三种运动方式对镍钛根管器械的成形能力及抗循环疲劳能力的影响研究

发布时间：2018-04-24 22:21

本文选题：根管预备 + 成形能力　；参考：《郑州大学》2017年硕士论文

【摘要】：根管预备一直是根管治疗中的关键步骤,决定着整个根管治疗的成败。而镍钛根管预备系统通常是进行根管预备的首选,镍钛器械的成形能力以及抗疲劳性能也一直是临床医生关注的重点。随着镍钛器械的不断推陈出新,除了在器械材质、横截面及尖端设计的改进,镍钛器械的运动方式也由原来的单一连续旋转模式发展到现今的三种主要模式:单向旋转、往复运动和自适应运动。本研究使用两种不同的镍钛根管预备系统,观察三种不同的运动方式对镍钛根管器械的成形能力及抗循环疲劳能力的影响。一三种不同运动模式对镍钛器械根管成形能力的影响目的利用Hyflex CM和机用Twisted File Adaptive两种不同的根管预备系统,分别在单向旋转、往复运动和自适应运动三种模式下对3D树脂复制根管进行根管预备,通过Micro-CT扫描及三维重建图像技术对根管预备前后的根管体积、根管表面积和根管偏移度改变量进行对比分析,以比较不同运动模式下器械成形能力的差异。以期为临床工作提供实验依据。材料与方法选择54颗3D复制树脂牙的上颌第二磨牙,上颌第二磨牙近中颊侧根管的根管弯曲度为50度,根尖孔直径为0.20mm,根管全长为15mm,随机分成6组,每组9个样本,依次进行标记编码。将54个样本分别放置于自制固定装置固定,Micro-CT进行预备前扫描。其中1、2、3组分别使用Hyflex CM在单向旋转、往复运动和自适应运动三种模式下进行根管预备。4、5、6组分别使用Twisted File Adaptive在单向旋转、往复运动和自适应运动三种模式下进行根管预备。将预备后的样本按照预备前扫描时的位点放置在自制固定装置上,再次Micro-CT进行扫描,两次扫描的参数保持一致。将扫描数据采用进行三维重建分析,对预备前后根管的形态(体积,表面积,偏移度)进行对比,所得数据利用SPSS 17.0进行统计学分析,分别评价两种根管预备器械在三种不同运动模式下对3D复制树脂根管的成形能力。结果在Hyflex CM预备的三组根管中,连续旋转组的体积改变量的平均值小于另外两实验组,且差异有统计学意义。而往复运动组和自适应运动组之间,根管的体积改变量无明显统计学差异。Hyflex CM在三种运动方式下,根管预备前后根管内壁的表面积改变结果与体积改变结果相似。连续旋转组的根管壁表面积的改变量的平均值小于另外两实验组,且差异有统计学意义,而往复运动组和采用自适应运动组之间,根管壁的表面积改变量无明显统计学差异。在对根管弯曲度的改变方面,往复运动组产生的根管偏移较其他两组小,但三组之间的差异无统计学意义。在Twisted File Adaptive预备的三组根管中,连续旋转组的体积改变量最小,但与其他两组之间的差异无统计学意义。在三组中,自适应运动组的根管预备前后根管内壁的表面积改变量最大,与其他两组无统计学差异。在对根管弯曲度的改变方面,连续旋转组,往复模式组和自适应组在预备弯曲树脂根管时的产生的根管偏移基本一致,无明显统计学差异。结论在成形能力实验中,往复运动的Hyflex CM和Twisted File Adaptive的切削效率最高。Hyflex CM和Twisted File Adaptive在连续旋转、往复运动和自适应运动下都表现出较好的成形能力,其中往复运动模式下的根管偏移出现的最少。二不同运动模式对器械循环疲劳能力的影响目的选用Hyflex CM和机用Twisted File Adaptive两种不同的镍钛器械,分别在单向旋转、往复运动和自适应运动三种模式下完成5个树脂弯曲根管的预备,对使用过器械表面用SEMJ进行观测,分析对比不同运动模式下器械表面疲劳的差异。之后再将检测过的器械进行循环疲劳断裂测试,比较不同运动模式下器械抗循环疲劳断裂能力。以期为临床工作提供实验依据。材料和方法选用300个弯曲树脂根管,弯曲度64度、弯曲半径6mm,全长17mm。所有树脂模拟根管被随机分为6组,每组50个。选用30支Hyflex CM,30支Twisted File Adaptive,型号均为20号,锥度0.04。每个品牌的器械被随机分为三组。三组器械分别在单向旋转、往复运动和自适应运动三种模式下完成树脂根管的预备。每个器械预备5个树脂根管。然后所有使用过的器械在扫描电镜(SEM)下放大200倍观察。沿器械的轴向进行五个视野的表面磨损分析观察,对所有样本的电子显微照片进行数字化编码储存。由三名观察员使用表1中的评分标准进行等级评分,记录所得评分。再将观测过后的器械完全插入树脂根管模型中,进行循环疲劳断裂实验。器照按照之前的分组,继续在相应的运动模式下在根管内运动,整个运动中器械保持完全插入根管的状态。15秒为一个运动周期,每个运动周期结束后用清水冲洗根管以及器械,然后再进行下一周期,直至器械发生断裂。记录器械断裂的周期数。使用SPSS 17.0软件,分别对所得的数据进行分析,比较不同运动下器械的表面磨损程度和抗疲劳断裂能力。结果Hyflex CM和Twisted File Adaptive镍钛器械在三种运动模式下完成5个树脂根管的预备后,器械表面均表现为不同程度的磨损,两种器械的连续旋转组器械表面的磨损程度都高于往复模式组和自适应模式组,而往复模式组和自适应模式组两组之前无明显差异。Hyflex CM器械断裂的15秒周期循环数值,连续旋转组是10.4+3.33次,该循环周期数短于往复模式的19.7+6.00次和自适应运动的15.7+5.54次。往复模式和自适应模式之间无统计学差异,而连续旋转运动组与前两组之间都有统计学差异。Twisted File Adaptive在连续旋转的断裂周期数是11.8+4.34次,该时间短于往复模式的18.5+5.08次和自适应运动的16.7+6.36次。往复模式和自适应模式之间无统计学差异,而连续旋转模式的与前两组之间都有统计学差异。结论往复运动和自适应运动下根管器械相比连续旋转运动都表现出更少的表面磨耗。而往复模式和自适应模式下的器械的折断时间也明显比连续旋转的器械长,而往复模式运动的器械在抗循环断裂方面的性能最好。
[Abstract]:Root canal preparation has always been a key step in root canal therapy, which determines the success or failure of root canal treatment. The nickel titanium root canal preparation system is usually the first choice for root canal preparation. The formability and fatigue resistance of the nickel titanium instrument are always the focus of the clinicians. The improvement of quality, cross section and tip design, the movement mode of NiTi instruments has also developed from the original single continuous rotation mode to the three main modes today: unidirectional rotation, reciprocating motion and adaptive motion. This study uses two different nickel titanium root canal preparation systems and observes three different kinds of movement methods for the nickel titanium root tube instruments. The influence of forming ability and resistance to cyclic fatigue. The effect of 13 different motion modes on the forming ability of the root tube of Ni Ti instruments. Purpose using the two different root canal preparation systems of Hyflex CM and Twisted File Adaptive, the root canal of 3D resin was carried out in three modes of one-way rotation, reciprocating motion and adaptive movement. To compare the volume of root canal, the surface area of root canal and the change of the root canal