不同根管预备器械对磨牙弯曲根管预备效果的CT研究
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摘要
目的:采用CT扫描结合三维重建技术,评价3种根管器械K-file、Protaper、Hero642的根管预备效果。
材料与方法:选用新鲜拔除的成人上颌第一、二恒磨牙共15颗,45个根管(MBII不计),随机分成3组,使用CT,在140Kv,300mA的条件下以层厚0.625mm间距扫描,将离体牙分别用手用K-file、机动Protaper、机动Hero642进行预备,将预备后的离体牙再次以相同条件进行CT扫描,将图象以DICOM格式输出保存,建立三维数字模型,对根管预备前、后的横截面面积、根管内容积、根管内表面积及根管偏移情况进行比较分析。
结果:
1.通过CT扫描结果,成功建立牙体及牙髓三维数字模型。
2.在根管预备前后的横截面面积、根管内容积、根管内方面Protaper组最大,分别为1.05±0.54(mm2),4.17±3.36(mm3),14.35±2.26(mm2);手用K-file组最小,分别为0.59±0.34(mm2),1.27±1.20(mm3),9.67±7.88(mm2);经LSD法比较组间差异,Protaper组与K-file组有统计学差异,K-file组与Hero642组无统计学差异。
3.在根管预备前后根管偏移量方面:手用K-file组最大,为0.45±0.19(mm);机动Hero642组最小,为0.22±0.13(mm);经LSD法比较组间差异,K-file组与Protaper组、K-file组与Hero642组有统计学差异,Protaper组与Hero642组无统计学差异。
结论:
1.机动镍钛根管预备器械具有良好的根管切割能力,机动Protaper优于机动Hero642。
2.在对磨牙弯曲根管的预备中,机动镍钛根管预备器械保持原有根管解剖走行的能力优于手用不锈钢器械。
3.使用CT扫描建立牙髓三维数字模型,并且以根管预备前后根管横截面面积、根管内容积、根管内表面积差值,以及预备前后根管同一截面中点距离作为测量评价指标,是一种简单、准确、无创的评价根管预备效果的方法。
Objective :Introduces one kind of appraisal root canal preparation effect the new method,Establishes using the software the large-scale CT scanning image the three dimensional numerical model, and compares 3 kind of root canal preparation instrument different preparation effect with this method the research.And will provide certain instruction for the next clinical work.
Methods :Selects new wiping out the adult upper jaw first, two does a lot of talking permanently 15, 45 root canals (MBII, does not count), divides into 3 groups stochastically; Uses CT to scan the experimental model under the 140Kv,140Ma condition, by level thick 0.625mm spacing scanning, data recording.Will scan after the exsomatize to use the different root canal preparation instrument to carry on the preparation separately, will prepare after the exsomatize tooth once more to carry on the scanning by the same condition, will scan the image by the DICOM form output backup, will prepare the before and after data to the exsomatize tooth to carry on the comparative analysis, and will establish the three dimensional numerical model.All root canal preparation operates by the identical person.
Result:
1. tooth bodies and dental pulp three-dimensional model success establishment.
2.3 groups of instruments the plan area, the volume, the surface area interpolation biggest are the Protaper groups, smallest is the manual K-file group; The LSD law 22 comparison groups the difference, the Protapergroup and the K-file group, the Hero642 group have the difference, the K-file group and the Hero642 group do not have the difference.
3. Between three groups of instruments, the K-file group root canal displacement quantity is biggest; The LSD law compares 22 comparison groups the difference, the K-file group and the Protaper group, the Hero642 group has the difference, between the Protaper group and the Hero642 group does not have the difference.
Conclusion:
1. in the cutting ability, the mobile Protaper nickel titanium file surpasses the Hero nickel titanium file and the stainless steel K file.
2. this experiment proved, the manual stainless steel instrument occurs the root canal displacement is biggest, but between 2 group of nickel titanium instrument then the not remarkable difference, this kind of displacement main origin in the instrument itself material quality reason, with mobile manual has nothing to do with.
3. uses large-scale CT to scan and establishes the three dimensional image model to study around the root canal preparation the shape change method although easy and feasible, but with micro compares in the accuracy also has certain disparity.
