一次性根管治疗约诊间疼痛的临床观察

发布时间：2018-05-23 17:11

  本文选题：一次性根管治疗 + 约诊间疼痛　； 参考：《山东大学》2014年硕士论文

【摘要】：目的： 根管治疗(root canal therapy)是牙髓病和根尖周病常用的有效治疗方法。经过两百多年的发展,特别是经过自二十世纪八十年代以来的突飞猛进的现代化根管治疗阶段,目前,根管治疗技术已成为一种国际公认的、适应证广泛、操作规范、要求明确和疗效恒定的一种治疗方法,其临床成功率可达95%以上。一次性根管治疗(single-visit root canal therapy)最早报道于1901年,是将根管预备、根管冲洗消毒、根管充填在一次治疗中完成,由于早期技术原因,术后疼痛发生率较高,限制了其在临床的应用。 在根管治疗的过程中,包括根管治疗期间或治疗后12h至数天内经常出现患牙疼痛、肿胀等急性炎症反应现象,称为根管治疗期间痛(endodontic interappointment pain EIP)或根管治疗期间急发症(endodontic interappointment emergencies EIE),发生率可达3%-58%。根管治疗急发症的发生是可以预防和减少的,在操作过程中,严格执行无菌操作,从根管预备的一开始就测定好根管的工作长度,防止根管预备器械和根管充填材料超出根尖孔,避免细菌及牙本质碎屑等感染物质进入根尖周组织,加上大锥度机用镍钛器械、超声荡洗等的应用,进入根尖周组织的感染物质进一步减少。 传统的根管治疗确保了在充填前有比较完善的根管消毒,目前依然是很多临床医生的常用治疗方法。但是需要患者多次就诊,增加了患者的时间和精力负担。一次性根管治疗,即将根管预备、根管冲洗消毒、根管充填在一次治疗中完成,其优点是减少了患者就诊次数及就诊压力,容易被患者接受,而且临床疗效较好。 随着口腔器械的不断发展,如今的一次性根管治疗已经具有较好的疗效。许多医生担心一次性根充后疼痛发生率高而不采用。本研究通过对患者进行随机的一次性根管治疗或分次根管治疗,比较两种根管治疗方法约诊间疼痛的发生情况,来探讨一次性根管治疗的可行性,为临床医生选择一次性根管治疗提供参考。 材料和方法： 选择临床诊断为牙髓炎和慢性根尖周炎的患牙172颗(172例)作为研究对象,按治疗方法随机分为A、B、C、D四组,A、C组为实验组,B、D组为对照组。A组：46例,采用机用ProTaper镍钛锉冠根向预备根管,根管冲洗消毒后,Vitapex为糊剂直接行根管充填。B组：45例,采用机用ProTaper镍钛锉冠根向预备根管,诊间封药7天,第二次复诊Vitapex为糊剂行根管充填。C组：41例,采用机用ProTaper镍钛锉冠根向预备根管,根管冲洗消毒后,直接以美松糊剂行根管充填。D组：40例,采用机用ProTaper镍钛锉冠根向预备根管,诊间封药7天,第二次复诊以美松糊剂行根管充填。四组均采用冷牙胶侧压充填法行根管充填。每例病例诊后第2天(48h)和第7天随访复诊,观察根管治疗术急症发生情况。 结果： 1.各组根充后EIE发生情况：A组：病例46例,术后第二天有5例发生根管治疗术后急症,术后急症发生率10.7%。术后第七天有2例发生根管治疗术后急症,术后急症发生率4.3%。B组：病例45例,术后第二天有2例发生根管治疗术后急症,术后急症的发生率4.4%。术后第七天有1例发生根管治疗术后急症,术后急症发生率2.2%。C组：病例41例,术后第二天有3例发生根管治疗术后急症,术后急症的发生率为7.3%。术后第七天有1例发生根管治疗术后急症,术后急症发生率2.4%。D组：病例40例,术后第二天有2例发生术后急症,术后急症发生率2.5%。术后第七天有1例发生根管治疗术后急症,术后急症发生率2.5%。经方差检验,实验组(A组)术后急症发生率与对照组(B组)无明显差异(P0.05)。实验组(C组)术后急症发生率与对照组(D组)无明显差异(P0.05)。实验组(A组)术后急症发生率与实验组(C组)无明显差异(P0.05)。 2.各组根充后疼痛发生情况：经秩和检验,实验组(A组)和对照组(B组)、实验组(C组)和对照组(D组)在术后第二天的各级疼痛发生率有统计学意义(P0.05)。实验组(A组)和对照组(B组)、实验组(C组)和对照组(D组)在术后第7天的疼痛发生无统计学意义(P0.05)。 结论与建议： 1.结论 结论1.本次试验中A组结果和B组结果经统计学分析,两组差异无统计学意义(P0.05),这表明Vitapex为糊剂的一次性根管治疗不会比分次性根管治疗有更高的术后急症发生率。 结论2.本次试验中C组结果和D组结果经统计学分析,两组差异无统计学意义(P0.05),这表明使用美松糊剂的一次性根管治疗不会比分次性根管治疗有更高的术后急症发生率。 结论3.本次试验中A组结果和C组结果经统计学分析,两组差异无统计学意义(P0.05),这表明一次性根管治疗选择Vitapex或者美松糊剂不会对术后急发症的发生造成明显影响。 结论4.本次试验中经秩和检验,A组和B组、C组和D组在术后第二天的各级疼痛发生率有统计学意义(P0.05),这表明一次根充比分次根充发生术后疼痛的概率高。 2.建议：一次根充比分次根充术后疼痛的发生率高,但对于术后急发症而言,二者没有差异,临床上只要是严格按照各步骤的操作规程来操作,次根管治疗适用于临床大多数病例,不必因为担心其术后急发症问题而不予采用。
[Abstract]:Objective:
Root canal therapy (root canal therapy) is an effective treatment for dental pulp disease and periapical periodontitis. After more than 200 years of development, especially through the rapid development of modern root canal therapy since 1980s, root canal therapy has become an internationally recognized, widely used, operating standard, The clinical success rate is more than 95%. The one-time root canal therapy (single-visit root canal therapy) is first reported in 1901. It is the root canal preparation, root canal washing and disinfection, root canal filling in one treatment. In clinical application.
