根管冠部预处理对弯曲根管工作长度影响的分析
摘要
目的探讨根管冠部预处理对弯曲根管工作长度(WL)的影响,了解根管弯曲度和弯曲部位是否为根管冠部预处理(CP)改变根管工作长度效果的影响因素,并且比较GG钻和镍钛器械手用ProTaper的Sx锉对弯曲根管进行根管冠部预处理对根管工作长度的影响是否相同。
材料和方法将40颗磨牙73个根管按不同弯曲度(中度弯曲、重度弯曲)和弯曲部位(弯曲位于根中1/3、根尖1/3)随机均分为2组,磨牙(牙合)面及根管根尖分别磨出可重复获得的参照点。第1组为GG钻组,用1#～3#GG钻进行根管冠部预处理,第2组为镍钛器械手用ProTaper的Sx挫,根管用Sx挫进行根管冠部预处理,两组根管均测量并记录处理前、后根管工作长度。将资料分别进行配对设计t检验、成组设计t检验和多因素析因分析的统计分析。
结果根管冠部预处理后,两组弯曲根管工作长度减小明显(P<0.05),减少均值分别为0.33mm(GG钻组),0.30mm(ProTaper组)。工作长度减小与弯曲部位无显著相关(P>0.05),而与根管的弯曲度显著相关(P<0.05)。GG钻和手用ProTaper的Sx锉进行根管冠部预处理对根管工作长度的影响在统计学上没有显著性差异(P>0.05)。
结论根管冠部预处理会影响根管工作长度,根管越弯曲,工作长度减小越明显,用GG钻和ProTaper的Sx锉分别进行根管冠部预处理,对根管工作长度的影响没有显著性差异。
Objective: To determine whether canal working length (WL) is altered as a result of coronal preflaring (CP), to assess the correlation between the degree of angulation and the position of root canal curvatures and their influence on the comparative results between the pre- and post-CP and to compare the effect on WL change between by using Gates Glidden drills (GG drills) and the Sx file of ProTaper to CP.
Methods: The 73 curved canals of 40 extracted molars were sorted by the degree of the curvatures as moderate (from over 5 to 25 degrees) and severe (over 25 degrees) and by the position of curvatures as median (the location of the curvature on the one-three middle of canal) and apical (the location of the curvature on the one-three of tip). The canals were divided into two similar groups having the approximative degree and position of curvatures: group 1, GG drills and group 2, ProTaper. The reference cusp tip and root-end were flattened to produce reproducible measurements. Then, CP was performed with GG drills in Group 1 and Sx file of ProTaper in Group 2. Measured and recorded the WL of each canal pre- and post-CP. Statistical analysis was performed using the Paired-Samples T Test, Independent-Samples T Test and Univariate analysis, respectively.
Results: The WL decreased after CP in two groups (P<0.05). The mean decrease in WL for group 1 was 0.33mm and for group 2 was 0.30mm. There was no correlation between the WL decreased and the position of the root curvature, but there was significant correlation between the WL decreased and the degree of the root curvature(P<0.05). There was no significant difference in the effect on WL between group 1 and group 2 (P>0.05) .
Conclusions: WL of curved canals decrease after CP. The more degree of the root curvature is, the more WL decreased occurs. There was no significant difference in the effect on WL change between using GG drills and Sx file of ProTaper to CP.
