一次性根管治疗联合清胃散口服对牙髓炎的治疗效果及对疼痛程度影响

摘要 目的：探讨一次性根管治疗联合清胃散口服对牙髓炎的治疗效果及对疼痛程度影响。方法：选取我院2021年1月到2022年12月收治的120例牙髓炎患者，分为观察组与对照组，各60例。对照组患者应用一次性根管治疗，观察组患者应用一次性根管联合清胃散口服治疗，对比两组患者的临床治疗效果，治疗前后咀嚼功能与疼痛程度，白细胞计数（WBC）、降钙素原（PCT）、C反应蛋白（CRP）相关炎症因子水平，并对比两组患者的菌斑指数（PLI），龈沟出血指数（SBI）、龈沟探诊深度（SPD）、牙龈指数（GI）相关牙周健康指标水平。结果：观察组总有效率为93.33%明显高于对照组总有效率80.00%（P<0.05）；两组患者治疗前咀嚼功能评分与视觉模拟量表（VAS）评分对比无差异（P＞0.05），治疗后咀嚼功能评分均升高，观察组较对照组高，VAS评分降低，观察组较对照组低（P＜0.05）；两组患者治疗前WBC、PCT、CRP水平对比无差异（P＞0.05），治疗后均降低，观察组较对照组低（P＜0.05）；两组患者治疗前GI、SPD、SBI、PLI水平对比无差异（P＞0.05），治疗后均降低，观察组较对照组低（P＜0.05）。结论：一次性根管治疗联合清胃散口服能够改善牙髓炎的临床疗效，提升患者咀嚼功能，减轻疼痛程度，降低机体炎症因子水平，同时能够进一步改善患者牙周健康程度，值得临床应用推广。     

速效牙痛宁酊辅助根管治疗对慢性牙髓炎患者口腔健康相关生活质量和血清Toll样受体4、CX3C趋化因子配体1的影响

摘要 目的：观察速效牙痛宁酊辅助根管治疗对慢性牙髓炎患者口腔健康相关生活质量和血清CX3C趋化因子配体1（CX3CL1）、Toll样受体4（TLR4）的影响。方法：选取衡水市中医院2019年9月~2021年6月期间收治的87例慢性牙髓炎患者（患牙87颗）,根据随机数字表法分为观察组44例（患牙44颗,给予速效牙痛宁酊辅助根管治疗）、对照组43例（患牙43颗,给予根管治疗）。对比两组临床疗效,观察两组疼痛症状和口腔健康相关生活质量改善情况,比较两组血清TLR4、CX3CL1水平变化,并记录两组不良反应发生情况。结果：观察组的临床总有效率高于对照组（P<0.05）。治疗2周后、4周后,两组视觉模拟量表（VAS）评分降低,且观察组较对照组低（P<0.05）。治疗4周后,两组口腔健康影响程度量表（OHIP-14）各领域（社交障碍、心理障碍、功能限制、生理障碍、残障、生理疼痛、心理不适）评分及总分降低,且观察组低于对照组（P<0.05）。治疗4周后,两组血清CX3CL1、TLR4水平下降,观察组较对照组低（P<0.05）。与对照组比较,观察组并发症总发生率较低（P<0.05）。结论：速效牙痛宁酊辅助根管治疗慢性牙髓炎患者,可有效减轻疼痛症状,提高口腔健康相关生活质量,作用机制可能与调节血清TLR4、CX3CL1水平有关。     

Mechanisms Underlying Ectopic Persistent Tooth-Pulp Pain following Pulpal Inflammation

