手动ProTaper根管扩大系统联合镍钛K锉在弯曲根管治疗术中的应用

目的:评估手动ProTaper根管扩大系统联合镍钛K锉对弯曲根管治疗的效果.方法:103例病人103个患牙随机分为两组,实验组53个,用手动ProTaper根管扩大系统和镍钛K锉进行根管预备,对照组50个,用不锈钢K锉预备,两组均以常规侧方加压法进行根管充填,在治疗前、中、后应用数字牙片了解根管数目形态、确定根管工作长度、判断治疗效果.结果:对103个患牙根管充填后拍摄数字牙片及观察术后反应,实验组根管成形及充填满意率88.68%,术后急性反应率为1.89%.对照组满意率64%,术后急性反应率为14%.经x2.检验进行分析,两组根管成形及充填满意率有显著性差异(P<0.01),术后急性反应率有显著性差异(P<0.01),实验组明显优于对照组.结论:手动ProTaper根管扩大系统联合镍钛K锉可有效改善弯曲根管治疗的效果.     

平衡力法结合改良双敞技术在老年人根管治疗术中的临床应用

目的:评价使用弹性K锉运用平衡力法结合改良双敞技术在老年人根管治疗术中的临床效果。方法:随机选取120例老年患者122颗患牙,分成实验组和对照组。实验组62例患者62颗患牙,采用弹性K锉(Flexofile)运用平衡力法结合改良双敞技术。对照组58例患者60颗患牙,采用不锈钢K锉运用逐步后退法结合改良双敞技术进行根管预备。两组应用侧方加压充填技术充填根管。根据治疗前、中、后X线片评价根管预备和充填效果,根据主诉及检查评价根管治疗期间急症情况。结果:两组在根管预备过程中均无器械折断,实验组无根尖阻塞、台阶形成、根尖孔敞开等情况发生,根管偏移少,能较好的维持根管弯曲度及走向,充填后的锥度和流畅度较好,术后急症反应率为4.83%。对照组有2例在根尖有台阶形成,发生根管偏移多于实验组(P<0.01),术后急症反应率有显著性差异(P<0.01)。结论:弹性K锉运用平衡力法结合改良双敞技术预备老年人根管能较好地维持根管的定向,根管偏移少,安全有效,可作为临床上预备老年人根管的有效方法。     

倒敞法结合2 种机用镍钛锉预备重度弯曲后牙根管的应用研究

目的:评价倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管的疗效.方法: 随机将100 颗患牙髓炎或根尖周炎、最大根管弯曲度≥25°的后牙分为2 组,各50 例.实验组(A组)采用倒敞法,而对照组(B组)不采用倒敞法机械预备.A组以机用开口锉根管中上端敞开后,手用K锉预备根尖,再先用镍钛器械Hero 642,后用ProTaper预备根管;B组则直接应用Hero 642和ProTaper冠向下法预备根管. 2 组均用侧压法充填根管.根据X线片情况,预备时间,器械折断、疼痛等并发症,评价根管预备和充填的疗效,1 年随访率95%.结果:A组倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管,锥度、流畅度好,术后疼痛少且程度轻,无器械折断;而B组发生器械折断3 支(P>0.05);充填恰充率、欠充率、流畅度、术后疼痛两者有显著性差异(P<0.05).结论: 倒敞法结合Hero 642和ProTaper机用镍钛锉预备重度弯曲后牙根管,成形、根充效果好,并发症少,最大限度发挥了各自优点,是预备重度弯曲后牙根管值得推广应用的有效方法.     

手用ProTaper根管扩大系统联合镍钛K锉在老年人磨牙根管治疗术中的应用

目的：评估手用ProTaper根管扩大系统联合镍钛K锉对老年人磨牙根管治疗的效果。方法：110例118个慢性根尖周炎磨牙随机分为两组,实验组60个患牙,采用手用ProTaper根管扩大系统和镍钛K锉进行根管预备,对照组58个患牙,采用不锈钢K锉根管预备,两组均以常规侧方加压法进行根管充填,在治疗前、中、后应用X线牙片了解根管数目、形态、确定根管工作长度、判断治疗效果。结果：对118个磨牙根管充填后拍摄X线牙片及观察术后反应,实验组根管成形及充填满意率85%,术后急症反应率3.33%,对照组满意率62.07%,术后急性反应率为15.5%。经x2检验,两组根管成形及充填满意率有显著性差异（P〈0.01）,术后急症反应率有显著性差异（P〈0.01）,实验组明显优于对照组。结论：手用ProTaper根管扩大系统联合镍钛K锉可有效提高老年人根管治疗的效果。     

数字化牙片系统在老年人磨牙保存治疗中的应用

目的：评估数字化牙片在对老年人患有牙髓病、尖周病的磨牙进行保存治疗中的效果.方法：采用数字化牙片系统结合规范的根管治疗技术对23例老年人（男性16人,女性7人）的29颗牙进行治疗,在根管内插入诊断丝并结合不同角度的数字化X线片,以测量工作长度.在治疗前、中、后应用数字化牙片判断治疗效果,多数病例完成根管治疗后采用修复的方法恢复功能和美观.结果：对23例的29颗牙随访3个月,所有患牙X线片均获得良好的临床疗效.结论：数字化牙片在老年人磨牙的保存治疗中与传统X线牙片相比可以更方便的测量工作长度、指导治疗并判断根管治疗术的疗效,也便于资料的收集和医患之间的交流.     

