不同根尖定位仪和测量锉直径对测量根管工作长度准确性的影响
摘要
根管工作长度测量的准确性是决定根管治疗成功的一个重要因素,是根管预备、根管充填的基础和前提。目前获得根管工作长度的的方法主要有X线比例计算法和根尖定位仪法等。其中根尖定位仪法是一种通过测定根尖孔牙周膜与口腔粘膜的电阻值来确定牙根管长度的方法,应用的仪器为根尖定位仪,因其准确度高、操作简单、减少患者的X线的照射次数等优点被广泛应用。根尖定位仪经过半个多世纪的发展,现在临床上常用的第三代(双频交流信号)和第四代(多频交流信号)产品与第一代相比准确性也有较大提高。但不同原理的根尖定位仪和根尖孔的大小之间关系仍是影响测量准确性的关键因素。为此,本实验采用磷酸盐缓冲液琼脂凝胶构建模拟牙齿在体内环境的模型,分别应用Root ZX100、Raypex5、ProPex和APEX-EYE KM-9000根尖定位仪测量根管工作长度,利用Digora系统直接数字化显影得到离体牙工作长度的真实值作对比,发现不同原理的根尖定位仪测量根管工作长度的准确性与测量锉直径有密切的相关性,所得结果为临床上更准确使用根尖定位仪法测量根管工作长度提供实验依据。
Root canal therapy(RCT) is an efficient method of treating pulposis and periapical disease. Root canal preparation is the most important step in RCT and it is the precondition and foundation of root canal disinfection and filling.Working length mentioned in RCT means the distance from the reference point on the crown to the apical stop and accurate working length is helpful to remove infected mass inside root canals effectively and protect apical constriction from being ruined by canal preparing instruments which are beyond root foramens.
Accurate working length plays an important role in canal cleaning and shaping which induce successful endodontic treatments.At present,there are many methods to determine the working length such as tactile perception,radiographic method and electronic apex locator method.As X-ray film shows two-dimensional images of objects and the dentino-cemental junction is determined by the apical plane in radiographic method,it is hard to determine apical constriction with a vague X-ray film.In recent years digital X-ray imaging technique makes root images more distinct and after clinical trials, better accuracy of working length is obtained by radiographic method with digital X-ray imaging technique.
Nowadays electronic apex locator method is most commonly used to determin the working length in the root canal therapy. After half a century’s development, the accuracy obtained by electronic apex locators of the third and fourth generation is better than that obtained by electronic apex locators of the first generation.
The advantages of electronic apex locator are as bellow: accurate, simple, convenient and less X-ray radiation to patients. Although the electronic apex locator presents the working length with high accuracy, the result would be affected by several factors. The hot spot of current studies is about the influence of the root canal apical foramen diameter and the solution quality inside the canal on the measuring accuracy and it is concluded that the residual pulp and strong electrolyte solution inside root canals can affect the measuring results and the measuring accuracy decreases when the apical foramen is larger than 0.4㎜ in many reaserches. Electronic apex locators with different working principles and apical foramens of different diameters are key factors in testing working length.
The objective of this study is to discuss the selection of files when measuring the working length of root canals prepared regularly and compare the accuracy of 4 electronic apex locator species commonly used in clinic.40 isolated teech are selected as subjects of this study after being screened.Each of the teeth has only one straight cannal.After the pretreatment of the teeth, model was established with teeth and phosphate buffer agar gel,and then put initial file into cannal to conduct digital imaging and gain working length.In order to make sure the value,we conduct digital imaging again,until the tip of the file locate at the apical narrow region,the length of the file in cannal equals to the standard value of working length.Then enlarge the cannal with Mtwo nickel-titanium file from 10# untile 30# and measure the working length with 8#-30# K files and 4 kinds of electronic apex locator.Analyze the results statistically to evaluate the differences between the measurement and the standard value.
