本文關(guān)鍵詞： M-Path PathFile K銼 約診間疼痛 根尖碎屑 根尖偏移 根尖中心定位 彎曲根管　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究探討使用三種不同根管通暢銼預(yù)備彎曲根管后發(fā)生約診間疼痛、推出根尖碎屑量以及根尖偏移和根尖中心定位能力的差異情況,從而初步評價(jià)不同根管通暢銼在根管治療過程中的應(yīng)用價(jià)值。方法:1.不同根管通暢銼預(yù)備彎曲根管效果的臨床研究選取下頜第一磨牙患急性牙髓炎的病人60例,通過Schneider法確定根管彎曲度,隨機(jī)分為3組:K銼組,Pathfile組,M-Path組。局部浸潤麻醉后于橡皮障下進(jìn)行預(yù)備洞型,常規(guī)開髓,建立直線通路。K銼組采用不銹鋼K銼順序疏通10#、15#至20#;Path File組采用Path File鎳鈦根管預(yù)備系統(tǒng)依次從13#、16#至19#進(jìn)行預(yù)備;M-Path組采用M-Path系統(tǒng)依次從13#、16#至19#進(jìn)行預(yù)備。三組在根管疏通過程中均配合EDTA凝膠RC-PREP預(yù)備,隨后分別使用M3機(jī)用鎳鈦根管預(yù)備系統(tǒng)行根向預(yù)備。2%Na Cl O與17%EDTA交替沖洗,超聲蕩洗,干燥,封氫氧化鈣糊劑根管消毒。7天后使用熱牙膠充填系統(tǒng)進(jìn)行根管充填。采用視覺模擬評分(VAS)量表記錄患者根管預(yù)備術(shù)后當(dāng)天、術(shù)后第一天、術(shù)后第二天的患牙疼痛情況。2.不同根管通暢銼預(yù)備彎曲根管效果的體外研究選取30顆離體下頜單根管前磨牙,通過Schneider法確定根管彎曲度,自頰側(cè)釉牙骨質(zhì)界上2mm垂直于牙體長軸的方向截?cái)?保留牙根部分,拔髓后用10#K銼插入根管直至看見銼尖剛好穿出根尖孔時(shí)調(diào)整為固定參考點(diǎn),記錄止動(dòng)片到器械尖端的距離,將此距離減去1mm確定為工作長度。將30顆離體牙隨機(jī)分成3組,K銼組、Path File組、M-Path組,各10例。將離體牙逐一編號,并按順序放置于相應(yīng)空瓶中,瓶口用不透明塑膠塞封閉,離體牙與瓶口塑膠塞之間縫隙用3M ESPE FiltekTMZ350XT納米流體樹脂封閉。瓶口塑膠塞上插入5ml注射器針頭以平衡瓶內(nèi)外氣壓。使用上述相同方法進(jìn)行根管預(yù)備。每次沖洗時(shí)使用側(cè)方開口沖洗針頭,針頭盡量深入根管內(nèi)最終達(dá)到距工作長度1mm,上下提拉、旋轉(zhuǎn)針頭,以達(dá)到無阻力、無嵌塞。根管預(yù)備后,用1m L蒸餾水沖洗根尖及其上方2mm以內(nèi)的牙根外表面,將沖洗液一并收集至空瓶中。收集空瓶中液體經(jīng)過離心、蒸干后,用電子天平(mg)對推出根尖碎屑量進(jìn)行稱重。利用錐形束CT(CBCT)分別對根管預(yù)備前后的離體牙樣本進(jìn)行掃描,然后用CBCT自帶軟件對圖像進(jìn)行分析測量根管預(yù)備前后每個(gè)牙根距根尖孔0.5mm、1mm、2mm 3個(gè)橫斷面彎曲內(nèi)外側(cè)根管壁的厚度,觀察根管預(yù)備后發(fā)生根尖偏移和根尖中心定位的情況。3.統(tǒng)計(jì)學(xué)分析用統(tǒng)計(jì)軟件SPSS17.0,采用單因素方差分析、SNK檢驗(yàn)兩兩比較分析,P值小于0.05表示有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.相比于使用K銼疏通根管治療牙髓炎,應(yīng)用Path File鎳鈦根管預(yù)備系統(tǒng)及M-Path系統(tǒng)疏通根管治療牙髓炎,患者術(shù)后疼痛反應(yīng)顯著降低(P0.05)。2.相比于使用K銼疏通根管,應(yīng)用Path File鎳鈦根管預(yù)備系統(tǒng)及M-Path系統(tǒng)疏通根管,根管預(yù)備后推出根尖碎屑量顯著減低(P0.05)。3.三種根管通暢銼預(yù)備彎曲根管后,測量點(diǎn)距離根尖孔0.5mm斷面,K銼組與Path File組、M-Path組比較,根管偏移量差異具有統(tǒng)計(jì)學(xué)意義(P0.05);測量點(diǎn)距離根尖孔1mm斷面,K銼組與Path File組、M-Path組比較,根管偏移量差異無統(tǒng)計(jì)學(xué)意義(P0.05);測量點(diǎn)距離根尖孔2mm斷面,K銼組與M-Path組比較,根管偏移量差異具有顯著性(P0.05),K銼組與Path File組比較,根管偏移量差異不具有顯著性(P0.05)。4.三種根管通暢銼預(yù)備彎曲根管后,測量點(diǎn)距離根尖孔0.5mm斷面,K銼組與Path File組、M-Path組比較,根尖中心定位能力差異具有統(tǒng)計(jì)學(xué)意義(P0.05);測量點(diǎn)距離根尖孔1mm和2mm斷面,K銼組與Path File組、M-Path組比較,根尖中心定位能力差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.Path File根管預(yù)備系統(tǒng)及M-Path系統(tǒng)能顯著降低彎曲根管預(yù)備后的疼痛反應(yīng)、推出根尖碎屑量,發(fā)揮良好的根尖定位能力,以減少根尖偏移的發(fā)生。2.Path File和M-Path根管通暢系統(tǒng)能夠提高工作效率,保存根管完好的解剖形態(tài),建立彈性彎曲的平滑路徑,從而保證了后期大錐度鎳鈦器械預(yù)備維持在根管原有的解剖形態(tài)基礎(chǔ)上。
[Abstract]:Objective: This study investigated the use of three kinds of root canal files in preparation of curved root canal unobstructed interappointment pain, the difference and the amount of debris launched apical migration and apical center apical positioning ability, so as to evaluate different root canal patency file in the root canal treatment in the process of application. Methods: 1. different root clinical study of tube patency files in curved canals using selected mandibular first molars with acute pulpitis patients in 60 cases, by Schneider method for the determination of root canal curvature, were randomly divided into 3 groups: Pathfile group, K file group, M-Path group. Local anesthesia after cavity preparation in rubber dam, conventional open pulp a straight line pathway of.K file group, 10# stainless steel K files in order to clear, 15# to 20#; Path File group with Path File nickel titanium system are from 13#, 16# to 19# for preparation; group M-Path with M-Path system are from 13#, 16# to 19# Prepare for. With EDTA RC-PREP gel prepared in both three groups in the root canal dredging process, then use M3 nickel titanium root system to prepare.2%Na Cl O and 17%EDTA douche, ultrasonic irrigation, dry seal, Calcium Hydroxide Paste.7 days after root canal disinfection using warm gutta percha root canal system filling. Using the visual analogue scale (VAS) were recorded after root canal preparation on the same day, the first day after operation, postoperative day second teeth pain.2. of different root canal file smooth curved canals using in vitro selection of 30 mandibular premolar root canal, through the Schneider method to determine the root tube bending, from buccal cemento enamel 2mm perpendicular to the long axis of the tooth direction truncation, keep the root part of pulpectomy with 10#K file inserted into the root canal until you see the file tip just through the apical foramen when adjusted for the fixed reference point to stop recording The instrument tip distance, the distance minus 1mm is determined as the working length. 