根管预备感染控制之惑与解惑之道

doi:10.7518/hxkq.2018.06.002

华西口腔医学杂志 ›› 2018, Vol. 36 ›› Issue (6): 590-594.doi: 10.7518/hxkq.2018.06.002

根管预备感染控制之惑与解惑之道

高原,张雨,周学东,黄定明()

口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院牙体牙髓病科,成都 610041

收稿日期:2018-07-31 修回日期:2018-09-22 出版日期:2018-12-01 发布日期:2018-12-12
通讯作者: 黄定明 E-mail:dingminghuang@163.com
作者简介:高原,副教授,博士,E-mail： gaoyuan@scu.edu.cn
基金资助:
国家自然科学基金(81200781);国家自然科学基金(11472183)

Endodontic infection management in root canal preparation: question and solution

Yuan Gao,Yu Zhang,Xue-dong Zhou,Dingming Huang()

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2018-07-31 Revised:2018-09-22 Online:2018-12-01 Published:2018-12-12
Contact: Dingming Huang E-mail:dingminghuang@163.com
Supported by:
The National Natural Science Foundation of China(81200781);The National Natural Science Foundation of China(11472183)

摘要/Abstract

摘要：

牙髓及根尖周病的本质是感染,良好的感染控制是病变愈合的前提和基础。根管预备是感染控制的最关键程序,根管系统的解剖形态、根管自身感染程度、根管预备过程中的物理切削以及清理措施的选择均会影响根管感染控制的质量。治疗前应正确评估根管感染程度及解剖形态难度并选择相应的预备方案,合理配合使用成形与清理手段,严重感染的根管建议可选用新型镍钛系统、超声和激光等多种根管清理措施以更好地控制感染,促进组织愈合。

关键词: 根管预备, 感染控制, 影响因素

Abstract:

The essence of pulp and periapical disease is bacterial infection. Thus, satisfactory infection control is the premise and foundation of healing, in which root canal preparation is a critical procedure. Root canal system anatomy, infection degree, physical cutting during root canal preparation, and certain cleaning measures affect the quality of infection control. Appropriate evaluation of the grades of infected root canals before treatment is necessary because different grades of root canal infection demand various disinfection schedules to facilitate tissue healing and guarantee the long-term success rate of endodontic treatment.

Key words: root canal preparation, infection control, influence factors

中图分类号:

R781.05

高原,张雨,周学东,黄定明. 根管预备感染控制之惑与解惑之道[J]. 华西口腔医学杂志, 2018, 36(6): 590-594.

Yuan Gao,Yu Zhang,Xue-dong Zhou,Dingming Huang. Endodontic infection management in root canal preparation: question and solution[J]. West China Journal of Stomatology, 2018, 36(6): 590-594.

