MTA根尖屏障术根尖微渗漏研究及临床初步应用

发布时间：2018-07-04 06:44

本文选题：矿物三氧化物凝聚体 + 根尖微渗漏　；参考：《天津医科大学》2014年硕士论文

【摘要】：根管治疗术(root canal therapy,RCT)是治疗牙髓病和根尖周病最常用、最有效的手段。此过程中,根管充填是根管治疗进程中的关键环节,目标在于对根管进行严密的充填,阻拦来自牙齿冠方和根方的微渗漏,从而防止根管系统的再感染。根管微渗漏是衡量根管治疗质量的重要指标。年轻恒牙根尖孔尚未发育完成,由于外伤、畸形尖折断以及龋病等因素导致牙髓不可逆性的损伤时,热牙胶充填技术难以严密充填根管,甚至会超充。年轻恒牙外伤后不经治疗,即使成年后,根尖孔也可能会呈现开放状态,为完善的根管充填造成一定的困难。根尖屏障术(apical barriers)是指用非手术方式将生物相容材料充填到根管的根尖部,立刻在根尖部行成人工止点。国内外研究显示：MTA (mineral trioxide aggregate)根尖屏障术是治疗牙髓坏死、发育不完全患牙的有效方法。我们临床应用根尖内屏障技术也取得了成功。本研究通过体外实验,应用葡萄糖氧化酶法,检测MTA根尖屏障技术的根尖微渗漏情况,同时结合临床研究,全面评估MTA根尖屏障术在根管治疗中的临床效果。目的： 1.在体外条件下,观察比较MTA封闭根尖的热牙胶充填方式与临床常用的连续波热牙胶充填方式的根尖封闭性能,为临床选取合适的根管充填方法提供一定的实验依据。 2.临床比较MTA根尖屏障术和传统的根尖诱导成形术应用于年轻恒牙慢性根尖周炎的临床疗效。方法： 1.体外研究30颗离体牙,随机分成实验组、对照组和空白对照组三组(每组10颗离体牙)。将所有样本截冠,断端到根尖的长度为15.0mm,用ProTaper镍钛系统按根向方式进行根管预备,所有根管均预备到同一标准-F3,用1#G钻扩通根尖孔,创建人工开放根尖孔(d=0.5mm) 实验分组：实验组：采用MTA根尖屏障术后热牙胶根管充填；对照组：采用连续波热牙胶根管充填；空白对照组：仅用牙胶尖充填根管,不使用任何根管封闭剂。待根管充填材料干燥后,除根尖孔上2mm以外均涂两层透明指甲油；建立葡萄糖微渗漏模型,分别于1、4、7、14、21、28天用葡萄糖定量法检测从牙冠向牙根方向渗漏的葡萄糖量,评估根尖微渗漏情况。 2.临床研究选取接近或超过根尖孔发育形成年龄的未闭合的、且已发展成为慢性根尖周炎的年轻恒牙(年龄上限不超过16岁)44颗。实验组：在根管显微镜下用MTA严密封闭根尖开放部位,硬固后行热牙胶根管充填；对照组：用Vitapex糊剂行根尖诱导成形术,在根尖部有硬组织形成后行根管充填。两组术后均定期复查,时间期限为18个月,评估临床疗效及X线片结果。结果： 1.体外研究空白对照组第1天均溢满微渗漏模型中的玻璃瓶,退出实验。实验组和对照组相比,实验组在各个时间点的葡萄糖渗出量均低于对照组,差别均有统计学意义(p0.01)。 2.临床研究经过18个月的观察,实验组中无1例出现临床不适症状,X线片显示,仅1例根尖病变无明显好转,总有效率为95.45%;对照组中1例发生牙齿的根折,4例在18个月的期限内未完全形成根尖屏障,总有效率为77.27%。实验组治疗次数少于对照组,差异有统计学意义(p0.01)。结论： 1.体外研究MTA根尖屏障术后热牙胶根管充填的微渗漏要低于连续波热牙胶根管充填。 2.临床研究MTA是一种较好的根尖封闭材料,它大大减少了复诊治疗的次数及治疗周期,提高了治疗成功率。
[Abstract]:Root canal therapy ( RCT ) is the most common and effective method for root canal therapy . In this process , root canal filling is a key link in root canal therapy .

Through in vitro experiments , the root tip microleakage of MTA root tip barrier technique was tested by glucose oxidase method . Combined with clinical study , the clinical effect of MTA root tip barrier technique in root canal therapy was comprehensively evaluated .

Purpose :

1 . Under the condition of in vitro , it was observed that the root tip sealing performance of MTA closed root tip was compared with that of the conventional continuous wave hot tooth filling method , which provided some experimental basis for selecting proper filling method for root canal .

2 . Clinical comparison of MTA root - tip barrier and traditional apical - induced angioplasty in the treatment of chronic periapical periodontitis in young permanent teeth .

Method :

1 . In vitro , 30 isolated teeth were randomly divided into experimental group , control group and blank control group ( 10 from each group ) . All the samples were cut , the length of root tip was 15.0mm , root canal preparation was carried out in the root canal by ProTaper nickel - titanium system , all the root canals were prepared to the same standard - F3 , and the root tip hole was expanded with 1 # G drill , and the artificial open root tip hole was created ( d = 0.5mm ) .

Experimental group : The experimental group : The root canal of MTA was filled with the root canal of MTA .
Control group : continuous wave hot tooth root canal filling was adopted ;
The blank control group : The root canal was filled with only the tip of the gum , and no root canal sealer was used .

after the root canal filling material is dried , two layers of transparent nail polish are coated except 2mm of the root tip hole ;
The glucose micro - leakage model was established , and the amount of glucose leaking from the crown to the root canal was measured with a glucose quantitative method at 1 , 4 , 7 , 14 , 21 and 28 days , respectively .

2 . The clinical study selected a young permanent tooth ( not more than 16 years old ) near or beyond the age of apical foramen development , and has developed into a young permanent tooth with chronic periapical periodontitis ( upper age limit of no more than 16 years ) .

The experimental group : The open parts of root tip were closed tightly with MTA under the root canal microscope , and the root canal was filled with hot tooth root canal .

The control group : The root tip was induced with Vitapex paste , and the root canal was filled with hard tissue at the root tip .

The two groups were periodically re - examined after operation , the time duration was 18 months , and the clinical efficacy and X - ray film results were evaluated .

Results :

1 . Compared with the control group , the amount of glucose in the experimental group was lower than that of the control group in the experimental group and the control group ( p < 0.01 ) .

2 . After 18 months of clinical study , none of the experimental groups had symptoms of clinical discomfort , X - ray films showed that only 1 case had no obvious improvement in root tip lesion , total effective rate was 95.45 % ; the total effective rate was 77.27 % in the control group , and the total effective rate was 77.27 % .

Conclusion :

1 . In vitro , the microleakage of the root canal filling of MTA was lower than that of continuous wave hot tooth root canal .

2 . The clinical research MTA is a kind of better root - tip sealing material , which greatly reduces the number of times of treatment and the treatment period , and improves the success rate of treatment .
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R781.05

【引证文献】