In order to clarify the peripheral mechanisms of ectopic persistent pain in a tooth pulp following pulpal inflammation of an adjacent tooth, masseter muscle activity, phosphorylated extracellular signal-regulated protein kinase (pERK) and TRPV1 immunohistochemistries and satellite cell activation using glial fibrillary acidic protein (GFAP) immunohistochemistry in the trigeminal ganglion (TG) were studied in the rats with molar tooth-pulp inflammation. And, Fluorogold (FG) and DiI were also used in a neuronal tracing study to analyze if some TG neurons innervate more than one tooth pulp. Complete Freund’s adjuvant (CFA) or saline was applied into the upper first molar tooth pulp (M1) in pentobarbital-anesthetized rats, and capsaicin was applied into the upper second molar tooth pulp (M2) on day 3 after the CFA or saline application. Mean EMG activity elicited in the masseter muscle by capsaicin application to M2 was significantly larger in M1 CFA-applied rats compared with M1 vehicle-applied rats. The mean number of pERK-immunoreactive (IR) TG cells was significantly larger in M1 CFA-applied rats compared with M1 vehicle-applied rats. Application of the satellite cell inhibitor fluorocitrate (FC) into TG caused a significant depression of capsaicin-induced masseter muscle activity and a significant reduction of satellite cell activation. The number of TRPV1-IR TG cells innervating M2 was significantly larger in M1 CFA-applied rats compared with M1 vehicle-applied rats, and that was decreased following FC injection into TG. Furthermore, 6% of TG neurons innervating M1 and/or M2 innervated both M1 and M2. These findings suggest that satellite cell activation following tooth pulp inflammation and innervation of multiple tooth pulps by single TG neurons may be involved in the enhancement of the activity of TG neurons innervating adjacent non-inflamed teeth that also show enhancement of TRPV1 expression in TG neurons, resulting in the ectopic persistent tooth-pulp pain following pulpal inflammation of adjacent teeth.     

Lidocaine patch (5%) is no more potent than placebo in treating chronic back pain when tested in a randomised double blind placebo controlled brain imaging study

ABSTRACT: The 5% Lidocaine patch is used for treating chronic neuropathic pain conditions such as chronic back pain (CBP), diabetic neuropathy and complex regional pain syndrome, but is effective in a variable proportion of patients. Our lab has reported that this treatment reduces CBP intensity and associated brain activations when tested in an open labelled preliminary study. Notably, effectiveness of the 5% Lidocaine patch has not been tested against placebo for treating CBP. In this study, effectiveness of the 5% Lidocaine patch was compared with placebo in 30 CBP patients in a randomised double-blind study where 15 patients received 5% Lidocaine patches and the remaining patients received placebo patches. Functional MRI was used to identify brain activity for fluctuations of spontaneous pain, at baseline and at two time points after start of treatment (6 hours and 2 weeks). There was no significant difference between the treatment groups in either pain intensity, sensory and affective qualities of pain or in pain related brain activation at any time point. However, 50% patients in both the Lidocaine and placebo arms reported a greater than 50% decrease in pain suggesting a marked placebo effect. When tested against an untreated CBP group at similar time points, the patch treated subjects showed significantly greater decrease in pain compared to the untreated group (n=15). These findings suggest that although the 5% Lidocaine is not better than placebo in its effectiveness for treating pain, the patch itself induces a potent placebo effect in a significant proportion of CBP patients.     

Ultrastructure of lymphatic capillaries in the human dental pulp

Summary Occlusal intradentinal cavities, prepared in normal human premolars and third molars to be extracted for orthodontic reasons, were filled for 7 to 11 days with gutta percha. A superficial pulpitis with localized small abscesses developed in the pulp chamber. Under local anesthesia, 0.2 to 0.3 cc of sterile colloidal carbon was injected in the pulp horn and the teeth were extracted 1 to 3 h later. Lymphatic capillaries could thus be identified in the pulpal tissues. They were characterized by a thin endothelium with occasional large intercellular clefts, absence or incompleteness of basement membrane, absence of pericytes, absence of luminal red blood cells, and presence of a filamentous material between the endothelium and the surrounding collagen fibrils. Moreover, some structural variations were observed.     

