标题：不同方法根管治疗对慢性根尖周炎患者填充物的清除效果

      作者：张彩宁 1，赵婧 2，白鸽 1    宝鸡市口腔医院牙体牙髓科 1、口腔外科 2，陕西 宝鸡 721000

      卷次： 2019年30卷8期

      【摘要】 目的 研究三种方法根管治疗对慢性根尖周炎患者填充物的清除效果。方法 选取宝鸡市口腔医院2017年11月至2018年11月因慢性根尖周炎拔除的上颌切牙69颗进行根管预备、冷侧压法充填、玻璃离子封闭1个月，按照治疗方法分成A、B、C三组，每组 23颗。A组应用Reciproc单只镍钛锉清理根管内充填材料，B组应用Protaper再治疗镍钛锉清理根管内充填材料，C组应用G钻+不锈钢手动H锉清理根管内充填材料。观察并比较三组样本牙根管治疗后根管内残留充填物效果、根管治疗后根管壁残留碎屑评分情况、去除根管内充填物所用时间、推出根尖孔碎屑量以及并发症发生情况。结果 A组根尖 1/3和根中 1/3根管壁残留碎屑评分[(2.91±0.43)分、(2.31±0.46)分]和B组根尖1/3和根中1/3根管壁残留碎屑评分[(3.31±0.55)分、(2.71±0.64)分]均明显优于C组[(4.11±0.74)分、(3.26±0.79)分]，且A组根管壁残留碎屑评分又明显优于B组，差异均具有统计学意义(P<0.05)；A组和B组颊舌向根中、根尖根管内留充填物占比和近远中根中、根尖根管内留充填物占比均优于C组，差异均具有统计学意义(P<0.05)，但A、B两组间比较差异均无统计学意义(P>0.05)；A组预备完成总时间和到达工作长度所用时间分别为(422.22±135.40) s、(158.32±69.30) s，B组的预备完成总时间和到达工作长度所用时间分别为(401.09±91.55) s、(204.58±83.48) s，均明显少于C组的(821.15±164.11) s和(256.21±125.66) s，差异均具有统计学意义(P<0.05)，但A、B组间比较差异均无统计学意义(P>0.05)；A组推出根尖孔碎屑量为(0.07±0.01) mg，少于B组的(0.13±0.02) mg，B组又少于C组的(0.31±0.03) mg，差异均具有统计学意义(P<0.05)；A组、B组和C组的并发症发生率分别为 17.39%、21.74%和26.09%，差异无统计学意义(P<0.05)。结论 Reciproc单只镍钛锉、Protaper再治疗镍钛锉以及G钻+不锈钢手动H锉均不能完全清除根管内填充物，但镍钛器械在操作时间、清除效果、并发症发生情况以及推出根尖孔碎屑量方面均明显优于手动器械，而镍钛器械中单只锉在牙齿保护和填充物清除效果中更具优势。
      【关键词】 根管治疗器械；根管疗法；慢性根尖周炎；填充物；镍钛锉；根管充填
      【中图分类号】 R781.34+1 【文献标识码】 A 【文章编号】 1003—6350（2019）08—1035—04

Effect of different methods of root canal therapy on filler clearance in patients with chronic apical periodontitis.ZHANG Cai-ning 1, ZHAO Jing 2, BAI Ge 1.
Dental Endodontics 1, Oral Surgery 2, the Stomatological Hospital of Baoji City,Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To study the effect of three methods of root canal therapy on filler clearance in patientswith chronic apical periodontitis. Methods A total of 69 patients who underwent maxillary incisors extraction due tochronic apical periodontitis in the Stomatological Hospital of Baoji City from November 2017 to November 2018 wereselected and treated with root canal preparation, cold lateral pressure filling, and glass ion blocking for 1 month. Accord-ing to the treatment method, they were divided into three groups of A, B and C, with 23 pieces in each group. Group Aused Reciproc single nickel-titanium tantalum to clean the filling material in the root canal, group B was treated with Pro-taper re-treatment of nickel-titanium tantalum to clean the filling material in the root canal, and group C used G drill andstainless steel materials H series to clean the filling material in the root canal. The effects of residual filler in the root ca-nal after root canal treatment in three groups were observed and compared, as well as the residual debris score of the rootcanal wall after root canal treatment, the time taken to remove the filler from the root canal, the amount of apical debrisin the sharp hole, and the occurrence of complications. Results The residual debris score of the root wall at 1/3 of theroot tip and 1/3 of the root wall was respectively (2.91±0.43) points and (2.31±0.46) points in group A, and (3.31±0.55) points and (2.71±0.64) points in group B, significantly better than corresponding (4.11±0.74) points and (3.26±0.79) points of group C; and the residual debris score of the root canal wall of group A was significantly better than thatof group B; all differences were statistically significant (P<0.05). The proportion of residual fillings near the distal rootand root tips at the buccolingual dimension and on the mesial and distal surfaces of group A and group B were betterthan those of the group C (P<0.05); however, there were no statistically significant differences between group A andgroup B (P>0.05). The total preparation time and the time taken to reach the working length in group A were respective-ly (422.22±135.40) s and (158.32±69.30) s, and the corresponding time in group B were respectively (401.09±91.55) sand (204.58±83.48) s, which were significantly less than corresponding (821.15±164.11) s and (256.21±125.66) s in