【作者】 吕海鹏；

【导师】 赵守亮；

【作者基本信息】 中国人民解放军第四军医大学 ， 口腔临床医学， 2003， 硕士

【摘要】 根管治疗术是通过根管预备、根管消毒和根管充填等步骤，消除来自根管的刺激源，利用尖周组织血运丰富、修复和再生力强的特点，治疗牙髓坏死或根尖周病的方法。其目的是：治愈牙髓坏死或尖周病，保存患牙，并恢复其功能。根管充填是将已经去除牙髓并经过预备的根管充填起来，以隔绝根管和根尖周组织的交通，防止再感染，它是根管治疗术中的一个重要步骤。其目的是：机械阻隔根管与尖周组织和口腔的交通，防止尖周组织的破坏或促进已破坏组织的愈合。 近年来，国内外对Vitapex根管充填糊剂和热熔牙胶的研究较多，但基础与临床相结合的研究报道较少。本实验采用临床实验与基础实验相结合的方法，评价了牙胶尖+氧化锌丁香油糊剂、Vitapex+牙胶尖、Thermafil热熔牙胶三种根管充填材料的性能和短期临床疗效。实验共分三个部分：一、Thermafil热熔牙胶、Vitapex+牙胶尖、氧化锌丁香油糊剂+牙胶尖的微渗漏实验研究 选取50个新鲜拔除的人单根管牙，在釉牙骨质界处切除牙冠。将所有牙根随机分为5组，每组10个。3个实验组分别用牙胶尖+氧化锌丁香油糊剂、Vitapex+牙胶尖和Thermafil热熔牙胶根管充填；剩余的两组中，一组根管预备后不进行充填，另一组不进行根管预备，也不进行根管充填。用印度墨水染色法对比三种根管充填材料对离体人牙根管的密封性能。结果如下：氧化锌丁香油糊剂+牙胶尖组、Vitapex+牙胶尖组和Thermafil热熔牙胶组的平均染色线长度分别为3.36±0.42mm、2.09±0.19mm、 第四军医大学硕士学位论文——l刀sed．37mm。统计学分析发现，用Vitapex糊剂＋牙胶尖或Thermafil热熔牙胶进行根管充填，产生的根管封闭性明显优于用氧化锌丁香油十牙胶尖进行根管充填爬功．05）；而Vtapex糊剂十牙胶尖和Thermafil热熔牙胶两组比较时，则无显著的统计学差异①川刀5）。二、去除拈污层对根管微渗漏影响的实验研究 选取60个新鲜拔除的人单根管牙，在釉牙骨质界处切除牙冠。将所有牙根随机分为3组，每组20个；分别用牙胶尖十氧化锌丁香油糊剂、Vitapex十牙胶尖和 Thermafil热熔牙胶根管充填；每组中有 10个牙根根管预备时保留沾污层，另外10个去除用污层。用印度墨水染色法对比研究去除沾污层对根管充填材料密封性能的影响。结果：牙胶尖十氧化锌丁香油糊剂组中，保留和去除珐污层组的染色线长度均值分别为：3．36t0．42mm。3．42t0．65mm：Vtapex十牙胶尖组中，染色线长度均值分别为：＊刀9i0．19mm、 1．70t0．22mm；Thermafil 热熔牙胶组中，染色线长度均值分别为：l刀5t0．37mm、0．56i0．llmm。三个实验组中，去除珐污层或保留沾污层对根管微渗漏影响的统计学差异均不显著（P＞0刀5）。提示去除沽污层对根管材料的密封性能无显著影响。三、Vitapex根管充填材料的短期临床疗效观察 通过临床对照研究，采用单盲法评价牙胶尖＋氧化锌丁香油糊剂、Vitapex糊剂＋牙胶尖两种根管充填材料的短期临床疗效。将需要进行根管治疗的患牙随机分成两组：氧化锌丁香油糊剂＋牙胶尖组、VitaPex糊剂十牙胶尖组。术后3、6、12个月复查，比较疗效。结果显示：术后3个月，氧化锌丁香油糊剂十牙胶尖组和VitaPex糊剂十牙胶尖组的有效率分别为80．3％和刃．1％，有显著统计学差异T二0刀20＜0刀引；术后6个月，氧化 、3． 第四军医大学硕士学位论文一锌丁香油糊剂十牙胶尖组和Vitapex糊剂十牙胶尖组的有效率分别为82％和95％，也有显著统计学差异T二0．022＜O．0引；术后12个月，氧化锌丁香油糊剂十牙胶尖组和Vtapex糊剂十牙胶尖组的有效率分别为sl．3％和89．4％，无显著统计学差异o二0．694为刀5人提示 VtcyCX是一种短期临床疗效较好的根管充填材料。更多还原