In-Silico modulation of Interleukin-8 (IL8) for the therapeutic management of endodontic pulpitis

Emerging clinical evidences highlight the association of Interleukin-8 (IL8) with endodontic pulpitis. Relatively higher expression of IL8 has been found in the pulp samples of pulpitis patients with moderate/severe pain. It is speculated that IL8 can be considered as a potential target for therapeutics of endodontic pulpitis. A library consisting of 3072 small molecules from the ZINC database was used to identify potential lead molecules with drug-like properties against the IL8. Based on the in-silico structure-assisted drug designing involving molecular docking, MD simulations, and MMPBSA analyses, we found a small molecule ZINC14613097 inhibits IL8. This study provides a new lead molecule than can be further validated in in-vitro, in-vivo, and ongoing clinical studies for the therapeutic management of endodontic pulpitis.     

Involvement of Trigeminal Transition Zone and Laminated Subnucleus Caudalis in Masseter Muscle Hypersensitivity Associated with Tooth Inflammation

A rat model of pulpitis/periapical periodontitis was used to study mechanisms underlying extraterritorial enhancement of masseter response associated with tooth inflammation. Periapical bone loss gradually increased and peaked at 6 weeks after complete Freund’s adjuvant (CFA) application to the upper molar tooth pulp (M1). On day 3, the number of Fos-immunoreactive (IR) cells was significantly larger in M1 CFA rats compared with M1 vehicle (veh) rats in the trigeminal subnucleus interpolaris/caudalis transition zone (Vi/Vc). The number of Fos-IR cells was significantly larger in M1 CFA and masseter (Mass) capsaicin applied (M1 CFA/Mass cap) rats compared with M1 veh/Mass veh rats in the contralateral Vc and Vi/Vc. The number of phosphorylated extracellular signal-regulated kinase (pERK)-IR cells was significantly larger in M1 CFA/Mass cap and M1 veh/Mass cap rats compared to Mass-vehicle applied rats with M1 vehicle or CFA in the Vi/Vc. Pulpal CFA application caused significant increase in the number of Fos-IR cells in the Vi/Vc but not Vc on week 6. The number of pERK-IR cells was significantly lager in the rats with capsaicin application to the Mass compared to Mass-vehicle treated rats after pulpal CFA- or vehicle-application. However, capsaicin application to the Mass did not further affect the number of Fos-IR cells in the Vi/Vc in pulpal CFA-applied rats. The digastric electromyographic (d-EMG) activity after Mass-capsaicin application was significantly increased on day 3 and lasted longer at 6 weeks after pulpal CFA application, and these increase and duration were significantly attenuated by i.t. PD98059, a MEK1 inhibitor. These findings suggest that Vi/Vc and Vc neuronal excitation is involved in the facilitation of extraterritorial hyperalgesia for Mass primed with periapical periodontitis or acute pulpal-inflammation. Furthermore, phosphorylation of ERK in the Vi/Vc and Vc play pivotal roles in masseter hyperalgesia after pulpitis or periapical periodontitis.     

咪达唑仑静脉麻醉与利多卡因局部麻醉联合在纤维支气管镜检查和治疗中的疗效比较

目的:探讨咪达唑仑静脉麻醉联合利多卡因局部麻醉在纤维支气管镜(FOB)检查和治疗中的疗效。方法:将我院在2013年1月~2014年1月期间需行FOB检查的118例患者随机分为试验组和对照组,各59例,对照组采用利多卡因局部麻醉,试验组患者在局部麻醉基础上予以咪达唑仑0.05 mg/kg。记录麻醉前(T0)、FOB进入咽腔时(T1)、进入声门时(T2)、进入支气管时(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2),并在各个时间点进行镇静评分,记录检查过程中的不良反应、知晓程度及检查结束后患者的满意度。结果:两组Ramsay评分随时间的麻醉时间延长而逐渐升高,T2、T3时两组间比较差异均有统计学意义(P0.05);试验组T1、T2、T3时MAP、HR、Sp O2较T0时差异无统计学意义(P0.05),试验组T1、T2、T3时点MAP、HR均较对照组低(P0.05),Sp O2均较对照组高,差异有统计学意义(P0.05);试验组的呛咳、躁动、中止检查及操作知晓率均明显低于对照组,而满意率明显高于对照组,差异有统计学意义(P0.05)。结论:咪达唑仑静脉麻醉与利多卡因局部麻醉联合在FOB检查和治疗中可以减轻心血管反应,减少插管反应及操作时的知晓率,安全性较高,值得临床推广应用。     