下颌第三磨牙根管治疗的临床疗效观察

目的 观察下颌第三磨牙根管治疗的临床疗效。方法 对22例下颌第三磨牙采用改良双敞技术预备、侧方加压方法充填根管，一年后复查观察其临床疗效。结果 22例根管治疗的下颌第三磨牙，一年复查成功19例，成功率为86．36％。结论 尽管下颌第三磨牙根管形态复杂，操作难度大，掌握了不同类型患牙的特点，根管治疗仍可获得较高的成功率。     

Vitapex糊剂在根管充填的应用观察

目的　观察Vitapex糊剂在根管治疗术后急性反应情况和治疗效果。方法　将患牙分为两组进行根管治疗 ,试验组用Vitapex糊剂加牙胶尖充填根管 ,对照组用氧化锌丁香油糊剂加牙胶尖充填根管 ,统计 16 0颗患牙根管治疗术后急性反应的发生率和治疗效果。结果　术后急性反应的发生率试验组为 3.75 % ,对照组为 13.75 % ,2组比较差异有显著性 (P <0 .0 1) ;术后追踪观察 2年成功率 ,试验组为 93.75 % ,对照组为 88.75 % ,2组比较差异无显著性 (P >0 .0 5 )。结论　用Vitapex糊剂充填根管术后急性反应少 ,疗效与氧化锌丁香油糊剂加牙胶尖充填根管相似。     

手用ProTaper镍钛器械预备弯曲根管的疗效评价

目的 评价手用ProTaper镍钛器械预备弯曲根管的临床疗效.方法 选取有弯曲根管的牙髓炎和根尖周炎患牙48颗,使用手用ProTaper镍钛锉冠根向深入法预备根管,侧向加压充填法充填根管,根据治疗前、中、后的X线片评价根管预备和充填的效果.结果 患牙在根管预备中均无器械折断、根尖阻塞、台阶形成等并发症,根管充填后显示发生根管偏移少,能较好地维持根管的弯曲度和走向.结论 手用ProTaper镍钛器械预备弯曲根管能较好地维持根管的走向和弯曲度,减少根管偏移,安全有效,可作为预备弯曲根管的有效方法推广应用.     

Raypex 5根尖定位仪测定牙根管长度的准确率及影响因素分析

目的 观察Raypex 5根尖定位仪测定牙根管长度的准确率,探讨影响准确率的因素.方法 选择210例牙髓病及根尖周病患者,其中225颗患牙含416个根管,先用手感法测量长度,再用根尖定位仪测定长度,充填主牙胶尖后在数字化X线成像系统上拍片确定牙齿工作长度,两者对比并进行统计学处理.结果 Raypex 5根尖定位仪测定牙根管长度准确率为93.99％,手感法准确率为74.76％.两者差异具有统计学意义（P＜0.05）;根尖定位仪测量单根管至四根管的准确率明显高于手感法,两者间的差异也具有统计学意义（P＜0.05）.结论 Raypex 5根尖定位仪测定牙根管长度操作简便,较少的X线辐射,准确率较高.     

两种镍钛机动器械预备根管的疗效评价

目的探讨机动镍钛器械Hero 642和ProTaper对根管的成形能力及其临床应用方法。方法60例60颗患牙分为2组,每组患牙30颗,分别采用机动镍钛器械Hero 642和ProTaper预备根管,侧向加压充填技术充填根管,根据治疗前后的X线片评价根管预备和充填效果,记录根管预备后器械折断、变形情况,1周后复诊,评价患牙的疼痛发生率。结果两组患牙根管预备后的根管不良形态率、根充适充率、术后疼痛率均无显著性差异。Hero 642操作简单,在根管预备过程中体现出较低的器械折断率。结论Hero 642和Protaper镍钛机动系统具有良好的根管成形作用,临床上可根据其各自的特点选用。     

