不同通畅锉预备弯曲根管效果的临床及体外研究

发布时间：2018-01-19 12:25

本文关键词： M-Path PathFile K锉约诊间疼痛根尖碎屑根尖偏移根尖中心定位弯曲根管　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本研究探讨使用三种不同根管通畅锉预备弯曲根管后发生约诊间疼痛、推出根尖碎屑量以及根尖偏移和根尖中心定位能力的差异情况,从而初步评价不同根管通畅锉在根管治疗过程中的应用价值。方法:1.不同根管通畅锉预备弯曲根管效果的临床研究选取下颌第一磨牙患急性牙髓炎的病人60例,通过Schneider法确定根管弯曲度,随机分为3组:K锉组,Pathfile组,M-Path组。局部浸润麻醉后于橡皮障下进行预备洞型,常规开髓,建立直线通路。K锉组采用不锈钢K锉顺序疏通10#、15#至20#;Path File组采用Path File镍钛根管预备系统依次从13#、16#至19#进行预备;M-Path组采用M-Path系统依次从13#、16#至19#进行预备。三组在根管疏通过程中均配合EDTA凝胶RC-PREP预备,随后分别使用M3机用镍钛根管预备系统行根向预备。2%Na Cl O与17%EDTA交替冲洗,超声荡洗,干燥,封氢氧化钙糊剂根管消毒。7天后使用热牙胶充填系统进行根管充填。采用视觉模拟评分(VAS)量表记录患者根管预备术后当天、术后第一天、术后第二天的患牙疼痛情况。2.不同根管通畅锉预备弯曲根管效果的体外研究选取30颗离体下颌单根管前磨牙,通过Schneider法确定根管弯曲度,自颊侧釉牙骨质界上2mm垂直于牙体长轴的方向截断,保留牙根部分,拔髓后用10#K锉插入根管直至看见锉尖刚好穿出根尖孔时调整为固定参考点,记录止动片到器械尖端的距离,将此距离减去1mm确定为工作长度。将30颗离体牙随机分成3组,K锉组、Path File组、M-Path组,各10例。将离体牙逐一编号,并按顺序放置于相应空瓶中,瓶口用不透明塑胶塞封闭,离体牙与瓶口塑胶塞之间缝隙用3M ESPE FiltekTMZ350XT纳米流体树脂封闭。瓶口塑胶塞上插入5ml注射器针头以平衡瓶内外气压。使用上述相同方法进行根管预备。每次冲洗时使用侧方开口冲洗针头,针头尽量深入根管内最终达到距工作长度1mm,上下提拉、旋转针头,以达到无阻力、无嵌塞。根管预备后,用1m L蒸馏水冲洗根尖及其上方2mm以内的牙根外表面,将冲洗液一并收集至空瓶中。收集空瓶中液体经过离心、蒸干后,用电子天平(mg)对推出根尖碎屑量进行称重。利用锥形束CT(CBCT)分别对根管预备前后的离体牙样本进行扫描,然后用CBCT自带软件对图像进行分析测量根管预备前后每个牙根距根尖孔0.5mm、1mm、2mm 3个横断面弯曲内外侧根管壁的厚度,观察根管预备后发生根尖偏移和根尖中心定位的情况。3.统计学分析用统计软件SPSS17.0,采用单因素方差分析、SNK检验两两比较分析,P值小于0.05表示有统计学意义。结果:1.相比于使用K锉疏通根管治疗牙髓炎,应用Path File镍钛根管预备系统及M-Path系统疏通根管治疗牙髓炎,患者术后疼痛反应显著降低(P0.05)。2.相比于使用K锉疏通根管,应用Path File镍钛根管预备系统及M-Path系统疏通根管,根管预备后推出根尖碎屑量显著减低(P0.05)。3.三种根管通畅锉预备弯曲根管后,测量点距离根尖孔0.5mm断面,K锉组与Path File组、M-Path组比较,根管偏移量差异具有统计学意义(P0.05);测量点距离根尖孔1mm断面,K锉组与Path File组、M-Path组比较,根管偏移量差异无统计学意义(P0.05);测量点距离根尖孔2mm断面,K锉组与M-Path组比较,根管偏移量差异具有显著性(P0.05),K锉组与Path File组比较,根管偏移量差异不具有显著性(P0.05)。4.三种根管通畅锉预备弯曲根管后,测量点距离根尖孔0.5mm断面,K锉组与Path File组、M-Path组比较,根尖中心定位能力差异具有统计学意义(P0.05);测量点距离根尖孔1mm和2mm断面,K锉组与Path File组、M-Path组比较,根尖中心定位能力差异无统计学意义(P0.05)。结论:1.Path File根管预备系统及M-Path系统能显著降低弯曲根管预备后的疼痛反应、推出根尖碎屑量,发挥良好的根尖定位能力,以减少根尖偏移的发生。2.Path File和M-Path根管通畅系统能够提高工作效率,保存根管完好的解剖形态,建立弹性弯曲的平滑路径,从而保证了后期大锥度镍钛器械预备维持在根管原有的解剖形态基础上。
[Abstract]:Objective: This study investigated the use of three kinds of root canal files in preparation of curved root canal unobstructed interappointment pain, the difference and the amount of debris launched apical migration and apical center apical positioning ability, so as to evaluate different root canal patency file in the root canal treatment in the process of application. Methods: 1. different root clinical study of tube patency files in curved canals using selected mandibular first molars with acute pulpitis patients in 60 cases, by Schneider method for the determination of root canal curvature, were randomly divided into 3 groups: Pathfile group, K file group, M-Path group. Local anesthesia after cavity preparation in rubber dam, conventional open pulp a straight line pathway of.K file group, 10# stainless steel K files in order to clear, 15# to 20#; Path File group with Path File nickel titanium system are from 13#, 16# to 19# for preparation; group M-Path with M-Path system are from 13#, 16# to 19# Prepare for. With EDTA RC-PREP gel prepared in both three groups in the root canal dredging process, then use M3 nickel titanium root system to prepare.2%Na Cl O and 17%EDTA douche, ultrasonic irrigation, dry seal, Calcium Hydroxide Paste.7 days after root canal disinfection using warm gutta percha root canal system filling. Using the visual analogue scale (VAS) were recorded after root canal preparation on the same day, the first day after operation, postoperative day second teeth pain.2. of different root canal file smooth curved canals using in vitro selection of 30 mandibular premolar root canal, through the Schneider method to determine the root tube bending, from buccal cemento enamel 2mm perpendicular to the long axis of the tooth direction truncation, keep the root part of pulpectomy with 10#K file inserted into the root canal until you see the file tip just through the apical foramen when adjusted for the fixed reference point to stop recording The instrument tip distance, the distance minus 1mm is determined as the working length. 