【作者】 张丽萍；

【导师】 吴补领；

【作者基本信息】 第四军医大学 ， 口腔临床医学， 2004， 硕士

【摘要】 根管治疗术是临床上治疗各型牙髓病和根尖周病的基本方法。根管治疗术的成功与否很大程度上取决于根管预备的质量及根管充填的密合度。根管治疗术通过根管预备、根管消毒和根管充填等步骤，消除根管内的病源刺激，利用尖周组织血运丰富，修复和再生力强的特点，治愈牙髓坏死或根尖周病。根管预备和充填是根管治疗术的重要步骤，预备的主要目的在于清理根管、根管成形，以利于根管充填；根管充填是将已经去除牙髓并经过预备的根管充填起来，隔绝根管和根尖周组织的交通，防止再感染，促进根尖周病变的愈合。 近年来，国内外对Profile技术预备根管及高温热塑牙胶充填根管的研究较多，但将不同预备方法及充填材料相结合的效果比较研究较少。本研究拟采用体视显微镜、扫描电镜技术及临床病例，观察不同根管预备方法对高温热塑牙胶充填根管效果的影响及中短期临床疗效。实验共分三个部分： 一、高温热塑牙胶充填根管的微渗漏研究 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。均采用Profile技术预备根管。A组用高温热塑牙胶充填；B组用氧化锌丁香油糊剂+牙胶尖充填；C组根管预备后不充填。用印度墨水染色法对比两种根管充填材料对离体人牙根管的密封性能。结果显示：高温热塑牙胶组的染色线长度为1.370mm，氧化锌丁香油糊第四军医大学硕士学位论文剂+牙胶尖组染色线长度为4.155~，两组之间差异显著伊切.001)，两组与空白对照组之间差异亦显著(P<0.001)。该结果说明，高温热塑牙胶充填法充填根管时，其微渗漏明显小于临床上最常应用的氧化锌丁香油糊剂+牙胶尖充填根管;牙胶与根管壁间、根尖孔扫描电镜结果显示A组微渗漏1一3um，B组3礴um，亦证明高温热塑牙胶根管密封性优于氧化锌丁香油糊剂+牙胶尖充填组。 二、不同方法预备根管商温热塑牙胶充填的微渗漏研究 40个因正畸拔除的下领前磨牙，室温下保存于含有0.2%叠氮钠的生理盐水中。随机分为4组，每组ro个:A组采用常规法预备根管:选用K型根管锉，自巧.器械开始，逐号进行，均预备至根尖止点，主尖锉扩大至40.。B组采用逐步深人法预备根管:根据ROfile根管预备系统的操作要求，以逐步深人法预备根管至06125。c组采用超声法预备根管:分别使用15.、25#、4护超声扩大锉扩大成形根管。D组采用 ROfile结合超声技术预备根管。各组预备过程中，交替使用3%双氧水、生理盐水冲洗根管。预备完毕后，按照实验一所述方法，用Obturan系统进行根管充填。对所有牙齿进行体视显微镜观察根管的微渗漏并采集数据，所得实验结果用5 PSS统计软件进行方差分析。结果显示:不同根管预备组微渗漏染色不同，A组染色线长度为6.941~，B组为4.700幻nrn，C组为5.494mln，D组为1.534m们n，说明常规法预备根管高温热塑牙胶充填组微渗漏最大，ROfile+超声预备热塑牙胶充填组微渗漏最小，密封性能最好，对高温热塑牙胶充填适充性好。 三、高温热塑牙胶充填根管的临床研究 观察高温热塑牙胶充填根管的中短期疗效。选择160个患牙随机分为两组，以ROfile机用根管器械采用逐步深人法进行根管预备。开髓、切冠髓、拔除根髓、初步预测根管长度，预备根管至06/25。根管预备过程中，以5 .25%次氯酸钠液反复冲洗根管，两组根管预备完毕后用纸捻吸干并封人FC棉球一周。A组按照obturan使用说明充填热塑牙胶，B组常规充填氧化锌丁香油糊剂+牙胶尖。通过摄X线片了解根管充填情况并进行调整，保证根管恰填。治疗完成后于l周、3个月、6个月进行复查。统计学比较两组第四军医大学硕士学位论文差异。结果:A组术后1周、3个月、6个月的治疗成功率分别为95 .1%、96.3%、98.8%，B组为88.5%、91.0%、93.6%，两组疗效无显著差异。但高温热塑牙胶充填根管术后反应少，临床操作时间短，故该方法是比较理想的根管充填技术。更多还原

【Abstract】 Root canal therapy(RCT) is an essential method for treating various endodontic and periapical diseases. The success of the treatment depends majorly on the quality of canal preparation and the strictness of the canal filling. Root canal therapy for treating dental pulp necrosis and periapical diseases consists of root canal preparation, disinfection and filling in order to eliminate the stimulus source derived of the root canal. The canal preparation is an important step of RCT whose purpose lies in clearing the canal and taking shape to benefit the filling. The prepared canal where the dental pulp has been removed is filled in order to cut off the communication of the canal and periapical tissues, to prevent reinfection and to promote the healing of periapical lesions.At present, studies in this field mainly focus on Profile technique applied in root canal preparation and thermoplasticized gutta-percha technique applied in root canal filling. Up to date, however, little is studied about the combination of those two kinds of techniques. Therefore, this study aimed at getting a better understanding on the filling effect affected by different preparation methods and the medium and short-term clinical effect. The main contents and results of the study are presented as follows:1 The microleakage study on thermoplasticized gutta-percha technique applied in root canal filling60 freshly pulled out teeth were selected and resected at cemento-enamel junction. All specimens were divided randomly into 3 groups that each contained 20 teeth. The specimens in Group A were filled with thermoplasticized gutta-percha; The ones in Group B were filled with zinc oxide clove oil pastewith gutta-percha point and the ones in Group C were left unfilled. The lutation quality of the two root canal filling materials was contrasted after India Ink staining. The results showed that the length of staining line of the teeth in Group A was significantly shorter than that in Group B (P<0.001). The difference between those two groups and the control group was significant (P<0.001). These results suggested that the microleakage in the specimens in Group A filled with heated Gutta-percha by high temperature thermoplasticized injectable obturation was significantly smaller than that filled with zinc oxide clove oil paste with gutta-percha. In addition, the lutation quality of the former was superior to the latter.2 The microleakage study on thermoplasticized gutta-percha technique applied in root canal filling prepared with different methods40 lower first premolars after being pulled out and preserved were divided randomly into 4 groups which each contained 10 teeth. The root canals of specimens in Group A were prepared with routine method, the ones in Group B prepared with step by step method, the ones in Group C prepared with ultrasound technique and the ones in Group D prepared with Profile and ultrasound technique. During root canal preparation every canal was rinsed with 3% hydrogen peroxide solution and saline alternatively. The canals were filled by Obtura II system when prepared. The microleakage in every specimen was obtained by observation under stereomicroscope and the data were collected and analyzed with SPSS software. The results showed that the length of staining line of the teeth in Group D; was significantly shorter than those in the other groups. These results suggested that the microleakage was the smallest and the lutation quality was best in the specimens which prepared with Profile and ultrasound technique and filled with injectable obturation with thermoplasticized gutta-percha.3 Short-term curative effect of filling with thermoplasticized gutta-perchaIn order to observe the short-term curative effect of heated gutta-percha of the Obtura n system, 160 teeth were divided into 2 groups. After they were all prepared with Profile system, Group A was filled with heated Gutta-percha by injectable obturation and Group B was filled with zinc oxide-eugenol paste withgutta-percha. The patients were更多还原