Fluid mechanics in dentinal microtubules provides mechanistic insights into the difference between hot and cold dental pain

Dental thermal pain is a significant health problem in daily life and dentistry. There is a long-standing question regarding the phenomenon that cold stimulation evokes sharper and more shooting pain sensations than hot stimulation. This phenomenon, however, outlives the well-known hydrodynamic theory used to explain dental thermal pain mechanism. Here, we present a mathematical model based on the hypothesis that hot or cold stimulation-induced different directions of dentinal fluid flow and the corresponding odontoblast movements in dentinal microtubules contribute to different dental pain responses. We coupled a computational fluid dynamics model, describing the fluid mechanics in dentinal microtubules, with a modified Hodgkin-Huxley model, describing the discharge behavior of intradental neuron. The simulated results agreed well with existing experimental measurements. We thence demonstrated theoretically that intradental mechano-sensitive nociceptors are not "equally sensitive" to inward (into the pulp) and outward (away from the pulp) fluid flows, providing mechanistic insights into the difference between hot and cold dental pain. The model developed here could enable better diagnosis in endodontics which requires an understanding of pulpal histology, neurology and physiology, as well as their dynamic response to the thermal stimulation used in dental practices.     

热牙胶充填与冷牙胶侧方加压在根管充填中应用的临床效果比较

目的:比较热牙胶充填与冷牙胶侧方加压在根管充填中应用的临床效果。方法:选择62例急性牙髓炎和根尖周炎患者,均分后分别选择热牙胶充填与冷牙胶侧方加压的方法进行根管充填,比较两组患者根管充填时间、术后牙周疼痛病例和术后3个月后充填质量及临床疗效。结果:两组患者术后牙周疼痛病例比较,差异无统计学意义(P>0.05);其余各方面比较,差异均均有统计学意义(P>0.05),热牙胶组优于冷牙胶组。结论:临床进行根管充填治疗时,应首选热牙胶充填的方式,可显著提高临床疗效,且不增加患者术后牙周疼痛的发生。     

Influence of cryopreservation on the pulpal tissue of immature third molars in vitro

The purpose of this study was to evaluate in vitro the viability of isolated and non-isolated pulpal tissue of immature third molars after cryopreservation. This study was divided in three different experiments. Experiment 1: Pulpal tissue isolated from 19 third molars was divided in horizontal segments. Each segment was cultured separately in order to evaluate whether differences in growth capacity within the tissue could be found. Experiment 2: Pulpal tissue isolated from 27 third molars was divided in a mesial and a distal part. One part was cryopreserved before culturing, the other part was cultured immediately. Growth capacity of cryopreserved and non-cryopreserved tissue was evaluated and compared. Experiment 3: 43 third molars were cryopreserved. After thawing, the dimension of the apical foramen was measured and the pulp was isolated and segmented horizontally. The different parts were cultured and growth capacity was evaluated and compared. Results of experiment 1 and 2 showed no significant difference in growth capacity between fibroblasts originating from different pulpal segments of the same tooth without cryopreservation and between fibroblasts originating from cryopreserved and non-cryopreserved isolated pulpal tissue. In experiment 3 it was demonstrated that the dimension of the apical foramen and pulpal viability after cryopreservation are positively correlated. A minimum dimension of 9.42 mm2 enables the cryoprotective agent to penetrate sufficiently and to protect the pulpal tissue from apex to crown. This study proved that cryopreservation of human pulpal tissue is possible if the cryoprotective agent can reach the entire pulp.     

