不同根管消毒方法对慢性根尖周炎根管内毒素 清除效果的临床研究

目的 研究Nd:YAG激光照射、超声冲洗及氢氧化钙封药等根管消毒方法对慢性根尖周炎患牙根管内毒素的清除效果.方法 选择临床诊断为慢性根尖周炎的上颌单根管前牙30颗,随机分为3组,镍钛器械常规预备后,分别采用Nd:YAG激光照射(A组)、超声冲洗(B组)及常规氢氧化钙封药(C组)等方法进行根管消毒,检测各组患牙治疗前后根管内内毒素的含量变化.结果 3组患牙治疗前内毒素含量的差异无统计学意义(P>0.05);A、B、C 3组患牙治疗前、预备后、治疗后内毒素含量差异均有统计学意义(P<0.05);治疗后3组间差异无统计学意义(P>0.05).结论 Nd:YAG激光照射、超声冲洗、氢氧化钙封药3种消毒方法均有较强清除灭活根管内毒素作用;50mjNd:YAG激光消毒1min或无菌蒸馏水超声冲洗1min可起到与氢氧化钙封药相同的根管内毒素清除效果.     

超声冲洗对感染根管内毒素的灭活及清除作用

目的探讨超声冲洗对感染根管内毒素的灭活及清除作用。方法选择因严重慢性根尖周炎拔除的具有双根管的离体上颌前磨牙10颗,常规开髓,用改良双敞法预备根管,将3％过氧化氢溶液30 μL注入根管,行超声振荡,每根管振荡2 min,分别于根管预备后和超声振荡后取样,测量内毒素活性。另外在临床患者中选择患有慢性根尖周炎的双根管上颌前磨牙10颗,采用相同的方法进行根管预备,预备后以无菌蒸馏水为介质进行超声冲洗,每根管均冲洗2 min,分别于根管预备前、根管预备后和超声冲洗2 min后根管取样,测量内毒素活性。内毒素活性的测定采用动态浊度法鲎试验,并对超声处理前后根管内毒素活性的差异进行分析。结果离体牙超声振荡前,根管内毒素的活性平均为4.069 EU·mL-1,超声振荡后为16.410 EU·mL-1,二者差异有统计学意义（P<0.01）,超声振荡后内毒素活性明显升高。临床样本中,根管预备前、根管预备后和超声冲洗后根管内毒素的平均活性分别为44.860、4.099、0.116 EU·mL-1,根管预备前与根管预备后内毒素活性的差异有统计学意义（P<0.01）,根管预备后内毒素活性明显下降;根管预备后与超声冲洗后内毒素活性的差异也有统计学意义（P<0.01）,超声冲洗后内毒素活性明显下降。结论在模拟临床操作的条件下,采用口腔科超声根管治疗仪进行超声冲洗可以明显增强根管冲洗液清除感染根管内毒素的作用,但不能增强根管冲洗液灭活感染根管内毒素的作用。     

超声振荡对于模拟根管内毒素的灭活作用研究

目的探讨超声振荡对于模拟根管内毒素的灭活作用。方法80个无热原玻璃单根管模型随机分为A～H8组,每组10个,分别注入标准内毒素溶液并给予不同处理：A、B、C组分别给予超声振荡5、7、10 min;D组加入过氧化氢溶液并超声振荡5 min,E组单纯加入过氧化氢溶液;F组加入次氯酸钠溶液并超声振荡5 min,G组单纯加入次氯酸钠溶液;H组为对照组。采用动态浊度法鲎试验测定各组内毒素活性,分析各组间内毒素活性的差异。结果A、B、C组间以及与对照组之间内毒素活性的差异均无统计学意义（P>0.05）;D、E、F、G组与对照组之间内毒素活性的差异均有统计学意义（P<0.001）,4个实验组明显低于对照组;单纯药物组与药物加超声组之间内毒素活性的差异无统计学意义（P>0.05）。结论在本实验条件下,采用口腔科超声根管治疗仪进行单纯超声振荡,不能灭活感染根管内毒素,亦不能加强根管冲洗液灭活内毒素的作用。     

