Protaper Universal镍钛再治疗器械去除根管内牙胶尖的临床疗效观察

发布时间：2018-05-12 01:30

本文选题：Protaper + Universal　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:本文采用病例报告的形式将机用Protaper Universal镍钛再治疗器械与手用不锈钢K锉去除根管内牙胶尖的疗效进行对比,比较根管再通率、再治疗的时间、再治疗后的疼痛发生率及再治疗后根充质量,为Protaper Universal镍钛再治疗器械的使用提供一定的临床依据。方法:依照就诊次序将纳入研究的40例需要进行再治疗的患者(共40个需再治疗的根管),随机分为实验组和对照组,每组各20例。所有患者身体健康,能配合治疗,患者的年龄不小于18周岁,X-ray示根尖孔完全闭合,既往牙胶尖根充不完善,需要进行再治疗。术前记录患者主观症状及临床检查情况,并拍摄X线片,了解患牙原治疗情况及根管情况。高速手机去除原充填物,明确根管口的位置。实验组:使用Protaper Universal镍钛再治疗器械以冠向下技术去除根管内牙胶尖,对照组:使用手用不锈钢K锉去除根管内牙胶尖。每次更换器械,用2ml 2%洗必泰溶液与2ml 17%EDTA溶液交替冲洗根管,当达到以下条件时认为完全去除充填物:(1)器械能到达工作长度或不能再疏通;(2)器械的刃部及冲洗液均无肉眼可见的充填材料。疏通完成一个根管后,清洗器械并观察其是否出现螺纹改变或折断,如未出现则继续使用;如出现则停止使用,每根器械的使用次数不超过10个根管。并记录每个根管再治疗的操作时间:从初始锉进入根管口至终末锉离开根管口(包括更换器械及冲洗根管的时间)。棉卷隔湿,纸尖干燥管腔,氯己定氢氧化钙糊剂+氧化锌封药。嘱患者如出现疼痛或肿胀情况应及时就诊。一周后复诊,记录患牙再治疗后疼痛发生情况,在患牙无叩痛、无明显渗出的情况下,去除原暂封,2%洗必泰溶液与0.9%生理盐水溶液交替冲洗,棉卷隔湿,纸尖干燥管腔,插入主尖拍摄试尖片,确定主尖到达工作长度后,氧化锌碘仿糊剂配合冷牙胶侧方加压充填根管,并拍摄完成片。结果:在根管再通率方面,实验组与对照组相比,差异没有统计学意义(P0.05);在操作时间方面,实验组完成根管再治疗的时间明显短于对照组,差异具有统计学意义(P0.05);在疼痛发生率方面,实验组明显低于对照组,差异有统计学意义(P0.05);在根充质量方面,术后X线片显示,实验组恰充率90%,为对照组恰充率为70%,差异具有统计学意义(P0.05)。结论:机用Protaper Universal镍钛再治疗器械能较快速的去除根管内原牙胶充填材料,再治疗期间的疼痛发生率较低,根充质量较好。
[Abstract]:Objective: to compare the curative effect of Protaper Universal nickel titanium retreatment instrument and stainless steel K file in removal of endodontic tip in root canal by case report, and to compare the rate of root canal reopening and the time of retreatment. The incidence of pain after retreatment and the root filling quality after retreatment provide a certain clinical basis for the use of Protaper Universal nickel titanium retreatment apparatus. Methods: according to the order of visit, 40 patients who needed retreatment were randomly divided into experimental group and control group with 20 cases in each group. All the patients were healthy and able to cooperate with the treatment. The patients' age was not less than 18 years old. X-ray showed that the apical foramen was completely closed, and the gum apical root filling was not perfect in the past, and needed to be retreated. The subjective symptoms and clinical examination were recorded before operation, and X-ray films were taken to understand the treatment of the affected teeth and the root canal. The high speed mobile phone removes the original filling and determines the location of the root canal orifice. The experimental group was treated with Protaper Universal nickel titanium retreatment device and the control group was treated with stainless steel K file. The root canal was washed alternately with 2ml 2% chlorhexidine solution and 2ml 17 TA solution. When the following conditions are met, it is considered that the complete removal of the filling material: 1) the device can reach the working length or can no longer be dredged) the edge of the device and the flushing fluid are not visible to the naked eye. After a root canal is cleared, clean the instrument and observe if the thread changes or breaks, and if not, continue to use it; if so, stop using the device, and no more than 10 root canals per instrument. The operating time of each root canal retherapy was recorded: from the initial file entering the root canal orifice to the end file leaving the root canal orifice (including the time of replacing the instrument and washing the root canal). Cotton roll wet, paper tip dry cavity, chlorhexidine calcium hydroxide paste zinc oxide sealing agent. Patients are advised to see a doctor in time for pain or swelling. One week later, the incidence of pain after retreatment was recorded. In the case of no percussion pain and no obvious exudation, the original temporary seal of 2% chlorhexidine solution and 0.9% saline solution were removed, cotton entrainment was wet, and the paper tip was dry. The root canal was filled with zinc oxide iodoform paste and cold gum side pressure after the test tip was inserted into the main tip to determine the working length of the main tip and the film was taken. Results: there was no significant difference in root canal recanalization rate between the experimental group and the control group (P 0.05), and in the operation time, the time of root canal retreatment in the experimental group was significantly shorter than that in the control group. The difference was statistically significant (P 0.05), the incidence of pain in the experimental group was significantly lower than that in the control group (P 0.05), and the root-filling quality was significantly lower in the experimental group than in the control group. The accuracy rate of the experimental group was 90 and that of the control group was 70. The difference was statistically significant (P 0.05). Conclusion: the mechanical Protaper Universal nickel titanium retreatment instrument can remove the root canal filling material quickly. The pain rate is lower and the root filling quality is better during the retreatment.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R781.05

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