Finally results are found as follows:1.Group Root ZX:The mean value between the standard and 8#,10#,15# K file measurements differs significantly whileno statistical differen-ce is found between the mean value of the standard and20#,25#,30#K file measurements. Group Raypex:The mean value between the standard and 8#,10# K file measurements diffe-rs significantly while no statistical difference is found between the meanvalue of the sta-ndard and 15#,20#,25#,30# Kfile measurements.Group ProPex:The mean value between the standard and 8# K file measurements differs significantly while no statistical difference is found between the meanvalue of the standard and 10#,15#,20#,25#,30# K file measurements.Group APEX-EYE: The mean value between the standard and 8# K file measurements dif-fers significantly while no statistical difference is found between the meanvalue of the standard and 10#,15#,20#,25#,30# K file measurements. 2.The accuracy of Root ZX is 85%; the accuracy of Propex is 87.5%;the accuracy of Reypex is 90%;the accuracy of APEX-EYE is 90%.
It is found that all the files of different diameters affect the results measured by the four electronic apex locator species.The results obtained by files of significantly different diameters from those of root canals are statitically smaller while the results obtained by files of diameters similar to those of root canals are of no statistical significance.Evaluated by the standard value(from the apical constriction±0.5mm to the reference point on the crown),the accuracy sequence of measuring results is Root ZX
Root canal therapy(RCT) is an efficient method of treating pulposis and periapical disease. Root canal preparation is the most important step in RCT and it is the precondition and foundation of root canal disinfection and filling.Working length mentioned in RCT means the distance from the reference point on the crown to the apical stop and accurate working length is helpful to remove infected mass inside root canals effectively and protect apical constriction from being ruined by canal preparing instruments which are beyond root foramens.
Accurate working length plays an important role in canal cleaning and shaping which induce successful endodontic treatments.At present,there are many methods to determine the working length such as tactile perception,radiographic method and electronic apex locator method.As X-ray film shows two-dimensional images of objects and the dentino-cemental junction is determined by the apical plane in radiographic method,it is hard to determine apical constriction with a vague X-ray film.In recent years digital X-ray imaging technique makes root images more distinct and after clinical trials, better accuracy of working length is obtained by radiographic method with digital X-ray imaging technique.
Nowadays electronic apex locator method is most commonly used to determin the working length in the root canal therapy. After half a century’s development, the accuracy obtained by electronic apex locators of the third and fourth generation is better than that obtained by electronic apex locators of the first generation.
The advantages of electronic apex locator are as bellow: accurate, simple, convenient and less X-ray radiation to patients. Although the electronic apex locator presents the working length with high accuracy, the result would be affected by several factors. The hot spot of current studies is about the influence of the root canal apical foramen diameter and the solution quality inside the canal on the measuring accuracy and it is concluded that the residual pulp and strong electrolyte solution inside root canals can affect the measuring results and the measuring accuracy decreases when the apical foramen is larger than 0.4㎜ in many reaserches. Electronic apex locators with different working principles and apical foramens of different diameters are key factors in testing working length.
The objective of this study is to discuss the selection of files when measuring the working length of root canals prepared regularly and compare the accuracy of 4 electronic apex locator species commonly used in clinic.40 isolated teech are selected as subjects of this study after being screened.Each of the teeth has only one straight cannal.After the pretreatment of the teeth, model was established with teeth and phosphate buffer agar gel,and then put initial file into cannal to conduct digital imaging and gain working length.In order to make sure the value,we conduct digital imaging again,until the tip of the file locate at the apical narrow region,the length of the file in cannal equals to the standard value of working length.Then enlarge the cannal with Mtwo nickel-titanium file from 10# untile 30# and measure the working length with 8#-30# K files and 4 kinds of electronic apex locator.Analyze the results statistically to evaluate the differences between the measurement and the standard value.
Finally results are found as follows:1.Group Root ZX:The mean value between the standard and 8#,10#,15# K file measurements differs significantly whileno statistical differen-ce is found between the mean value of the standard and20#,25#,30#K file measurements. Group Raypex:The mean value between the standard and 8#,10# K file measurements diffe-rs significantly while no statistical difference is found between the meanvalue of the sta-ndard and 15#,20#,25#,30# Kfile measurements.Group ProPex:The mean value between the standard and 8# K file measurements differs significantly while no statistical difference is found between the meanvalue of the standard and 10#,15#,20#,25#,30# K file measurements.Group APEX-EYE: The mean value between the standard and 8# K file measurements dif-fers significantly while no statistical difference is found between the meanvalue of the standard and 10#,15#,20#,25#,30# K file measurements. 2.The accuracy of Root ZX is 85%; the accuracy of Propex is 87.5%;the accuracy of Reypex is 90%;the accuracy of APEX-EYE is 90%.