超声对Beagle犬前牙根管内微生物作用的实验研究

目的:研究超声根管治疗仪对根管内微生物的作用。方法:选择Beagle犬前牙建立根尖周炎模型,随机分成两组:一组为超声根管治疗组,另一组为常规根管预备组;常规组于预备前和预备至#25、#40时、超声组于超声冲洗10s、30s、60s后,分别于根管内取样接种,检测细菌数量和检出率的变化。结果:充分的机械预备、长时间超声根管冲洗后细菌数量明显降低,与预备前有显著性差异(P<0.05)。超声冲洗根管与单纯的器械预备对根管内细菌作用无显著差异。结论:超声处理能有效地减少根管内微生物数量,但其效果与单纯器械预备无明显差异。     

EDTA与次氯酸钠联合应用对根管内粪肠球菌清除效果:体外研究

目的:评价17%EDTA联合1%次氯酸钠对根管内粪肠球菌的清除效果.方法: 将40 个离体前牙的感染根管标本随机分为5组,器械预备时分别辅以冲洗液冲洗根管.其中A、B、C组分别用5.25%、2.5%及1%次氯酸钠冲洗,D组用17%EDTA联合1%次氯酸钠冲洗,E组用0.9%NaCl冲洗.冲洗前、后计数根管内的细菌量,并观察72 h细菌复苏情况.结果: 5 组根管内的细菌量均显著下降(P<0.01),其中D组与A、C组间差异有显著性(P<0.05),与B组间差异无显著性(P>0.05).结论: 17%EDTA联合1%次氯酸钠可有效清除根管内粪肠球菌, 其效果优于1%次氯酸钠,与2.5%次氯酸钠相近似.     

根管内Ca(OH)2去除效果对根尖封闭性能影响的研究

目的:研究不同冲洗方法对根管内氢氧化钙封药的去除效果及残留药物对根尖封闭性能的影响.方法:200 颗离体单根管前磨牙,根管预备后随机分为A、B 2 个实验组(每组96 颗,剩余8 颗为对照组),分别水调氢氧化钙和成品氢氧化钙制剂Multi- Cal根管内封药.7 d后,根据冲洗方法不同将A、B 2 组分别均分为6 组,去除氢氧化钙.每组随机选8 颗牙扫描电子显微镜(SEM)观察;剩余8 颗与对照组,采用冷牙胶侧方加压法根管充填后,进行染料渗透实验.结果:SEM观测显示,相同冲洗条件下,不同剂型氢氧化钙的去除情况无统计学差异(P>0.05).在其他条件相同时,超声根管冲洗组去除效果好于注射器冲洗组,有统计学差异(P<0.05);次氯酸钠与EDTA联合应用组的效果最好,单独使用次氯酸钠组的效果次之,使用蒸馏水组的效果最差,有统计学差异(P<0.05).染料渗透实验结果无统计学差异(P>0.05).结论:超声根管冲洗配合次氯酸钠与EDTA,去除根管内氢氧化钙效果最好;无论哪种方法,均无法完全去除根管内的氢氧化钙封药,但残留的氢氧化钙对根管充填短期内的封闭性能无明显影响.     

中药洁尔阴冲洗剂用于超声波根管清理的扫描电镜观察

目的:评价中药冲洗剂洁尔阴用于超声根管冲洗的清理效果。方法:将20颗离体单根管牙随机分成4组:生理盐水组、3.33%洁尔阴组、30%洁尔阴组和2.5%次氯酸钠(NaClO)组。超声根管预备后,用15#锉在根管内不贴管壁超声冲洗清理10s,用扫描电镜观察根管内壁颈、中、尖部位的清洁程度,并进行ANOVA分析及Bonferroni检验。结果:在根管颈部,30%洁尔阴的清理能力与2.5%次氯酸钠相似(P>0.05),显著优于3.33%洁尔阴(P<0.01)和生理盐水组(P<0.05),且30%洁尔阴在根管颈部的清理能力又显著好于中、尖部(P<0.01)。在根管中部,各组之间无显著差异(P>0.05)。在根尖部,2.5%次氯酸钠的清洁程度显著好于生理盐水组(P<0.05)。3.33%洁尔阴与生理盐水之间各部位均无显著差异。结论:30%洁尔阴、2.5%次氯酸钠超声根管冲洗液在根管颈部的清洁能力较强,3.33%洁尔阴、生理盐水清理能力较差。     