图/表 1

参考文献 23

[1]	Ricucci D, Siqueira JF Jr . Biofilms and apical periodontitis: study of prevalence and association with clinical and his-topathologic findings[J]. J Endod, 2010,36(8):1277-1288. doi: 10.1016/j.joen.2010.04.007 URL pmid: 20647081
[2]	Ferreira FB, Ferreira AL, Gomes BP , et al. Resolution of persistent periapical infection by endodontic surgery[J]. Int Endod J, 2004,37(1):61-69. doi: 10.1111/j.1365-2591.2004.00753.x URL pmid: 14870760
[3]	Peters OA, Paque F . Current developments in rotary root canal instrument technology and clinical use: a review[J]. Quintessence Int, 2010,41(6):479-488. doi: 10.1097/PRS.0b013e3181e3519c URL pmid: 20490390
[4]	Kishen A . Advanced therapeutic options for endodontic biofilms[J]. Endod Topics, 2010,22(1):99-123. doi: 10.1111/j.1601-1546.2012.00284.x URL
[5]	De-Deus G, Souza EM, Barino B , et al. The self-adjusting file optimizes debridement quality in oval-shaped root canals[J]. J Endod, 2011,37(5):701-705. doi: 10.1016/j.joen.2011.02.001 URL pmid: 21496675
[6]	Metzger Z, Kfir A, Abramovitz I , et al. The self-adjusting file system[J]. Endod Pract Today, 2013,7(3):189-210.
[7]	Norrington DW, Ruby J, Beck P , et al. Observations of biofilm growth on human dentin and potential destruction after exposure to antibiotics[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008,105(4):526-529. doi: 10.1016/j.tripleo.2007.11.005 URL pmid: 18329587
[8]	Siqueira JF Jr, Rôças IN, Lopes HP . Patterns of microbial colonization in primary root canal infections[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002,93(2):174-178. doi: 10.1067/moe.2002.119910 URL pmid: 11862207
[9]	Ng YL, Mann V, Gulabivala K . A prospective study of the factors affecting outcomes of nonsurgical root canal treat-ment: part 1: periapical health[J]. Int Endod J, 2011,44(7):583-609. doi: 10.1111/j.1365-2591.2011.01872.x URL pmid: 21366626
[10]	Hecker H, Bartha T, Löst C , et al. Determining the apical preparation size in premolars: part Ⅲ[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010,110(1):118-124. doi: 10.1016/j.tripleo.2010.03.001 URL pmid: 20610301
[11]	Bartha T, Kalwitzki M, Löst C , et al. Extended apical enlar-gement with hand files versus rotary NiTi files. Part Ⅱ[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006,102(5):692-697. doi: 10.1016/j.tripleo.2005.11.014 URL pmid: 17052649
[12]	Usman N, Baumgartner JC, Marshall JG . Influence of in-strument size on root canal debridement[J]. J Endod, 2004,30(2):110-112. doi: 10.1097/00004770-200402000-00012 URL pmid: 14977309
[13]	Kfir A, Moza-Levi R, Herteanu M , et al. Apical extrusion of debris during the preparation of oval root canals: a com-parative study between a full-sequence SAF system and a rotary file system supplemented by XP-endo finisher file[J]. Clin Oral Investig, 2018,22(2):707-713. doi: 10.1007/s00784-017-2144-9 URL
[14]	Lacerda MFLS, Marceliano-Alves MF, Pérez AR , et al. Cleaning and shaping oval canals with 3 instrumentation systems: A correlative micro-computed tomographic and histologic study[J]. J Endod, 2017,43(11):1878-1884. doi: 10.1016/j.joen.2017.06.032 URL
[15]	Bao P, Shen Y, Lin J , et al. In vitro efficacy of XP-endo finisher with 2 different protocols on biofilm removal from apical root canals[J]. J Endod, 2017,43(2):321-325. doi: 10.1016/j.joen.2016.09.021 URL pmid: 27939826
[16]	Torabinejad M . Endodontic microbiology[M] //Endodontics: principles and practice. 5th ed. St. Louis: Elsevier, 2015: 37-47.
[17]	Peters OA, Boessler C, Zehnder M . Effect of liquid and paste-type lubricants on torque values during simulated rotary root canal instrumentation[J]. Int Endod J, 2005,38(4):223-229. doi: 10.1111/j.1365-2591.2005.00937.x URL pmid: 15810972
[18]	Ma J, Wang Z, Shen Y , et al. A new noninvasive model to study the effectiveness of dentin disinfection by using con-focal laser scanning microscopy[J]. J Endod, 2011,37(10):1380-1385. doi: 10.1016/j.joen.2011.06.018 URL pmid: 21924186
[19]	Paqué F, Boessler C, Zehnder M . Accumulated hard tissue debris levels in mesial roots of mandibular molars after sequential irrigation steps[J]. Int Endod J, 2011,44(2):148-153. doi: 10.1111/j.1365-2591.2010.01823.x URL pmid: 21083577
[20]	Bago I, Plečko V, Gabrić Pandurić D , et al. Antimicrobial efficacy of a high-power diode laser, photo-activated disin-fection, conventional and sonic activated irrigation during root canal treatment[J]. Int Endod J, 2013,46(4):339-347. doi: 10.1111/j.1365-2591.2012.02120.x URL pmid: 22970886
[21]	Bergmans L, Moisiadis P, Teughels W , et al. Bactericidal effect of Nd:YAG laser irradiation on some endodontic pathogens ex vivo[J]. Int Endod J, 2006,39(7):547-557. doi: 10.1111/j.1365-2591.2006.01115.x URL pmid: 16776759
[22]	Peters OA, Bardsley S, Fong J , et al. Disinfection of root canals with photon-initiated photoacoustic streaming[J]. J Endod, 2011,37(7):1008-1012. doi: 10.1016/j.joen.2011.03.016 URL pmid: 21689561
[23]	Waltimo T, Trope M, Haapasalo M , et al. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing[J]. J Endod, 2005,31(12):863-866. doi: 10.1097/01.don.0000164856.27920.85 URL pmid: 16306819

