高频电流牙髓失活干髓术一次法组织病理及临床研究
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摘要
目的：探讨高频电流对牙髓失活作用的可靠性、对根尖周围组织的安全性及临床疗效。方法：1、进行动物实验研究，将实验动物分为A、B两组，共计96颗实验牙，高频电刀按电流强度分别设为低、中、较高、高四个档位，电灼时间设为5秒。将A、B两组动物的实验牙又各自分为四个小组，分别与电流强度档位相对应。电灼时，将扩大针电灼头插入根髓冠侧1/3处，A组两天后处死，劈开牙齿，观察整个牙髓形态，然后连同周围组织进行切片组织病理学检查，B组在七天后同样方法处死及检查; 2、临床组织病理学检查，选择需拔髓治疗前牙18颗，高频电流处理牙髓后拔髓，进行切片组织病理学检查；3、临床疗效观察，随机复查了治疗4年后患者348人、367颗牙，确定高频电流牙髓干髓术成功率。结果：1、动物实验显示，根髓根尖1/3为凝固性坏死，
根尖孔处坏死最明显，而靠近根尖孔的成牙骨质细胞连续存在，形态规则，无死亡迹象，根尖孔处牙骨质及其外侧牙周膜、牙槽骨无坏死现象；中~高电流组根髓凝固性坏死区域逐渐增大，但不超过全部根髓的2/3，根尖孔处坏死最明显；2、临床组织病理学检查，经目镜测微尺测量可见牙髓从烧灼处至根尖方向呈变性坏死改变，变性坏死在烧灼处为牙髓直径的1/3—1/4，根髓中段以下至根尖全部变性坏死；3、临床疗效观察，成功率91.55%。结论：高频电流牙髓失活干髓术可靠、安全，其优点：（1）避免了使用砷剂；（2）牙髓完全失活，避免残髓炎的发生，及高温杀菌和汽化干燥，可提高成功率；（3）干髓术一次完成。
Object: To approach the reliability of high-frequency current acting upon the devitalization of dental pulp , the safety and clinical effect for peripheral tissues of root tip .Method:1.Conduct animal experiment . Divide the animals into A and B groups , 96 experimental teeth in total . Set high-frequency knife to low , middle higher ,and top-gear .The time of electric cauterization is 5 sec . Divide the experimental teeth of A and B group into four smaller group separately , each group to each gear correspondence . When electric cauterizing , put the enlarging reamer bit into 1/3 part of root pulp cap . Two days later put A group to death . Split the teeth and observed the shape of pulp , then cut sections of pulp as well as peripheral tissues for histopathological examination . After 7 days put group B to death and examined in the same way. 2.Clinical histopathological examination . Choose 18 teeth needing extirpation of pulp , extirpated pulp after treating it with high-frequency current, then cut sections of pulp for histopathological examination .3. Clinical effect observation . Random reexamine 348 persons and treated 367 teeth for four years to ensure the rate of success of mummification of pulp with high-frequency current treating dental pulp .Result: 1. The animals experiment showed that the 1/2 part of root pulp and root tip became coagulative necrosis ,especially the part of apical foramen of teeth , while the cement cell of the alveolar periosteum and parodontium
closing to the apical foramen of teeth survived continuously , it′shape is
regular ,no sign of death . The cement at apical foramen of tooth , the outer parodontium and alveolar periosteum have no sign off necrosis. Among middle to top current groups , solidifying necrosis area of pulp gradually became larger ,but not over 2/3 parts of all root pulp .The necrosis at root tip was very obvious .2.Clinical histopathological examination .With eyepiece the change of denatured necrosis from electric burn is 1/3 to 1/4 of dental pulp`s diameter ,the root pulp from the middle to the root tip all became necrosis .3. Clinical observation .The rate of success is 91.55%. Conclusion : The mummification of pulp using high-frequency current devitalizing dental pulp one time is reliable and safe .Its advantage is as follows (1) Avoiding using arsenical ; (2) Devitalized dental pulp completely and avoided residual pulpitis. High-temperature sterilization and vaporizing dry improved the rate of success ; (3) Mummification of pulp could be finished at one time .
