根管手动与旋转器械预备时牙根裂纹扩展的对比分析——一项体外研究
Comparative Analysis of Crack Propagation in Roots with Hand and Rotary Instrumentation of the Root Canal -An Ex-vivo Study.
作者信息
Kumari Manju Raj, Krishnaswamy Manjunath Mysore
机构信息
Post Graduate Student, Department of Conservative Dentistry and Endodontics, J.S.S Dental College and Hospital , Mysuru India .
Professor and Head of the Department, Department of Conservative Dentistry and Endodontics, J.S.S Dental College and Hospital , Mysuru, India .
出版信息
J Clin Diagn Res. 2016 Jul;10(7):ZC16-9. doi: 10.7860/JCDR/2016/17576.8122. Epub 2016 Jul 1.
INTRODUCTION
Success of any endodontic treatment depends on strict adherence to 'endodontic triad'. Preparation of root canal system is recognized as being one of the most important stages in root canal treatment. At times, we inevitably end up damaging root dentin which becomes a Gateway for infections like perforation, zipping, dentinal cracks and minute intricate fractures or even vertical root fractures, thereby resulting in failure of treatment. Several factors may be responsible for the formation of dentinal cracks like high concentration of sodium hypochlorite, compaction methods and various canal shaping methods.
AIM
To compare and evaluate the effects of root canal preparation techniques and instrumentation length on the development of apical root cracks.
MATERIALS AND METHODS
Seventy extracted premolars with straight roots were mounted on resin blocks with simulated periodontal ligaments, exposing 1-2 mm of the apex followed by sectioning of 1mm of root tip for better visualization under stereomicroscope. The teeth were divided into seven groups of 10 teeth each - a control group and six experimental groups. Subgroup A & B were instrumented with: Stainless Steel hand files (SS) up to Root Canal Length (RCL) & (RCL -1 mm) respectively; sub group C & D were instrumented using ProTaper Universal (PTU) up to RCL and (RCL -1mm) respectively; subgroup E & F were instrumented using ProTaper Next (PTN) up to RCL & (RCL -1 mm) respectively. Stereomicroscopic images of the instrumentation sequence were compared for each tooth. The data was analyzed statistically using descriptive analysis by 'Phi' and 'Cramers' test to find out statistical significance between the groups. The level of significance was set at p< 0.05 using SPSS software.
RESULTS
Stainless steel hand file group showed most cracks followed by ProTaper Universal & ProTaper Next though statistically not significant. Samples instrumented up to 1mm short of working length (RCL-1mm) showed lesser number of cracks.
CONCLUSION
All groups showed cracks formation, the stainless steel group being the highest. Working 1mm short of apex reduces the incidence of crack formation.
引言
任何牙髓治疗的成功都取决于严格遵循“牙髓三联征”。根管系统的预备被认为是根管治疗中最重要的阶段之一。有时，我们不可避免地会最终损伤根管牙本质，而这会成为诸如穿孔、拉链状、牙本质裂纹以及微小复杂骨折甚至垂直根折等感染的通道，从而导致治疗失败。有几个因素可能导致牙本质裂纹的形成，如高浓度次氯酸钠、压实方法和各种根管预备方法。
目的
比较和评估根管预备技术及器械长度对根尖根裂发展的影响。
材料与方法
七十颗直根的离体前磨牙被固定在带有模拟牙周韧带的树脂块上，根尖暴露1 - 2毫米，然后将根尖1毫米处切片，以便在体视显微镜下更好地观察。牙齿被分为七组，每组10颗牙——一个对照组和六个实验组。A组和B组分别用不锈钢手动锉预备至根管长度（RCL）和（RCL - 1毫米）；C组和D组分别使用ProTaper Universal（PTU）预备至RCL和（RCL - 1毫米）；E组和F组分别使用ProTaper Next（PTN）预备至RCL和（RCL - 1毫米）。对每颗牙齿预备过程的体视显微镜图像进行比较。使用“Phi”和“Cramers”检验进行描述性分析对数据进行统计学分析，以找出组间的统计学显著性。使用SPSS软件将显著性水平设定为p < 0.05。
结果
不锈钢手动锉组显示的裂纹最多，其次是ProTaper Universal组和ProTaper Next组，不过在统计学上无显著差异。预备至工作长度短1毫米（RCL - 1毫米）的样本显示的裂纹数量较少。
结论
所有组均显示有裂纹形成，不锈钢组的裂纹最多。在根尖短1毫米处操作可降低裂纹形成的发生率。
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