材料和方法将40颗磨牙73个根管按不同弯曲度(中度弯曲、重度弯曲)和弯曲部位(弯曲位于根中1/3、根尖1/3)随机均分为2组,磨牙(牙合)面及根管根尖分别磨出可重复获得的参照点。第1组为GG钻组,用1#～3#GG钻进行根管冠部预处理,第2组为镍钛器械手用ProTaper的Sx挫,根管用Sx挫进行根管冠部预处理,两组根管均测量并记录处理前、后根管工作长度。将资料分别进行配对设计t检验、成组设计t检验和多因素析因分析的统计分析。
结果根管冠部预处理后,两组弯曲根管工作长度减小明显(P<0.05),减少均值分别为0.33mm(GG钻组),0.30mm(ProTaper组)。工作长度减小与弯曲部位无显著相关(P>0.05),而与根管的弯曲度显著相关(P<0.05)。GG钻和手用ProTaper的Sx锉进行根管冠部预处理对根管工作长度的影响在统计学上没有显著性差异(P>0.05)。
结论根管冠部预处理会影响根管工作长度,根管越弯曲,工作长度减小越明显,用GG钻和ProTaper的Sx锉分别进行根管冠部预处理,对根管工作长度的影响没有显著性差异。
Objective: To determine whether canal working length (WL) is altered as a result of coronal preflaring (CP), to assess the correlation between the degree of angulation and the position of root canal curvatures and their influence on the comparative results between the pre- and post-CP and to compare the effect on WL change between by using Gates Glidden drills (GG drills) and the Sx file of ProTaper to CP.
Methods: The 73 curved canals of 40 extracted molars were sorted by the degree of the curvatures as moderate (from over 5 to 25 degrees) and severe (over 25 degrees) and by the position of curvatures as median (the location of the curvature on the one-three middle of canal) and apical (the location of the curvature on the one-three of tip). The canals were divided into two similar groups having the approximative degree and position of curvatures: group 1, GG drills and group 2, ProTaper. The reference cusp tip and root-end were flattened to produce reproducible measurements. Then, CP was performed with GG drills in Group 1 and Sx file of ProTaper in Group 2. Measured and recorded the WL of each canal pre- and post-CP. Statistical analysis was performed using the Paired-Samples T Test, Independent-Samples T Test and Univariate analysis, respectively.
Results: The WL decreased after CP in two groups (P<0.05). The mean decrease in WL for group 1 was 0.33mm and for group 2 was 0.30mm. There was no correlation between the WL decreased and the position of the root curvature, but there was significant correlation between the WL decreased and the degree of the root curvature(P<0.05). There was no significant difference in the effect on WL between group 1 and group 2 (P>0.05) .
Conclusions: WL of curved canals decrease after CP. The more degree of the root curvature is, the more WL decreased occurs. There was no significant difference in the effect on WL change between using GG drills and Sx file of ProTaper to CP.
引文
[1]Wael M.Survey of attitudes,materials and methods employed in endodontic treatment by general dental practitioners in North Jordan[J].BMC Oral Health,2004,4:1-6
[2]朱亚琴,杜嵘,丁晟,等.上海市髓病治疗方法临床应用现状调查[J].上海口腔医学,2005,14(6):652-656
[3]Basmadjian-Charles CL,Farge P,Bourgeois DM.Factors influencing the long term results of endodontic treatment:a review of the literature[J].Int Dent J,2002,52(2):81-86
[4]陈晖,朱海华,李秀央,等.根管治疗技术在浙江省临床应用的现状调查[J].上海口腔医学,2007,16(1):11-14
[5]王晓仪,朱亚琴.现代根管治疗学.第二版[M].北京:人民卫生出版社,2006:26-42
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[8]王青,熊世江,窦惠芹,等.根管冠部预处理对磨牙根管工作长度的影响[J].上海口腔医学,2004,13(3):179-181
[9]Carrotte P.21st century endodontics:part 3[J].Int Dent J,2005,55(4):247-253
[10]Sjogren U,Hagglund B,Sundqvist G etc.Factors affecting the long term results of endodontic treatment[J].J Endodon.1990,16:498-504
[11]Szep S,Gerhardt T,Leitzbach C etc.Preparation of severely curved simulated root canals using engine-driven rotary and conventional hand instruments[J].Clin Oral Investig,2001,5(1):17-25
[12]Thompson SA,Dummer PM.Shaping ability of NT Engine and McXim rotary nickel-titanium instruments in simulated root canals.Part 1[J].Int Endod J,1997,30(4):262-269
[13]Rivera EM,Seraji MK.Effect of recapitulation on accuracy of electronically determined canal length[J].Oral Surg Oral Med Oral Pathol.1993,76(2):225-230.