【Abstract】 Root canal therapy is a method of treating pulp necrosis and periapical diseases with the help of periapical tissues which are characterized by abundant blood flow and strong ability of repair and regeneration. It can eliminate the stimulation from root canal by following steps: preparation, disinfection and obturation of the root canal. Main purpose of the treatment is to cure the teeth with pulp necrosis or periapical diseases. The function of root canal filling, which is one of the major steps of root canal therapy, is to obturate the root canal that has been prepared and eliminate all portals of entry between the root canal and periodontium or oral cavity.Many studies at home and abroad have focused on Vitapex and heated gutta-percha in recent years, but only a few combined studies of basic and clinical investigation have been reported. Thus, the purpose of this study is to evaluate the performance and clinical short-term therapeutic effect of three root canal filling materials, including Vitapex + gutta-percha, zinc oxide-eugenol paste+ gutta-percha and Thermafil. The experiment was divided into three parts:1. In vitro study on microleakage of Vitapex + gutta-percha, zinc-5-oxide-eugenol paste* gutta-percha and ThermafilFreshly extracted fifty single-rooted human teeth were selected for this experiment and cut at the amelocemental junction using a diamond disk under water coolant. All roots were randomly divided into five groups of 10 roots each. The roots of three experimental groups were prepared and filled with zinc oxide-eugenol paste+ gutta-percha (Group A), Vitapex + gutta-percha (Group B) and Thermafil(Group C), respectively. 10 canals were prepared but not filled and remaining 10 canals were left untreated. Apical microleakage was evaluated with Indian Ink dye penetration. The results showed that mean depths of microleakage for group A, B and C were 3.36?.42mm, 2.09?.19mm and 1.05?.37mm respectively, there was significant difference between zinc oxide-eugenol paste+ gutta-percha group and Vitapex + gutta-percha or Thermafil group(P<0.05), and the sealing ability of Vitapex + gutta-percha and Thermafil was better than that of zinc oxide-eugenol paste+ gutta-percha. No significant difference between Vitapex + gutta-percha and Thermafil was found(P>0.05).2. Effect of removal of the smear layer on apical microleakage Freshly extracted sixty single-rooted human teeth were selected for this experiment and cut at the amelocemental junction using a diamond disk under water coolant. All roots were randomly divided into three groups of 20 roots each. The smear layers of 10 roots of each group were removed by 15% EDTA after the preparation. The roots of three groups were filled with zinc oxide-eugenol paste+ gutta-percha (Group A), Vitapex + gutta-percha (Group B)-6-and Thermafil(Group C), respectively. Apical microleakage was evaluated with Indian Ink dye penetration. The results showed that mean depths of microleakage in root canals with or without the smear layer in Group A, B and C were 3.36?.42mm, 3.42?.65mm, 2.09?.19mm, 1.70?.22mm 1.05?.37mm and 0.56?.11mm respectively. No significant difference was found between root canals with or without smear layer in all three groups (P>0.05) .It suggested that removal of the smear layer had no effect on the sealing ability of root canal materials.3. Clinical short-term therapeutic effect of Vitapex in root canal filling The purpose of this study was to compare the clinical short-term therapeutic effect of Vitapex with zinc oxide-eugenol paste+ gutta-percha in root canal filling. 161 teeth were randomly divided into two groups. The root canals of 82 teeth (Group A) were filled with zinc oxide-eugenol paste+ gutta percha, those of 79 teeth (Group B) were filled with Vitapex + gutta percha. The therapeutic effects were evaluated by follow-up of 3, 6 or 12 months. The results showed that efficiency rates of group A and group B were 80.3% , 93.1% (after 3 months), 82% , 95%( after 6 months), 81.3% , 89.4%( after 12 mont更多还原