冲洗液对超声根管预备抗菌效果的影响

目的研究生理盐水、EDTA、次氯酸钠、口泰与超声波联合应用杀灭感染根管内厌氧菌的效果。方法将100例慢性根尖周炎患者共100颗患牙随机分为常规组、生理盐水组、EDTA组、次氯酸钠组、口泰组5组,每组各20颗患牙,常规组用常规法手持器械根管预备并分别用3%双氧水和生理盐水常规针筒式冲洗根管,后四组均用超声法进行根管预备并分别以生理盐水、EDTA、次氯酸钠、口泰作为超声冲洗液,根管预备前后分别取样进行厌氧培养。结果次氯酸钠组和口泰组其厌氧菌减少程度均显著大于生理盐水组(P<0.01),明显大于EDTA组(P<0.05);生理盐水组和EDTA组之间其厌氧菌的减少程度无显著性差异(P>0.05);次氯酸钠组和口泰组之间其厌氧菌减少程度无显著性差异(P>0.05)。结论口泰与超声波联合应用可有效杀灭感染根管内厌氧菌,其抗菌效果与次氯酸钠相近似。     

不同超声冲洗液和不同时间对根管预备后清洁效果的扫描电镜观察

目的　比较不同超声冲洗液及不同超声冲洗时间对根管预备后清洁的效果。方法　80颗离体单根管上颌前牙应用机用镍钛Protaper根管预备至F3后随机分为8组,分别用不同冲洗液超声冲洗1 min和3 min,A、B组用复方氯己定含漱液,C、D组用3%H2O2溶液,E、F组用蒸馏水,G、H组用17%EDTA溶液。最后将牙体沿颊舌向纵劈,扫描电镜观察各组样本在根颈、中、尖1/3牙本质碎屑与玷污层的清除情况,根据评分统计分析比较各组根管清洁效果。结果　不同冲洗液超声冲洗1 min时,在根颈部和根中部,G组与其它各组之间比较有显著性差异（P＜0.05）。在根尖部,G组与C组差异有统计学意义（P＜0.05）,C组与A、E组比较差异有统计学意义（P＜0.05）。不同冲洗液超声冲洗3 min时,在根颈部和根中部,H组与其它各组之间比较有显著性差异（P＜0.05）。在根尖部,H组与D组比较无显著性差异（P＞0.05）,但与B、F组比较差异有统计学意义（P＜0.05）。相同冲洗液不同冲洗时间时, A、B组在根中及根尖部差异有统计学意义（P＜0.05）,C、D组在根尖部差异有统计学意义（P＜0.05）,E、F组之间和G、H组之间比较无显著性差异（P＞0.05）。结论　17%EDTA溶液超声冲洗1 min就可去除根管玷污层和碎屑。3%H2O2和复方氯己定含漱液超声冲洗1 min效果虽不及17%EDTA,但适当延长冲洗时间可增强根尖部清洁效果。     

根尖终末工作宽度对根管内细菌清除效果的体外研究

目的:比较不同的根尖预备终末工作宽度对根管内细菌清除效果的影响。方法:将已感染粪肠球菌的48颗离体上颌磨牙的远中颊侧根管标本随机分为6组,实验组分别预备根管至25#(A组)、30#(B组)、35#(C组)、40#(D组);对照组E、F组不进行机械预备而只进行冲洗。采用ProTaper机用镍钛锉和不锈钢K锉冠向下法预备根管。A、B、C、D、E组用1%次氯酸钠和17%EDTA冲洗根管,F组仅用生理盐水冲洗。根管预备前和预备后分别取样作细菌学培养计数,并做统计学分析。结果:预备冲洗后6组根管内的粪肠球菌量均显著下降(P<0.05),其中D组下降最明显。A、B组间差异无统计学意义,其余各组间比较均有显著性差异(P<0.05)。在实验组A、B、C、D组中,根管预备后阴性培养的百分率分别为0%、12.5%、37.5%和75%;对照组E、F组中均未获得阴性培养。结论:增大根尖预备终末工作宽度能提高根管内细菌清除的效果。但上颌磨牙远中颊侧根管预备至40#配合抗菌性冲洗液,尚不能完全清除根管内粪肠球菌。     