[14]Davis RD,Marshall JG,Baumgartner JC.Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments[J].J Endod,2002,28(6):438-442
[15]徐琼,范兵,樊明文,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):136-138
[16]顾迎新,朱亚琴.根管弯曲分类与弯曲度测量方法的研究进展[J].上海口腔医学,2002,11(4):366-368
[17]丁国盛,李涛.SPSS统计教程-从研究设计到数据分析[M].北京:机械工业出版社.2005,11:77-78
[18]Peters OA,Schonenberger K,Laib A.Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography[J].Int Endod J,2001,34:221-230
[19]Cunningham CJ,Senia ES.A three-dimensional study of canal curvatures in the mesial roots of mandibular molars[J].J Endond,1992:18:294-300
[20]Kartal N,Cimilli HK.The degrees and configurations of mesial canal curvatures of mandibular first molars.J Endond,1997,23(6):358-362
[21]Schafer E,Diez C,Hoppe W etc.Roentgenographic investigation of frequency and degree of canal curvatures in human permanent teeth[J].J Endod,2002,28(3):211-216
[22]Weine FS.Endodontic therapy on the mandibular second molar:easiest to treat of the difficult,molar teeth[J].Compendium,1994,15(5):l130,1133-1136
[23]Blaskovic-Subat V.Frequency and most common localisation of root canal curvature[J].Acta Stomatol Croat,1991,25(2):109-115
[24]Schroeder KP,Walton RE,Rivera EM.Straight line access and coronal flaring:effect on canal length[J].J Endod,2002,28(6):474-476
[25]Constante IG,Davidowicz H,Barletta FB etc.Location and angulation of curvatures of mesiobucal canals of mandibular molars debrided by three endodontic techniques[J].Braz Oral Res,2007,21(1):22-8
[26]Lim KC,Webber J.The effect of root canal preparation on the shape of the curved root canal[J].Int Endod J,1985,18(4):233-239
[27]张震康.2002-口腔科学新进展[M].北京:人民卫生出版社,2002:60
[28]Gary Chueng.镍钛机用根管器械的临床应用和注意事项[J].牙体牙髓牙周病学杂志,1999,9(增):7
[29]Yang GB,Zhou XD,Zheng YL etc.Shaping ability of progressive versus constant taper instruments in curved root canals of extracted teeth[J].Int Endod J,2007,40(9):707-714
[30]Schirrmeister JF,Strohl C,Altenburger MJ etc.Shaping ability and safety of five different rotary nickel-titanium instruments compared with stainless steel hand instrumentation in simulated curved root canals[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2006,101(6):807-813
[31]Di Fiore PM,Genov KA,Komaroff E etc.Nickel-titanium rotary instrument fracture:a clinical practice assessment[J].Int Endod J,2006,39(9):700-708
[32]Peters OA,Peters CI,Sch6nenberger K etc.ProTaper rotary root canal preparation:effects of canal anatomy on final shape analysed by micro CT[J],Int Endod J,2003,36(2):86-92
[33]雍颹,高学军.ProTaper机用镍钛锉对弯曲根管成形效果的评价[J].华西口腔医学杂志,2007,25(2):139-141
[34]Wu MK,van der Sluis LW,Wesselink PR.The risk of furcal perforation in mandibular molars using Gates-Glidden drills with anticurvature pressure[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2005,99(3):378-382
[35]Simon S,Lumley P,Tomson P etc.Protaper-hybrid technique[J].Dent Update,2008,35(2):110-112,115-116
[1]葛久禹,王铁梅,根管预备.根管治疗学[M].南京:江苏科学技术出版社,1998:126
[2]王晓仪,朱亚琴.现代根管治疗学.第二版[M].北京:人民卫生出版社,2006:26-38
[3]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].中华口腔一些杂志,2006,41(3):184-187
[4]王青,熊世江,窦惠芹等.根管冠部预处理对磨牙根管工作长度的影响[J].上海口腔医学,2004,13(3):179-181
[5]Davis PD,Marshall JG,Baumgartner JC.Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments[J].J Endod,2002,28(6):438-442
[6]Schroeder KP,Walton RE,Rivera EM.Straight line access and coronal flaring:effect on canal length[J].J Endod,2002,28(6):474-476
[7]樊明文.牙髓牙体病学.第1版[M].北京:人民卫生出版社,2003,257
[8]Wu MK,Barkis D,Roris A,Wesselink PR.Does the first file to bind correspond to the diameter of the canal in the apical region?[J].Int Endod J,2002,35:264-267
[9]Tan BT,Messer H.The effect of instrument type and preflaring on apical file size determination[J].Int Endod J,2002,35:752-758
[10]Contretras MAL,Zinman EH,Kaplan SK.Comparison of the first file that fits at the apex,before and after early flaring[J].J Endod,2001,27:113-116.
