發(fā)布時間：2018-04-24 22:21

  本文選題：根管預備 + 成形能力�。� 參考：《鄭州大學》2017年碩士論文

【摘要】：根管預備一直是根管治療中的關鍵步驟,決定著整個根管治療的成敗。而鎳鈦根管預備系統(tǒng)通常是進行根管預備的首選,鎳鈦器械的成形能力以及抗疲勞性能也一直是臨床醫(yī)生關注的重點。隨著鎳鈦器械的不斷推陳出新,除了在器械材質(zhì)、橫截面及尖端設計的改進,鎳鈦器械的運動方式也由原來的單一連續(xù)旋轉(zhuǎn)模式發(fā)展到現(xiàn)今的三種主要模式:單向旋轉(zhuǎn)、往復運動和自適應運動。本研究使用兩種不同的鎳鈦根管預備系統(tǒng),觀察三種不同的運動方式對鎳鈦根管器械的成形能力及抗循環(huán)疲勞能力的影響。一三種不同運動模式對鎳鈦器械根管成形能力的影響目的利用Hyflex CM和機用Twisted File Adaptive兩種不同的根管預備系統(tǒng),分別在單向旋轉(zhuǎn)、往復運動和自適應運動三種模式下對3D樹脂復制根管進行根管預備,通過Micro-CT掃描及三維重建圖像技術對根管預備前后的根管體積、根管表面積和根管偏移度改變量進行對比分析,以比較不同運動模式下器械成形能力的差異。以期為臨床工作提供實驗依據(jù)。材料與方法選擇54顆3D復制樹脂牙的上頜第二磨牙,上頜第二磨牙近中頰側(cè)根管的根管彎曲度為50度,根尖孔直徑為0.20mm,根管全長為15mm,隨機分成6組,每組9個樣本,依次進行標記編碼。將54個樣本分別放置于自制固定裝置固定,Micro-CT進行預備前掃描。其中1、2、3組分別使用Hyflex CM在單向旋轉(zhuǎn)、往復運動和自適應運動三種模式下進行根管預備。4、5、6組分別使用Twisted File Adaptive在單向旋轉(zhuǎn)、往復運動和自適應運動三種模式下進行根管預備。將預備后的樣本按照預備前掃描時的位點放置在自制固定裝置上,再次Micro-CT進行掃描,兩次掃描的參數(shù)保持一致。將掃描數(shù)據(jù)采用進行三維重建分析,對預備前后根管的形態(tài)(體積,表面積,偏移度)進行對比,所得數(shù)據(jù)利用SPSS 17.0進行統(tǒng)計學分析,分別評價兩種根管預備器械在三種不同運動模式下對3D復制樹脂根管的成形能力。結(jié)果在Hyflex CM預備的三組根管中,連續(xù)旋轉(zhuǎn)組的體積改變量的平均值小于另外兩實驗組,且差異有統(tǒng)計學意義。而往復運動組和自適應運動組之間,根管的體積改變量無明顯統(tǒng)計學差異。Hyflex CM在三種運動方式下,根管預備前后根管內(nèi)壁的表面積改變結(jié)果與體積改變結(jié)果相似。連續(xù)旋轉(zhuǎn)組的根管壁表面積的改變量的平均值小于另外兩實驗組,且差異有統(tǒng)計學意義,而往復運動組和采用自適應運動組之間,根管壁的表面積改變量無明顯統(tǒng)計學差異。在對根管彎曲度的改變方面,往復運動組產(chǎn)生的根管偏移較其他兩組小,但三組之間的差異無統(tǒng)計學意義。在Twisted File Adaptive預備的三組根管中,連續(xù)旋轉(zhuǎn)組的體積改變量最小,但與其他兩組之間的差異無統(tǒng)計學意義。在三組中,自適應運動組的根管預備前后根管內(nèi)壁的表面積改變量最大,與其他兩組無統(tǒng)計學差異。在對根管彎曲度的改變方面,連續(xù)旋轉(zhuǎn)組,往復模式組和自適應組在預備彎曲樹脂根管時的產(chǎn)生的根管偏移基本一致,無明顯統(tǒng)計學差異。結(jié)論在成形能力實驗中,往復運動的Hyflex CM和Twisted File Adaptive的切削效率最高。Hyflex CM和Twisted File Adaptive在連續(xù)旋轉(zhuǎn)、往復運動和自適應運動下都表現(xiàn)出較好的成形能力,其中往復運動模式下的根管偏移出現(xiàn)的最少。二不同運動模式對器械循環(huán)疲勞能力的影響目的選用Hyflex CM和機用Twisted File Adaptive兩種不同的鎳鈦器械,分別在單向旋轉(zhuǎn)、往復運動和自適應運動三種模式下完成5個樹脂彎曲根管的預備,對使用過器械表面用SEMJ進行觀測,分析對比不同運動模式下器械表面疲勞的差異。之后再將檢測過的器械進行循環(huán)疲勞斷裂測試,比較不同運動模式下器械抗循環(huán)疲勞斷裂能力。以期為臨床工作提供實驗依據(jù)。材料和方法選用300個彎曲樹脂根管,彎曲度64度、彎曲半徑6mm,全長17mm。所有樹脂模擬根管被隨機分為6組,每組50個。選用30支Hyflex CM,30支Twisted File Adaptive,型號均為20號,錐度0.04。每個品牌的器械被隨機分為三組。三組器械分別在單向旋轉(zhuǎn)、往復運動和自適應運動三種模式下完成樹脂根管的預備。每個器械預備5個樹脂根管。然后所有使用過的器械在掃描電鏡(SEM)下放大200倍觀察。沿器械的軸向進行五個視野的表面磨損分析觀察,對所有樣本的電子顯微照片進行數(shù)字化編碼儲存。由三名觀察員使用表1中的評分標準進行等級評分,記錄所得評分。再將觀測過后的器械完全插入樹脂根管模型中,進行循環(huán)疲勞斷裂實驗。器照按照之前的分組,繼續(xù)在相應的運動模式下在根管內(nèi)運動,整個運動中器械保持完全插入根管的狀態(tài)。15秒為一個運動周期,每個運動周期結(jié)束后用清水沖洗根管以及器械,然后再進行下一周期,直至器械發(fā)生斷裂。記錄器械斷裂的周期數(shù)。使用SPSS 17.0軟件,分別對所得的數(shù)據(jù)進行分析,比較不同運動下器械的表面磨損程度和抗疲勞斷裂能力。結(jié)果Hyflex CM和Twisted File Adaptive鎳鈦器械在三種運動模式下完成5個樹脂根管的預備后,器械表面均表現(xiàn)為不同程度的磨損,兩種器械的連續(xù)旋轉(zhuǎn)組器械表面的磨損程度都高于往復模式組和自適應模式組,而往復模式組和自適應模式組兩組之前無明顯差異。Hyflex CM器械斷裂的15秒周期循環(huán)數(shù)值,連續(xù)旋轉(zhuǎn)組是10.4+3.33次,該循環(huán)周期數(shù)短于往復模式的19.7+6.00次和自適應運動的15.7+5.54次。往復模式和自適應模式之間無統(tǒng)計學差異,而連續(xù)旋轉(zhuǎn)運動組與前兩組之間都有統(tǒng)計學差異。Twisted File Adaptive在連續(xù)旋轉(zhuǎn)的斷裂周期數(shù)是11.8+4.34次,該時間短于往復模式的18.5+5.08次和自適應運動的16.7+6.36次。往復模式和自適應模式之間無統(tǒng)計學差異,而連續(xù)旋轉(zhuǎn)模式的與前兩組之間都有統(tǒng)計學差異。結(jié)論往復運動和自適應運動下根管器械相比連續(xù)旋轉(zhuǎn)運動都表現(xiàn)出更少的表面磨耗。而往復模式和自適應模式下的器械的折斷時間也明顯比連續(xù)旋轉(zhuǎn)的器械長,而往復模式運動的器械在抗循環(huán)斷裂方面的性能最好。
[Abstract]:Root canal preparation has always been a key step in root canal therapy, which determines the success or failure of root canal treatment. The nickel titanium root canal preparation system is usually the first choice for root canal preparation. The formability and fatigue resistance of the nickel titanium instrument are always the focus of the clinicians. The improvement of quality, cross section and tip design, the movement mode of NiTi instruments has also developed from the original single continuous rotation mode to the three main modes today: unidirectional rotation, reciprocating motion and adaptive motion. This study uses two different nickel titanium root canal preparation systems and observes three different kinds of movement methods for the nickel titanium root tube instruments. The influence of forming ability and resistance to cyclic fatigue. The effect of 13 different motion modes on the forming ability of the root tube of Ni Ti