连续波热牙胶垂直充填技术的临床评价

目的 通过连续波热牙胶垂直充填方法与冷牙胶侧压根管充填方法在充填时间、根管充填质量、术后疼痛的比较,对连续波热牙胶充填技术进行临床评价.方法 选择需要做根管治疗的患牙140颗,随机分为2组,其中冷牙胶组76颗,热牙胶组64颗,比较2组患牙根管充填时间、充填质量、侧支根管充填情况、术后疼痛情况等.结果 冷牙胶组充填时间为切牙（6.51 ±0.26） min/根管、前磨牙（4.13 ±0.26） min/根管、磨牙（4.17 ±0.27） min/根管,热牙胶组则分别为（3.07 ±0.16） rmin/根管、（2.79 ±0.31） rmin/根管、（2.91±0.24） min/根管,差异均具有统计学意义（P＜0.05）;2组根管充填质量差异无统计学意义（P＞0.05）,根管超填与根管充填方法无关;热牙胶组侧支根管充填率高于冷牙胶组;2组根管充填术后疼痛差异无统计学意义（P＞0.05）.结论 连续波热牙胶垂直充填方法可以快速、高质量地完成根管充填,提高侧支根管充填率,不会增加根管超填以及术后疼痛的风险.     

四种根管消毒剂对乳牙根管消毒作用的临床观察

目的：对比大蒜素、甲硝唑、甲醛甲酚（FC）、樟脑酚（CP）4种根管消毒药物,对乳牙感染根管消毒作用的应用前景,从中选出较适用于乳牙感染根管的消毒药物。方法：选择2．5～8岁患儿乳牙牙髓炎、根尖周炎160例共168个牙,随机分成4组,分别封人大蒜素、甲硝唑、FC、CP,7d复诊,观察临床疗效。结果：4种根管消毒剂对乳牙感染根管的消毒作用,大蒜素组有效率90％,甲硝唑组有效率88％;FC组有效率89％;三组间比较无显著性差异（P〉0．05）,CP组有效率77％。组间比较有显著性差异（P〈0．05）,4种根管消毒药物与牙位无显著性差异,4组病例中FC组出现2例治疗期间急症,对有瘘型根尖炎大蒜素和甲硝唑组与FC和cP组比较有显著性差异。结论：4种根管消毒药物应用于乳牙感染根管最佳选择依次为大蒜素,甲硝唑、甲醛甲酚、樟脑酚。     

车针转速对GuttaFlow根管充填后微渗漏的影响

目的 研究桩道预备过程中不同车针转速对GuttaFlow根管充填后微渗漏的影响。方法 40颗人上颌前牙截冠后统一工作长度为16mm,根管预备后GuttaFlow充填根管。样本按桩道预备车针转速随机分为5组:A组(车针转速为400r/min)、B组(800r/min)、C组(7000r/min)、D组(14000r/min)、E组(对照组,不进行桩道预备)。1周后各组按设定转速进行桩道预备,保留根尖4mm充填物。液体转移法测量根管微渗漏。实验数值采用SPSS13.0统计学软件进行单因素方差分析。结果 A组微渗漏值最大(7.531±1.309)×10-3μl/(kPa·min),与E组间有统计学差别。A组和D组间有统计学差异。其余各组间无统计学差异。结论 桩道预备过程中车针转速对GuttaFlow根管充填后微渗漏产生影响,转速过低时(400r/min)增加充填根管的微渗漏,不推荐使用于临床。?     