根尖孔处坏死最明显，而靠近根尖孔的成牙骨质细胞连续存在，形态规则，无死亡迹象，根尖孔处牙骨质及其外侧牙周膜、牙槽骨无坏死现象；中~高电流组根髓凝固性坏死区域逐渐增大，但不超过全部根髓的2/3，根尖孔处坏死最明显；2、临床组织病理学检查，经目镜测微尺测量可见牙髓从烧灼处至根尖方向呈变性坏死改变，变性坏死在烧灼处为牙髓直径的1/3—1/4，根髓中段以下至根尖全部变性坏死；3、临床疗效观察，成功率91.55%。结论：高频电流牙髓失活干髓术可靠、安全，其优点：（1）避免了使用砷剂；（2）牙髓完全失活，避免残髓炎的发生，及高温杀菌和汽化干燥，可提高成功率；（3）干髓术一次完成。
Object: To approach the reliability of high-frequency current acting upon the devitalization of dental pulp , the safety and clinical effect for peripheral tissues of root tip .Method:1.Conduct animal experiment . Divide the animals into A and B groups , 96 experimental teeth in total . Set high-frequency knife to low , middle higher ,and top-gear .The time of electric cauterization is 5 sec . Divide the experimental teeth of A and B group into four smaller group separately , each group to each gear correspondence . When electric cauterizing , put the enlarging reamer bit into 1/3 part of root pulp cap . Two days later put A group to death . Split the teeth and observed the shape of pulp , then cut sections of pulp as well as peripheral tissues for histopathological examination . After 7 days put group B to death and examined in the same way. 2.Clinical histopathological examination . Choose 18 teeth needing extirpation of pulp , extirpated pulp after treating it with high-frequency current, then cut sections of pulp for histopathological examination .3. Clinical effect observation . Random reexamine 348 persons and treated 367 teeth for four years to ensure the rate of success of mummification of pulp with high-frequency current treating dental pulp .Result: 1. The animals experiment showed that the 1/2 part of root pulp and root tip became coagulative necrosis ,especially the part of apical foramen of teeth , while the cement cell of the alveolar periosteum and parodontium
closing to the apical foramen of teeth survived continuously , it′shape is
regular ,no sign of death . The cement at apical foramen of tooth , the outer parodontium and alveolar periosteum have no sign off necrosis. Among middle to top current groups , solidifying necrosis area of pulp gradually became larger ,but not over 2/3 parts of all root pulp .The necrosis at root tip was very obvious .2.Clinical histopathological examination .With eyepiece the change of denatured necrosis from electric burn is 1/3 to 1/4 of dental pulp`s diameter ,the root pulp from the middle to the root tip all became necrosis .3. Clinical observation .The rate of success is 91.55%. Conclusion : The mummification of pulp using high-frequency current devitalizing dental pulp one time is reliable and safe .Its advantage is as follows (1) Avoiding using arsenical ; (2) Devitalized dental pulp completely and avoided residual pulpitis. High-temperature sterilization and vaporizing dry improved the rate of success ; (3) Mummification of pulp could be finished at one time .
引文
1 岳松龄主编. 口腔内科学, 第二版, 北京：人民卫生出版社 1985，148
2 何志明. 干髓术失败200例回顾分析. 口腔医学纵横, 1991；7（3）：159-160
3 李雨琴，钱惠娟. 残髓炎的诊断与病因分析. 中华医学杂志 , 1987; 22：106-107
4 王鑫源，路玲玲等. 干髓术后组织变化的研究. 实用口腔医学杂志, 1990; 6：331-332
5 张翠贤、赵皿等. 蟾酥液体失活剂应用和组织学观察. 口腔医学, 1995 ; 15（4）：173—174
6 郭兮惠，扬宁江，牟子义等. 高频电流牙髓干髓术一次法组织病理及临床研究 . 临床口腔医学杂志，1994；10（4）：228-229
7 郭兮惠，扬宁江，牟子义等.高频电流牙髓失活的实验研究 . 白求恩医科大学学报, 2000 ; 26（3）：325—326
8 郭兮惠，扬宁江，牟子义等. 高频电流牙髓失活一次法367例疗效观察. 吉林医学, 1999 ; 20（5）276—277
黄力子. 关于根管长度电测法原理的研究㈠. 第四军医
9 大学学报,1982；3（1）：73~81
10 甘心照主编. 用于治疗大的医疗电子仪器与设备. 南京大学出版社,1982，216
2 何志明. 干髓术失败200例回顾分析. 口腔医学纵横, 1991；7（3）：159-160
3 李雨琴，钱惠娟. 残髓炎的诊断与病因分析. 中华医学杂志 , 1987; 22：106-107
4 王鑫源，路玲玲等. 干髓术后组织变化的研究. 实用口腔医学杂志, 1990; 6：331-332
5 张翠贤、赵皿等. 蟾酥液体失活剂应用和组织学观察. 口腔医学, 1995 ; 15（4）：173—174
6 郭兮惠，扬宁江，牟子义等. 高频电流牙髓干髓术一次法组织病理及临床研究 . 临床口腔医学杂志，1994；10（4）：228-229
7 郭兮惠，扬宁江，牟子义等.高频电流牙髓失活的实验研究 . 白求恩医科大学学报, 2000 ; 26（3）：325—326
8 郭兮惠，扬宁江，牟子义等. 高频电流牙髓失活一次法367例疗效观察. 吉林医学, 1999 ; 20（5）276—277
黄力子. 关于根管长度电测法原理的研究㈠. 第四军医
9 大学学报,1982；3（1）：73~81
10 甘心照主编. 用于治疗大的医疗电子仪器与设备. 南京大学出版社,1982，216