感染根管类型及分级	分级依据
Ⅰ级根管	因正畸、修复等治疗需行根管治疗的
（洁净根管）	活髓牙
	意外穿髓
	外伤露髓早期
	隐裂活髓牙
Ⅱ级根管	去龋未尽穿髓
（非感染根管）	急性牙髓炎早期
	冠髓局限性部分坏死
Ⅲ级根管	急性牙髓炎晚期
（感染根管）	慢性牙髓炎
	牙髓坏死
	急性根尖周炎
	无症状慢性根尖周炎
Ⅳ级根管	慢性根尖周炎伴根尖病损较大
（严重感染根管）	慢性根尖周炎伴根尖吸收
	慢性根尖周炎伴窦（瘘）道
	慢性根尖周炎伴髓腔暴露
	慢性根尖周炎急性发作
	根管治疗失败后患牙

根管预备感染控制之惑与解惑之道

Endodontic infection management in root canal preparation: question and solution

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 1

参考文献 23

相关文章 15

编辑推荐

Metrics

本文评价

[1]	王梓, 薛明. 4种机用镍钛锉根管预备后形成牙本质微裂的研究[J]. 华西口腔医学杂志, 2024, 42(1): 75-81.
[2]	严鑫淼, 孙桃兰, 卢雨航, 谭馨, 王卓, 李淼晶. 基于机器学习的四川省12岁儿童龋齿预测模型[J]. 华西口腔医学杂志, 2023, 41(6): 686-693.
[3]	黄翠, 朱嘉康, 王茜. 桩核冠修复的感染控制[J]. 华西口腔医学杂志, 2023, 41(3): 247-253.
[4]	杨雯君, 韩佳佳, 王逸尘, 李凤翔, 杜启涛. 不同方法去除根管内充填材料的效果评价[J]. 华西口腔医学杂志, 2022, 40(6): 685-689.
[5]	吴侃, 李巍铭, 钟亦思, 程立, 唐甜, 尹伟. 成都市社区中老年人口腔健康相关生活质量评价及其影响因素分析[J]. 华西口腔医学杂志, 2022, 40(4): 440-445.
[6]	林超, 张心怡, 田洪雨, 栾可峰, 孙昊, 范欣. 潍坊市7~8岁儿童口腔卫生服务利用影响因素研究[J]. 华西口腔医学杂志, 2022, 40(2): 197-203.
[7]	孙国芳, 吴侃, 胡涛, 包崇云, 钟亦思, 尹伟. 成都市社区居民对口腔家庭医生服务模式签约意愿及其影响因素分析[J]. 华西口腔医学杂志, 2022, 40(1): 80-85.
[8]	陈益燕, Pradan Siras Prasad, 杨锦波. 302例显微根尖手术的回顾性研究[J]. 华西口腔医学杂志, 2021, 39(4): 458-463.
[9]	常乐, 徐静晨, 王翔宇, 陈嵩. 太原市养老机构老年人口腔健康状况的调查分析[J]. 华西口腔医学杂志, 2021, 39(2): 175-181.
[10]	张佳丽, 姚军, 仁青措姆, 许元泓. 西藏昌都市3~5岁儿童龋病及其影响因素调查分析[J]. 华西口腔医学杂志, 2021, 39(1): 53-57.
[11]	华成舸, 刘治清, 王晴, 杨征, 徐庆鸿, 张静. 从新型冠状病毒肺炎疫情防控看传染病流行期口腔门诊管理策略[J]. 华西口腔医学杂志, 2020, 38(2): 117-121.
[12]	王晓华,刘艾芃,邓文正. 数字化导板在口腔种植中的研究进展[J]. 华西口腔医学杂志, 2020, 38(1): 95-100.
[13]	王静雪,杨正艳,吴晓艳,蔡婷,邓力,吕晓燕,丁贤彬,周智. 重庆市主城区学龄前儿童患龋情况及口腔卫生服务需要、利用情况和影响因素的研究[J]. 华西口腔医学杂志, 2019, 37(2): 187-192.
[14]	邱昱, 李媛媛, 李天国, 陈怡歌, 孔静珺, 潘剑. 四川省口腔医生急救知识水平及影响因素调查[J]. 华西口腔医学杂志, 2018, 36(2): 199-203.
[15]	李晋蒙, 欧国敏. 计算机辅助设计种植导板精确性及其影响因素[J]. 华西口腔医学杂志, 2017, 35(1): 93-98.