It is found that all the files of different diameters affect the results measured by the four electronic apex locator species.The results obtained by files of significantly different diameters from those of root canals are statitically smaller while the results obtained by files of diameters similar to those of root canals are of no statistical significance.Evaluated by the standard value(from the apical constriction±0.5mm to the reference point on the crown),the accuracy sequence of measuring results is Root ZX
引文
[1]樊明文.临床口腔医学[M] .湖北:湖北科学技术出版社,1991:51.
[2] Vajrabhaya L,Tepmongkol P.Accuracy of apex locator[J].Endod Dent Traumatol, 1997,13(4):180-182.
[3] Chihiro Kobayash I.Electronic canal length measurement[J].Oral Surg,OralMed,Oral Pathol,1995,79:226-231.
[4] Fouad A F,et al.A clinical evaluation of electronic root canal length measuring five instruments[J].Endodon,1990,16:446-449.
[5] Keller M E,et al.A clinical evaluation of the Endocater:An electronic apex locater[J].Endodon,1991,17:271-274.
[6] MeDonald N T,et al.An evaluation of the apex locator Endocater[J].Endodon,1990,16:5-8.
[7] Himel V T,et al.An evaluation of the durability of apex locater insulated probes after autoclaving[J].Endodon,1993,19:392-394.
[8] Ushiyama J.New principle and method for measuring the root canal length [J].Endoden,1983,9:97-104.
[9] Ushiyama J.Reliability and safety of the voltage gradient method of root canal mearsurement[J].Endodon,1984,10:532-537.
[10] McDonald N J.The electronic determination of working length[J].Dent North Am,1992,36:293-307.
[11]川口叔宏,他.Endodonic Meterにつひて[J].日齿保志,1974,17(2):98.
[12]毛紫英,黄力子.用根管长度电测仪诊断残髓及残髓炎[J].四军医大学学报, 1985, 6(2):119-122.
[13]钟立丽,丁江峰,范兵.两种电子根尖定位仪测量准确性的实验研究[J].口腔医学研究, 2007, 23(2)∶170-172.
[14]周学东,岳松龄主编.牙体牙髓病治疗学[M].北京:人民卫生出版社,2004.
[15] Yu D C, Schilder H. Cleaning and shaping the apical third of a root canal system[J]. Gen Dent, 2001, 49(3):266-270.
[16] Kuttler. Microscopic investigation of root apexes[J]. AmDent Assoc, 1955,50:544-552.
[17]高宝贤.不同根管工作长度测量法的准确性比较[J].口腔材料器械杂志,1999,8(2):83-84.
[18] Martinez-Lozan MA, Forner-Navarro L, Sanchez-Cortes J L, Llena-Puy C. Methodological considerations in the determination of working length[J]. Int End, 2001, 34:371-376.
[19]范兵,边专,樊明文.牙体牙髓临床治疗Ⅱ:根管预备的工作长度、宽度和锥度[J].中华口腔医学杂志, 2006, 41(3):184.
[20] Barthelemy B, Gregor L, Krejci I. Accuracy of electronic apex locater-controlled handpieces[J]. OOOE, 2009, 107(3):437-441.
[21] Dunlap CA, Remeikis NA, BeGole EA. An in vivo evaluation of an electronic apex locator that uses the ratio method invital and necrotic canals[J]. J Endod, 1998, 24(1):48-50.
[22]邓蔓菁,刘鲁川,安建平.牙髓状态对Root ZX根尖电测仪准确性的影响[J].口腔医学研究, 2005, 21(6):628-630.
[23]雷月娟,何克新,罗莉.根管干湿状态对电测根管长度准确性的影响[J].广东牙病防治,2008,16(7):294-296.
