根管治疗后冠部封闭材料微渗漏的比较研究

发布时间：2018-06-07 15:17

本文选题：微渗漏 + 根管治疗　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：根管治疗是目前牙髓病与根尖周病最有效并且最根本的治疗方法，评价根管治疗成功与否的关键因素是根管系统的三维充填是否严密，而根管充填后存在的微渗漏是导致根管治疗失败的重要原因。根管微渗漏包括冠渗漏和根尖渗漏，均可引起治疗的失败。长期以来，根尖渗漏一直是国内外研究的重点，而近年来，冠渗漏亦逐渐引起广大学者的注意，认为其是根管治疗失败的潜在原因。国内外对一些根管治疗过程中应用的暂封材料的封闭性能有一定的研究，而对于根管治疗后临床常用的冠部填充材料的封闭性能研究相对较少。目前临床上根管治疗后根据牙体的剩余组织量以及患者意愿，冠部封闭方式可大致分为两种：永久充填及暂封材料暂时充填后行冠部修复治疗。临床常用的永久充填材料为树脂类，暂封材料包括玻璃离子水门汀类及氧化锌丁香油酚类等，这些材料的封闭性能可能影响根管治疗的效果及成功率，根管治疗后的冠部渗漏亦可能为根管治疗后根管再感染的原因，因此本实验通过对这些材料的封闭性能进行检测，为根管治疗后冠部封闭材料的选择提供参考。方法：选取100颗牙体基本完整，无充填物，无隐裂的离体前磨牙，备标准Ⅰ类或Ⅱ类洞，统一方法根管预备，热牙胶连续波根充，X线检测以保证根充密合，在牙颈部切断牙胶尖，随机分成A、B、C、D、E五组，分别为空白组；氧化锌丁香油粘固粉充填，厚度2mm；氧化锌丁香油粘固粉充填，厚度3.5mm；玻璃离子水门汀充填；磷酸锌垫底后树脂充填；根尖孔及牙合面所备洞缘2mm外全部涂布指甲油2层；将所有样本浸入装满2%亚甲蓝溶液的完全封闭容器内，再将其置于37℃恒温箱内。于第1、2、3、4周后分别取出每组各5颗样本牙齿，去除指甲油后冲洗并干燥，沿窝洞中心顺牙长轴近远中向纵向剖开。在体视显微镜(16倍)下观察，并用游标卡尺（0．05mm）测量亚甲蓝沿材料与洞壁界面渗入的最大长度，以此作为染料渗漏长度，进行记录并用统计学软件进行分析。结果：A、B、C、D、E五组分别在第1、2、3、4周后的染料渗透长度及其平均值(单位mm)（表1-4），及各组在不同时间段染料渗漏达根管内的牙数（表5）。五组均自第1周起即均可检测到染料渗漏，其中在第1周时A组和B组的染料渗漏长度即达根管内，而C、D、E组渗漏长度未达根管内；第2周时C组染料渗漏长度达根管内，第4周时D、E组各有部分样本染料渗漏长度达根管内，，4周内随时间延长，各组染料渗漏长度均增加，但均未达根尖。结论：1、根管治疗后冠部封闭物的微渗漏影响根管治疗的远期效果；2、暂时性充填材料中玻璃离子的冠部封闭效果相对更好；3、3.5mm厚度氧化锌丁香油粘固粉冠部封闭可保证1周内无冠渗漏达到根管内；4、永久性充填材料可能比暂时性封闭材料具有更好的封闭性；5、根管治疗后牙齿的冠部封闭物脱落4周可不引起根尖感染；6、随时间延长，各类冠部封闭物的冠渗漏均增加。
[Abstract]:Objective: root canal therapy is the most effective and fundamental treatment for dental pulp disease and periapical disease. The key factor for evaluating the success of root canal therapy is the tight three-dimensional filling of root canal system, and microleakage after root canal filling is the major cause of root canal treatment failure. Root canal leakage includes crown leakage and root canal leakage. The apical leakage can cause the failure of the treatment. The root apex leakage has been the focus of research at home and abroad for a long time. In recent years, the crown leakage has also gradually aroused the attention of the vast number of scholars. It is considered as a potential cause of the failure of root canal therapy. There are relatively few studies on the sealing properties of crown filling materials commonly used after root canal therapy.
At present, after the clinical root canal therapy, according to the residual volume of the tooth body and the wishes of the patients, the crown closure method can be roughly divided into two kinds: permanent filling and temporary filling after temporary filling and crown repair. The commonly used permanent filling materials are resin, temporary sealing materials including glass ionomer cements and Zinc Oxide syringol. The sealing performance of these materials may affect the effect and success rate of root canal therapy. The coronal leakage after root canal therapy may also be the cause of reinfection of root canal after root canal treatment. Therefore, this experiment provides a reference for the selection of the sealing material after root canal treatment by testing the sealing performance of these materials.
Methods: 100 teeth were divided into two groups: 100 teeth, which were basically complete, without fillings and no hidden cracks. The standard type I or class II cavities were prepared, the root canal preparation, the hot tooth glue continuous root filling, X-ray examination to ensure the root filling and cutting the gum tip on the tooth neck, were randomly divided into A, B, C, D, E, the blank group, and the Zinc Oxide lilac oil paste filling powder. Filling, thickness 2mm; Zinc Oxide clove oil paste filling, thickness 3.5mm; glass ionomer cement filling; zinc phosphate bottom resin filling; all 2 layers of nail oil coated outside the hole edge 2mm of the root tip hole and coodont surface; immerse all samples in a completely sealed container full of 2% submethylene blue solution and put it in a 37 C thermostat box. After week 1,2,3,4, each group of 5 samples of the teeth were removed, and the nail oil was removed and dried, and the teeth were opened along the long axis of the CIS of the cave center. Under the stereoscopic microscope (16 times), the maximum length of methylene blue along the interface between the material and the wall was measured with the vernier caliper (0.05mm) as the leakage length of the dye. The records were recorded and analyzed with statistical software.
Results: A, B, C, D, E five groups after week 1,2,3,4 dye penetration length and the average value (unit mm) (table 1-4), and the number of teeth in each group of dyes leaking in the root canal at different time periods (Table 5). Five groups from first weeks can detect the dye leakage, of which first weeks, A and B group of dyestuff leakage length is in the canal, C, D, E. The leakage length of the group was not in the root canal; at second weeks, the dyestuff leakage in group C was within the canal of the root canal. At fourth weeks, the leakage length of some samples in the group E was within the root canal, and the length of the dyestuffs was prolonged in 4 weeks. All the dyestuffs in each group increased in length, but all of the dyestuffs were not at the end of the root.
Conclusions: 1, the microleakage of the coronal seal after root canal treatment affects the long-term effect of root canal therapy; 2, the effect of the crown closure of the glass ions in the temporary filling material is relatively better; the closure of the crown part of the 3,3.5mm thickness of Zinc Oxide clove oil visco powder can guarantee the non coronal leakage within 1 weeks to reach the root canal; 4, permanent filling material may be more than temporary. 5, the closure of the crown of the teeth after root canal treatment could not cause apical infection for 4 weeks after root canal treatment. 6, the crown leakage of all kinds of crowns increased with time.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R781.05

【参考文献】