instruments. Purpose using the two different root canal preparation systems of Hyflex CM and Twisted File Adaptive, the root canal of 3D resin was carried out in three modes of one-way rotation, reciprocating motion and adaptive movement. To compare the volume of root canal, the surface area of root canal and the change of the root canal offset before and after the preparation of the root canal by Micro-CT scan and three-dimensional reconstruction image technique, in order to compare the difference of the formability of the apparatus under different motion modes. In order to provide the experimental basis for clinical work. Materials and methods choose 54 3D replicating teeth. The maxillary second molars, the root canal bending degree of the proximal and middle buccal lateral root canal of the maxillary second molar was 50 degrees, the root canal diameter was 0.20mm, the root canal was 15mm, and was randomly divided into 6 groups. Each group had 9 samples in turn. The 54 samples were placed in the self-made fixtures, and the Micro-CT was scanned before preparation. Among them, the 1,2,3 group used Hyf respectively. Lex CM carries out root canal preparation under three modes of unidirectional rotation, reciprocating movement and adaptive motion, and.4,5,6 group is prepared by Twisted File Adaptive under one-way rotation, reciprocating motion and adaptive motion. The prepared samples are placed on the self-made fixtures according to the pre prepared scanning sites and M again. M Icro-CT was scanned and the parameters of the two scan were consistent. The scanned data were analyzed by three-dimensional reconstruction, and the morphology (volume, surface area, offset) of the root canal before and after preparation was compared. The data obtained by SPSS 17 were statistically analyzed, and two kinds of root canal preparation instruments were evaluated for 3D replication in three different modes of motion respectively. In the three groups of root canals prepared by Hyflex CM, the average value of the volume modification of the continuous rotation group was less than that of the other two experimental groups, and the difference was statistically significant. There was no significant difference in the volume change of the root canal between the reciprocating movement group and the adaptive exercise group, and.Hyflex CM was in the three types of movement, The change of the surface area of the inner wall of the root canal was similar to that of the volume change before and after the root canal preparation. The average value of the change of the surface area of the root canal wall in the continuous rotation group was less than that of the other two experimental groups, and the difference was statistically significant, but the surface area change of the root canal wall was not statistically significant difference between the reciprocating movement group and the adaptive movement group. In the change of the root canal curvature, the root canal migration in the reciprocating group was smaller than the other two groups, but the difference between the three groups was not statistically significant. In the three groups of root canals prepared by Twisted File Adaptive, the volume change of the continuous rotation group was the smallest, but the difference between the other two groups was not statistically significant. In the three groups, the adaptation was self suitable. The surface area change of the inner wall of the root canal was the largest in the motion group before and after the root canal preparation. There was no statistical difference with the other two groups. In the aspect of the change of the root canal bending degree, the root canal offset of the continuous rotation group, the reciprocating model group and the adaptive group in the preparation of the bent resin root canal were consistent, and there was no significant statistical difference. In the ability experiment, the cutting efficiency of Hyflex CM and Twisted File Adaptive of reciprocating movement is the highest.Hyflex CM and Twisted File Adaptive in continuous rotation, both