[24] Kaufmen A Y, Fuss Z, Kela S, et al. Reliability of different electronic apex locators to detect root perforation in vitro[J]. Int Endod, 2003, 29(8):497-500.
[25] Shabahang S, Goon W W, Gluskin A H. An in vivo evaluation of Root ZX electronic apex locator[J]. Endodon, 1996, 22:616-618.
[26]张扬,庄最新,张爱华.根管扩大程度影响根管长度电测仪的准确性研究[J].广东牙病防治, 2007, 15(1):9-11.
[27]黄力子.根管长度电测法及其原理及三种新的口腔科电子仪器[J].口腔医学, 1989,9(8):121-123.
[28]薛法义,王素杰,孙汉堂.电子根尖定位仪测量根管长度偏差分析[J].牙体牙髓牙周病学杂志, 2005, 15(6):346-347.
[29]刘虹,李奉华,谢晓莉.副根管对根管长度电测法准确性影响的临床研究[J].临床口腔医学杂志,2002,18(5):354-355.
[30] Ebrahim A K, Wadachi R, Suda H. Ex vivo evaluation of the ability of four different electronic apex locators to determine the working length in teeth with various foramendiameters[J]. Australian Dental Journal, 2006, 51(3):258-262.
[31] Aurelio J A, Nahmias Y, Gerstein H. A model for demonstration an electronic canal length measuring device[J]. J Endo, 1983, 9:568-569.
[32] Nahmias Y, Aureli o J A, Gerstein H. An in vitro model for evaluation of electronic root canal length measuring devices[J]. Endo, 1987, 13 (5) : 209 - 214.
[33] Donnelly J C. A simplified model to demonstrate the operation of electronic root canal measuring device[J]. J Endo, 1993, 19(11):579-580.
[34] Czerw R J, Fulkerson M S, Donnelly J C. An in vitro test of a simplified model to demonstrate the operation of electronic root canal measuring devices[J]. J Endo, 1994, 20(12):605-606.
[35] Ingle J I,Bakland L K.Endodontics [M]. USA: Williams Wilkins, 1994, 252-254.
[36]范兵,史俊南,樊明文.手用根管扩大器械的研究现状[J].国外医学口腔医学分册, 1993, 20(3):141- 145.
[37]徐琼,樊明文,范兵,等. ProTaper预备弯曲根管的临床评价[J].中华口腔医学杂志, 2004, 39(2):l36-138.
[38] Thompson S A.An overview of nickel-titanium alloys used indentistry[J].In Endod J, 2000,33(4):297-310.
[39] Bramante C M,Berbert A,Borges R P.A methodology for evaluation of root canal instrumentation[J]. Journal of Endodonties,1987,13(7):243-245.
[40] Savage N W,Walsh L J. The use of autoelaves in the dental surgery[J]. Australian dental Journal,1995,40(5):197-200.
[41] Bürklein S, Sch ? fer E. The influence of various automated devices on the shaping ability of Mtwo rotary nickel-titanium instruments[J]. Int Endod J, 2006, 39(12):945-951.
[42] Blume H, Jost R G. Chest imaging within the radiology department by means of photostimulable phosphor eomputerd radiography[J]. J Digit Imaging, 1992, 5: 67.
[43] Chen S K, Hollender L. Digitizing of radiographs with a flathed scanner[J]. J Dent, 1995, 23:205.
[44]雷雨,王虎,朱智敏.磷存储影像板影像系统在口腔诊断中的应用[J].牙体牙髓牙周病学杂志, 2004, 14(8):468-471.
[45] Velders X L, Sanderink G C, Vander Stelt P F, et al. Dose reduction of two digitalsens or systems measuring file lengths[J]. Oral Surg Oral Med Oral Pathol Oral Radio Endod, 1996, 81:607.
[46] Nery E B, Olson J W, Henkin J M, et al. Film - holder device for radiographic assessment of periodontal tissues[J]. Periodont Res, 1985, 20:97.
[47]邹兆菊,马绪臣.口腔颌面医学影像诊断学[M].北京:人民卫生出版社, 1997.
