磨牙组.结论：熟练、精确的操作能提高根管预备的疗效.     

Root canal treatment performed by Flemish dentists. Part 1. Cleaning and shaping

AIM: To gather information on root canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire was handed to 312 dentists attending peer review sessions organized by the Flemish Universities. Basic information (age, gender, year of graduation, practice profile) and information on various issues relating to the cleaning and shaping of root canals was collected. RESULTS: A total of 310 questionnaires were returned. The majority (85.7%) of respondents categorized themselves as general practitioners; 25.7% mentioned a clinical interest or speciality in practice. Most practitioners (64.5%) did not use rubber dam routinely during root canal treatment and performed treatment over two visits irrespective of the number of root canals. The majority of respondents (82.4%) used sodium hypochlorite as an irrigant, but 10.6% did not know the concentration they used; EDTA was used by 61.6%. The vast majority exposed a radiograph with an instrument of known length in situ to gauge the working length; only 3.6% relied on tactile sense; electronic root canal length determination was seldom used. Amongst the root canal instruments, K-files were used solely or in combination with other instruments by 60.3% of the respondents, reamers were used solely or in combination with other instruments by 55.4%. The stepback technique was used by 31.2% of the participants, a combination of stepdown and stepback by 26.4%, a reaming technique by 26.1% and the step-down technique by 14.7%. The majority were familiar with mechanical root canal Instruments. Almost half of the practitioners believed their preparation technique could be improved: only 1.3% felt that their procedures were poor. CONCLUSIONS: The results of this study indicate that the theoretical knowledge of dentists working in Flanders is good. However, the use of rubber dam remained low, half believed their preparation technique could be improved.     

关于根管治疗畏惧程度的调查

目的：了解患者对根管治疗有关方面的畏惧程度。方法：对武汉大学口腔医学院牙体牙髓科需作根管治疗的成年患者103人进行问卷调查。结果：44．7％的患者经历根管治疗后畏惧程度降低。局麻注射,扩锉根管以及叩击疼痛牙齿分别被列为排序中的第6,第5,第7位,仅有50．4％的患者今后仍选择根管治疗来保留患牙,结论：患者对根管治疗各有关方面的畏惧程度是不同的,局麻注射,扩链根管及叩击疼痛牙是最易引起患者畏惧的方面。     

根管治疗后三年疗效评价及影响因素分析

目的评价根管治疗的疗效及其影响因素。方法回访检查根管治疗后3年患牙的临床状况和根尖周X线片表现,对根管治疗的疗效及可能的影响因素进行分析。结果695颗患牙根管治疗后3年的治愈率为75．1％,有咀嚼功能的占96．0％。单因素分析发现,前牙、活髓牙、术前根尖周组织正常、适充及牙体修复完好的患牙治愈率较高;回归分析表明,无根尖周病变、适充及牙体修复完好的患牙比术前有根尖周病变、欠充及根充物暴露的患牙治愈率分别高2倍、3倍和1．6倍。结论患牙有无根尖周病变、根管充填质量和牙体修复的完好程度均可对根管治疗的疗效产生影响。     

Root canal treatment in general practice in Sudan

AIM: The aim of this study was to evaluate the practice and depth of knowledge of root canal treatment by dental practitioners in Khartoum, the capital city of Sudan, in order to improve the current status of endodontic therapy. METHODOLOGY: A questionnaire was posted to 55 registered dental practitioners. Completed questionnaires were analysed in term of simple summary statistics. RESULTS: A total of fifty-two (95%) practitioners responded. Eighty-five per cent of the respondents indicated that they performed root canal treatment for their patients. Of these, 84% included molars in their activity. Amongst those who carried out root canal treatment, only one practitioner used rubber dam for isolation, whilst the remainder used cotton wool rolls. The majority of respondents (80%) used hydrogen peroxide to irrigate canals during treatment. Three-quarters of practitioners used formocresol as an inter-appointment medicament. The stepback preparation technique was the method of choice for 98% of respondents. All practitioners used hand instruments to prepare root canals and all used gutta-percha for obturation; three-quarters of them used cold lateral condensation for all or some cases. The average number of radiographs routinely taken for root canal treatment was three. Only 73% used radiographs for measuring the working length. Ninety-five per cent of respondents indicated that they usually completed a root filling in three or more visits. Three-quarters of practitioners restored the teeth permanently immediately after the obturation and one-quarter preferred waiting for 1 or 2 weeks. CONCLUSIONS: In Sudan, there are no dental practices limited to endodontics and no postgraduate training programmes. This survey shows the importance of establishing higher specialist training or continuing dental education for practitioners to update their knowledge.     

根管治疗中75例器械折断的临床分析

目的：分析器械折断的原因,提出处理方法和预防措施。方法：对根管治疗中器械折断的病例进行归纳、总结、分析。结果：器械折断的发生率为２．６１％。断械以扩孔钻、根管锉和电动扩孔钻为主,占９０．７％。器械折断于上磨牙近颊根管和下磨牙近中根管者居多,占７０．７％。器械折断在根管中下段多见,占７０％。结论：发生断械的患牙经过适当处理,大多数因无临床症状而得以保存。