Pulp sensibility test in elderly patients

doi: 10.1111/j.1741‐2358.2012.00623.x
Pulp sensibility test in elderly patients Background: The ageing process transforms the histological composition of the dental pulp and may affect the response to pulp sensibility tests. Objectives: The aim of this study was to assess the influence of age on pulp response time and on pain intensity. Material and methods: Fifty elderly patients and 50 young patients were selected. Different classes of teeth were evaluated. The pulp sensibility test was performed with a refrigerant spray. The pulp response time was measured in seconds and the pain intensity was assessed by visual analogue scale. Results: The Spearman coefficient was calculated and detect a positive correlation between age and pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). On the contrary, there was a negative correlation between age and pain intensity for maxillary incisors, mandibular incisors, and mean (p < 0.05). Also, the results of elderly and young groups were compared by Mann–Whitney test. Significant difference was noted regarding the pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). Significant difference was detected regarding the pain intensity for mandibular incisors only (p < 0.05). Conclusions: Pulp response time increases when people get older while pain intensity decreases. There were variations among the classes of teeth.     

Esthetic reconstruction of teeth in patient with dentinogenesis imperfecta--a case report

Dentinogenesis imperfecta (DI) is the result of a dominant genetic defect and affects both the deciduous and permanent dentitions. It is characterized by opalescent teeth composed of irregularly formed and undemineralized dentin which obliterates pulp chamber and root canal. DI can appear as a separate disorder or with osteogenesis imperfecta (OI). The teeth with DI show a grayish-blue to brown hue with dislodged enamel, dysplastic dentine with irregular dentinal tubules and interglobular dentine, short roots and pulpal obliteration, which all may lead to rapid and extensive attrition which require adequate crown reconstruction. The aim of this study was to show a reconstruction of frontal teeth in upper jaw with direct composite veneers in young adult patient with DI.     

Comparative evaluation of various analgesics in reducing pain in irreversible pulpitis

It is of interest to evaluate a single dose of three different analgesics compared to placebo in patients with symptomatic irreversible pulpitis. 120 patients were enrolled with severe pain in this prospective clinical trial. Patients were randomly divided into four groups after shaping and cleaning of root canals. This includes placebo, piroxicam 20mg, acetaminophen 325mg with aceclofenac sodium 100mg and acetaminophen 650mg. Participants were given a questionnaire to note the pain scores at various time intervals (6 hrs, 12 hrs, and 24 hrs) along with the respective tablets in a concealed manner. Data thus collected was analyzed for statistical significance. The severity of pain decreased in all the three interventional groups compared to the control group (p <0.01) at 6 hours. Zerodol-P and dolonex showed better pain reduction in comparison to the placebo and dolo 650 group (p <0.05) at 12 and 24 hours. Data shows that both zerodol-P and dolonex groups had similar effects at all time intervals. Thus, a single dose of analgesic such as Zerodol-P and Dolonex following shaping and cleaning of root canals relieved pain at all time intervals of the treatment. However, Dolo 650 performed better during the initial 6hrs after completion of the shaping and cleaning of root canals compared to the placebo.     

Efficacy of liposome-encapsulated mepivacaine for infiltrative anesthesia in volunteers

This blinded crossover study evaluated the efficacy and pain sensitivity evoked by a previously reported liposome-encapsulated mepivacaine formulation (). Thirty healthy volunteers received an intraoral injection (1.8?mL), at four different sessions, of the following formulations: 2% mepivacaine with 1:100,000 epinephrine (MVC_2%EPI), 3% mepivacaine (MVC_3%), and 2 and 3% liposome-encapsulated mepivacaine (MVC_2%LUV and MVC_3%LUV). Latency period and duration of anesthesia were assessed by an electrical pulp tester and injection discomfort by a visual analog scale (VAS). Data were analyzed with Tukey-Kramer and Friedman tests (P?<?0.05). No significant difference was found regarding latency period (in minutes) among the formulations (P?>?0.05). The duration of anesthesia after the injection of MVC_3%LUV was higher than the one obtained after the infiltration of MVC_2%LUV and of MVC_3% (P?<?0.05). However, the duration of anesthesia obtained with MVC_3% did not differ from the one obtained with MVC_2%LUV (P?>?0.05). MVC_3%LUV showed lower VAS median values than MVC_2%EPI (P?<?0.05), and there were no significant differences among the others formulations. Liposome-encapsulated 3% mepivacaine showed longer duration of anesthesia, in comparison to the commercial formulation of MVC_3%. MVC_2%LUV was able to produce a similar duration of anesthesia as the 3% commercial formulation, despite the 50% decrease in the anesthetic concentration. Thus, the encapsulation of mepivacaine increased the duration of anesthesia and reduced the injection discomfort caused by vasoconstrictor-associated formulations in healthy volunteers.     