offset before and after the preparation of the root canal by Micro-CT scan and three-dimensional reconstruction image technique, in order to compare the difference of the formability of the apparatus under different motion modes. In order to provide the experimental basis for clinical work. Materials and methods choose 54 3D replicating teeth. The maxillary second molars, the root canal bending degree of the proximal and middle buccal lateral root canal of the maxillary second molar was 50 degrees, the root canal diameter was 0.20mm, the root canal was 15mm, and was randomly divided into 6 groups. Each group had 9 samples in turn. The 54 samples were placed in the self-made fixtures, and the Micro-CT was scanned before preparation. Among them, the 1,2,3 group used Hyf respectively. Lex CM carries out root canal preparation under three modes of unidirectional rotation, reciprocating movement and adaptive motion, and.4,5,6 group is prepared by Twisted File Adaptive under one-way rotation, reciprocating motion and adaptive motion. The prepared samples are placed on the self-made fixtures according to the pre prepared scanning sites and M again. M Icro-CT was scanned and the parameters of the two scan were consistent. The scanned data were analyzed by three-dimensional reconstruction, and the morphology (volume, surface area, offset) of the root canal before and after preparation was compared. The data obtained by SPSS 17 were statistically analyzed, and two kinds of root canal preparation instruments were evaluated for 3D replication in three different modes of motion respectively. In the three groups of root canals prepared by Hyflex CM, the average value of the volume modification of the continuous rotation group was less than that of the other two experimental groups, and the difference was statistically significant. There was no significant difference in the volume change of the root canal between the reciprocating movement group and the adaptive exercise group, and.Hyflex CM was in the three types of movement, The change of the surface area of the inner wall of the root canal was similar to that of the volume change before and after the root canal preparation. The average value of the change of the surface area of the root canal wall in the continuous rotation group was less than that of the other two experimental groups, and the difference was statistically significant, but the surface area change of the root canal wall was not statistically significant difference between the reciprocating movement group and the adaptive movement group. In the change of the root canal curvature, the root canal migration in the reciprocating group was smaller than the other two groups, but the difference between the three groups was not statistically significant. In the three groups of root canals prepared by Twisted File Adaptive, the volume change of the continuous rotation group was the smallest, but the difference between the other two groups was not statistically significant. In the three groups, the adaptation was self suitable. The surface area change of the inner wall of the root canal was the largest in the motion group before and after the root canal preparation. There was no statistical difference with the other two groups. In the aspect of the change of the root canal bending degree, the root canal offset of the continuous rotation group, the reciprocating model group and the adaptive group in the preparation of the bent resin root canal were consistent, and there was no significant statistical difference. In the ability experiment, the cutting efficiency of Hyflex CM and Twisted File Adaptive of reciprocating movement is the highest.Hyflex CM and Twisted File Adaptive in continuous rotation, both reciprocating motion and adaptive motion show good forming ability, in which the root tube in the reciprocating motion mode is offset at least. Two different motion