显微CT评价Er:YAG激光对完全型管间峡区碎屑的清理能力

目的应用显微CT技术,观察和评价不同功率Er:YAG激光与NaClO冲洗液联合使用时对完全型管间峡区内碎屑的清理效果,为探索清理完全型管间峡区的新方法提供实验依据。方法通过CBCT扫描后,挑选出经统一截冠且根管预备后仍含完全型管间峡区的前磨牙20颗,随机分成4组,显微CT初次扫描,采集图像,峡区定位。实验组分别使用1.5 W、2.0 W、2.5 W Er:YAG激光照射根管1 min并使用1.0%NaClO冲洗根管,对照组仅用1.0%NaClO溶液冲洗根管1 min。激光照射冲洗根管完成后,显微CT再次扫描标本,采集图像,计算处理前后完全型管间峡区碎屑量的变化值百分比,并进行统计学分析。结果实验组随激光功率增大,峡区碎屑的减少量亦增大,分别为7.15%、9.19%和10.14%。对照组碎屑减少量为0.51%。3个实验组的碎屑减少量与对照组之间的差异具有统计学意义(P<0.05)。结论使用Er:YAG激光配合NaClO溶液处理根管,能较好的清理完全型管间峡区,激光功率越大,清理效果越好。     

机用Pro Taper、R-Endo根管预备的效果评价

［摘要］ 目的 评价机用镍钛器械Pro Taper和R-Endo根备系统预备根管的临床效果。方法 选择临床上需进行根管治疗的160颗患牙(共512个根管),随机分为实验组(253个根管)和对照组(259个根管),每组各80颗牙。实验组使用机用镍钛器械Pro Taper技术预备根管,对照组使用R-Endo技术预备根管。两组均用冷牙胶侧方加压技术充填根管。记录两组根管预备时间和术后并发症出现情况,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 实验组根管预备时间为15 min,明显少于对照组40 min,根管成形和充填效果两组无差异。结论 机用Pro Taper系统应用于根管治疗预备具有良好的成形和充填效果,且根管预备快速、高效; R-Endo系统操作简单,对根尖周组织激惹度较小。     

Evaluation of the effect of endodontic irrigation solutions on the microhardness and the roughness of root canal dentin

The purpose of this study was to evaluate the effect of 0.2% chlorhexidine gluconate on the microhardness and roughness of root canal dentin compared with widely used irrigation solutions. Ninety, mandibular, anterior teeth extracted for periodontal reasons were used. The crowns of the teeth were removed at the CEJ. The roots were separated longitudinally into two segments, embedded in acrylic resin, and polished. A total of 180 specimens were divided into 6 groups of 30 teeth at random according to the irrigation solution used: group 1: 5.25% NaOCl for 15 min; group 2: 2.5% NaOCl for 15 min; group 3: 3% H2O2 for 15 min; group 4: 17% EDTA for 15 min; group 5: 0.2% chlorhexidine gluconate for 15 min; and group 6: distilled water (control). Each group was then divided into 2 subgroups of 15 specimens: groups 1a, 2a, 3a, 4a, 5a, and 6a were submitted to Vickers microhardness indentation tests; groups 1b, 2b, 3b, 4b, 5b, and 6b were used for determination of the roughness of root dentin. The data were recorded as Vickers numbers and Ra, microm for roughness test. The results were analyzed statistically by using one-way ANOVA and Tukey tests. The results indicated that all the irrigation solutions except chlorhexidine significantly decreased microhardness of root canal dentin (p < 0.05); 3% H2O2 and 0.2% chlorhexidine gluconate had no effect on roughness of the root canal dentin (p > 0.05). Although there are many other factors for irrigation solution preference, according to the results of this study, 0.2% chlorhexidine gluconate seems to be an appropriate endodontic irrigation solutions because of its harmless effect on the microhardness and roughness of root canal dentin.     