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost

Objective: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic. Design: A randomised controlled trial of 403 patients with inguinal hernias. Setting: Two acute general hospitals in London between May 1995 and December 1996. Subjects: 400 patients with a diagnosis of groin hernia, 200 in each group. Main outcome measures: Time until discharge, postoperative pain, and complications; patients’ perceived health (SF-36), duration of convalescence, and patients’ satisfaction with surgery; and health service costs. Results: More patients in the open group (96%) than in the laparoscopic group (89%) were discharged on the same day as the operation (χ²=6.7; 1 df; P=0.01). Although pain scores were lower in the open group while the effect of the local anaesthetic persisted (proportional odds ratio at 2 hours 3.5 (2.3 to 5.1)), scores after open repair were significantly higher for each day of the first week (0.5 (0.3 to 0.7) on day 7) and during the second week (0.7 (0.5 to 0.9)). At 1 month there was a greater improvement (or less deterioration) in mean SF-36 scores over baseline in the laparoscopic group compared with the open group on seven of eight dimensions, reaching significance on five. For every activity considered the median time until return to normal was significantly shorter for the laparoscopic group. Patients randomised to laparoscopic repair were more satisfied with surgery at 1 month and 3 months after surgery. The mean cost per patient of laparoscopic repair was £335 (95% confidence interval £228 to £441) more than the cost of open repair. Conclusion: This study confirms that laparoscopic hernia repair has considerable short term clinical advantages after discharge compared with open mesh hernioplasty, although it was more expensive.

Key messages

• In the 4 hours after surgery laparoscopic hernia repair with general anaesthesia causes more pain than open repair with local anaesthesia (mainly because of the anaesthesia used) and necessitates longer stay in hospital. Laparoscopic hernia repair, however, causes less pain than open hernia repair during the first 2 weeks after discharge
• Laparoscopic hernia repair results in fewer episodes of wound infection, persistent local pain, genital swelling, numbness, and constipation than open repair. Urinary disturbances are more common after laparoscopic than after open repair
• Patients’ perception of health 1 month after the operation (assessed with the SF-36) and satisfaction with treatment is superior for laparoscopic patients who also have a shorter period of convalescence after surgery
• The health service cost of day case laparoscopic repair is £335 more than the cost of open mesh hernioplasty performed on a day case basis

     

0.5%盐酸罗哌卡因复合芬太尼腰麻在剖宫产术中的临床应用效果

目的:探讨0.5%盐酸罗哌卡因复合芬太尼腰麻在剖宫产术中临床应用效果。方法:选取自2015年01月~2015年05月择期在我院行剖宫产的产妇70例,随机分为观察组和对照组,每组35例。对照组采用0.5%盐酸罗哌卡因进行腰麻,观察组采用0.5%盐酸罗哌卡因复合芬太尼进行腰麻。比较两组的麻醉效果及产妇麻醉指标,记录两组麻醉前后血压及心率变化,并对比两组新生儿出生后1、5、10 min的Apgar评分。结果:观察组麻醉优良率为97.14%,明显高于对照组的85.71%(P0.05)。两组麻醉后30 min血压、心率与麻醉前相比,差异具有统计学意义(P0.05),且两组间比较差异具有统计学意义(P0.05)。观察组痛觉阻滞起效时间、痛觉恢复时间、运动阻滞起效时间、运动恢复时间与对照组相比,差异具有统计学意义(P0.05);观察组新生儿出生后1、5、10min Apgar评分均明显高于对照组(P0.05)。结论:0.5%盐酸罗哌卡因复合芬太尼腰麻应用于剖宫产术,能有效提升麻醉效果,麻醉阻滞起效快,持续时间长,有利于改善新生儿结局,具有临床推广意义。     

Inferior alveolar nerve reconstruction with a polyglycolic acid bioabsorbable nerve conduit.