30 teeth were randomly divided into 3 groups, K Path group File, file group, M-Path group, 10 cases each. The teeth are numbered sequentially, and placed in the corresponding empty bottle, bottle with opaque plastic plug closed. From the gap between the teeth and the plastic bottle plug with 3M ESPE FiltekTMZ350XT nano fluid resin sealing plug is inserted into the 5ml bottle. The plastic syringe needle to balance the air pressure inside and outside the bottle. Use the same method for root canal preparation. Each flushing using lateral opening flushing needle, needle as deep root canal working length to reach from 1mm pulling up and down, in order to achieve the rotation of the needle, no resistance, no impaction. After root canal preparation, root surface and root irrigation within the above 2mm 1m L with distilled water, rinse liquid together to collect the empty bottle. Collect the empty bottle liquid after centrifugation, After drying, with electronic balance (mg) on the launch of apical quantity of debris were weighed. The use of cone beam CT (CBCT) scanning teeth samples respectively before and after root canal preparation, and then use CBCT software to analyse the image measurement of root canal preparation before and after each hole from the root apex of 0.5mm, 1mm, 2mm 3 a cross section of curved root canals inside and outside wall thickness analysis of.3. was observed after root canal preparation and root apical positioning center shift using the statistical software SPSS17.0, using single factor variance analysis, comparative analysis of 22 SNK test, P values less than 0.05 were statistically significant. Results: 1. compared to the K file in root canals the treatment of pulpitis, application of Path File nickel titanium system and M-Path system to clear the root canal treatment of pulpitis, pain reaction of patients decreased significantly after.2. (P0.05) compared to the K file to clear the root canal, the application of Path File nickel titanium root Canal system and M-Path system to clear the root canal, root canal preparation after the launch of root quantity of debris was significantly decreased (P0.05).3. three root canal unobstructed files in preparation of curved root canal, the measurement points from the foramen of 0.5mm section, K file group and Path File group, M-Path group, root canal offset. The difference was statistically significant (P0.05); the measurement points from the foramen of 1mm section, K file group and Path File group, M-Path group, root canal deviation was no statistically significant difference (P0.05); the measurement points from the foramen of 2mm section, K file group compared with M-Path group, the root canal deviation had a significant difference (P0.05) K file, Path group compared with File group, root canal offset does not have significant difference (P0.05).4. three root canal unobstructed files in preparation of curved root canal, the measurement points from the foramen of 0.5mm section, K file group and Path File group, M-Path group, the difference was statistically significant (apical center positioning capability P0.05); The measurement points from the foramen of 1mm and the 2mm section, K file group and Path File group, M-Path group, no statistically significant difference between the apical center positioning capability (P0.05). Conclusion: 1.Path File root canal system and the M-Path system can significantly reduce the bending pain reaction after root canal preparation, push out root quantity of debris, play apical positioning ability, in order to reduce the occurrence of.2.Path File and the apical M-Path root canal patency system can improve the work efficiency, save the morphology and anatomy of intact root canal, the establishment of a smooth path of elastic bending, thus ensuring the later large taper nickel titanium rotary instruments in preparation to maintain the original anatomy in the root canal.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R781.05

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