摘要
根管治疗术是通过根管预备、根管消毒和根管充填等步骤，消除来自根管的刺激源，利用尖周组织血运丰富、修复和再生力强的特点，治疗牙髓坏死或根尖周病的方法。其目的是：治愈牙髓坏死或尖周病，保存患牙，并恢复其功能。根管充填是将已经去除牙髓并经过预备的根管充填起来，以隔绝根管和根尖周组织的交通，防止再感染，它是根管治疗术中的一个重要步骤。其目的是：机械阻隔根管与尖周组织和口腔的交通，防止尖周组织的破坏或促进已破坏组织的愈合。
近年来，国内外对Vitapex根管充填糊剂和热熔牙胶的研究较多，但基础与临床相结合的研究报道较少。本实验采用临床实验与基础实验相结合的方法，评价了牙胶尖+氧化锌丁香油糊剂、Vitapex+牙胶尖、Thermafil热熔牙胶三种根管充填材料的性能和短期临床疗效。实验共分三个部分：一、Thermafil热熔牙胶、Vitapex+牙胶尖、氧化锌丁香油糊剂+牙胶尖的微渗漏实验研究
选取50个新鲜拔除的人单根管牙，在釉牙骨质界处切除牙冠。将所有牙根随机分为5组，每组10个。3个实验组分别用牙胶尖+氧化锌丁香油糊剂、Vitapex+牙胶尖和Thermafil热熔牙胶根管充填；剩余的两组中，一组根管预备后不进行充填，另一组不进行根管预备，也不进行根管充填。用印度墨水染色法对比三种根管充填材料对离体人牙根管的密封性能。结果如下：氧化锌丁香油糊剂+牙胶尖组、Vitapex+牙胶尖组和Thermafil热熔牙胶组的平均染色线长度分别为3.36±0.42mm、2.09±0.19mm、
第四军医大学硕士学位论文
——
l刀sed．37mm。统计学分析发现，用Vitapex糊剂＋牙胶尖或Thermafil热熔
牙胶进行根管充填，产生的根管封闭性明显优于用氧化锌丁香油十牙胶尖
进行根管充填爬功．05）；而Vtapex糊剂十牙胶尖和Thermafil热熔牙胶两组
比较时，则无显著的统计学差异①川刀5）。
二、去除拈污层对根管微渗漏影响的实验研究
选取60个新鲜拔除的人单根管牙，在釉牙骨质界处切除牙冠。将所有
牙根随机分为3组，每组20个；分别用牙胶尖十氧化锌丁香油糊剂、Vitapex
十牙胶尖和 Thermafil热熔牙胶根管充填；每组中有 10个牙根根管预备时
保留沾污层，另外10个去除用污层。用印度墨水染色法对比研究去除沾污
层对根管充填材料密封性能的影响。结果：牙胶尖十氧化锌丁香油糊剂组
中，保留和去除珐污层组的染色线长度均值分别为：3．36t0．42mm。
3．42t0．65mm：Vtapex十牙胶尖组中，染色线长度均值分别为：＊刀9i0．19mm、
1．70t0．22mm；Thermafil 热熔牙胶组中，染色线长度均值分别为：
l刀5t0．37mm、0．56i0．llmm。三个实验组中，去除珐污层或保留沾污层对
根管微渗漏影响的统计学差异均不显著（P＞0刀5）。提示去除沽污层对根管
材料的密封性能无显著影响。
三、Vitapex根管充填材料的短期临床疗效观察
通过临床对照研究，采用单盲法评价牙胶尖＋氧化锌丁香油糊剂、
Vitapex糊剂＋牙胶尖两种根管充填材料的短期临床疗效。将需要进行根管
治疗的患牙随机分成两组：氧化锌丁香油糊剂＋牙胶尖组、VitaPex糊剂十
牙胶尖组。术后3、6、12个月复查，比较疗效。结果显示：术后3个月，
氧化锌丁香油糊剂十牙胶尖组和VitaPex糊剂十牙胶尖组的有效率分别为
80．3％和刃．1％，有显著统计学差异T二0刀20＜0刀引；术后6个月，氧化
、3．
第四军医大学硕士学位论文
一
锌丁香油糊剂十牙胶尖组和Vitapex糊剂十牙胶尖组的有效率分别为82％和
95％，也有显著统计学差异T二0．022＜O．0引；术后12个月，氧化锌丁香
油糊剂十牙胶尖组和Vtapex糊剂十牙胶尖组的有效率分别为sl．3％和
89．4％，无显著统计学差异o二0．694为刀5人提示 VtcyCX是一种短期临床
疗效较好的根管充填材料。
Root canal therapy is a method of treating pulp necrosis and periapical diseases with the help of periapical tissues which are characterized by abundant blood flow and strong ability of repair and regeneration. It can eliminate the stimulation from root canal by following steps: preparation, disinfection and obturation of the root canal. Main purpose of the treatment is to cure the teeth with pulp necrosis or periapical diseases. The function of root canal filling, which is one of the major steps of root canal therapy, is to obturate the root canal that has been prepared and eliminate all portals of entry between the root canal and periodontium or oral cavity.