数字化牙片在磨牙根管治疗术中的应用

目的评估数字化牙片对磨牙根管治疗术中的效果。方法用常规根管治疗方法对194人(男107人,女87人)的198个牙进行治疗,在根管内插入诊断丝并结合不同角度的数字化X片,以测量工作长度。在治疗前、中、后应用数字化牙片判断治疗效果。结果对194人的198个牙随访3~6月,所有患牙获得良好的临床和X线片疗效。结论数字化牙片在磨牙复杂根管治疗中有很重要的作用,便于测量根管长度和判断术后疗效,也便于资料的收集和医患之间的交流。     

Hand and nickel-titanium root canal instrumentation performed by dental students: a micro-computed tomographic study

The aim of this study was to evaluate root canals instrumented by dental students using the modified double-flared technique, nickel-titanium (NiTi) rotary System GT files and NiTi rotary ProTaper files by micro-computed tomography (MCT). A total of 36 root canals from 18 mesial roots of mandibular molar teeth were prepared; 12 canals were prepared with the modified double-flared technique, using K-flexofiles and Gates-Glidden burs; 12 canals were prepared using System GT and 12 using ProTaper rotary files. Each root was scanned using MCT preoperatively and postoperatively. At the coronal and mid-root sections, System GT and ProTaper files produced significantly less enlarged canal cross-sectional area, volume and perimeter than the modified double-flared technique (P < 0.05). In the mid-root sections there was significantly less thinning of the root structure towards the furcation with System GT and ProTaper (P < 0.05). The rotary techniques were both three times faster than the modified double-flared technique (P < 0.05). Qualitative evaluation of the preparations showed that both ProTaper and System GT were able to prepare root canals with little or no procedural error compared with the modified double-flared technique. Under the conditions of this study, inexperienced dental students were able to prepare curved root canals with rotary files with greater preservation of tooth structure, low risk of procedural errors and much quicker than with hand instruments.     

不同投照角度X线片诊断下颌第一前磨牙多根管的临床分析

目的探讨不同投照角度X线片在诊断下颌第一前磨牙多根管中的作用。方法选取需行根管治疗的88颗下颌第一前磨牙为研究对象。每颗患牙均拍摄术前X线正位、偏位投照片判断是否为多根管牙；K型锉探查和定位根管口，冠下法预备根管，冷侧压法充填根管，充填时记录根管形态及数量，并拍摄根管充填术后X线正位和偏位投照片，对根管进行分型。结果88颗下颌第一前磨牙中，术前X线片诊断多根管31颗，临床发现多根管30颗。术前X线诊断为多根管的31颗牙，临床治疗中3颗未定位到多根管；而术前诊断为单根管的2颗牙，在临床治疗中发现为多根管。术前正位X线片诊断多根管牙13颗，术前偏位X线片诊断多根管牙25颗，其中7颗牙的术前正位和偏位X线片均表现为多根管影像。下颌第一前磨牙多根管的临床发现率为34.09%（30/88），其中Ⅳ、Ⅴ型根管为21颗，占多根管牙的70.00%。结论不同投照角度X线片有助于提高下颌第一前磨牙多根管的临床发现率。     

三种器械用于磨牙弯曲根管预备的临床评价

目的：评价不锈钢K锉、机用ProTaper和机用Safe Sider预备磨牙弯曲根管的临床疗效。方法：选取因牙髓炎或根尖周炎需要进行根管治疗的磨牙180颗（413个根管）,随机分为K-file组、ProTaper组和Safe Sider组,每组60颗牙。分别用不锈钢K锉、机用ProTaper和机用Safe Sider进行根管预备。三组均采用冷牙胶侧方加压技术充填根管。记录三组病例根管预备时间和术后并发症发生情况,根据治疗前、中、后的X线片评价根管预备和充填效果。结果：机用ProTaper、机用Safe Sider分别与不锈钢K锉在根管预备时间、根管成形以及充填效果方面在统计学上有显著性差异（P﹤0.05）,机用ProTaper与机用Safe Sider在上述方面无显著性差异（P﹥0.05）。结论：机用ProTaper和机用Safe Sider预备磨牙弯曲根管时能较好地保持原有根管形态,省时省力,术后反应少。     

利用根管显微镜诊治恒牙变异根管的临床疗效

目的：评价运用根管手术显微镜和超声技术诊治成人恒牙变异根管的临床疗效。方法：选择需行显微根管治疗的恒牙97颗,在根管手术显微镜下诊断、定位变异根管,机用镍钛旋转器械冠向下法预备根管,热牙胶垂直加压技术充填根管。记录根管变异类型,治疗过程中并发症情况,统计成功率。结果：97颗含有变异根管的患牙波及下颌前牙区、前磨牙区、磨牙区和上颌磨牙区。上颌磨牙区根管变异的主要类型为近颊根双根管,其中2-2型根管多见;下颌第二磨牙根管变异以C形根管为主,C2型根管多见。91颗患牙治疗成功,成功率为93.81%。无一例发生根管壁侧穿或牙根折裂。结论：成人恒牙根管系统的复杂变异是临床诊治的难点,运用现代治疗技术寻找和定位变异根管是治疗成功的关键,根管手术显微镜对提高变异根管的诊治成功率具有重要价值。     