reciprocating motion and adaptive motion show good forming ability, in which the root tube in the reciprocating motion mode is offset at least. Two different motion modes are exhausted to the instrument cycle. Two different kinds of nickel and titanium instruments were selected by Hyflex CM and Twisted File Adaptive to complete the preparation of 5 resin curved root tubes under three modes of unidirectional rotation, reciprocating motion and adaptive motion respectively. The surface fatigue of the instruments under different motion modes was analyzed and compared. In order to provide experimental basis for clinical work, 300 flexural resin root tubes were selected, the bending degree was 64 degrees, the bending radius 6mm, and the full length 17mm. of all resin simulated root canals were randomly divided into two types. 6 groups, each group of 50. 30 Hyflex CM, 30 Twisted File Adaptive, type 20, and each brand of taper 0.04. was randomly divided into three groups. The three sets of instruments were prepared in one direction rotation, reciprocating motion and adaptive motion for the preparation of the resin root canal. Each instrument was prepared with 5 resin root tubes. Then all of the devices were used. The instruments were amplified 200 times under scanning electron microscope (SEM). The surface wear analysis of five fields of vision was observed along the axis of the instrument. The electronic microphotographs of all the samples were digitized and stored. The grades were scored by three observers using the scoring standard in Table 1. In the resin root canal model, the cyclic fatigue fracture experiment was carried out. According to the previous grouping, the apparatus continued to move in the root canal in the corresponding motion mode. The whole apparatus in the whole movement kept the root tube completely inserted into the root canal for.15 seconds. After each period, the root canal and the instrument were washed with clean water and then carried out again. The period of the next cycle until the instrument breaks. Record the period of the fracture of the instrument. Using SPSS 17 software, the data were analyzed to compare the surface wear and fatigue fracture ability of the instruments under different motion. Results Hyflex CM and Twisted File Adaptive nickel titanium apparatus completed 5 resin root tubes under three modes of motion. After the preparation, the surface of the apparatus showed varying degrees of wear and wear. The wear degree of the two instruments of continuous rotation group was higher than that of the reciprocating model group and the adaptive model group, but there was no significant difference between the reciprocating model group and the adaptive model group before the two groups. The 15 second cycle cycle value of the fracture of the.Hyflex CM apparatus was not significantly different, and the continuous rotation group was 10.4. +3.33 times, the cycle number is shorter than the 19.7+6.00 times in the reciprocating mode and the 15.7+5.54 times of the adaptive motion. There is no statistical difference between the reciprocating mode and the adaptive mode, but there is a statistical difference between the reciprocating mode and the adaptive model, while the continuous rotation movement group and the first two groups have statistical difference between the.Twisted File Adaptive and the continuous rotation of the fracture period is 11.8+4.34 times, which is shorter than that of the previous one. The 18.5+5.08 times of the reciprocating mode and the 16.7+6.36 times of the adaptive motion. There is no statistical difference between the reciprocating mode and the adaptive mode, but there is a statistical difference between the continuous rotation mode and the first two groups. The breaking time of the device in the mode and adaptive mode is also longer than that of the continuous rotating instrument, and the apparatus in the reciprocating mode has the best performance in the anti cycle fracture.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R781.05

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