30 teeth were randomly divided into 3 groups, K Path group File, file group, M-Path group, 10 cases each. The teeth are numbered sequentially, and placed in the corresponding empty bottle, bottle with opaque plastic plug closed. From the gap between the teeth and the plastic bottle plug with 3M ESPE FiltekTMZ350XT nano fluid resin sealing plug is inserted into the 5ml bottle. The plastic syringe needle to balance the air pressure inside and outside the bottle. Use the same method for root canal preparation. Each flushing using lateral opening flushing needle, needle as deep root canal working length to reach from 1mm pulling up and down, in order to achieve the rotation of the needle, no resistance, no impaction. After root canal preparation, root surface and root irrigation within the above 2mm 1m L with distilled water, rinse liquid together to collect the empty bottle. Collect the empty bottle liquid after centrifugation, After drying, with electronic balance (mg) on the launch of apical quantity of debris were weighed. The use of cone beam CT (CBCT) scanning teeth samples respectively before and after root canal preparation, and then use CBCT software to analyse the image measurement of root canal preparation before and after each hole from the root apex of 0.5mm, 1mm, 2mm 3 a cross section of curved root canals inside and outside wall thickness analysis of.3. was observed after root canal preparation and root apical positioning center shift using the statistical software SPSS17.0, using single factor variance analysis, comparative analysis of 22 SNK test, P values less than 0.05 were statistically significant. Results: 1. compared to the K file in root canals the treatment of pulpitis, application of Path File nickel titanium system and M-Path system to clear the root canal treatment of pulpitis, pain reaction of patients decreased significantly after.2. (P0.05) compared to the K file to clear the root canal, the application of Path File nickel titanium root Canal system and M-Path system to clear the root canal, root canal preparation after the launch of root quantity of debris was significantly decreased (P0.05).3. three root canal unobstructed files in preparation of curved root canal, the measurement points from the foramen of 0.5mm section, K file group and Path File group, M-Path group, root canal offset. The difference was statistically significant (P0.05); the measurement points from the foramen of 1mm section, K file group and Path File group, M-Path group, root canal deviation was no statistically significant difference (P0.05); the measurement points from the foramen of 2mm section, K file group compared with M-Path group, the root canal deviation had a significant difference (P0.05) K file, Path group compared with File group, root canal offset does not have significant difference (P0.05).4. three root canal unobstructed files in preparation of curved root canal, the measurement points from the foramen of 0.5mm section, K file group and Path File group, M-Path group, the difference was statistically significant (apical center positioning capability P0.05); The measurement points from the foramen of 1mm and the 2mm section, K file group and Path File group, M-Path group, no statistically significant difference between the apical center positioning capability (P0.05). Conclusion: 1.Path File root canal system and the M-Path system can significantly reduce the bending pain reaction after root canal preparation, push out root quantity of debris, play apical positioning ability, in order to reduce the occurrence of.2.Path File and the apical M-Path root canal patency system can improve the work efficiency, save the morphology and anatomy of intact root canal, the establishment of a smooth path of elastic bending, thus ensuring the later large taper nickel titanium rotary instruments in preparation to maintain the original anatomy in the root canal.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R781.05

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