CN119326526A

CN119326526A - A method for re-treatment with resin sealing in the pulp cavity after root canal treatment

Info

Publication number: CN119326526A
Application number: CN202411761401.9A
Authority: CN
Inventors: 周艳; 方聪; 郝晶
Original assignee: Hangzhou Dental Hospital Group Co ltd
Current assignee: Hangzhou Dental Hospital Group Co ltd
Priority date: 2024-12-03
Filing date: 2024-12-03
Publication date: 2025-01-21

Abstract

The invention discloses a method for resin sealing and retreatment in a intramedullary cavity after root canal treatment, which relates to the technical field of root canal treatment and comprises the following steps of S1, sampling before operation, S2, removing a restoration body and other materials, wherein the material removing technology and the tool are used for removing the crown surface restoration body and the resin sealing material in the intramedullary cavity, the material removing technology and the tool comprise a grinding device or a laser technology with a sensor, S3, root canal retreating and sterilizing, a root canal sterilizing medicine added with nano silver particles is used after the root canal is cleaned, the nano silver particles are mixed with traditional sterilizing medicines such as calcium hydroxide paste, S4, filling retreatment, a computer color matching technology is used before filling the intramedullary cavity, and an intelligent design monitoring platform is also included.

Description

Method for resin sealing and retreatment in intramedullary cavity after root canal treatment

Technical Field

The invention relates to the technical field of root canal treatment, in particular to a method for resin sealing and retreatment in a intramedullary canal after root canal treatment.

Background

Root canal therapy is a common method of treating pulp diseases and periapical diseases. It mainly uses the method of removing inflammation dental pulp and necrosis material in root canal, then makes disinfection and filling treatment to root canal so as to prevent the occurrence of periapical lesion or promote the healing of original periapical lesion. After the root canal treatment, the pulp cavity is usually sealed, the root canal system is generally filled with materials such as gutta-percha points and root canal sealing agents, and then the pulp cavity part is possibly sealed with materials such as resin, so that bacteria can be prevented from entering the root canal again, and the function of protecting the internal structure of teeth is achieved. When there is a problem in the teeth after the root canal treatment, such as reinfection after the root canal treatment (possibly due to the defect of filling the root canal, bacteria reinjection, etc.), or recurrent periapical periodontitis, etc., a re-treatment is required.

There are a number of problems in the traditional post-endodontic resin sealing retreatment process. First, when removing the original restoration and the sealing material, excessive damage to the dental tissue is often easily caused by lack of accurate monitoring means. The doctor can only operate by experience, so that when the doctor approaches key parts such as an pulp cavity, the doctor can wear through tooth body tissues due to misjudgment to influence the structural integrity and subsequent treatment effect of the teeth, and the lack of an accurate method for selecting the resin color can cause the color of the repaired teeth to be uncoordinated with that of surrounding teeth to influence the beauty.

In view of this, the present application has been made.

Disclosure of Invention

The invention aims to provide a method for resin sealing and retreatment in a intramedullary cavity after root canal treatment, so as to solve the problem of damage to dental tissues in the prior art.

In order to solve the technical problems, the invention provides a method for resin sealing and retreatment in a intramedullary cavity after root canal treatment, which comprises the following steps of S1, sampling before operation; removing dental crown surface restoration and intramedullary resin sealing materials by using a material removing technology and a tool, wherein the material removing technology and the tool comprise a grinding device or a laser technology with a sensor, the sensor is a depth sensor, a reflection or change is generated when a transmitting signal contacts an interface of different materials, a laser technology generates a high-energy laser beam by a laser generator, chemical bond breakage, sublimation or vaporization physicochemical change is generated after the resin material molecule absorbs energy, so that the material is removed, S3, root canal rescuing and disinfection is realized, a rubber barrier isolation technology is used in the root canal rescuing and disinfection process, a root canal disinfection medicament added with nano silver particles is used after the root canal is cleaned, the nano silver particles are mixed with a traditional disinfection medicament such as calcium hydroxide paste, S4, filling and rescuing is carried out by preferentially using a resin material with biocompatibility in the steps of refilling the intramedullary canal and the root canal, setting resin color is carried out by using a computer color matching technology before the filling the intramedullary canal, the self-resin and the light resin are respectively provided with a taper shape and the computer-aided by designing a taper shape, the dental canal is prepared by a computer-aided care platform (computer-aided by designing and performing a care plan and a care plan) and performing a care treatment on a care treatment process of a care plan, if a care plan is required for a patient is prepared by a computer, meanwhile, the medical device has the intraoperative emergency treatment and pain management measures in the treatment process.