材料与方法:选用新鲜拔除的成人上颌第一、二恒磨牙共15颗,45个根管(MBII不计),随机分成3组,使用CT,在140Kv,300mA的条件下以层厚0.625mm间距扫描,将离体牙分别用手用K-file、机动Protaper、机动Hero642进行预备,将预备后的离体牙再次以相同条件进行CT扫描,将图象以DICOM格式输出保存,建立三维数字模型,对根管预备前、后的横截面面积、根管内容积、根管内表面积及根管偏移情况进行比较分析。
结果:
1.通过CT扫描结果,成功建立牙体及牙髓三维数字模型。
2.在根管预备前后的横截面面积、根管内容积、根管内方面Protaper组最大,分别为1.05±0.54(mm2),4.17±3.36(mm3),14.35±2.26(mm2);手用K-file组最小,分别为0.59±0.34(mm2),1.27±1.20(mm3),9.67±7.88(mm2);经LSD法比较组间差异,Protaper组与K-file组有统计学差异,K-file组与Hero642组无统计学差异。
3.在根管预备前后根管偏移量方面:手用K-file组最大,为0.45±0.19(mm);机动Hero642组最小,为0.22±0.13(mm);经LSD法比较组间差异,K-file组与Protaper组、K-file组与Hero642组有统计学差异,Protaper组与Hero642组无统计学差异。
结论:
1.机动镍钛根管预备器械具有良好的根管切割能力,机动Protaper优于机动Hero642。
2.在对磨牙弯曲根管的预备中,机动镍钛根管预备器械保持原有根管解剖走行的能力优于手用不锈钢器械。
3.使用CT扫描建立牙髓三维数字模型,并且以根管预备前后根管横截面面积、根管内容积、根管内表面积差值,以及预备前后根管同一截面中点距离作为测量评价指标,是一种简单、准确、无创的评价根管预备效果的方法。
Objective :Introduces one kind of appraisal root canal preparation effect the new method,Establishes using the software the large-scale CT scanning image the three dimensional numerical model, and compares 3 kind of root canal preparation instrument different preparation effect with this method the research.And will provide certain instruction for the next clinical work.
Methods :Selects new wiping out the adult upper jaw first, two does a lot of talking permanently 15, 45 root canals (MBII, does not count), divides into 3 groups stochastically; Uses CT to scan the experimental model under the 140Kv,140Ma condition, by level thick 0.625mm spacing scanning, data recording.Will scan after the exsomatize to use the different root canal preparation instrument to carry on the preparation separately, will prepare after the exsomatize tooth once more to carry on the scanning by the same condition, will scan the image by the DICOM form output backup, will prepare the before and after data to the exsomatize tooth to carry on the comparative analysis, and will establish the three dimensional numerical model.All root canal preparation operates by the identical person.
Result:
1. tooth bodies and dental pulp three-dimensional model success establishment.
2.3 groups of instruments the plan area, the volume, the surface area interpolation biggest are the Protaper groups, smallest is the manual K-file group; The LSD law 22 comparison groups the difference, the Protapergroup and the K-file group, the Hero642 group have the difference, the K-file group and the Hero642 group do not have the difference.
3. Between three groups of instruments, the K-file group root canal displacement quantity is biggest; The LSD law compares 22 comparison groups the difference, the K-file group and the Protaper group, the Hero642 group has the difference, between the Protaper group and the Hero642 group does not have the difference.
Conclusion:
1. in the cutting ability, the mobile Protaper nickel titanium file surpasses the Hero nickel titanium file and the stainless steel K file.
2. this experiment proved, the manual stainless steel instrument occurs the root canal displacement is biggest, but between 2 group of nickel titanium instrument then the not remarkable difference, this kind of displacement main origin in the instrument itself material quality reason, with mobile manual has nothing to do with.
3. uses large-scale CT to scan and establishes the three dimensional image model to study around the root canal preparation the shape change method although easy and feasible, but with micro compares in the accuracy also has certain disparity.
引文
1.Smith CS,Setchell DJ,Harty FJ. Factors influencing the success of conventional root canal therapy--a five-year retrospective study.Int Endod J.1993,26(6):321-332.
2.Schilder H.Cleaning and shaping the root canal.Dent Clin North AM,1974,18(2):2 69-96 .
3.Eldeeb ME,Boraas JC. The effect of different files on the preparation shape of severely curved canals.Int Endod J.1985,18(1):1-7.
4.Walia H,Brantley WA,Gerstein H.An initial investigation of the bending and torsional properties of nitinol root canal files.J Endod,1988,14(7):346-351.
5.Zmener O, Baneqas G. Comparison of three instrumentation techniques in the preparation of simulated curved root canals.Int Endod J.1996,29(5):315-319.