[48]付少平,范兵,乐进秋. Root ZX根尖定位仪准确性的体外实验研究[J].牙体牙髓牙周病学杂志, 2008, 18(2):80-83.
[49] Huang L. An experimental study of the principle of electronic root canal measurement[J]. J Endod, 1987, 13(2):60-64.
[50] Ibarrola J L, Chapman B L, Howard J H, et al. Effect of preflaring on Root ZX apex locators[J]. J Endod, 1999, 25(9):625-626.
[2] Vajrabhaya L,Tepmongkol P.Accuracy of apex locator[J].Endod Dent Traumatol, 1997,13(4):180-182.
[3] Chihiro Kobayash I.Electronic canal length measurement[J].Oral Surg,OralMed,Oral Pathol,1995,79:226-231.
[4] Fouad A F,et al.A clinical evaluation of electronic root canal length measuring five instruments[J].Endodon,1990,16:446-449.
[5] Keller M E,et al.A clinical evaluation of the Endocater:An electronic apex locater[J].Endodon,1991,17:271-274.
[6] MeDonald N T,et al.An evaluation of the apex locator Endocater[J].Endodon,1990,16:5-8.
[7] Himel V T,et al.An evaluation of the durability of apex locater insulated probes after autoclaving[J].Endodon,1993,19:392-394.
[8] Ushiyama J.New principle and method for measuring the root canal length [J].Endoden,1983,9:97-104.
[9] Ushiyama J.Reliability and safety of the voltage gradient method of root canal mearsurement[J].Endodon,1984,10:532-537.
[10] McDonald N J.The electronic determination of working length[J].Dent North Am,1992,36:293-307.
[11]川口叔宏,他.Endodonic Meterにつひて[J].日齿保志,1974,17(2):98.
[12]毛紫英,黄力子.用根管长度电测仪诊断残髓及残髓炎[J].四军医大学学报, 1985, 6(2):119-122.
[13]钟立丽,丁江峰,范兵.两种电子根尖定位仪测量准确性的实验研究[J].口腔医学研究, 2007, 23(2)∶170-172.
[14]周学东,岳松龄主编.牙体牙髓病治疗学[M].北京:人民卫生出版社,2004.
[15] Yu D C, Schilder H. Cleaning and shaping the apical third of a root canal system[J]. Gen Dent, 2001, 49(3):266-270.
[16] Kuttler. Microscopic investigation of root apexes[J]. AmDent Assoc, 1955,50:544-552.
[17]高宝贤.不同根管工作长度测量法的准确性比较[J].口腔材料器械杂志,1999,8(2):83-84.
[18] Martinez-Lozan MA, Forner-Navarro L, Sanchez-Cortes J L, Llena-Puy C. Methodological considerations in the determination of working length[J]. Int End, 2001, 34:371-376.
[19]范兵,边专,樊明文.牙体牙髓临床治疗Ⅱ:根管预备的工作长度、宽度和锥度[J].中华口腔医学杂志, 2006, 41(3):184.
[20] Barthelemy B, Gregor L, Krejci I. Accuracy of electronic apex locater-controlled handpieces[J]. OOOE, 2009, 107(3):437-441.
[21] Dunlap CA, Remeikis NA, BeGole EA. An in vivo evaluation of an electronic apex locator that uses the ratio method invital and necrotic canals[J]. J Endod, 1998, 24(1):48-50.
[22]邓蔓菁,刘鲁川,安建平.牙髓状态对Root ZX根尖电测仪准确性的影响[J].口腔医学研究, 2005, 21(6):628-630.
[23]雷月娟,何克新,罗莉.根管干湿状态对电测根管长度准确性的影响[J].广东牙病防治,2008,16(7):294-296.
[24] Kaufmen A Y, Fuss Z, Kela S, et al. Reliability of different electronic apex locators to detect root perforation in vitro[J]. Int Endod, 2003, 29(8):497-500.
[25] Shabahang S, Goon W W, Gluskin A H. An in vivo evaluation of Root ZX electronic apex locator[J]. Endodon, 1996, 22:616-618.
[26]张扬,庄最新,张爱华.根管扩大程度影响根管长度电测仪的准确性研究[J].广东牙病防治, 2007, 15(1):9-11.