Further, in the step S1, the medical history collection and analysis, the oral examination and imaging review and the psychological counseling and informed consent of the patient are carried out on the patient before operation, the method comprises the steps of inquiring the root canal treatment history, the whole body health condition and the allergy history of the patient in detail in the medical history collection and analysis step, analyzing information to evaluate the retreatment risk and special preparation requirements, wherein the oral examination and imaging review comprises the comprehensive examination and various imaging examinations of the affected teeth and the adjacent teeth, and the indication, the tabu and the treatment plan are determined according to the result, and the psychological counseling and informed consent of the patient is to explain the treatment process and the condition to the patient and ensure the understanding and the signing of the consent.

Further, in the step S2, the grinding device with the sensor sends out an alarm when approaching to the safe thickness of the tooth body in the grinding process, so that a doctor adjusts the operation parameters according to the alarm, reduces the damage to the tooth body tissue, especially the tooth neck and the position approaching to the pulp cavity, sets parameters according to the characteristics of the resin material, and reduces the thermal influence and mechanical damage of the surrounding tooth body tissue to treat the complex restoration and the resin sealing condition.

Further, in the step S3, the rubber barrier isolation technology completely isolates the affected teeth from saliva and bacteria in the oral cavity, creates a relatively sterile environment for root canal cleaning and disinfection operation, reduces the possibility of root canal re-infection, and the nano silver particles penetrate into the root canal system microstructure by virtue of the small particle size, plays a continuous antibacterial role, effectively kills microorganisms such as bacteria and fungi in the root canal, prolongs the antibacterial time, and improves the success rate of retreatment.

Further, in the step S4, the color of the resin is prepared by using a computer color matching technology before filling the medullary cavity, the color of the prepared resin is matched with the surrounding dental tissue by accurately analyzing the color parameters of the dental tissue around the patient, the aesthetic degree of the repaired tooth is improved, the self-setting resin and the photo-curing resin are filled according to corresponding operations, the root canal preparation quality is ensured when the root canal is filled again, and a proper material is selected.

Furthermore, in S5, the oral CBCT, i.e. cone beam CT, and the CAD/CAM, i.e. computer aided design/computer aided manufacturing, are used to evaluate and plan the operation procedure of the affected teeth before treatment, and unnecessary operation steps are reduced by the CAD/CAM technology according to the CBCT display information, so as to improve the retreatment efficiency and quality.

Further, in the intelligent design monitoring platform, the post-operation doctor's advice and nursing guidance comprises informing the patient that the patient is prevented from chewing too hard food on the affected side, keeping the oral cavity clean and sanitary, avoiding bad habit and explaining and relieving the post-operation reaction method, and the regular follow-up and review comprises carrying out oral cavity and imaging examination according to a specific time interval and processing the found problems.

Further, in the intelligent design monitoring platform, the intraoperative emergency treatment comprises a dental pulp cavity perforation and root canal appliance breaking treatment method, and the pain management comprises the selection of a proper anesthesia method and medicine and postoperative pain control and treatment measures.

Compared with the prior art, the invention has the beneficial effects that:

1. The grinding depth can be monitored in real time when the prosthesis and the resin sealing material are removed by the grinding device with the sensor. When the tooth thickness is close to the safe thickness, an alarm is sent out, so that a doctor can adjust the operation parameters in time, and the damage to tooth tissues, especially key parts such as the tooth neck and the parts close to the dental pulp cavity is obviously reduced. The laser technology sets parameters according to the characteristics of the resin material, can effectively decompose or vaporize the restoration body and the resin material, simultaneously control the thermal influence and mechanical damage to the surrounding dental tissue to be in a minimum range, and can safely treat the complex restoration body and the resin sealing condition;

2. The rubber barrier isolation technology can completely isolate the affected teeth from saliva and bacteria in the oral cavity in the process of cleaning and disinfecting the root canal, creates a nearly sterile environment for the cleaning and disinfecting operation of the root canal, and greatly reduces the possibility of reinfection of the root canal. The root canal disinfection medicament added with the nano silver particles has extremely small particle diameter and goes deep into the root canal system micro structure, continuously plays a strong antibacterial effect, can effectively kill various bacteria, fungi and other microorganisms in the root canal, including drug-resistant bacteria, has long antibacterial time, obviously improves the success rate of retreatment, effectively solves the infection control problem existing in the traditional disinfection method, enhances the infection control and reduces the operation risk;

3. In the step of refilling the pulp cavity, the color of the resin is prepared by utilizing a computer color matching technology, and the color of the prepared resin is perfectly matched with the color parameters of the peripheral teeth of a patient through the accurate analysis of the color parameters of the peripheral teeth, so that the aesthetic degree of the repaired teeth can be remarkably improved no matter the front teeth or the rear teeth, and the aesthetic requirement of the patient is met. The novel resin material with better biocompatibility and low shrinkage rate is selected, and the material can not cause adverse reactions such as inflammation, allergy and the like of surrounding tissues after being implanted into a human body, thereby being beneficial to long-term health of dental pulp and periapical tissues. Meanwhile, the low shrinkage rate characteristic can effectively reduce the occurrence of micro leakage, and prevent bacteria and oral liquid from entering a pulp cavity or a root canal through the micro leakage, thereby reducing the risk of dental pulp inflammation or recurrence of root tip Zhou Bingbian, improving the long-term effect of retreatment, improving the repairing attractiveness and the material performance;

