彎曲根管使用側方充填法時根管擴大錐度及 主針錐度對充填品質的影響

The effect of the taper of root canal enlargement and the taper of the master cone on the filling quality using cold lateral compaction technique in curved canal

郭振隆(Cheng-Long Guo)

指導教授 ： 洪純正

共同指導教授 ： 陳文正(Chen Wen-Cheng)

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00142

摘要

研究目的：現代根管治療的目標在於經過適當擴大與清潔後完全的移除根管內的感染物質並且給予一個永久性的充填。研究顯示根管充填的密封性來自於黏著劑，且黏著劑在充填的百分比上應該越低越好以提升長期的密封性。對於彎曲根管使用側方充填法雖會遭遇困難，但目前大部分的臨床醫師對於彎曲根管的治療仍是使用側方充填法。本實驗的目的在對於彎曲根管進行兩種不同錐度的擴大，並以兩種不同錐度的主針進行側方充填，來探討在彎曲根管使用側方充填法時，根管擴大錐度與主針錐度對於牙膠針充填百分率的影響。
材料與方法：本次實驗選用40個樹脂根管模型(長度16.5mm，彎曲度45度)分成四組進行實驗。實驗第一大組，擴大至根尖30號、0.10錐度；第二組擴大至根尖30號、0.06錐度。每一組分為a、b兩小組分別使用0.02錐度與0.06錐度的主針進行充填。實驗樣本靜置一星期後以慢速切割機在距離工作長度終點2釐米與4釐米處進行橫切，橫切面在光學顯微鏡下放大50倍進行觀察，以電腦軟體計算牙膠針、黏著劑與氣泡的面積換算成百分比進行分析比較。結果分析採用JMP 8.0統計軟體進行分析比較。實驗另外記錄各組擴大所需時間與充填材料溢出根尖情形進行比較。
結果：以變異數分析與Tukey-Kramer HSD test事後檢定發現距根尖2釐米橫切面牙膠針充填率四組間有顯著的差異(p<0.001)，0.06/0.06組顯著高於其他三組，0.06/0.02組別顯著高於0.010/0.06組。距離根尖4mm橫切面處，各組間GP充填百分比有顯著的差異(p<0.001)，0.06/0.06組顯著高於其他三組，其餘各組間無顯著差異。氣泡的百分率於2釐米切面四組無顯著的差異，於4釐米切面0.06/0.02組顯著的高於0.06/0.06組(p=0.03)。
結論：在本次實驗的設計條件下，結果顯示在彎曲根管使用側方充填法時，以0.06錐度的擴大錐度搭配0.06錐度主針充填牙膠針充填的比例最高，在距離根尖切面2釐米與4釐米切面都顯著的優於其它各組。0.10錐度擴大的組別，使用主針的錐度對於牙膠針充填百分率並無顯著的影響，牙膠針充填的百分率較0.06/0.06組低，但與0.06/0.02組相當。結果可推論對於彎曲根管進行較大錐度擴大與使用與擴大錐度相同主針充填相比較，牙膠針的充填百分率較低，使用的主針錐度對於充填的結果無顯著的影響。實驗另外發現，在0.06的擴大錐度下使用0.02錐度的主針充填產生氣泡的機率會增加。使用0.06錐度主針充填的組別，無論擴大的錐度黏著劑溢出根尖的比率都會顯著的增加。

關鍵字

側方充填法 ； 牙膠針充填百分率 ； 彎曲根管 ； 大錐度牙膠針

並列摘要

Purpose：The objectives of modern root canal therapy was to proper clean and shape the root canal system and complete removing the intracanal infection substance and sealing the system with a permanent sealing. Studies shows the sealer provides the seal and the percentage of the sealer should be as lower as possible in order to increase the long term sealing ability. Although it is difficult to use cold lateral compaction technique in curved canal, but the most clinical dentist still use it . The purpose of this study was to use two different tapered root canal enlargement and two different tapered master cone in curved canal obturation using cold lateral compaction technique, in order to find the effect of the taper of the root canal enlargement and the taper of the master cone on the percentage of GP filling using cold lateral compaction technique in curved canal.

Material and Method: 40 simulated canals in resin blocks with 16.5mm in length and a 32 degrees curve were divided to two groups in this study.
In the first group, root canal was prepared by using Gates-Glidden drills and K Flexo file files to an apical size 35 and the 0.1 tapered.
In the secondary groupe, root canal was enlargement by using SystemGP® (Dentsply France SAS) NiTi rotary instruments to an apical size 30 and the 0.06 tapered. Every group were divided into two subgroups (subgroup A and B)，and filled the canal by using 0.02-tapered and 0.06-tapered gutta-percha master cone. Type C NiTi finger spreader (Dentsply,Ballaigues,SWISS) was used for lateral compaction technique, and the compaction force was controlled at 2 Kg. All samples were sectioned at 2mm and 4 mm from the canal terminus by using low speed saw after stewing one week. The horizontal cutting surface was examined under microscope with 50 times magnifying power. The percentages of gutta-percha, sealer or voids to the total root canal area were calculated using software JMP 8.0.The data was to test the significant differences .Among the effect of the taper of the root canal enlargement and the taper of the master cone on the percentage of GP filling with ANOVA and Tukey-Kramer HSD test using JMP6.0 software package.
Result：Between the four groups which were cross-section at 2 mm from the canal terminus, the percentage of the area filled with gutta-percha were significant difference than the other groups (p<0.001).From the result of Tukey-Kramer HSD test, the group IIB was grater than the other three groups, and the group IIA was grater than the group IB. There was no significant different between other gropes. In the groups which was cross-section at 4 mm from the canal terminus, the percentage of GP filling was significant difference between etch groups(p<0.001).The result of Tukey-Kramer HSD test showed group IIB was grater than the others. There was no significant different in other groups. About the percentage of void, there was no significant different between the four groups which were cross-section at 2mm from the canal terminus, but the IIA group in the group which were cross-section at 4mm from the canal terminus was higher than IIB group(p=0.03).
Conclusion: When filling the curved canal by using lateral compaction technique, we could get the best percentage of GP filling if preparing the canal to 0.06-tapered and using 0.06-tapered master cone.
It showed the batter percentages no mater the cross-section at either 2 mm or 4 mm at canal terminus. If we prepared the canals to 0.01-tapered, the tapered sizes of master cons were no influences to the percentages of GP.
ge of GP was no influence by using the 0.02 tapered master cones filling curve canal by later compaction technique if we increased the canal tapered. But if we used 0.06 tapered master cones, the percentages of GP would be significantly decrease. We also found, if we enlarged the root canal to 0.06-tapered and filled with 0.02-tapered master cones, we have larger percentages of voids than using 0.06-tapered master cones at the cross-section at 4 mm of canal terminus

並列關鍵字

ateral compaction technique ； PGP ； curved canal ； large tapered GP

參考文獻

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