6.Haikel Y,Serfaty R,Wilson P,et al.Mechanical properties of nickel-titanium endodontic instruments and the effect of sodium hypochlorite treatment.J Endod,1988,24(11):731-735.
7.Knowles KI,Ibarrola JL,Christiansen RK. Assessing apical deformation and transportation following the use of LightSpeed root-canal instruments.Int Endod J.1996,29(2)113-117.
8.Bramante CM,Berbert A,Borqes RP.A methodology for evaluation of root canal instrumentation.J endod.1987,13(5)243-245.
9.Campos JM,del Rio C.Comparison of mechanical and standard hand instrumentation techniques in curved root canals.J Endod.1990,16(5)230-234
10.Hulsmann M,Gambal A,Bahr R. An improved technique for the evaluation of root canal preparation.J Endod.1999,25(9):59-602.
11.Coleman CL,Svec TA.Analysis of nickel-titanium versus stainless steel instrumentation by means of direct digital imaging.J Endod.1996,22(11):603-60
12.Peters OA,Laib A.Three-dimensional analysis of root canal geometry by high-resolution computed tomography.J Dent Res.2000,79(6):1405.
13. 梁 睿 贞 , 吴 有 农 . 根 管 形 态 研 究 方 法 比 较 . 牙 体 牙 髓 牙 周 病 学 杂志.2005,15(11):641-644.
14.Antonpoulos KG,Attin T,Hellwiq E. Evaluation of the apical seal of root canal fillings with different methods.J Endod.1998,24(10):655-658.
15.Dowker SE,Elliott JC,Wonq F,Anderson P. Determination of mineral concentration in dental enamel from X-ray attenuation measurements.ConnectTissue Re.1998,38(1-4):61-72.
16.Nielsen RB,Alvassin AM.Microcomputed tomography: an advanced system for detailed endodontic research.J Endod.1995,21(11)561-568.
17.Rhodes JS,Ford TR,Lynch JA,et al. Micro-computed tomography: a new tool for experimental endodontology.Int Endod.1999,32(3):165-170.
18.万阔,李玉彬,景权,等.使用微焦点CT对四种根管预备器械根管预备效果的研究.北京口腔医学.2005,13(2):111-113.
19.Bjorndal L,Carlsen O,Thuesen G,et al. External and internal macromorphology in
3D-reconstructed maxillary molars using computerized X-ray microtomography. Int Endod.1999,32(2):3-9.
20.Peters OA,Laib A,Gohring TN,et al. Changes in root canal geometry after prepa- Ration assessed by high-resolution computed tomography.J Endod.2001,27(1):1-6
21.张富强,魏斌,李玲 .牙颌组织及修复体三维几何、有限元模型的设计 .上海口腔医学,2002,11(3):240-242.
22.Varady T,Martin RR,Coxt J.Reverse engineering of geometric models-an introduction.Computer Aided Design.1997,29(4):255-268.
23.Peters OA,Peters CI,Schonenberqer K,et al. ProTaper rotary root canal preparation: assessment of torque and force in relation to canal anatomy.Int Endod.2003,36(2):93-99.
24.朱亚琴 ,顾迎新 ,杜嵘 .三种器械预备磨牙弯曲根管成形能力的比较 .华西口腔医学杂志.2005,23(5):393-396.
1. Knowles KI,Ibarrola JL,Christiansen RK. Assessing apical deformation and transportation following the use of LightSpeed root-canal instruments.Int Endod J,1996,29(2):113-117.
2. Bramante CM,Berbert A,Borqes RP.A methodology for evaluation of root canal instrumentation.J Endod,1987,13(5):243-245.
3. Coleman CL,Svec TA.Analysis of nickel-titanium versus stainless steel instrumentation by means of direct digital imaging.J Endod, 1996, 22(11): 603-607.
4. Campos JM,del Rio C.Comparison of mechanical and standard hand instrumentation techniques in curved root canals.J Endod, 1990, 16(5): 230-234.
5. Hulsmann M,Gambal A,Bahr R.An improved technique for the evaluation of root canal preparation.J Endod,1999,25(9):599-602.
6. Goldman M,Sakurai-Fuse E,Turco J,White RR.A silicone model method to compare three methods of preparing the root canal.Oral Surg Oral Med Pathol Oral, 1989, 68 (4):457-461.
