Tomson Phillip L, Adams Nick, Kavanagh Damian, Virdee Satnam Singh
Senior Clinical Lecturer and Honorary Consultant in Restorative Dentistry, University of Birmingham School of Dentistry, College of Medicine and Health, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, United Kingdom.
Specialist Endodontist, Part-Time Clinical Lecturer in Restorative Dentistry, University of Birmingham School of Dentistry, College of Medicine and Health, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK; Madeley Dental Practice, 69 High Street, Madeley, Telford, Shropshire, TF7 5AU, United Kingdom.
Br Dent J. 2025 Apr;238(7):478-486. doi: 10.1038/s41415-025-8599-1. Epub 2025 Apr 11.
Treatment of apical periodontitis requires disinfection of the root canal system through means of biomechanical preparation. This is achieved by a process of shaping the root canal space while simultaneously using antibacterial agents to reduce microbiological load in the root canal system in order for inflammation of the periradicular tissues to resolve and the body to heal itself. The fundamental principles underlying this process have not changed in decades; however, in contrast, the armamentarium available to the clinician continues to evolve rapidly. Nickel-titanium file design has made a significant step forward in the last ten years. Areas of development have focused on the metallurgic properties, motion of the instrument and cross-sectional design. The resulting contemporary designs have allowed the clinician to manage more complex root canal systems more predictably in situations which would otherwise have proved difficult using conventional techniques; effectively, it has made it easier to prepare a root canal. These newer systems also require fewer instruments to prepare a canal and some, which have adopted a reciprocating (rotational) motion, may only require one engine-driven file. Significant energy has been devoted to attempting to enhance efficacy of irrigant activity using different techniques. Although this has shown promise in in vitro studies, this has yet to be shown to translate to an improved clinical success rate based on comparative clinical studies performed. Contemporary biomechanical techniques used to clean and shape the root canal system should result in improved confidence and predictability when managing endodontic disease.
根尖周炎的治疗需要通过生物力学预备手段对根管系统进行消毒。这是通过塑造根管空间的过程来实现的，同时使用抗菌剂来减少根管系统中的微生物负荷，以使根尖周组织的炎症消退，身体实现自我愈合。几十年来，这一过程的基本原理并未改变；然而，相比之下，临床医生可用的器械却在不断快速发展。在过去十年中，镍钛锉的设计取得了重大进展。发展领域集中在冶金性能、器械运动和横截面设计方面。由此产生的现代设计使临床医生在使用传统技术原本会很困难的情况下，能够更可预测地处理更复杂的根管系统；实际上，它使根管预备变得更容易。这些更新的系统在预备根管时也需要更少的器械，而且一些采用往复（旋转）运动的系统可能只需要一个发动机驱动的锉。人们投入了大量精力试图通过不同技术提高冲洗液的效能。尽管这在体外研究中显示出了前景，但根据所进行的比较临床研究，这尚未转化为提高的临床成功率。用于清洁和塑造根管系统的当代生物力学技术在处理牙髓疾病时应能提高信心和可预测性。
