Protaper器械治疗不可复性牙髓炎中残髓及IAE关系临床探究.docVIP

Protaper器械治疗不可复性牙髓炎中残髓及IAE关系临床探究[摘要]目的:探讨Protaper镍钛器械根管预备不可复性牙髓炎后残髓与IAE的关系。方法:按Crown-down预备技术进行根管预备,约诊时记录初次预备后是否疼痛和发生时间、程度并做再次清理预备,仔细观察是否存在残髓和预备过程疼痛与否,必要时行多次清理和预备。结果:第1次预备后疼痛者往往在第2次预备时发现残髓。结论:残髓的存在是导致根管治疗期间疼痛应足够重视的原因之一,约诊期间最好行二次或以上次数的根管清理和预备。 [关键词]Protaper镍钛器械;根管治疗术;残髓;根管治疗期间急症 [中图分类号]R783[文献标识码]A [文章编号]1008-6455(2010)09-1363-03 Clinical study of relation of the residual pulp and the IAE on treatment of irreversible pulpitis by Protaper Ni-Ti instrument LIU Shu-ping,WANG Lin-hu,SUN Shi-rao (1.Department of Stomatology,the 161th Hospital of People’s Liberation Army Wuhan 430010;2.Department of Stomatology,Wuhan General Hospital of Guangzhou Command) Abstract: ObjectiveTo investigate their relationship between the residual pulp and the IAE on root canal preparation of irreversible pulpitis by Protaper nickel-titanium instruments. MethodsRoot canal preparation was made by crown-down technique .The time and extent of pain were recorded after the first root canal preparation.And then,a clear preparation was again made,to carefully observe whether there is residual pulp and pain in preparation process. If necessary,many times of cleaning and preparation were used. ResultsResidual pulp were often found at the second preparation,when the pain was found after the first preparation. ConclusionResidual pulp was lead to one of the pain reasons during root canal therapy.It should be sufficient attention.Two times and more times root canal cleaning and preparation should used during appointment. Key words:Protaper Ni-Ti instruments;root canal therapy;residual pulp;IAE 根管治疗术是治疗牙髓病和根尖周病最有效的方法已经得到人们的公认,随着现代根管治疗学的发展,许多新的理念和器械广泛应用于实践,极大的提高了根管治疗的成功率,但根管治疗期间急症(endodonticinterappointmentemergency, IAE)一直困扰临床,是目前较为棘手的问题之一。根管治疗期间急症是指根管治疗期间的急性炎性反应,主要表现为剧烈的疼痛和肿胀,给患者造成很大痛苦并增加就诊次数,同时也给医患之间的沟通和信任带来障碍。有报道根管治疗期间疼痛大部分(65%)出现在根管治疗初诊后的第1天[1],如何预防和减少IAE的发生,学者们从不同的角度进行了研究,文献屡有报道。笔者自2005年以来以Protaper镍钛器械按Crow-down技术进行根管治疗术,通过长期的临床实践和观察,发现根管残髓的存在可能是IAE发生应引起足够重视的原因之一,彻底清理残髓对减少IAE的发