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[17]顾迎新,朱亚琴,杜嵘.根管冠部预处理对前磨牙弯曲根管预备效果的影响[J].上海口腔医学,2004,13(5):403-407
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[22]王红,黄霞,徐琼,等.根管冠部预处理和不同锥度牙胶尖对根管充填后根尖部封闭性能的影响[J].牙体牙髓牙周病学杂志,2005,15(11):627-629
[23]范兵,樊明文,边专,等.根管偏移对充填材料封闭根管能力的影[J].口腔医学纵横杂志,2001,17(2):83-87
[2]朱亚琴,杜嵘,丁晟,等.上海市髓病治疗方法临床应用现状调查[J].上海口腔医学,2005,14(6):652-656
[3]Basmadjian-Charles CL,Farge P,Bourgeois DM.Factors influencing the long term results of endodontic treatment:a review of the literature[J].Int Dent J,2002,52(2):81-86
[4]陈晖,朱海华,李秀央,等.根管治疗技术在浙江省临床应用的现状调查[J].上海口腔医学,2007,16(1):11-14
[5]王晓仪,朱亚琴.现代根管治疗学.第二版[M].北京:人民卫生出版社,2006:26-42
[6]葛久禹,王铁梅.根管治疗学[M].江苏:江苏科学技术出版社,1997:133-134
[7]Ricucci D,Langeland K.Apical limit of root canal instrumentation and obturation,part 2.A histological study[J].Int Endod J,1998,31(6):394-409
[8]王青,熊世江,窦惠芹,等.根管冠部预处理对磨牙根管工作长度的影响[J].上海口腔医学,2004,13(3):179-181
[9]Carrotte P.21st century endodontics:part 3[J].Int Dent J,2005,55(4):247-253
[10]Sjogren U,Hagglund B,Sundqvist G etc.Factors affecting the long term results of endodontic treatment[J].J Endodon.1990,16:498-504
[11]Szep S,Gerhardt T,Leitzbach C etc.Preparation of severely curved simulated root canals using engine-driven rotary and conventional hand instruments[J].Clin Oral Investig,2001,5(1):17-25
[12]Thompson SA,Dummer PM.Shaping ability of NT Engine and McXim rotary nickel-titanium instruments in simulated root canals.Part 1[J].Int Endod J,1997,30(4):262-269
[13]Rivera EM,Seraji MK.Effect of recapitulation on accuracy of electronically determined canal length[J].Oral Surg Oral Med Oral Pathol.1993,76(2):225-230.
