The whole process of root canal treatment mainly includes three aspects: root canal preparation, root canal disinfection, and root canal filling, and these three aspects are also continuous. Among them, the more important one is the stage of root canal preparation. In the implementation of clinical operations, the phenomenon of dental endo files and the like leading to broken needles during the operation, which has an adverse effect on the treatment effect.
Analysis of the causes of broken endodontic files in root canal therapy
1)：Operator’s operation problem
Clinically, there are operators who have insufficient understanding of the root canal system, as well as the characteristics of operating instruments and correct operating methods. Because about half of the root apex of the tooth is not at the root tip, but will be biased to one side. It is easy because the X-ray film has not reached the position of the apex, but if the operator forcibly advances to the position of the apex, the enlarged needle is broken at the position of the lower third of the root.
Many times, the operator may rotate or press too much for various reasons during the operation. However, related studies have shown that a large vertical force or applying vertical pressure before the device works will cause the torque of the device to increase, which can easily cause the device to break.
Root canal irrigation can effectively lubricate the root canal wall and reduce the problem of device breakage, but this advantage is easily overlooked. Sometimes because of the increased use of expanded needles, there is no early detection of existing damage, resulting in broken needles. So if you want to prevent this problem, you can clarify the frequency of expansion of the needle to prevent this problem.
2): Characteristics of root canals
The commonality of root canals is also unique because of individual differences, because of differences between individuals, secondary dentin formation and growth of peritubular dentin, and calcification of dentin tubules, root canal thinning and calcification will fail And bending.
The degree of bending of the root canal is relatively large, that is to say, the radius of the bending is relatively small, and fatigue is easy to occur during the use of the instrument. During the operation, the gradual increase of the stress and torsional force of the instrument results in the reduction of the fatigue cycle of the instrument. Breaking problems are prone to occur.
Relevant research also shows that the degree of root canal fineness is directly proportional to the probability of broken needles.
3) The problem of root canal irrigation
Related mechanical preparation and step-by-step in-depth method can make the root canal irrigation solution reach the forefront of root canal preparation. Therefore, it is necessary to effectively play this advantage in clinical practice. After each step, sufficient irrigation must be performed.
At present, there are many types of clinical rinsing solutions, such as 30mL/L hydrogen peroxide solution and normal saline, 2.5 g/L tinidazole solution, 150 g/L EDTA solution, and 52.5 g/L. The sodium hypochlorite solution and so on.
The above mentioned irrigation solutions have their own advantages. Among them, 150 g/L of EDTA solution and 52.5 g/L of sodium hypochlorite solution have a chelating effect on the stained layer of the root canal wall and Ca2+, and have an effect on dentin The softening effect played is quite prominent and has a positive effect on root canal preparation, but there are related reports that 150 g/L of EDTA solution will be absorbed in the root canal, which needs to be paid attention to.
Analysis of clinical treatment of broken needles
According to the X-ray film, you can know the length and thickness of the broken instrument and whether there is no bend in the internal position of the root canal.Estimate the difficulty of removal. If it can be removed or the component is bypassed, conventional filling is performed. .
If there is no condition or can not be taken out and the bypass can not be constructed, it can be filled with plasticized or root canal paste and tooth gum tip. In the process of treatment of living pulp, the system of device separation and root canal is not open and there is no microbial invasion, then the long-term prognosis is better. If the patient has periapical periodontitis, it is best to take it out and implement apical closure through the separation device It is difficult to achieve.
Patients can use oral antibiotics to restore the roots as soon as possible. In the root canal, 5% sodium hypochlorite, 3% hydrogen peroxide, and 0.9% sodium chloride are used for rinsing. A large amount is required before filling or plasticizing 5% of sodium hypochlorite is soaked and disinfected to reduce the reproduction of microorganisms in the root canal. After filling treatment, temporary restorations are used to protect or adjust the affected teeth.
Prevention method analysis
First of all, doctors need to carry out standardized operations. If the operator is not standardized in the operation of the treatment and other issues, he can not effectively understand the specific shape of the root canal, so that the angle between the instrument and the long axis of the root canal, it is easy to cause the instrument to break at the position of the fulcrum.
Operators did not follow the order of the expander from small to large, or there was resistance during the treatment of root canal stenosis. Violent operation was also carried out, and the problem of device breakage was also easy to occur.
In addition, it is necessary to prevent the quality from failing to meet the requirements or the equipment being immersed in the disinfectant for a long time, which will cause rust problems. Prevent adverse effects caused by excessive reuse of equipment.
For damage and deformation and poor elasticity, it needs to be replaced as soon as possible to avoid the problem of broken equipment. It should also be noted that the operator needs to grasp the apex shape and anatomical structure in order to ensure that the operation can be understood.
Before using the instrument, you need to carry out a careful inspection to check whether there are problems of rust and thread deformation and elongation. In the process of operation, you need to be careful and meticulous, and be patient and careful.
It should also be carried out according to the formal requirements in actual operation,to avoid the problems of over-expansion and over-rotation or excessive rotation force or excessive force. You can apply the method of rotating forward and returning, alternately flushing and number-by-number expansion. get on.
If the resistance is relatively large, it can be combined with mechanical expansion or chemical preparation method.
In conclusion:All in all, the root canal treatment technology is gradually innovating with economic development and social progress, and the frequency of needle breakage is also gradually decreasing, but it is still necessary to strengthen the analysis of root canal treatment, the operator must master the anatomy of the root canal, Patience and meticulousness are guaranteed during operation.
Under such premises, according to the operating procedures, it will effectively prevent the occurrence of broken root canal files and ensure the effect of root canal treatment.