During root canal therapy, acute inflammatory reactions such as tooth pain and swelling often occur during or after 12h to days of root canal therapy, known as endodontic interappointment pain EIP or endodontic interappointment emergencies EIE during root canal therapy (endodontic interappointment emergencies EIE), and the incidence can reach 3%-58. The root canal treatment of acute onset can be prevented and reduced. In the process of operation, the aseptic operation is strictly carried out, the length of the root canal is measured from the beginning of the root canal preparation, and the root canal preparation and root canal filling materials are prevented from exceeding the apex hole, and the infected substances such as bacteria and dentine detritus will be prevented from entering the periapical tissue. The infection of substances entering the periapical tissue was further reduced by the use of nickel titanium instruments, ultrasonic scaling and so on.
Traditional root canal therapy ensures a better root canal disinfection before filling, and is still a common treatment for many clinicians. However, it is still a common treatment for many clinicians. However, patients need multiple visits to increase the patient's time and energy burden. One time root canal treatment is done, the root canal preparation, root canal washing and disinfection, root canal filling are completed in a single treatment. The advantage is that it reduces the number of patients and the pressure of visiting patients, and is easy to be accepted by patients.
With the continuous development of dental instruments, disposable root canal therapy has been a good therapeutic effect. Many doctors worry that the incidence of one-time root post filling pain is high and not. This study compares two root canal therapy with random root canal therapy or sub root canal therapy. To explore the feasibility of disposable root canal therapy, and provide a reference for clinicians to select disposable root canal therapy.
Materials and methods:
172 teeth (172 cases), which were diagnosed as pulpitis and chronic periapical periodontitis, were selected as the research object, and were randomly divided into groups of A, B, C, D, group A and C, group A and C as experimental group, B and D group as control group.A group: 46 cases, using ProTaper NiTi file crown root to prepare root canal, root canal washing and disinfection, Vitapex for paste filling.B directly to root canal.B Group: 45 cases, using ProTaper Ni Ti file crown root to prepare root canal for 7 days, second times of Vitapex as paste to fill root canal.C group: 41 cases, using ProTaper nickel titanium file crown root to prepare root canal, root canal washing and sterilizing directly with root canal filling.D group: 40 cases, use ProTaper nickel titanium file crown root root file The root canal was used for the preparation of the root canal for 7 days, and the root canal was filled with the second times. The four groups were filled with the root canal filling with cold tooth glue. Each case was followed up for second days (48h) and seventh days, and the occurrence of emergency treatment of root canal therapy was observed.
Result锛，

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