4. Oral CBCT and CAD/CAM techniques are used to evaluate and program the operational procedure for the affected teeth prior to treatment. The three-dimensional shape of the root canal, the original filling material condition, the thickness distribution of the tooth tissue and other detailed information provided by the CBCT provide key basis for doctors to make treatment plans, so that the doctors can operate more accurately in the process of cleaning the root canal, unnecessary exploration and cleaning steps are reduced, and the damage to normal tooth tissue and root canal structure is avoided. The CAD/CAM technology pre-plans the filling mode and thickness of the resin and the operation track of root canal preparation according to the CBCT information, reduces repeated attempts in the operation process, obviously shortens the operation time, improves the retreatment efficiency and quality, improves the overall treatment effect, and improves the treatment efficiency and quality;

5. By designing an intelligent design monitoring platform, the affected teeth are comprehensively evaluated before operation. The method can clearly know the specific conditions of the affected teeth, such as accurately grasping the internal structure of the teeth according to CBCT display information, provides detailed basis for the subsequent establishment of reasonable treatment plans, can reduce unnecessary operation steps, improve the quality of retreatment, ensure the treatment effect to be more in line with expectations, guide patients to care and timely find and treat problems after operation, and effectively control pain during operation in response to emergency.

Drawings

Fig. 1 is a schematic block diagram of a method for intramedullary resin occlusion re-treatment after endodontic treatment.

Detailed Description

The following description of the embodiments of the present invention will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present invention, but not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the invention without making any inventive effort, are intended to be within the scope of the invention.

Referring to fig. 1, the invention provides a method for resin sealing and retreatment in a intramedullary cavity after root canal treatment, which comprises the following steps:

1. Preoperative patient assessment and preparation:

medical history collection and analysis:

Special medical staff is arranged to communicate with the patient in detail. The patient is asked when the first endodontic treatment, e.g. the patient recalls that the endodontic treatment was received two years ago due to pulpitis. The treatment causes are known to be due to caries or other factors such as trauma. The inquiry is made as to whether or not there is a special condition during the treatment, such as the patient mentions that there is a slight pain lasting for about one week after the root canal treatment, but that there is self-relief after no special treatment. And inquiring about the postoperative recovery condition, including whether the chewing function is normal, whether the chewing function is swollen or not, and other discomfort.

The general health conditions of patients are comprehensively known, including whether patients suffer from systemic diseases such as hypertension, heart disease, diabetes and the like. For example, a patient may be indicated as having diabetes and may be asked about the glycemic control in detail. The patient is asked about a history of allergies, such as whether to be allergic to certain drugs (e.g., penicillins, cephalosporins) or oral materials. Based on this information, the risk of retreatment is assessed, and for diabetics, treatment is required with good glycemic control due to the slow healing of the wound and anti-infective measures are added after surgery, and for patients with a history of allergies, materials that may cause allergies are avoided.

Oral examination and imaging review:

The doctor performs a comprehensive examination of the patient's mouth. The affected teeth and the adjacent teeth are visually inspected to see whether the color and the shape of the tooth surface are normal, whether new caries signs exist or whether the edges of the restoration are sealed or not. For example, the affected crown is found to be slightly dark in color and the adjacent teeth are slightly pigmented. The caries and defect of the teeth are checked by using the probe, the edge of the affected dental restoration is detected to have a seamless gap, whether the gum is red and swollen or bleeding is checked, and the periodontal pocket depth is detected. The method can be used for carrying out percussion on the affected teeth and adjacent teeth to judge the reaction of dental pulp and periapical tissues, for example, the percussion of the affected teeth has no obvious pain or discomfort. Checking the looseness of teeth, the affected teeth have no obvious looseness.

In addition to using oral CBCT, imaging examinations were performed in combination with oral full-view and root tip. The arrangement of the whole mouth teeth, the general morphology and density of the alveolar bone were observed through the oral whole-view film. The root tip can more clearly show the length, shape, general number and trend of the affected tooth root. CBCT can provide three-dimensional information of root canal system, including number, bending degree and length of root canal, and observe the condition of original filling in root canal, such as whether there is overcharge or undercharge, and thickness distribution of tooth tissue. For example, CBCT images show that the affected tooth has three root canals, one of which has a slight filling under-filling in one third of the root tip, and the thickness of the dental tissue of the neck is thinner in some areas. Based on these examination results, the indication and contraindication of retreatment are determined, and for the affected teeth, the indication of retreatment is present due to the under-filling of root canal, and the indication is contraindication if the whole body condition of the patient is worse and the treatment cannot be tolerated. And to formulate personalized treatment plans, including the number of treatments anticipated, the materials that may be used, etc.

