三种机用镍钛器械预备弯曲根管的临床评价

三种机用镍钛器械预备重度弯曲根管的临床评价

贾卫青1，刘继红2，王慧茹1

(030006 山西太原武警山西总队医院口腔科)

【摘要】目的评价ProTaper, Mtwo, K3三种机用镍钛器械预备重度弯曲根管的临床疗效。方法选取患有牙髓炎或根尖周炎的、有重度弯曲根管的磨牙90颗，随机分为三组，分别使用机用镍钛器械ProTaper, Mtwo, K3预备根管，其中Mtwo组采用单一长度技术预备，其余两组采用冠根向深入法预备，三组均采用侧压充填法充填根管。根据治疗前后的X线片评价根管预备效果以及根充效果，比较根管预备时间，术后疼痛，器械折断数量。使用SPSS13.0软件包进行统计分析，根管弯曲度和操作时间的比较用t检验，根管偏移、器械折断和术后疼痛的发生用χ2检验。结果机用镍钛器械能较好地维持重度弯曲根管的弯曲度和走向，Mtwo组未出现根管偏移，ProTaper 和K3组各有1例根管偏移；ProTaper和Mtwo组各有1例发生器械折断；Mtwo组有1例出现术后疼痛；Mtwo的操作时间较ProTaper 和K3短。结论3种机用镍钛器械预备重度弯曲根管效率高，成形效果好，且较少有根管内并发症发生。Mtwo系统采用单一长度技术预备更简单，预备时间短且有效，但临床操作中须注意预防器械折断和术后疼痛的发生。

【关键词】单一长度技术；冠根向深入法；根管预备；机用镍钛器械Clinical effect of three kinds of nickel-titanium rotary instrument on preparing severely curved canals

Jia Weiqing, Liu Jihong, Wang Huiru (Dentistry of Shanxi Armed

Police Corps Hospital , Taiyuan 030006)

【Abstract】Objective To evaluate clinical effects of three types of nickel-titanium rotary instruments on preparing severely curved canals. Methods Ninty teeth with curved root canals need to be treated for pulpal or periapical involvement, were randomly divided into three groups, were instrumented by ProTaper, Mtwo and K3. All teeth were obturated by lateral compaction technique. Treatment effect and obturated effect of three groups were evaluated according to pre- and post-operative X-ray films.The time for root canal preparation, complication after root cananl preparation, number of broken instruments were compared. All statistical analysis was performed using SPSS13.0 software package. Data of root canal curvatures and preparation time was compared using t test; the incidence of complications of root canal treatment and postoperative pain was analyzed using Chi-square test. Results The NiTi rotary instruments could keep the curvature and flow of curved canals very well. There was one transportation in ProTaper and K3 group separately. Two rotary instruments fractured in ProTaper and Mtwo group. Postoperative pain seldom occurred in Mtwo group. The operative time was shorter for Mtwo than that of ProTaper and K3. Conclusion With the NiTi rotary instruments, ProTaper, Mtwo and K3, curved root canals can be prepared effectively and quickly. The Mtwo instrument is much

easier and faster during preparation with single length technology; however, the problem of instrument separation and endodontic flare-up should be prevented.

【Key words】single length technology；crown down technology；root canal preparation；nickel-titanium rotary instrument

根管预备过程中保持根管原有的弯曲度和走向十分重要，有利于根管的清理成形。创造良好的根管充填形状是确保根管治疗成功的关键步骤之一，但由于根管系统的复杂性和预备器械物理性能的影响，在弯曲根管的预备中常出现根尖孔敞开、根管偏移、侧壁穿孔、台阶形成等并发症[1]。镍钛器械具有超弹性和良好的抗扭断性，预备弯曲根管时成形效果好，可有效减少根管内并发症的出现[2]。不同类型的镍钛器械工作刃设计不同，其根管成形效果也可能存在差异。本研究使用三种机用镍钛器械ProTaper, Mtwo, K3预备弯曲根管，比较三者根管预备与充填效果，并对三种根管锉的预备时间，术后疼痛，器械折断数量等进行评价。

1 材料与方法

1.1 研究对象与分组

选择2010年1月~2011年12月在武警山西总队医院口腔中心就诊的患者为本研究的对象，年龄21~65岁，平均40岁。纳入标准：①诊断为急、慢性牙髓炎或根尖周炎的恒磨牙；②患牙根尖孔已完全形成且根管通畅；③无牙髓治疗史；④按Schneider法[3]测量根管弯