Tomson Phillip L, Simon Stéphane R
The University of Birmingham College of Medical and Dental Sciences, School of Dentistry, St Chad's Queensway, Birmingham B4 6NN, UK.
Prim Dent J. 2016 May 1;5(2):46-53. doi: 10.1308/205016816819304196.
Prevention or treatment of apical periodontitis is aimed at disinfecting the root canal system so that the periradicular tissues are not vulnerable to attack from microbiota within the tooth. This is achieved by a process of cleaning and shaping the root canal space. The fundamental principles underlying this process have not changed in decades. In contrast, the armamentarium available to the clinician continues to evolve rapidly. The use of specially designed nickel titanium (NiTi) files to create a glidepath allows the clinician to manage tight curved canals more predictably in situations which would otherwise have proved too difficult using conventional techniques. Other files, designed to shape the canal, have been developed using metallurgic principles which permit NiTi files to be more flexible and resistant to cyclic fatigue. These newer systems also require fewer instruments to prepare a canal and some, which have adopted a reciprocating (rotational) motion, may only require one file. Progress is also being made in enhancing efficacy of irrigant activity using negative apical pressure systems, sonic and ultrasonic agitation techniques. These contemporary techniques used to clean and shape the root canal system should result in improved confidence and predictability when managing endodontic disease.
根尖周炎的预防或治疗旨在对根管系统进行消毒，以使根尖周组织不易受到牙齿内部微生物群的攻击。这是通过清理和塑形根管空间的过程来实现的。几十年来，这一过程的基本原理并未改变。相比之下，临床医生可用的器械却在不断迅速发展。使用专门设计的镍钛（NiTi）锉来建立引导通路，使临床医生在使用传统技术原本会被证明过于困难的情况下，能够更可预测地处理弯曲狭窄的根管。其他用于根管塑形的锉已根据冶金原理开发出来，使镍钛锉更具柔韧性且抗循环疲劳。这些更新的系统在预备根管时所需的器械也更少，有些采用往复（旋转）运动的系统可能只需要一根锉。在利用根尖负压系统、声波和超声波振荡技术提高冲洗液活性方面也取得了进展。这些用于清理和塑形根管系统的现代技术，在处理牙髓病时应能提高信心和可预测性。
