结合锥形束CT评价两种镍钛器械预备老年人磨牙弯曲根管的效果

摘要

目的：比较镍钛器械Twisted Files(TF)和ProTaper 在老年人磨牙弯曲根管预备中的临床应用效果。方法：选择2011年8月至2013年8月在我科门诊就诊的有弯曲根管的牙髓炎或根尖周炎的老年患者磨牙90颗，随机分成三组，每组30颗， T 组和P 组分别采用机用镍钛器械Twisted Files(TF)和ProTaper 以冠向下技术预备根管， K 组采用手用不锈钢K 锉以逐步后退法预备根管，全部患牙均采用冷牙胶侧方加压技术充填。记录三组病例根管预备时间和器械折断数，根据治疗前、中、后的X 线片评价根管预备和充填情况，通过锥形束CT 记录预备前后距离根尖3mm 处根管偏移值。结果： T 组、P 组均能保持原根管的弯曲和走向，根管预备的锥度和流畅度好，根管充填质量高， T 组的偏移量比P 组和K 组的偏移量小，三组间差异有统计学意义(P<0.05)。T 组的操作时间比P 组和K 组短，三组间差异有统计学意义(P<0.05)。预备过程中T 组未发生器械折断， P 组3例发生器械折断。结论： TF 相对与Protaper 用于预备老年人磨牙弯曲根管，效率较高，成形效果佳，较安全，更适合于狭窄弯曲的老年根管。%Objective:To study and evaluate clinical application of Twisted File (TF) and ProTaper , two nickel-titanium instruments, during molar root canal preparation in elderly people.Methods:A total of 90 teeth with curved root canals , collected from August 2011 to August 2013 in Department of Stomatology, Affliliated Hospital of Jining Medical College, were prepared by TF(group t) ,ProTaper( groups p) with crown down technique in test groups and by stainless steel K files with Step-back technique in control group (group k).All root canals were filled with cold lateral condensation technique. The root canal preparation time and the numbers of broken equipment were recorded. The evaluation of preparation and root canal therapy was based on the treatment effect according to the X-ray images pre-,intra-and post-operation. Moreover, postoperative pain was also assessed. The apical transportation was calculated by cone-beam computed tomography (CBCT).Result:In both groups, root canals could maintain the original anatomy, and achieve desired result .The apical transportation and average root canal preparation time of the TF group was significantly less than that in group p and group k (P<0.05). Three ProTaper files were fractured in Protaper group, while no files were broken in TF group.Conclusion:Two rotary nickel-titanium system tested in this study are effective in the molar root canal preparation in elderly people. Compared with Protaper system, TF has better ability of higher efficiency, more secure, and thus more suitable for treating stenosis curved root canals in elderly patients.