modes are exhausted to the instrument cycle. Two different kinds of nickel and titanium instruments were selected by Hyflex CM and Twisted File Adaptive to complete the preparation of 5 resin curved root tubes under three modes of unidirectional rotation, reciprocating motion and adaptive motion respectively. The surface fatigue of the instruments under different motion modes was analyzed and compared. In order to provide experimental basis for clinical work, 300 flexural resin root tubes were selected, the bending degree was 64 degrees, the bending radius 6mm, and the full length 17mm. of all resin simulated root canals were randomly divided into two types. 6 groups, each group of 50. 30 Hyflex CM, 30 Twisted File Adaptive, type 20, and each brand of taper 0.04. was randomly divided into three groups. The three sets of instruments were prepared in one direction rotation, reciprocating motion and adaptive motion for the preparation of the resin root canal. Each instrument was prepared with 5 resin root tubes. Then all of the devices were used. The instruments were amplified 200 times under scanning electron microscope (SEM). The surface wear analysis of five fields of vision was observed along the axis of the instrument. The electronic microphotographs of all the samples were digitized and stored. The grades were scored by three observers using the scoring standard in Table 1. In the resin root canal model, the cyclic fatigue fracture experiment was carried out. According to the previous grouping, the apparatus continued to move in the root canal in the corresponding motion mode. The whole apparatus in the whole movement kept the root tube completely inserted into the root canal for.15 seconds. After each period, the root canal and the instrument were washed with clean water and then carried out again. The period of the next cycle until the instrument breaks. Record the period of the fracture of the instrument. Using SPSS 17 software, the data were analyzed to compare the surface wear and fatigue fracture ability of the instruments under different motion. Results Hyflex CM and Twisted File Adaptive nickel titanium apparatus completed 5 resin root tubes under three modes of motion. After the preparation, the surface of the apparatus showed varying degrees of wear and wear. The wear degree of the two instruments of continuous rotation group was higher than that of the reciprocating model group and the adaptive model group, but there was no significant difference between the reciprocating model group and the adaptive model group before the two groups. The 15 second cycle cycle value of the fracture of the.Hyflex CM apparatus was not significantly different, and the continuous rotation group was 10.4. +3.33 times, the cycle number is shorter than the 19.7+6.00 times in the reciprocating mode and the 15.7+5.54 times of the adaptive motion. There is no statistical difference between the reciprocating mode and the adaptive mode, but there is a statistical difference between the reciprocating mode and the adaptive model, while the continuous rotation movement group and the first two groups have statistical difference between the.Twisted File Adaptive and the continuous rotation of the fracture period is 11.8+4.34 times, which is shorter than that of the previous one. The 18.5+5.08 times of the reciprocating mode and the 16.7+6.36 times of the adaptive motion. There is no statistical difference between the reciprocating mode and the adaptive mode, but there is a statistical difference between the continuous rotation mode and the first two groups. The breaking time of the device in the mode and adaptive mode is also longer than that of the continuous rotating instrument, and the apparatus in the reciprocating mode has the best performance in the anti cycle fracture.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

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