本文選題：一次性根管治療 + 約診間疼痛��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的： 根管治療(root canal therapy)是牙髓病和根尖周病常用的有效治療方法。經(jīng)過兩百多年的發(fā)展,特別是經(jīng)過自二十世紀(jì)八十年代以來的突飛猛進(jìn)的現(xiàn)代化根管治療階段,目前,根管治療技術(shù)已成為一種國際公認(rèn)的、適應(yīng)證廣泛、操作規(guī)范、要求明確和療效恒定的一種治療方法,其臨床成功率可達(dá)95%以上。一次性根管治療(single-visit root canal therapy)最早報道于1901年,是將根管預(yù)備、根管沖洗消毒、根管充填在一次治療中完成,由于早期技術(shù)原因,術(shù)后疼痛發(fā)生率較高,限制了其在臨床的應(yīng)用。 在根管治療的過程中,包括根管治療期間或治療后12h至數(shù)天內(nèi)經(jīng)常出現(xiàn)患牙疼痛、腫脹等急性炎癥反應(yīng)現(xiàn)象,稱為根管治療期間痛(endodontic interappointment pain EIP)或根管治療期間急發(fā)癥(endodontic interappointment emergencies EIE),發(fā)生率可達(dá)3%-58%。根管治療急發(fā)癥的發(fā)生是可以預(yù)防和減少的,在操作過程中,嚴(yán)格執(zhí)行無菌操作,從根管預(yù)備的一開始就測定好根管的工作長度,防止根管預(yù)備器械和根管充填材料超出根尖孔,避免細(xì)菌及牙本質(zhì)碎屑等感染物質(zhì)進(jìn)入根尖周組織,加上大錐度機(jī)用鎳鈦器械、超聲蕩洗等的應(yīng)用,進(jìn)入根尖周組織的感染物質(zhì)進(jìn)一步減少。 傳統(tǒng)的根管治療確保了在充填前有比較完善的根管消毒,目前依然是很多臨床醫(yī)生的常用治療方法。但是需要患者多次就診,增加了患者的時間和精力負(fù)擔(dān)。一次性根管治療,即將根管預(yù)備、根管沖洗消毒、根管充填在一次治療中完成,其優(yōu)點是減少了患者就診次數(shù)及就診壓力,容易被患者接受,而且臨床療效較好。 隨著口腔器械的不斷發(fā)展,如今的一次性根管治療已經(jīng)具有較好的療效。許多醫(yī)生擔(dān)心一次性根充后疼痛發(fā)生率高而不采用。本研究通過對患者進(jìn)行隨機(jī)的一次性根管治療或分次根管治療,比較兩種根管治療方法約診間疼痛的發(fā)生情況,來探討一次性根管治療的可行性,為臨床醫(yī)生選擇一次性根管治療提供參考。 材料和方法： 選擇臨床診斷為牙髓炎和慢性根尖周炎的患牙172顆(172例)作為研究對象,按治療方法隨機(jī)分為A、B、C、D四組,A、C組為實驗組,B、D組為對照組。A組：46例,采用機(jī)用ProTaper鎳鈦銼冠根向預(yù)備根管,根管沖洗消毒后,Vitapex為糊劑直接行根管充填。B組：45例,采用機(jī)用ProTaper鎳鈦銼冠根向預(yù)備根管,診間封藥7天,第二次復(fù)診Vitapex為糊劑行根管充填。C組：41例,采用機(jī)用ProTaper鎳鈦銼冠根向預(yù)備根管,根管沖洗消毒后,直接以美松糊劑行根管充填。D組：40例,采用機(jī)用ProTaper鎳鈦銼冠根向預(yù)備根管,診間封藥7天,第二次復(fù)診以美松糊劑行根管充填。四組均采用冷牙膠側(cè)壓充填法行根管充填。每例病例診后第2天(48h)和第7天隨訪復(fù)診,觀察根管治療術(shù)急癥發(fā)生情況。 結(jié)果： 1.各組根充后EIE發(fā)生情況：A組：病例46例,術(shù)后第二天有5例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥發(fā)生率10.7%。術(shù)后第七天有2例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥發(fā)生率4.3%。B組：病例45例,術(shù)后第二天有2例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥的發(fā)生率4.4%。術(shù)后第七天有1例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥發(fā)生率2.2%。C組：病例41例,術(shù)后第二天有3例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥的發(fā)生率為7.3%。術(shù)后第七天有1例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥發(fā)生率2.4%。D組：病例40例,術(shù)后第二天有2例發(fā)生術(shù)后急癥,術(shù)后急癥發(fā)生率2.5%。術(shù)后第七天有1例發(fā)生根管治療術(shù)后急癥,術(shù)后急癥發(fā)生率2.5%。經(jīng)方差檢驗,實驗組(A組)術(shù)后急癥發(fā)生率與對照組(B組)無明顯差異(P0.05)。實驗組(C組)術(shù)后急癥發(fā)生率與對照組(D組)無明顯差異(P0.05)。實驗組(A組)術(shù)后急癥發(fā)生率與實驗組(C組)無明顯差異(P0.05)。 2.各組根充后疼痛發(fā)生情況：經(jīng)秩和檢驗,實驗組(A組)和對照組(B組)、實驗組(C組)和對照組(D組)在術(shù)后第二天的各級疼痛發(fā)生率有統(tǒng)計學(xué)意義(P0.05)。實驗組(A組)和對照組(B組)、實驗組(C組)和對照組(D組)在術(shù)后第7天的疼痛發(fā)生無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論與建議： 1.結(jié)論 結(jié)論1.本次試驗中A組結(jié)果和B組結(jié)果經(jīng)統(tǒng)計學(xué)分析,兩組差異無統(tǒng)計學(xué)意義(P0.05),這表明Vitapex為糊劑的一次性根管治療不會比分次性根管治療有更高的術(shù)后急癥發(fā)生率。 結(jié)論2.本次試驗中C組結(jié)果和D組結(jié)果經(jīng)統(tǒng)計學(xué)分析,兩組差異無統(tǒng)計學(xué)意義(P0.05),這表明使用美松糊劑的一次性根管治療不會比分次性根管治療有更高的術(shù)后急癥發(fā)生率。 結(jié)論3.本次試驗中A組結(jié)果和C組結(jié)果經(jīng)統(tǒng)計學(xué)分析,兩組差異無統(tǒng)計學(xué)意義(P0.05),這表明一次性根管治療選擇Vitapex或者美松糊劑不會對術(shù)后急發(fā)癥的發(fā)生造成明顯影響。 結(jié)論4.本次試驗中經(jīng)秩和檢驗,A組和B組、C組和D組在術(shù)后第二天的各級疼痛發(fā)生率有統(tǒng)計學(xué)意義(P0.05),這表明一次根充比分次根充發(fā)生術(shù)后疼痛的概率高。 2.建議：一次根充比分次根充術(shù)后疼痛的發(fā)生率高,但對于術(shù)后急發(fā)癥而言,二者沒有差異,臨床上只要是嚴(yán)格按照各步驟的操作規(guī)程來操作,次根管治療適用于臨床大多數(shù)病例,不必因為擔(dān)心其術(shù)后急發(fā)癥問題而不予采用。
[Abstract]:Objective:
Root canal therapy (root canal therapy) is an effective treatment for dental pulp disease and periapical periodontitis. After more than 200 years of development, especially through the rapid development of modern root canal therapy since 1980s, root canal therapy has become an internationally recognized, widely used, operating standard, The clinical success rate is more than 95%. The one-time root canal therapy (single-visit root canal therapy) is first reported in 1901. It is the root canal preparation, root canal washing and disinfection, root canal filling in one treatment. In clinical application.
During root canal therapy, acute inflammatory reactions such as tooth pain and swelling often occur during or after 12h to days of root canal therapy, known as endodontic interappointment pain EIP or endodontic interappointment emergencies EIE during root canal therapy (endodontic interappointment emergencies EIE), and the incidence can reach 3%-58. The root canal treatment of acute onset can be prevented and reduced. In the process of operation, the aseptic operation is strictly carried out, the length of the root canal is measured from the beginning of the root canal preparation, and the root canal preparation and root canal filling materials are prevented from exceeding the apex hole, and the infected substances such as bacteria and dentine detritus will be prevented from entering the periapical tissue. The infection of substances entering the periapical tissue was further reduced by the use of nickel titanium instruments, ultrasonic scaling and so on.
Traditional root canal therapy ensures a better root canal disinfection before filling, and is still a common treatment for many clinicians. However, it is still a common treatment for many clinicians. However, patients need multiple visits to increase the patient's time and energy burden. One time root canal treatment is done, the root canal preparation, root canal washing and disinfection, root canal filling are completed in a single treatment. The advantage is that it reduces the number of patients and the pressure of visiting patients, and is easy to be accepted by patients.
With the continuous development of dental instruments, disposable root canal therapy has been a good therapeutic effect. Many doctors worry that the incidence of one-time root post filling pain is high and not. This study compares two root canal therapy with random root canal therapy or sub root canal therapy. To explore the feasibility of disposable root canal therapy, and provide a reference for clinicians to select disposable root canal therapy.
Materials and methods:
172 teeth (172 cases), which were diagnosed as pulpitis and chronic periapical periodontitis, were selected as the research object, and were randomly divided into groups of A, B, C, D, group A and C, group A and C as experimental group, B and D group as control group.A group: 46 cases, using ProTaper NiTi file crown root to prepare root canal, root canal washing and disinfection, Vitapex for paste filling.B directly to root canal.B Group: 45 cases, using ProTaper Ni Ti file crown root to prepare root canal for 7 days, second times of Vitapex as paste to fill root canal.C group: 41 cases, using ProTaper nickel titanium file crown root to prepare root canal, root canal washing and sterilizing directly with root canal filling.D group: 40 cases, use ProTaper nickel titanium file crown root root file The root canal was used for the preparation of the root canal for 7 days, and the root canal was filled with the second times. The four groups were filled with the root canal filling with cold tooth glue. Each case was followed up for second days (48h) and seventh days, and the occurrence of emergency treatment of root canal therapy was observed.
Result錛，

本文編號：1925625