Psychological counseling and informed consent of patients:

the doctor explains in detail the course of the retreatment after the root canal treatment to the patient. Informing the patient that the original prosthesis and the sealing material in the intramedullary canal first need to be removed, the procedure may have some slight vibration sensation but is not very painful. The root canal is then cleaned and disinfected again and the medullary cavity and root canal refilled as the case may be.

The patient is presented with conditions that may occur, such as transient pain during treatment, especially when treating the root canal if the pulp is still partially viable. The patient is informed that there may be a slight swelling after surgery, which is a normal postoperative response, typically fading gradually over a period of days. Introducing a treatment cycle to the patient may require about 1-2 hours for each visit. Informing the patient of the approximate cost range, including material costs, treatment costs, etc. The stress of the patient is relieved through the patience explanation, and the patient is ensured to sign the informed consent after fully understanding.

2. Removing the original prosthesis and the sealing material:

use of a grinding device with a sensor:

The doctor selects a proper grinding device with a sensor, and adjusts the angle and the rotating speed of the grinding device according to the positions and the ranges of the prosthesis and the resin sealing material. When the dental crown surface restoration is abraded, the abrasion device starts to work, and the sensor monitors the abrasion depth in real time. When the abrading operation approaches the safe thickness of the tooth, such as abrading the restoration at the neck of a tooth nearer to the pulp chamber, the sensor sounds an alarm that sounds that the practitioner is currently approaching a safe limit. The doctor immediately adjusts the grinding force according to the alarm, reduces the pressure, and properly adjusts the grinding direction, thereby avoiding the continuous grinding to the deep part, accurately removing the prosthetic material, and minimizing the damage to the dental tissues, especially the dental neck and the part close to the dental pulp cavity. When the resin sealing material in the medullary cavity is abraded, the resin sealing material is also prevented from being abraded through the medullary cavity wall according to the alarm operation of the sensor.

1. The instrument and the equipment are a grinding device with a sensor. The device mainly comprises a grinding tool head, a depth sensor, a control unit, a display unit, a power system and the like. The grinding tool head is used for grinding the prosthesis and the resin material, the depth sensor can sense the ground depth information in real time and transmit the data to the control unit, the control unit is responsible for receiving the sensor data and comparing the sensor data with preset safe thickness data, when the sensor data reach an early warning value, a command is sent to the display unit and the power system is controlled to adjust the grinding force, the display unit is used for intuitively displaying the grinding depth and other related information, the grinding depth and other related information are convenient for a doctor to observe during operation, and the power system provides power support for the grinding operation and ensures that the grinding device runs normally.

2. The implementation mode is that a specific signal (such as an ultrasonic signal or an electromagnetic induction signal) is transmitted through the depth sensor, the signal can reflect or change when contacting with interfaces of different materials (dental tissues and a prosthesis or a resin material), and the sensor receives the reflected signal and converts the reflected signal into an electric signal to be transmitted to the control unit. The control unit analyzes and processes the electric signals according to a built-in algorithm, and the current grinding depth is calculated. Once the depth is close to a preset safe thickness threshold value, the control unit triggers the alarm device to give out alarm sound, and simultaneously adjusts the output power of the power system, so that the rotating speed or torque of the grinding tool head is reduced, the grinding operation is accurately controlled, and the damage to dental tissues is reduced.

3. The detailed steps are as follows:

The doctor selects the matched grinding device with the sensor according to the positions and the ranges of the prosthesis and the resin sealing material.

According to the actual situation, the angle and the rotating speed of the grinding device are accurately adjusted, and the preparation work before grinding is finished.

And starting the grinding device to grind the dental crown surface restoration, synchronously starting the sensors at the moment, and monitoring the grinding depth in real time.

The sensor sounds an alarm when the restoration is abraded to a near safe thickness of the tooth, such as by abrading the restoration at the neck of the tooth near the pulp chamber.

After the doctor hears the alarm, the grinding force is reduced immediately, the grinding direction is changed appropriately, the deep grinding is prevented from being continued, the prosthetic material is removed accurately, and the damage to the dental tissues, especially the dental neck and the dental pulp cavity near part is reduced to the greatest extent.

When the resin sealing material in the medullary cavity is processed, the steps are repeated, and the grinding through the medullary cavity wall is avoided according to the alarm operation of the sensor.

Use of novel laser technology:

First, according to previous analysis of the resin material, the doctor detects the resin material as a specific type of composite resin, which has moderate hardness and high polymerization degree. Depending on these characteristics, suitable laser parameters are set, including wavelength, power, pulse frequency, etc. of the laser. For example, setting the wavelength to a specific value, the power is adjusted to an appropriate level to ensure that the resin material is effectively decomposed without causing excessive damage to the dental tissue.