7. Barthel CR,Gruber S,Roulet JF.A new method to assess the results of instrumentation techniques in the root canal.J Endod, 1999, 25(8) : 535-538.
8. Nielsen RB,Alvassin AM.Microcomputed tomography: an advanced system for detailed endodontic research.J Endod,1995,21(11):561-568.
9. Peters OA,Laib A.Three-dimensional analysis of root canal geometry by high-resolution computed tomography.J Dent Res,2000,79(6):1405.
10. Rhodes JS,Ford TR,Lvnch JA.Micro-computed tomography: a new tool for experimental endodontology.Int Endod J,1999,32(3):165-170.
11. Arai Y.Tammisalo E.Development of a compact computed tomographic apparatus for dental use.Dentomaxillofac Radiol,1999,28(4):245-248.
12. Appel TR,Baumann MA.Solid-state nuclear magnetic resonance microscopy demonstrating human dental anatomy.Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2002,94(2):256-261.
13. Baumann MA,Schwebel T,Kriete A.Dental anatomy portrayed with microscopic volume investigations.Comput Med Imaging Graph, 1993, 17(3):221-228.
14. Pommel L,About I,Pashlev D.Apical leakage of four endodontic sealers.J Endod, 2003,29(3):208-210.
15. Schafer E,Lau R.Comparison of cutting efficiency and instrumentation of curvedcanals with nickel-titanium and stainless-steel instruments.J Endod, 1999,25 (6):427-430.
16. 朱 亚 琴 , 王 晓 仪 . 常 用 手 持 根 管 扩 大 器 械 根 管 成 形 作 用 的 研 究 .上 海 口 腔 医学,1998,7(1):37-39.
17. Miletic I,Ribaric SP,Karlovic Z.Apical leakage of five root canal sealers after one year of storage.J Endod,2002,28(6):431-432.
18. Oi T,Saka H,Ide Y.Three-dimensional observation of pulp cavities in the maxillary first premolar tooth using micro-CT.Int Endod J,2004, 37(1):46-51.
2.Schilder H.Cleaning and shaping the root canal.Dent Clin North AM,1974,18(2):2 69-96 .
3.Eldeeb ME,Boraas JC. The effect of different files on the preparation shape of severely curved canals.Int Endod J.1985,18(1):1-7.
4.Walia H,Brantley WA,Gerstein H.An initial investigation of the bending and torsional properties of nitinol root canal files.J Endod,1988,14(7):346-351.
5.Zmener O, Baneqas G. Comparison of three instrumentation techniques in the preparation of simulated curved root canals.Int Endod J.1996,29(5):315-319.
6.Haikel Y,Serfaty R,Wilson P,et al.Mechanical properties of nickel-titanium endodontic instruments and the effect of sodium hypochlorite treatment.J Endod,1988,24(11):731-735.
7.Knowles KI,Ibarrola JL,Christiansen RK. Assessing apical deformation and transportation following the use of LightSpeed root-canal instruments.Int Endod J.1996,29(2)113-117.
8.Bramante CM,Berbert A,Borqes RP.A methodology for evaluation of root canal instrumentation.J endod.1987,13(5)243-245.
9.Campos JM,del Rio C.Comparison of mechanical and standard hand instrumentation techniques in curved root canals.J Endod.1990,16(5)230-234
10.Hulsmann M,Gambal A,Bahr R. An improved technique for the evaluation of root canal preparation.J Endod.1999,25(9):59-602.
11.Coleman CL,Svec TA.Analysis of nickel-titanium versus stainless steel instrumentation by means of direct digital imaging.J Endod.1996,22(11):603-60
12.Peters OA,Laib A.Three-dimensional analysis of root canal geometry by high-resolution computed tomography.J Dent Res.2000,79(6):1405.
13. 梁 睿 贞 , 吴 有 农 . 根 管 形 态 研 究 方 法 比 较 . 牙 体 牙 髓 牙 周 病 学 杂志.2005,15(11):641-644.
14.Antonpoulos KG,Attin T,Hellwiq E. Evaluation of the apical seal of root canal fillings with different methods.J Endod.1998,24(10):655-658.
15.Dowker SE,Elliott JC,Wonq F,Anderson P. Determination of mineral concentration in dental enamel from X-ray attenuation measurements.ConnectTissue Re.1998,38(1-4):61-72.
16.Nielsen RB,Alvassin AM.Microcomputed tomography: an advanced system for detailed endodontic research.J Endod.1995,21(11)561-568.