[27]黄力子.根管长度电测法及其原理及三种新的口腔科电子仪器[J].口腔医学, 1989,9(8):121-123.
[28]薛法义,王素杰,孙汉堂.电子根尖定位仪测量根管长度偏差分析[J].牙体牙髓牙周病学杂志, 2005, 15(6):346-347.
[29]刘虹,李奉华,谢晓莉.副根管对根管长度电测法准确性影响的临床研究[J].临床口腔医学杂志,2002,18(5):354-355.
[30] Ebrahim A K, Wadachi R, Suda H. Ex vivo evaluation of the ability of four different electronic apex locators to determine the working length in teeth with various foramendiameters[J]. Australian Dental Journal, 2006, 51(3):258-262.
[31] Aurelio J A, Nahmias Y, Gerstein H. A model for demonstration an electronic canal length measuring device[J]. J Endo, 1983, 9:568-569.
[32] Nahmias Y, Aureli o J A, Gerstein H. An in vitro model for evaluation of electronic root canal length measuring devices[J]. Endo, 1987, 13 (5) : 209 - 214.
[33] Donnelly J C. A simplified model to demonstrate the operation of electronic root canal measuring device[J]. J Endo, 1993, 19(11):579-580.
[34] Czerw R J, Fulkerson M S, Donnelly J C. An in vitro test of a simplified model to demonstrate the operation of electronic root canal measuring devices[J]. J Endo, 1994, 20(12):605-606.
[35] Ingle J I,Bakland L K.Endodontics [M]. USA: Williams Wilkins, 1994, 252-254.
[36]范兵,史俊南,樊明文.手用根管扩大器械的研究现状[J].国外医学口腔医学分册, 1993, 20(3):141- 145.
[37]徐琼,樊明文,范兵,等. ProTaper预备弯曲根管的临床评价[J].中华口腔医学杂志, 2004, 39(2):l36-138.
[38] Thompson S A.An overview of nickel-titanium alloys used indentistry[J].In Endod J, 2000,33(4):297-310.
[39] Bramante C M,Berbert A,Borges R P.A methodology for evaluation of root canal instrumentation[J]. Journal of Endodonties,1987,13(7):243-245.
[40] Savage N W,Walsh L J. The use of autoelaves in the dental surgery[J]. Australian dental Journal,1995,40(5):197-200.
[41] Bürklein S, Sch ? fer E. The influence of various automated devices on the shaping ability of Mtwo rotary nickel-titanium instruments[J]. Int Endod J, 2006, 39(12):945-951.
[42] Blume H, Jost R G. Chest imaging within the radiology department by means of photostimulable phosphor eomputerd radiography[J]. J Digit Imaging, 1992, 5: 67.
[43] Chen S K, Hollender L. Digitizing of radiographs with a flathed scanner[J]. J Dent, 1995, 23:205.
[44]雷雨,王虎,朱智敏.磷存储影像板影像系统在口腔诊断中的应用[J].牙体牙髓牙周病学杂志, 2004, 14(8):468-471.
[45] Velders X L, Sanderink G C, Vander Stelt P F, et al. Dose reduction of two digitalsens or systems measuring file lengths[J]. Oral Surg Oral Med Oral Pathol Oral Radio Endod, 1996, 81:607.
[46] Nery E B, Olson J W, Henkin J M, et al. Film - holder device for radiographic assessment of periodontal tissues[J]. Periodont Res, 1985, 20:97.
[47]邹兆菊,马绪臣.口腔颌面医学影像诊断学[M].北京:人民卫生出版社, 1997.
[48]付少平,范兵,乐进秋. Root ZX根尖定位仪准确性的体外实验研究[J].牙体牙髓牙周病学杂志, 2008, 18(2):80-83.
[49] Huang L. An experimental study of the principle of electronic root canal measurement[J]. J Endod, 1987, 13(2):60-64.
[50] Ibarrola J L, Chapman B L, Howard J H, et al. Effect of preflaring on Root ZX apex locators[J]. J Endod, 1999, 25(9):625-626.