When the crown surface restoration and the intramedullary resin sealing material are processed, the laser device is started, and laser energy is transmitted to the action part through the optical fiber. The laser energy is concentrated on the prosthesis and the resin material to cause them to rapidly decompose or vaporize. For complex restorations of the posterior teeth and resin closure situations, such as the presence of restorations on the distal surface of the molar and deep, conventional grinding tools are difficult to reach effectively, and laser light can easily reach these sites through optical fibers. In the laser action process, due to accurate control of parameters, the thermal influence and mechanical damage to the surrounding dental tissues are small, the temperature rise of the dental tissues is controlled within a safe range, and the problems of dental pulp damage, microcrack of dental hard tissues and the like caused by overheating are avoided.

1. Instrument and equipment, novel laser equipment and optical fiber. The novel laser device comprises a laser generator, an energy adjusting system, a cooling system, a laser transmission interface and the like. The laser generator is responsible for generating high-energy laser beams, the energy adjusting system can accurately adjust parameters such as wavelength, power, pulse frequency and the like of the laser to adapt to the processing requirements of different resin materials, the cooling system is used for emitting heat generated by laser equipment in the working process, preventing the equipment from being overheated and damaged, simultaneously being beneficial to controlling the temperature of dental tissues around a laser action area, and the laser transmission interface is used for connecting optical fibers to transmit laser energy to an action part. The optical fiber is used as an energy transmission medium, can accurately transmit the energy generated by the laser device to a target position on the surface of the dental crown or in the intramedullary cavity, has good flexibility and light conductivity, and can conveniently reach the parts which are difficult to reach by the traditional grinding tool.

2. Implementation the laser generator generates a high energy laser beam based on specific laser generation principles, such as stimulated radiation, etc. The energy regulating system precisely regulates the wavelength, power and pulse frequency of the laser by changing the working conditions (such as current, voltage, resonant cavity structure and the like) in the laser generator according to preset parameter values. The laser beam enters the optical fiber through the laser transmission interface and is transmitted to the action part through total reflection in the optical fiber. When laser energy acts on the prosthesis and the resin material, due to the high energy characteristic of the laser, physical and chemical changes such as chemical bond fracture, sublimation or vaporization and the like are rapidly generated after the resin material molecules absorb the energy, so that the material is removed. Meanwhile, the laser equipment and the surrounding environment of the action area are cooled through the cooling system, and the laser parameters are precisely controlled, so that the heat absorbed by the dental tissue is in a safe range, and adverse consequences such as dental pulp damage and dental hard tissue microcracks caused by overheating are avoided.

3. The detailed steps are as follows:

the doctor firstly analyzes the resin material to determine that the resin material is the composite resin with a specific type, moderate hardness and higher polymerization degree.

According to the resin material characteristics, appropriate laser parameters including wavelength, power, pulse frequency, etc. of the laser are set, for example, the wavelength is set to a specific value, and the power is adjusted to an appropriate level, so that the dental tissue is not excessively damaged while the resin material is effectively decomposed.

The laser device is started, and laser energy is conducted to the action part through the optical fiber, the dental crown surface restoration body and the resin sealing material in the intramedullary cavity.

The laser energy is concentrated to act on the repairing body and the resin material to enable the repairing body and the resin material to be rapidly decomposed or vaporized, so that the treatment of the repairing body and the resin sealing material is completed. When the complex restoration of the rear tooth and the resin sealing condition, such as the restoration of the molar distal surface and the position is deeper, the laser can easily reach the target part by the optical fiber. In the whole process, due to the fact that laser parameters are accurately controlled, the thermal influence and mechanical damage to surrounding dental tissues are small, the temperature rise of the dental tissues is controlled in a safe range, and the problems of dental pulp damage, dental hard tissue microcracks and the like are effectively avoided.

3. Cleaning and sterilizing the root canal:

Rubber barrier isolation technique:

And selecting a rubber dam with proper size and model, and installing around the affected teeth. The rubber band clamp is used for fixing the rubber band on the affected teeth, so that the rubber band is tightly attached to the teeth, and the affected teeth are completely isolated from saliva and bacteria in the oral cavity. In the whole root canal re-cleaning and sterilizing process, the rubber barrier can effectively prevent bacteria and saliva in the oral cavity from polluting the root canal, create a relatively sterile environment for root canal cleaning and sterilizing operation, and greatly reduce the possibility of root canal re-infection. For example, when cleaning the root canal, even if there is a large amount of bacteria in the patient's mouth, the bacteria cannot enter the root canal due to isolation by the rubber dam.