17.Rhodes JS,Ford TR,Lynch JA,et al. Micro-computed tomography: a new tool for experimental endodontology.Int Endod.1999,32(3):165-170.
18.万阔,李玉彬,景权,等.使用微焦点CT对四种根管预备器械根管预备效果的研究.北京口腔医学.2005,13(2):111-113.
19.Bjorndal L,Carlsen O,Thuesen G,et al. External and internal macromorphology in
3D-reconstructed maxillary molars using computerized X-ray microtomography. Int Endod.1999,32(2):3-9.
20.Peters OA,Laib A,Gohring TN,et al. Changes in root canal geometry after prepa- Ration assessed by high-resolution computed tomography.J Endod.2001,27(1):1-6
21.张富强,魏斌,李玲 .牙颌组织及修复体三维几何、有限元模型的设计 .上海口腔医学,2002,11(3):240-242.
22.Varady T,Martin RR,Coxt J.Reverse engineering of geometric models-an introduction.Computer Aided Design.1997,29(4):255-268.
23.Peters OA,Peters CI,Schonenberqer K,et al. ProTaper rotary root canal preparation: assessment of torque and force in relation to canal anatomy.Int Endod.2003,36(2):93-99.
24.朱亚琴 ,顾迎新 ,杜嵘 .三种器械预备磨牙弯曲根管成形能力的比较 .华西口腔医学杂志.2005,23(5):393-396.
1. Knowles KI,Ibarrola JL,Christiansen RK. Assessing apical deformation and transportation following the use of LightSpeed root-canal instruments.Int Endod J,1996,29(2):113-117.
2. Bramante CM,Berbert A,Borqes RP.A methodology for evaluation of root canal instrumentation.J Endod,1987,13(5):243-245.
3. Coleman CL,Svec TA.Analysis of nickel-titanium versus stainless steel instrumentation by means of direct digital imaging.J Endod, 1996, 22(11): 603-607.
4. Campos JM,del Rio C.Comparison of mechanical and standard hand instrumentation techniques in curved root canals.J Endod, 1990, 16(5): 230-234.
5. Hulsmann M,Gambal A,Bahr R.An improved technique for the evaluation of root canal preparation.J Endod,1999,25(9):599-602.
6. Goldman M,Sakurai-Fuse E,Turco J,White RR.A silicone model method to compare three methods of preparing the root canal.Oral Surg Oral Med Pathol Oral, 1989, 68 (4):457-461.
7. Barthel CR,Gruber S,Roulet JF.A new method to assess the results of instrumentation techniques in the root canal.J Endod, 1999, 25(8) : 535-538.
8. Nielsen RB,Alvassin AM.Microcomputed tomography: an advanced system for detailed endodontic research.J Endod,1995,21(11):561-568.
9. Peters OA,Laib A.Three-dimensional analysis of root canal geometry by high-resolution computed tomography.J Dent Res,2000,79(6):1405.
10. Rhodes JS,Ford TR,Lvnch JA.Micro-computed tomography: a new tool for experimental endodontology.Int Endod J,1999,32(3):165-170.
11. Arai Y.Tammisalo E.Development of a compact computed tomographic apparatus for dental use.Dentomaxillofac Radiol,1999,28(4):245-248.
12. Appel TR,Baumann MA.Solid-state nuclear magnetic resonance microscopy demonstrating human dental anatomy.Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2002,94(2):256-261.
13. Baumann MA,Schwebel T,Kriete A.Dental anatomy portrayed with microscopic volume investigations.Comput Med Imaging Graph, 1993, 17(3):221-228.
14. Pommel L,About I,Pashlev D.Apical leakage of four endodontic sealers.J Endod, 2003,29(3):208-210.
15. Schafer E,Lau R.Comparison of cutting efficiency and instrumentation of curvedcanals with nickel-titanium and stainless-steel instruments.J Endod, 1999,25 (6):427-430.
16. 朱 亚 琴 , 王 晓 仪 . 常 用 手 持 根 管 扩 大 器 械 根 管 成 形 作 用 的 研 究 .上 海 口 腔 医学,1998,7(1):37-39.
17. Miletic I,Ribaric SP,Karlovic Z.Apical leakage of five root canal sealers after one year of storage.J Endod,2002,28(6):431-432.
18. Oi T,Saka H,Ide Y.Three-dimensional observation of pulp cavities in the maxillary first premolar tooth using micro-CT.Int Endod J,2004, 37(1):46-51.