- 學位論文
比較手動根管銼及鎳-鈦旋轉根管銼有無輔助超音波沖洗在C 型根管之清潔率
The cleanliness comparison of hand file and rotary file with/without ultrasonic irrigation in C shaped root canals.
摘要
目的：本實驗之目的在於以組織切片評估使用K型根管銼、Protaper系統鎳-鈦旋轉根管銼以及是否配合使用超音波器械之沖洗方式，應用在C 型根管時，對於冠部、中部、及根尖部以及C型根管的主根管和峽部處清潔率的比較，以檢視K型根管銼和鎳-鈦旋轉根管銼修形以及有無配合超音波器械的沖洗，其根管內殘屑移除率是否具有顯著性差異，以期找出在治療C型根管之適當及有效的根管修形方式。 方法：收集40顆具Melton第一、二類C型根管型態之下顎大臼齒，隨機分為五組，分別為使用K型根管銼清潔加上針筒沖洗的A組、使用K型根管銼配合超音波沖洗的B組、使用Protaper系統加上針筒沖洗的C組、使用Protaper配合超音波沖洗的D組。以及未經任何處理的E組。A、B、C、D組皆以冠端向下法(crown down)進行根管修形，B組、D組除了器械修形外，加以超音波器械進行次氯酸鈉溶液之沖洗；E組則未施予任何治療步驟；修形後進行組織切片之製作，於根尖部、中部、冠部三處加以橫切。將其以影像處理系統取得組織切片影像後，以繪圖軟體Photoshop 7.0進行影像分析，並以統計分析比較K型根管銼與Protaper系統、以及是否輔以超音波沖洗，在C型根管根尖部、中部、冠部之間、以及C型主根管及C型峽部，其殘屑移除能力是否有所差異。 結果顯示，在主根管的冠部以及根尖部使用Protaper系統修形，其清潔率顯著高於使用K型根管銼的組別；在主根管的根尖處，使用超音波器械沖洗的組別其清潔率顯著高於未使用超音波器械沖洗的組別。在峽部的中部，使用K型根管銼修形其清潔率顯著高於使用Protaper系統的組別；在峽部的冠部、中部、以及根尖部，使用超音波器械沖洗的組別其清潔率皆顯著高於未使用超音波器械沖洗的組別。而分析之結果亦顯示修形方式、使用超音波器械沖洗與否、根管位置及根管型態都是清潔率之顯著影響因素。 由以上結果可得到結論：對於C型根管的清潔以及修形，建議在主根管處使用鎳鈦旋轉器械，能使在修形的步驟上較為省時且維持根尖三分之一處不錯的清潔效果，搭配峽部處使用傳統手動器械以及次氯酸鈉溶液和超音波器械沖洗，以提升C型根管峽部處的清潔效果。
並列摘要
The purpose of this study was to compare the cleanliness of hand file and rotary file with/without ultrasonic irrigation in C-shaped root canals Forty extracted human mandibular molars classified by Melton’s classification type I,II C-shaped root canals randomly divided into five groups. The five groups were respectively prepared by crown down technique using K-file with syringe irrigation, K-file with ultrasonic irrigation ,Protaper system with syringe irrigation ,Protaper system with ultrasonic irrigation for 1 min and uninstrumentation group. Following instrumentation, histological preparation and staining, the apical third, middle third and coronal third levels were evaluated by software PHTOSHOP 7.0.1 for percentage of cleanliness in main canal and isthmus areas of C-shaped root canals. ANOVA and MANOVA were used to analyze the differences of percentage of necrotic debris removal in five groups, three positions and two canal anatomy . Results by morphometric analysis indicated that in C-shaped main canal,groups using Protaper system at coronal and apical levels were significant more efficient in cleanliness than K-file instrumentation groups, and groups with ultrasonic irrigation at apical level were significant more efficient in cleanliness than without ultrasonic irrigation. In C-shaped isthmus, Groups with K-file instrumentation at middle third were significant more efficient in cleanliness than using Protaper system, and groups with ultrasonic irrigation were significant more efficient at all three levels in cleanliness than without ultrasonic irrigation. The two-way ANOVA showed that the canal positions ,canal morphology,instrumentation techniques and using ultrasonic irrigation were significant risky factors for percentage of cleanliness.. It was concluded that using rotary file in main canal followed by manual instrumentation using K-file with final irrigation of 5.25% NaOCl energized by ultrasonic unit leads to more efficient debris removal from isthmus of complex C-shaped root canals.