【作者】 柳茜；

【导师】 周学东；

【作者基本信息】 四川大学 ， 口腔临床医学， 2002， 硕士

【摘要】 根管预备是根管治疗成败的关键步骤，根管预备的好坏直接影响根管治疗的效果。根管预备包括根管清理和根管成形。目前多采用机械预备并配合使用各种冲洗液的方法，以达到根管清理成形和去除玷污层的目的。本文通过体外实验比较不同扩锉器械和含表面活性剂的冲洗液与常用冲洗液根管预备的效果。 研究分两部分：第一部分：将60颗离体牙随机分为6组，分别为空白对照组、扩大针组、扩与K型锉组、扩与H型锉组、K型锉组和超声扩锉组，采用逐步后退法预备根管。扫描电镜观察根管内壁，比较碎屑面积大小。第二部分在2％SDS、1％tween-80,3.4％AEO三种表面活性剂中筛选出3.4％AEO溶液后，采取分层随机的方法，将不同牙龄的样本随机分为6组，分别为蒸馏水组、3.4％AEO溶液组、10％EDTA组；10％EDTA与1％氯亚明交替冲洗组、1％氯亚明与3％双氧水交替冲洗组、10％EDTA与3.4％AEO的混合组。采用逐步后退法预备根管。扫描电镜观察根管内壁，比较碎屑面积大小。实验同时比较了感染根管及非感染根管经相同处理后的碎屑面积， 结果表明：1、形态学观察：根管壁碎屑面积比较：K型锉组＞扩大针组＞扩与K型锉组＞空白对照＞扩与H型锉组＞超声扩锉组，且前三组与各组之间具有显著性差异(P＜0.05)，而后三者之间无显著性差异(P＞0.05)。2、AEO组根管内壁牙本质小管开口情况明显优于SDS及Tween－80组，AEO组碎屑分布面积也明显少于SDS及Tween-80组。3、蒸馏水组的根管内壁 碎屑面积最大，牙本质小管开放程度最低，EDTA与AEO混合组次之， 氯亚明双氧水交替冲洗组有部分碎屑产生，牙本质小管大部分开放。此三 组与其它各组比较均有显著性差异叩m．05人AEO组、EDTA组、氯亚 明与EDTA交替冲洗组根管预备效果均较好，牙本质小管口清楚，碎屑 面积少。三组间无显著性差异（P＞0．05）。4、感染根管与非感染根管经相 同处理后的碎屑面积无显著性差异（P＞0．05）。 结论：二、超声扩挫与扩与H型挫效果最好；扩与K型挫交替使用次 之；单纯扩或挫不能有效进行根管清理。建议临床采用扩与N型挫交替预 备根管。2、使用AEO进行根管清理的效果优于SDS和TWeen．80。3、单 独使用AEO根管冲洗液根管预备效果较好，由于AEO对人体无毒，作为 根管冲洗液具有一定前景。4、在扫描电镜观察根管冲洗液的效果的研究 时，选择基线一致的离体牙，既可以选择感染根管、也可以选择非感染根 管。珐污层的形成情况与预备器械、预备方法和冲洗液密切相关。更多还原

【Abstract】 Background: root canal preparation is crucial step of root canal therapy, including cleaning and shaping of root canal by mechanical instrumentation and irrigation.Objective: to investigate the effects of root canal preparation by different instrumentation and irrigation containing surface active agent(SAA).Methods: Part I : The fresh extracted 60 single-rooted teeth were collected,then random distributed in 6 groups of 10 each. Group 1, the negative control; group 2, reaming instrumentation with reamers only; group 3, reaming and filing instrumentation with reamers and K files; group 4, reaming and filing instrumentation with reamers and H files; group 5, filing instrumentation with K files only; group 6, the ultrasonic instrumentation. The effects of canal preparation were evaluated by Scanning electron microscopic photomicrographs.Part II :Screen the best SAA irrigation from the 3.4%AEO, 2%SDS, l%tween-80. The fresh extracted 60 teeth were random stratified distributed in 6 groups of 10 each. Group 1, the negative control; group 2, screening SAA irrigation; group 3, 10%EDTA; group 4, 10% EDTA+ screening SAA irrigation; groupS, 10% EDTA and 1% NaCLO in turn. Group 6, 1% NaCLO and 3%H2O2 in turn. The effects of canal preparation were evaluated by Scanning electron microscopic photomicrographs.At the same time, the effects of infected and uninfected root canal which have the same baseline were compared.Results: Part I : the debris area of the root canal wall of group 5 was the largest, followed by group 2, group 3, group 1, group 4 and group 6. There was significant difference between the group5/group2/group3 and the other groups(P<0.05). However, there was no significant difference among the last three groups(l,4&6) (P <0.05).Part II: the dentin tuble opening degree of 3.4%AEO is superior to 2%SDS and l%tween-80,and the debris area of AEO group is smaller than the other. The second experiment show that the area of bebris of H2O group is the largest,followed by the mixture of EDTA and AEO, NaCLO and H2O2 inturn, .there was significant difference between any of the above three group and the others. AEO, EDTA; EDTA and NaCLO in turn show good effect. There was no significant difference among the three groups. There was no significant difference between the infected root canal and the uninfected root canal.Conclusion: Part I : the effect of the ultrasonic treatment and the reamer and H file treatment were the best. K file or reamer file can not effectively remove the debris. The result is useful for the canal preparation in endodontic therapy.PartII:the effect of root canal cleaning by 3.4%AEO is superior to 2%SDS and l%tween-80. 3.4%AEO alone is harmless to human and maybe the promising root canal irrigation. When study the effect of the root canal irrigation by SEM, there is no difference between the infected root canal and the uninfected root canal. The smear layer is dramatic relative to mstruments,irrigations, and preparing methods.更多还原