Many studies at home and abroad have focused on Vitapex and heated gutta-percha in recent years, but only a few combined studies of basic and clinical investigation have been reported. Thus, the purpose of this study is to evaluate the performance and clinical short-term therapeutic effect of three root canal filling materials, including Vitapex + gutta-percha, zinc oxide-eugenol paste+ gutta-percha and Thermafil. The experiment was divided into three parts:
1. In vitro study on microleakage of Vitapex + gutta-percha, zinc
-5-
oxide-eugenol paste* gutta-percha and Thermafil
Freshly extracted fifty single-rooted human teeth were selected for this experiment and cut at the amelocemental junction using a diamond disk under water coolant. All roots were randomly divided into five groups of 10 roots each. The roots of three experimental groups were prepared and filled with zinc oxide-eugenol paste+ gutta-percha (Group A), Vitapex + gutta-percha (Group B) and Thermafil(Group C), respectively. 10 canals were prepared but not filled and remaining 10 canals were left untreated. Apical microleakage was evaluated with Indian Ink dye penetration. The results showed that mean depths of microleakage for group A, B and C were 3.36?.42mm, 2.09?.19mm and 1.05?.37mm respectively, there was significant difference between zinc oxide-eugenol paste+ gutta-percha group and Vitapex + gutta-percha or Thermafil group(P<0.05), and the sealing ability of Vitapex + gutta-percha and Thermafil was better than that of zinc oxide-eugenol paste+ gutta-percha. No significant difference between Vitapex + gutta-percha and Thermafil was found(P>0.05).
2. Effect of removal of the smear layer on apical microleakage Freshly extracted sixty single-rooted human teeth were selected for this experiment and cut at the amelocemental junction using a diamond disk under water coolant. All roots were randomly divided into three groups of 20 roots each. The smear layers of 10 roots of each group were removed by 15% EDTA after the preparation. The roots of three groups were filled with zinc oxide-eugenol paste+ gutta-percha (Group A), Vitapex + gutta-percha (Group B)
-6-
and Thermafil(Group C), respectively. Apical microleakage was evaluated with Indian Ink dye penetration. The results showed that mean depths of microleakage in root canals with or without the smear layer in Group A, B and C were 3.36?.42mm, 3.42?.65mm, 2.09?.19mm, 1.70?.22mm 1.05?.37mm and 0.56?.11mm respectively. No significant difference was found between root canals with or without smear layer in all three groups (P>0.05) .It suggested that removal of the smear layer had no effect on the sealing ability of root canal materials.
3. Clinical short-term therapeutic effect of Vitapex in root canal filling The purpose of this study was to compare the clinical short-term therapeutic effect of Vitapex with zinc oxide-eugenol paste+ gutta-percha in root canal filling. 161 teeth were randomly divided into two groups. The root canals of 82 teeth (Group A) were filled with zinc oxide-eugenol paste+ gutta percha, those of 79 teeth (Group B) were filled with Vitapex + gutta percha. The therapeutic effects were evaluated by follow-up of 3, 6 or 12 months. The results showed that efficiency rates of group A and group B were 80.3% , 93.1% (after 3 months), 82% , 95%( after 6 months), 81.3% , 89.4%( after 12 mont
引文
(1) Gartner AH, Dorn SO. Advances in endodontic surgery. Dent Clin North Am, 1992, 36: 357-379
(2) 王素文，韩林，刘建平．用镍钛合金针做固体根管充填剂的临床研究．中华口腔医学杂志，1994，29(3)：183-185
(3) 张举之．口腔内科学(第3版)．北京：人民卫生出版社，1997：149
(4) 谢欣梅，肖明振，陈礼森．复方羟磷灰石钛尖根管充填料的临床研究．牙体牙髓牙周病学杂志，1997，7(4)：256-257