An audit of the technical quality of primary orthograde root canal treatment performed by undergraduate dental students

Aim To investigate the technical quality of primary orthograde root canal treatment performed by undergraduate dental students. Methodology A retrospective radiographic analysis of the technical standard of root canal treatment performed over 1 year of the undergraduate course was undertaken. All primary root canal treatments performed by late 4th and final year students between 1 April 2006 and 31 March 2007 were evaluated. All students had completed an introductory laboratory course using stainless steel hand instruments and Gates Glidden drills and a subsequent course using Nickel titanium instruments. Additionally, some students completed a voluntary one‐term special study module (Endodontics) for 12 sessions. All radiographs of completed root canal treatments were assessed as to the technical quality of the root filling. Two calibrated observers assessed the radiographs under standard conditions using a lightbox and SDI radiograph viewer. The root fillings in each canal were assessed by length, satisfactory being within 0–2 mm of the radiographic apex, quality of obturation (absence of voids) classified as satisfactory, and taper, with the radiographic appearance of a uniform taper classed as satisfactory. The type of clinic, either a general restorative or endodontic was also recorded. Results A total of 266 root canals were evaluated in 149 teeth. The final radiograph was unsuitable in four teeth and one tooth was extracted shortly after canal preparation. The remaining sample size was 253 canals in 144 teeth (61 anterior, 37 premolar, 46 molar). No endodontic instruments were fractured during the study. Overall, 163 individual root canals (64.4%) and 87 teeth (60.4%) were classed as satisfactory. Fifty‐five canals and 21 teeth (one lower anterior, five premolars, 15 molars) were treated on the endodontic clinic, 46 canals (83.6%) and 15 teeth (71.4%) of these were satisfactory. A total of 198 canals in 123 teeth (60 anterior, 32 premolar, 31 molar) were treated on the restorative clinic with 117 canals (59.1.6%) and 72 teeth (58.5%) being satisfactory. Conclusions Overall, 60.4% of teeth met the criteria of root filling within 2 mm of the radiographic apex, no voids and uniform taper. A higher percentage of compliance was noted on the endodontic special study module.     

慢性根尖周炎一次性根管治疗的临床疗效观察

目的：评价慢性根尖周炎一次性根管治疗的临床效果和可靠性。方法：选择患有慢性根尖周炎的直根管患牙200例,采用改良双敞技术和平衡力法预备根管,0．5％次氯酸钠及17％EDTA冲洗,随机均分为两组：一次性根管治疗组在上述操作完成后立即行牙胶尖加树脂类封闭剂AHplus侧方加压术充填根管;多次性根管治疗组根管内封入氢氧化钙糊剂复诊,待无症状后再行根充。治疗结束后1d、7d、30d随访记录患者的疼痛反应。1年后进行临床及X线复查,计算每组根管治疗的成功及失败率,并进行统计学检验。结果：有94例患者回访,一次性根管治疗组43例,多次根管治疗51例。根管治疗术后1d疼痛发生率一次性治疗组高于多次性组,且有统计学差异,7d、30d的疼痛发生率两组间无明显差异。1年后复查两组的成功率无统计学差异。一次性根管治疗组的前牙与后牙治疗成功率间无统计学差异。结论：慢性根尖周炎一次性根管治疗术后疼痛发生率较多次法高,但远期疗效等同于多次法者。     

MTA apical plugs in the treatment of traumatized immature teeth with large periapical lesions

Abstract – This case report describes the management of a late‐referral case of periapically involved, traumatized immature permanent incisors by endodontic treatment and the use of mineral trioxide aggregate (MTA) apical plugs. A 10‐year‐old boy was referred to the clinic with a chief complaint of pain in his maxillary central incisors, which had experienced subluxation trauma 2 years earlier. Periapical radiograph of the teeth showed incomplete root development with wide‐open apices and large periradicular lesions. The canals were gently debrided using K‐files in conjunction with 2.5% NaOCl irrigation and 2% chlorhexidine for final flush. The root canals became asymptomatic after employing the same endodontic regimen for three visits. MTA plugs were placed in the apical area of the root canals, and the rest of the canal space was obturated by warm compaction of gutta‐percha and AH Plus sealer. Resolution of the large periapical lesions was observed 2 months after treatment. At 18 months, the periapical areas revealed radiographic evidence of bone healing. Following successful removal of the toxic content of the root canal, placement of MTA plugs resulted in both healing of the periradicular radiolucency and regeneration of the periapical tissue.