空管药物疗法治疗牙髓病和根尖周病疗效观察

用ＳＭＴＤ复合药物对牙髓病和根尖周病实施空管药物疗法。７８例１０３颗获得完整随访资料患牙经两年观察，９２．２％治愈率。文章介绍了治疗方法，讨论了空管药物疗法的愈合机理、优点、失败原因及其预防措施。     

Endodontic retreatment of a lower canine associated with a periapical lesion: case report of an unusual anatomy

ObjectivesTo describe the endodontic orthograde retreatment of a lower canine with a rare anatomy, affected by a symptomatic periapical lesion.Materials and methodsA 30-year-old Caucasian woman came to our office reporting severe pain and swelling located at the right mandible. A two-roots/two-canals configuration was discovered for the lower canine which sustained the periapical infection; a missed lingual canal was not recognized and treated at the previous primary endodontic therapy.A full pre-operative examination and diagnosis, the application of modern endodontic strategies along with the use of magnification technologies (like the Surgical Operating Microscope - SOM) and proper disinfection protocols were employed for endodontic re-treatment.Result and conclusionsHealing of the periapical infection was clinically and radiographically confirmed at a 9-month follow-up. Endodontists should know the anatomical variations of human teeth and be vigilant about them when approaching treatments. More than a single radiographic projection is recommended in the diagnostic phase.Careful procedures related to instrumentation, cleaning and filling of the entire root canal system enhance the potential for healing of apical lesions.     

La risoluzione delle complessità nei ritrattamenti

ObjectivesThe aim of this study is to describe the main causes and prevalence of endodontic therapy failures, to promote a diagnostic and prognostic work-up suited to the relevant pathology evolution degree and to suggest appropriate clinical strategies to achieve the expected results.Materials and methodsThrough an extensive review of recent literature, combined with an accurate analysis of clinical cases and epidemiological investigation, it was possible to gather and evaluate the necessary information and data for providing clinical dictates on the solution of endodontic retreatment problems.ResultsThe success percentage of endodontic retreatments is quite variable, ranging from 60% to 85% of treated cases. Such percentage is strongly dependent on two critical variables: the preoperative condition of periapical tissues and the previously provided treatment. A chronic apical periodontitis subjected to inadequate therapy leading to the structural alteration of dental elements, is indeed a crucial factor affecting the retreatment prognosis.ConclusionsAll retreatment procedures should be preceded by an accurate case analysis. Adverse anatomical conditions and periapical bone lesions may predict an unfavorable prognosis and should be taken into great consideration. However, in all other clinical conditions, high success rates can be achieved, ensuring a long-term survival of dental elements.     

基质金属蛋白酶-1和8在根尖肉芽肿中的表达及意义

目的：探讨基质金属蛋白酶-1（MMP-1）和8（MMP-8）的表达水平与根尖肉芽肿的关系及意义。方法：采用免疫组化方法,检测了20例根尖肉芽肿和20例正常根尖组织中MMP-1和MMP-8的表达水平,并用独立样本t检验分析MMP-1和MMP-8的表达水平与根尖肉芽肿的关系。结果：MMP-1和MMP-8在根尖肉芽肿组织中均有表达,且表达的阳性细胞数高于正常组,差异具有统计学意义（P〈0.05）。结论：MMP-1和MMP-8可能参与了根尖肉芽肿的发病过程。     

iRoot BP Plus根管倒充填联合Bio-Oss植骨在治疗慢性根尖周病变中的临床效果

目的 探讨显微根尖外科手术中iRoot BP Plus倒充填和Bio-Oss植骨在治疗慢性根尖周病变的临床效果。方法 选取2015年10月～2018年1月期间收治的慢性根尖周炎共计126颗患牙作为研究对象,按是否进行iRoot BP Plus根管倒充填和Bio-Oss植骨修复缺损分为三组。术后复查,通过临床检查和X线片评定结果,分析临床疗效。结果 术后12个月根尖手术中行iRoot BP Plus和Bio-Oss联合应用组治疗成功率达97.62%,iRoot BP Plus治疗组未行Bio-Oss植骨组的治疗成功率达80.95%,而单纯根尖手术治疗组治疗成功率仅为54.76%,组间差异有统计学意义(P0.05)。结论 显微根尖外科手术中iRoot BP Plus倒充填联合Bio-Oss植骨具有良好的临床效果。     

唇腭裂患者牙槽突裂植骨区牙移入的临床观察

目的:探讨牙槽突裂植骨区牙移入的可行性及牙移入的方式,评价移入牙的牙槽骨支持率和移植骨高度变化。方法:选取唇腭裂伴牙槽突裂患者10例,行牙槽突裂自体髂骨植骨术后,分别拍摄植骨后3个月(T1)及牙移入植骨区后(T2)的根尖片,观察牙移入植骨区的情况,测量T1和T2阶段移入牙的牙槽骨支持率,采用SPSS17.0软件包对测量数据进行配对t检验,并参照Bergland四分法评价移植骨的高度变化。结果:①牙整体移入植骨区,牙槽骨支持率为(89.85±2.51)%(T1)和(90.22±2.44)%(T2),牙移入植骨区后的牙槽骨支持率与植骨后3个月的牙槽骨支持率无显著差异(P>0.05)。②移植牙槽骨的高度在牙移入前后无显著变化。结论:唇腭裂患者植骨后,可将裂隙邻近的牙移入植骨区,获得良好的牙槽骨支持。牙的移入有助于维持移植骨高度,提高植骨的成功率。