(5) 翁雨来．磷酸钙生物陶瓷应用于盖髓、根管充填研究进展．国外医学口腔医学分册，1987，14：267-269
(6) 刘敏川．根管充填方法的现状述评．国外医学口腔医学分册，1995，22(5)：285-290
(7) Smith JJ, Mongornery S. J. Comparison of apical seal: chloroform versus halothothane-dipped gutta-percha cones. J Endod, 1992, 18(4): 146-149
(8) Scott AC, Vire DE. An evaluation of Thermafil endodontic obturation technique. J Endod, 1992, 18(7): 520-523
(9) 刘国勤，宋培智，徐逸敏．磁性固定根充材料临床应用分析．牙体牙髓牙周病学杂志，1995，5(3)：158-159
(10) 王青．热牙胶注射根管充填封闭性的研究．中华口腔医学杂志，1996，31(3)：160-162
(11) Sweatman TL, Baumgartner JC, Sakaguchi RL. Radicular temperatures associated with thermoplasticized gutta-percha. J Endod, 2001,
27(8):512-515
(12) Clinton K, Van Himel T. Comparison of a warm gutta-percha obturation technique and lateral condensation. J Endod, 2001, 27(11):692-695
(13) Mendoza KA, Manfra Marretta S, Siegel AM, et al. Comparison of two heated gutta-percha and sealer obturation techniques in canine teeth of dogs. J Vet Dent, 2000, 17(2):69-74
(14) Smith RS, Weller RN, Loushine RJ, et al. Effect of varying the depth of heat application on the adaptability of gutta-percha during warm vertical compaction. J Endod, 2000, 26(11):668-672
(15) Torabinejad M, Hong CV, Pitt Ford TR, et al. Antibacterial effect of some root and filling materials. J Endod, 1995, 121(8):403-406
(16) Garcia-Godoy F. Evaluation of an iodoform paste in root canal therapy for infected priamary teeth. J Dent Child, 1987, 54(1):30-34
(17) Jose J. F.. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review[J]. Int Endod J, 1999, 32(3):361-369
(18) Han GY, Park SH, Yoon TC. Antimicrobial activity of Ca(OH)_2 containing pastes with Enterococcus faecalis in vitro[J]. J Endod, 2001, 27(5):328-32
(19) Cotran RS, Kumar V, Collins T. Robbins pathologic basis of disease, 6th edn. Philadelphia, USA: W. B. Saunder, 1999, 564
(20) Voet D. Biochemistry. New York, USA: 1995, 251
(21) Kontakiotis E, Nakou M, Georgopoulou M. In vitro study of the indirect action of calcium hydroxide on the anaerobic flora of the root canal. Int
Endod J 1995, 28(6): 285-289
(22) Siqueira JF, Uzeda M. Intracanal medicaments: evaluation of the antibacterial effects of chlorhexidine, metronidazole and calcium hydroxide associated with three vehicles. J Endod, 1997, 23(2): 167-169
(23) Siqueira JF. Influence of different vehicles on the antibacterial effects of calcium hydroxide. J Endod, 1996, 22(10): 663-665
(24) Siqueira JF. Recontamination of coronal unsealed root canals medicated with camphorated paramonochlorophenol or calcium hydroxide pastes after saliva challenge. J Endod, 1998, 24(1): 11-14
(25) Peters L. B., Winkeloff A. J. van, Buijs J. F.. Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions. Int Endod J, 2002, 35(1): 13-21
(26) De Moor R. J. G., De Witte A. M. J.. Periapical lesions accidentally filled with calcium hydroxide. Int Endod J, 2002, 35(9): 946-958
(27) 吴海珍，王林艳，汪学华等．氢氧华钙用于封药的动物实验研究．牙体牙髓牙周病学杂志，2002，12(6)：314-316
(28) Weiger R, Rosendahl R, Lost C. Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions. Int Endod J, 2000, 33(3): 219-226
(29) 秦念红，邹韵秋．改良氢氧化钙糊剂与甲醛甲酚在根管消毒中的抗菌效果比较．牙体牙髓牙周病学杂志，2000，12(4)：219-220
(30) Oztan MD. Endodontic treatment of teeth associated with a large periapical lesion. Int Endod J, 2002, 35(1): 73-78
(31) Huang F-M, Tai K. W., Chang M. Y.. Cytotoxicity of resion-, zinc oxide-eugenol-, and calcium hydroxide-based root canal sealers on human periodontal ligament cells and permanent V79 cells. Int Endod J, 2002, 35(1):153-158
(32) Tanaka M, Kato K, Ono H, et al. Chemical change of calcium hydroxide contained in root canal filling materials in serum. Shoni Shikagaku Zasshi, 1989, 27(1):41-5