A custom-designed polyglycolic acid (PGA) bioabsorbable nerve conduit was used to reconstruct a 25-mm defect in the right inferior alveolar nerve. The initial nerve injury, following a dental extraction, resulted in loss of lower lip sensation and severe facial pain. Sixteen months after tooth extraction, with no improvement in symptomatology, the alveolar canal was enlarged in diameter by means of mandibular osteotomy to accommodate a 2-mm-diameter polyglycolic acid tube. The proximal end of the inferior alveolar nerve was sutured into the polyglycolic acid tube. The mental nerve was sutured into the distal end of the tube. Pain of neural origin was relieved in the early postoperative period. Two years following nerve reconstruction, pain relief remains excellent and perception of pressure and vibration is similar to the thresholds for these perceptions on the contralateral lip.     

ProTaper根管扩大系统联合镍钛K锉在老年磨牙根管术中的应用价值

目的:探讨ProTaper根管扩大系统联合镍钛K锉在老年磨牙根管治疗中的应用价值。方法:收集2012年2月~2013年10月在我院口腔科就诊的156例急、慢性牙髓炎及根尖周炎的老年患者的临床资料,共发现患牙193颗,随机分为3组,A组60颗,B组64颗,C组69颗。A组采用ProTaper手动根管扩大系统联合镍钛K锉预备根管;B组采用ProTaper机动根管扩大系统联合镍钛K锉预备根管;C组采用不锈钢K锉预备根管。对适充率、填充满意率、急症反应发生率进行评定。结果:A、B、C组的适充率分别为为94.02%(110/117)、93.80%(121/129)、62.22%(89/143);A、B、C组的填充满意率分别为96.58%(113/117)、96.12%(124/129)、58.04%(83/143);A、B、C组急症反应发生率分别为4.27%(5/117)、4.65%(6/129)、26.57%(38/143)。A、B两组在适充率、填充满意率、急症反应发生率方面相比,无统计学差异(P0.05),但分别与C组相比,均显著高于对照C组,差异有统计学意义(P0.05)。结论:ProTaper根管扩大系统联合镍钛K锉在老年磨牙根管治疗中的疗效显著。     

Dexamethasone effects on Na<Subscript>v</Subscript>1.6 in tooth pulp,dental nerves,and alveolar osteoclasts of adult rats

Dexamethasone causes extensive physiologic reactions including the reduction of inflammation and pain. Here, we asked whether it also affected dental or periodontal cells or dental innervation by altering voltage-gated sodium channel Na_v1.6 immunoreactivity (IR) or neural synaptophysin. Daily dexamethasone (0.2 mg/kg) given for 1 week to rats caused 12-fold increased intensity of Na_v1.6-IR in dendritic pulpal cells of normal molars and incisors compared with vehicle treatment. These cells also co-localized monocyte (ED-1) or dendritic cell (CD11b/Ox42) markers, and their location in molars expanded during dexamethasone treatment to include deeper pulp. Furthermore, dexamethasone caused a 10-fold decrease in the number of Na_v1.6-immunoreactive multinucleate osteoclasts along the alveolar bone of molar root sockets. No changes occurred for neural Na_v1.6 at axonal nodes of Ranvier, even though IR for calcitonin gene-related peptide was greatly decreased, as expected, and neural synaptophysin-IR was decreased 59% by dexamethasone. At 4 days after tooth injury, pulpal vasodilation and increased Na_v1.6-immunoreactive pulp cells were similar for all groups. Thus, dexamethasone changes dental pulp cell and alveolar osteoclast Na_v1.6-IR in normal teeth, but different mechanisms occur after tooth injury when tissue reactions were similar for dexamethasone- and vehicle-treated rats. Steroid-induced alterations of dental pain and inflammation coincide with altered exocytic capability in dental nerve fibers as shown by synaptophysin-IR and with altered pulp cell Na_v1.6-IR and osteoclast number, but not with any changes in Na_v1.6-IR for nodes of Ranvier in myelinated dental axons.