[14]Davis RD,Marshall JG,Baumgartner JC.Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments[J].J Endod,2002,28(6):438-442
[15]徐琼,范兵,樊明文,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):136-138
[16]顾迎新,朱亚琴.根管弯曲分类与弯曲度测量方法的研究进展[J].上海口腔医学,2002,11(4):366-368
[17]丁国盛,李涛.SPSS统计教程-从研究设计到数据分析[M].北京:机械工业出版社.2005,11:77-78
[18]Peters OA,Schonenberger K,Laib A.Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography[J].Int Endod J,2001,34:221-230
[19]Cunningham CJ,Senia ES.A three-dimensional study of canal curvatures in the mesial roots of mandibular molars[J].J Endond,1992:18:294-300
[20]Kartal N,Cimilli HK.The degrees and configurations of mesial canal curvatures of mandibular first molars.J Endond,1997,23(6):358-362
[21]Schafer E,Diez C,Hoppe W etc.Roentgenographic investigation of frequency and degree of canal curvatures in human permanent teeth[J].J Endod,2002,28(3):211-216
[22]Weine FS.Endodontic therapy on the mandibular second molar:easiest to treat of the difficult,molar teeth[J].Compendium,1994,15(5):l130,1133-1136
[23]Blaskovic-Subat V.Frequency and most common localisation of root canal curvature[J].Acta Stomatol Croat,1991,25(2):109-115
[24]Schroeder KP,Walton RE,Rivera EM.Straight line access and coronal flaring:effect on canal length[J].J Endod,2002,28(6):474-476
[25]Constante IG,Davidowicz H,Barletta FB etc.Location and angulation of curvatures of mesiobucal canals of mandibular molars debrided by three endodontic techniques[J].Braz Oral Res,2007,21(1):22-8
[26]Lim KC,Webber J.The effect of root canal preparation on the shape of the curved root canal[J].Int Endod J,1985,18(4):233-239
[27]张震康.2002-口腔科学新进展[M].北京:人民卫生出版社,2002:60
[28]Gary Chueng.镍钛机用根管器械的临床应用和注意事项[J].牙体牙髓牙周病学杂志,1999,9(增):7
[29]Yang GB,Zhou XD,Zheng YL etc.Shaping ability of progressive versus constant taper instruments in curved root canals of extracted teeth[J].Int Endod J,2007,40(9):707-714
[30]Schirrmeister JF,Strohl C,Altenburger MJ etc.Shaping ability and safety of five different rotary nickel-titanium instruments compared with stainless steel hand instrumentation in simulated curved root canals[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2006,101(6):807-813
[31]Di Fiore PM,Genov KA,Komaroff E etc.Nickel-titanium rotary instrument fracture:a clinical practice assessment[J].Int Endod J,2006,39(9):700-708
[32]Peters OA,Peters CI,Sch6nenberger K etc.ProTaper rotary root canal preparation:effects of canal anatomy on final shape analysed by micro CT[J],Int Endod J,2003,36(2):86-92
[33]雍颹,高学军.ProTaper机用镍钛锉对弯曲根管成形效果的评价[J].华西口腔医学杂志,2007,25(2):139-141
[34]Wu MK,van der Sluis LW,Wesselink PR.The risk of furcal perforation in mandibular molars using Gates-Glidden drills with anticurvature pressure[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2005,99(3):378-382
[35]Simon S,Lumley P,Tomson P etc.Protaper-hybrid technique[J].Dent Update,2008,35(2):110-112,115-116
[1]葛久禹,王铁梅,根管预备.根管治疗学[M].南京:江苏科学技术出版社,1998:126
[2]王晓仪,朱亚琴.现代根管治疗学.第二版[M].北京:人民卫生出版社,2006:26-38
[3]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].中华口腔一些杂志,2006,41(3):184-187
[4]王青,熊世江,窦惠芹等.根管冠部预处理对磨牙根管工作长度的影响[J].上海口腔医学,2004,13(3):179-181
[5]Davis PD,Marshall JG,Baumgartner JC.Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments[J].J Endod,2002,28(6):438-442
[6]Schroeder KP,Walton RE,Rivera EM.Straight line access and coronal flaring:effect on canal length[J].J Endod,2002,28(6):474-476
[7]樊明文.牙髓牙体病学.第1版[M].北京:人民卫生出版社,2003,257
[8]Wu MK,Barkis D,Roris A,Wesselink PR.Does the first file to bind correspond to the diameter of the canal in the apical region?[J].Int Endod J,2002,35:264-267
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