(33) Metin A, Abbasoglu, M. Uysal, et al. Cytotoxicity of Root Canal Filling Materials on Rat Connective Tissues. California: Oral tissues toxicology Ⅱ, San Diego Convention Center, 2002, 274
(34) Nurko C, Ranly DM, Garcia-Godoy F, et al. Resorption of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth: a case report[J]. Pediatr Dent, 2000, 22(6):517-20
(35) Thomas A. M. Elimination of infection in pulpectomized deciduous teeth: A short time studying of Iodoform paste. J Endod, 1994, 20(5):233-5
(36) Kawakami T, Nakamura C, Eda S. Effects of the penetration of a root canal filling material into the mandibular canal. 1. Tissue reaction to the material [J]. Endod Dent Traumatol, 1991, 7(1):36-41
(37) Kawakami T, Nakamura C, Hasegawa H, et al. Ultrastructural study of initial calcification in the rat subcutaneous tissues elicited by a root canal filling material. Oral Surg Oral Med Oral Pathol, 1987, 63(3):360-365
(38) American Association of Endodontists Response on Biocalex~(TM) 6/9: Case of the Month. J Endod, 2001, 27(12):789-790
(39) Estrela C, Sydney GB, Bammann LL, et al. Mechanism of action of calcium hydroxyl ions of calcium hydroxide on tissue and bacteria. Braz Dent J, 1995, 6: 85-90
(40) Dalat DM, Onal B. Apical leakage of a new glass ionomer root canal sealer. J Endod, 1998, 24(3): 161-163
(41) Huang TH, Kao CT. PH measurement of root canal sealers. J Endod, 1998, 24(2): 236-238
(42) 侯本祥．玻璃离子粘固剂研究进展．国外医学口腔医学分册，1992，19：581-583
(43) 李永生，李曙辉，李映芳．吲哚拉辛根管充填治疗猴牙根尖周炎的实验研究．昆明医学院学报，1998，19(4)：4-6
(44) 凌均启．新型药物控释根充尖用于牙髓尖周病的可行性研究．牙体牙髓牙周病学杂志，1995，5(4)：195-197
(45) 邹静．乳牙根管充填材料．国外医学口腔医学分册，1999，26(5)：265-267
(46) 雍畏，王嘉德，碘化钠显影塑化剂的初步研究．现代口腔医学杂志，1992，10(3)：193-195
(47) 牛忠英．磁性胶体根管充填材料密封性能的研究．口腔医学杂志，1993，(1)：23-25
(48) 徐逸敏，宋培智，史俊南等．两种磁胶根管充填料的临床疗效对比观察．牙体牙髓牙周病学杂志，1997，7(4)：272-273
(49) 徐逸敏，史俊南，肖明振．新型磁胶根管充填料的研制和一般特性研究．牙体牙髓牙周病学杂志，1993，3(4)：210-211
(50) Kuttler Y. Microscopic investigation of root apexes. JADA, 1995, 50:544-522
(51) Green E. N. Microscopic investigation of root canal diameters. JADA, 1998, 57:634-644
(52) Baher N. A. Scanning electron microscopic study of the efficacy of various irrigating solutions. J Endod, 1975, 1(4):127-135
(53) Carns E. J., Skidmore A. E. Configuration and deviations of root canals of maxillary first premolars. Oral Surg, 1973, 36(8):880-886
(54) Fisher D. E., Ingersoll N, Bucher J. F. Anatomy of the pulpal canal: three dimensional visualization. J Endod, 1975, 1(1):22-25
(55) Don Robertson, Jose Leeb, Mike Mckee, et al. A clearing technique for the study of root canal systems. J Endod, 1980, 6(1):421-424
(56) De Moor R, Hommez G. The importance of apical and coronal leakage in the success or failure of endodontic treatment. Rev Belge Med Dent 2000, 55(4):334-344
(57) Siqueira JF Jr, Rocas IN, Abad EC, et al. Ability of three root-end filling materials to prevent bacterial leakage. J Endod, 2001, 27(11):673-675
(58) Wallis E, Andelin, David F, et al. Microleakage of resected MTA. J Endod, 2002, 28(8):573-575
(59) Ludovic Pommel, Bruno Jacquot, Jean Camp. Lack of correlation among three methods for evaluation of apical leakage. J Endod, 2001, 27(5):347-351
(60) Charles Roy, Billie, Thomas, et al. Effect of an acid environment on
leakage of root-end filling materials. J Endod, 2001, 27(1):7-9
(61) Edgar, Schafer, Gudrun, et al. Effect of three different sealers on the sealing ability of both Thermafil obturators and cold laterally compacted gutta-percha. J Endod, 2002, 28(9): 638-641
(62) Siriporn Timpawat, Suwit Wimonchit, Noppakun, et al. A comparison of techniques for assessment of coronal dye leakage. J End, 2002; 28(1): 1-4