Root canal disinfection drug with added nano silver particles:

After cleaning the root canal, preparing the root canal disinfection medicament by mixing nano silver particles with traditional disinfection medicaments such as calcium hydroxide paste and the like. The nano silver particles are uniformly mixed with the calcium hydroxide paste according to a specific proportion, and the particle size of the nano silver particles is very small and is usually in the nano level. The mixed disinfection medicine is slowly introduced into the root canal by using a special root canal injector, so that the medicine can reach all parts of the root canal, especially the root tip area. The nano silver particles penetrate into the micro structure of the root canal system by virtue of the small particle size, and are fully contacted with bacteria. The unique physical and chemical properties of the composition exert continuous antibacterial effect, and can effectively kill various bacteria, fungi and other microorganisms in root canals, including some drug-resistant bacteria. And the antibacterial effect lasts for a long time, and compared with the single use of calcium hydroxide paste, the antibacterial agent can maintain the sterile state in root canal more effectively, and the success rate of retreatment is improved. For example, after the use of such mixed disinfectant drugs, the number of bacteria in the root canal is significantly reduced and kept at a low level for a longer period of time.

4. Refilling the medullary cavity and root canal:

Selecting a novel resin material and a computer color matching technology:

According to the treatment plan, a resin material having biocompatibility is preferably used. The resin material has no irritation to dental pulp tissue and periodontal tissue, and has good biocompatibility with dental tissue. Prior to filling the medullary cavity, the resin color is formulated using in silico color matching techniques. A special color measuring instrument is arranged close to the tooth tissue around the patient, and the instrument accurately analyzes color parameters including brightness, hue, saturation and the like of the tooth tissue around the patient through an optical sensor. These parameters are then input into a computer color matching system which matches the color of the resin according to a built-in algorithm. Whether front teeth or rear teeth, the color of the restored teeth is consistent with the color of surrounding natural teeth, the beautiful degree of the restored teeth is improved, and the beautiful requirement of patients is met. For example, for anterior restorations, the color of the formulated resin is barely distinguishable from adjacent natural teeth.

Resin filling operation:

And (3) filling self-setting resin, namely if the self-setting resin is selected for filling, the resin materials are blended on the blending plate according to a strict proportion, the blending operation is rapid and uniform, and the components of the resin are fully mixed. After tempering, the resin is rapidly filled into the medullary cavity for a limited time before it begins to cure. The resin is gently compacted by using a small filler, and gradually compacted to the crown direction from the bottom of the medullary cavity, so that the resin is distributed more uniformly in the medullary cavity, and the defects of pores and the like are avoided. For example, during filling, the physician ensures that the corners of the medullary cavity are filled by adding resin a small number of times and compacting.

And (3) filling the light-cured resin, namely filling the light-cured resin into the medullary cavity in a layering way. A small amount of resin is delivered to the medullary cavity at a time using a special resin delivery tool, each layer of resin having a thickness of no more than 2mm. After filling a layer of resin, the resin is irradiated and cured for a predetermined time and distance by using a light curing lamp. For example, the wavelength and power of the light curing lamp are set to parameters suitable for curing the resin, the irradiation time is about 20-40 seconds, and the distance from the surface of the resin is about 1-2mm, so that each layer of resin can be fully irradiated with light to achieve complete curing. This process is repeated until the medullary cavity is filled.

Root canal filling-if it is found in the examination that the root canal filling needs to be performed again, the quality of the root canal preparation is ensured first. The root canal file is used for further operations such as expansion, forming and the like, the model of the file is gradually increased according to the length and the diameter of the root canal, so that the root canal forms a continuous cone shape, and the sealing of filling materials is facilitated. The root canal filling material, such as gutta percha point, is selected to be matched with the root canal sealer. The gutta-percha point with proper model is selected according to the shape and the size of the root canal, the gutta-percha point can be tightly attached to the root canal wall, and meanwhile, certain resistance exists in the root canal, so that the filling stability is ensured. The root canal sealer is smeared on the root canal wall uniformly to fill the tiny gap between the gutta-percha point and the root canal wall, thereby effectively sealing the root canal system and preventing bacteria from invading again.

5. The operational flow is optimized by CBCT and CAD/CAM technology:

use of CBCT in preoperative evaluation:

Before treatment, three-dimensional morphology of root canal was clearly presented by oral CBCT. The doctor can accurately observe the number of root canals, such as whether the affected teeth are single or multiple (e.g., double or triple). The degree of curvature of the root canal is clearly seen, as is whether the canal is slightly curved or has a complex S-shaped curvature. The length of the root canal is determined, and an accurate basis is provided for root canal preparation and filling. Meanwhile, the CBCT can also display the condition of the original filling in the root canal, judge whether the filling is complete or not, if the filling is found to be broken or separated, whether the filling is overcharged or undercharged or not, the specific position and degree of the overcharged or undercharged, and also see the thickness distribution of the dental tissue and the like. For example, a root tip of a certain root canal is found to be slightly underfilled by CBCT images, and the buccal dental tissue of the dental neck is thinner. The detailed information is important for a doctor to make a treatment plan, helps the doctor accurately judge the position of residual substances in the root canal, can guide the doctor to operate more pertinently in the process of cleaning the root canal again, avoids unnecessary root canal exploration and cleaning, and reduces damage to normal dental tissues and root canal structures.