91颗前牙根尖周囊肿治疗的临床观察

目的探讨单纯性根管治疗和根管治疗辅以根尖切除治疗前牙根尖周囊肿的疗效。方法将91颗前牙根尖周囊肿行根管治疗后随机分为2组,44颗作为试验组,行根尖切除术,另外47颗作为对照组。术后3个月到1年跟踪追访。结果试验组治疗的有效率为90.9%,对照组治疗的有效率为87.2%,且两组间的疗效差异无统计学意义(P>0.05)。结论对于前牙根尖周囊肿,应先行根管治疗,待明确效果后再考虑是否需要外科手术治疗,根尖切除不是必须的治疗方法。     

Evaluation of the anti‐resorptive ability of an experimental acetazolamide paste for the treatment of late replanted teeth: a study in rats

Abstract – When late replantation is performed, the root surface and root canal should be treated. Notwithstanding failures still occur, because of the high rates of root resorption, evidencing the need to search for substances that may inhibit root resorption. The acetazolamide is a known anti‐resorptive agent, and its use as root canal dressing may increase the success rates in the treatment of root resorption. Therefore, this study evaluated the effect of an acetazolamide paste used as root canal dressing in late replanted teeth. The study was conducted on 24 maxillary right incisors of rats, which were avulsed and divided in two groups. In group I, the teeth were kept dry for 30 min, had their root surfaces rubbed with a blade, and were treated with 2% sodium fluoride at pH 5.5 for 20 min; the root canals were instrumented and filled with acetazolamide paste; and then the teeth were replanted. In group II, the treatment was similar to group I, except for the root canal dressing, with utilization of calcium hydroxide in group II. At 15 and 60 days after replantation, the animals were killed and the specimens were processed in a histotechnical laboratory for microscopic and morphometric analysis. The results demonstrated the ability of both intracanal substances to limit root resorption, yet they were unable to completely inhibit the root resorption. Replacement resorption lacunae were present in greater proportion in group II, at 60 days. It was concluded that the acetazolamide paste was effective to limit the root resorption, being more effective in limiting the replacement resorption compared with calcium hydroxide.     

Root canal configuration of deciduous mandibular first molars--an in vitro study

Root canal morphology of deciduous mandibular first molar was studied using roentgenographic and decalcification and clearing methods. Two groups of 15 teeth were formed. In the roentgenographic group, roots of the teeth were separated from the crown at the level of CEJ. Cut roots of the teeth were radiographed from both mesiodistal and buccolingual directions using separate IOPA films. In the decalcification and clearing group, teeth were decalcified and made transparent. Dye was injected later. The roots of the teeth were examined under 10 times for number, curvature, types and additional features of root canals. Deciduous mandibular first molar showed variability in root canal morphology. Four to five root canals were recorded. Majority of the teeth had 1-1 type of root canal anatomy, but 1-2 type anatomy was also reported. Straight, curved and S-shaped canal curvatures were recorded. Horizontal anastomosis, lateral canals and buccolingually broad root canals were also recorded.     

The effect of application time of EDTA and NaOCl on intracanal smear layer removal: an SEM analysis

AIM: To verify, under the scanning electron microscope (SEM), the influence of irrigation time with ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) on intracanal smear layer removal. METHODOLOGY: Twenty-one extracted human permanent teeth with single straight root canals were included. The root canals of the teeth were instrumented and, at the end of preparation, were irrigated with 3 mL of 15% EDTA, followed by 3 mL of 1% NaOCl for 1 min (group 1), for 3 min (group 2), and for 5 min (group 3). The canals of teeth in group 4 (control) did not receive the final irrigation. The teeth were sectioned longitudinally and prepared for an SEM. The dentinal wall of cervical, middle and apical thirds was graded according to the amount of debris and smear layer remaining on the walls. The results were analysed using the Kruskal-Wallis and Conover-Inman tests. RESULTS: In all the canals of experimental groups irrigation with EDTA and NaOCl completely removed the smear layer from the cervical and middle thirds. In the apical third, the dentine surface were partially covered, particularly in the teeth of group 1, where there was significantly more smear layer when compared with the other thirds in the same group (P<0.007). However, the Kruskal-Wallis test showed overall that there were no significant differences between groups 1, 2 and 3 (P>0.05). CONCLUSION: In this limited laboratory study, canal irrigation with EDTA and NaOCl for 1, 3 and 5 min were equally effective in removing the smear layer from the canal walls of straight roots.