Application of CAD/CAM technology in operational flow planning:

By using CAD/CAM technology, the physician plans the whole retreatment operation flow in advance according to the information acquired by CBCT. In the resin filling step, the mode and thickness of the resin filling are more reasonably selected according to the conditions of tooth tissues and root canal. For example, if the root canal morphology is complex, such as there are multiple bends or large variations in root canal diameter, CAD/CAM techniques may help the physician to design more appropriate resin filling paths and thickness profiles. By computer simulation, it is determined from which direction and in which order the resin is filled, the tightness and accuracy of the filling can be ensured. In the root canal preparation process, the motion track of the root canal file can be accurately controlled according to CAD/CAM planning, so that the root canal preparation is more accurate. By the pre-planning, repeated attempts and unnecessary operation steps in the operation process can be reduced, so that the operation time is obviously reduced, the retreatment efficiency is improved, the treatment quality is improved, and complications caused by misoperation or blind operation are reduced.

6. Postoperative care and follow-up:

postoperative physician order and care guidance:

Informing the patient of post-operative care. Exhort patients can avoid chewing hard food on affected side in short term (such as within a week) after operation, and can prevent the prosthesis or filler from falling off or damaging. The patient is instructed to keep the oral cavity clean and hygienic, and the specific mouthwash recommended by the doctor, such as the mouthwash containing chlorhexidine ingredients, can be used for rinsing 3-4 times per day. Meanwhile, the patient is taught to brush teeth gently by using the soft-hair toothbrush, so that the gum and the restoration are prevented from being damaged. Patients are informed to avoid bad habits such as smoking, drinking, etc., as these activities may affect local blood circulation and tissue healing in the mouth. For minor pain, swelling, etc. that may occur after surgery, the patient is interpreted as a normal post-operative response. If the pain is light, the pain can be relieved by cold compress side parts, and if the pain is obvious, a proper amount of non-steroidal anti-inflammatory drugs (such as ibuprofen) can be taken according to the doctor's advice. For swelling, patients are informed that swelling generally reaches a peak 2-3 days after operation, and then gradually subsides, if swelling is continuously aggravated or symptoms such as heat are accompanied, the patients need to be re-diagnosed in time.

Periodic follow-up and review:

Patients were scheduled for follow-up at specific time intervals after surgery. The first follow-up is performed 1 week after the operation to check the oral condition of the patient, including asking the patient for subjective feeling (pain, swelling, etc.), observing the state of the prosthesis and gum, and checking the oral hygiene. Follow-up was performed again at time points of 1 month, 3 months, 6 months, etc. after surgery. The follow-up content comprises oral examination and imaging examination, and the dental looseness is checked by checking whether the restoration is complete, loosening and color changing, whether the gingiva is red and swollen, bleeding, retraction and the like. Imaging examination by taking root tip slices or CBCT (as the case may be), the condition in the root canal, such as whether the filling is stable, whether there is a new periapical lesion, and healing of surrounding alveolar bone, is observed. And (5) timely finding and processing possible problems such as resin micro-leakage, recurrent periapical inflammation and the like according to the follow-up result, and timely adjusting subsequent treatment or nursing schemes.

7. Emergency treatment in operation:

Emergency treatment of pulp cavity perforation:

During the removal of the original restoration and the closure material or the rescreening of the root canal, the physician immediately stops the procedure if pulp chamber perforation occurs. The perforated part is washed with physiological saline, and the chips, blood and the like at the wound are washed clean. For smaller perforations, e.g., perforation diameters less than 1mm, immediate repair using a biocompatible repair material (e.g., MTA) may be attempted. The MTA material is blended into paste according to the specified water-powder proportion, and is accurately conveyed to the perforation position by using a special conveying tool, and then lightly compacted, so that the material is ensured to completely cover the perforation position and is tightly attached to surrounding dental tissues. For larger perforations (e.g., greater than 1mm in diameter), the treatment plan may be changed, and depending on the location of the perforation and the particular situation of the affected tooth, it may be necessary to perform an endodontic cutting operation or to take into account the removal of the affected tooth (in cases where other treatments are not effective). At the same time, the patient is given appropriate anti-infective therapy, such as oral antibiotics, to prevent spread of the infection.

Emergency treatment of instrument breakage:

if the root canal file and other instruments are broken in the root canal in the process of cleaning the root canal again, the position and the length of the broken instruments are determined by X-ray films or CBCT. If the broken instrument is positioned at the root canal coronal part and can be directly taken out, the ultrasonic instrument or a special root canal instrument taking-out device can be used for taking out. The ultrasonic instrument tip is regulated to proper frequency and power, and the ultrasonic instrument tip is gently vibrated near the breaking instrument to loosen the breaking instrument and to take out the breaking instrument or a special instrument taking-out device is used to clamp the breaking instrument and pull out the breaking instrument through the special design. If the breaking instrument is located in the middle or tip of the root canal, its effect on the root canal treatment is evaluated. If the root canal filling and prognosis are not affected, the root canal filling can be considered to be treated as part of the root canal filling, and if the treatment effect is affected, such as the root canal filling is blocked or periapical inflammation is possibly caused, more complex treatment methods such as microscopic root canal surgery and the like are considered to be adopted, and the broken instrument is accurately removed under a microscope.

8. Pain management:

local anesthesia optimization:

Depending on the location of the affected teeth and the pain threshold of the patient, appropriate local anesthetic methods and anesthetic drugs are selected. For anterior maxillary teeth, local infiltration anesthesia can be selected, and a lidocaine anesthetic containing epinephrine can be used, so that intraoperative bleeding can be reduced and anesthesia time can be prolonged. For the area with complex pulp nerve distribution such as mandibular molar, conducting anesthesia can be adopted, for example, medicines with better anesthesia effects such as activacaine can be used. For patients with pulp activity or pain sensitivity, a surface anesthetic (such as tetracaine gel) can be used for assisting infiltration anesthesia or conduction anesthesia on the surface of the affected teeth before treatment, so that the anesthesia effect is improved, and the pain feeling of the patients in the treatment process is reduced. During anesthesia, proper injection techniques, such as selecting the proper needle insertion point, are noted to avoid damaging surrounding tissue and causing unnecessary pain. The anesthetic is slowly injected by pushing during injection, and the reaction of the patient is closely observed.

Intraoperative pain control:

During operation, if the patient still has pain sensation, the dosage of local anesthetic or the type of anesthetic can be appropriately increased within a safe range. For example, if lidocaine is poorly anesthetized, it is conceivable to replace it with bupivacaine or another equivalent anesthetic. Meanwhile, the doctor should operate gently to avoid overstimulation of dental pulp and periodontal tissues. When the root canal instrument is used for cleaning and preparing the root canal, the entering depth and the force of the instrument are controlled, and the instrument is prevented from exceeding the root canal hole to stimulate the periapical tissue. For patients with severe pain, oral or intravenous analgesic administration may be considered during the course of treatment, but care should be taken to take into account the effects of the drug on the general condition of the patient and possible adverse effects, such as the potential for non-steroidal anti-inflammatory drugs to irritate the gastrointestinal tract, which should be used with caution.

Postoperative pain prevention and treatment:

After the treatment is completed, a drug with analgesic effect (such as oleum Caryophylli cotton ball) can be placed in the pulp cavity to relieve pain response of dental pulp after operation. The patient is informed of the pain conditions and relief that may occur after surgery, as pain typically begins to occur within hours after surgery, may be more pronounced within 1-2 days, and then gradually lessens. For patients with significant postoperative pain, oral non-steroidal anti-inflammatory drugs or other analgesics, such as acetaminophen, etc., may be administered depending on the degree of pain. If pain continues unreliably or aggravates, e.g., pain is more than 3 days and gradually aggravates, or is accompanied by symptoms such as heat, swelling, etc., the patient is scheduled for review in time to determine if there is an infection or other complication.

The intelligent design monitoring platform is combined with an oral cavity CBCT (cone beam CT) technology, and is used for detecting the change of relative position angles between a grinding device and a working surface of a sensor and between a laser generator and the working surface, so that the accuracy of removing the dental crown surface restoration and the resin sealing material in the intramedullary cavity is further improved, the complex restoration and the resin sealing condition can be safely treated, and the treatment safety and the accuracy are further improved.

Claims

1. A method for resin sealing retreatment of the medullary cavity after root canal treatment, characterized in that it comprises the following steps:

S1: preoperative sampling;

S2: Removal of restorations and other materials: Use material removal techniques and tools to remove crown surface restorations and intramedullary resin sealing materials, where material removal techniques and tools include abrasive devices with sensors or laser technology; the sensor is a depth sensor, and the emitted signal will be reflected or changed when it contacts the interface of different materials; in laser technology, the laser generator generates a high-energy laser beam, which causes the resin material molecules to absorb energy and undergo physical and chemical changes such as chemical bond breaking, sublimation or vaporization, thereby achieving material removal;

S3: Root canal re-cleaning and disinfection: Rubber dam isolation technology is used during the root canal re-cleaning and disinfection process, and root canal disinfection drugs with added nanosilver particles are used after the root canal is cleaned. Nanosilver particles are mixed with traditional disinfection drugs such as calcium hydroxide paste;

S4: Re-filling treatment: In the process of re-filling the pulp cavity and root canal, biocompatible resin materials should be used first. Before filling the pulp cavity, the color of the resin should be adjusted using computer color matching technology. For self-curing resin and light-curing resin, filling should be performed according to the prescribed operation. If re-filling of the root canal is required, the quality of the root canal preparation should be ensured and the appropriate root canal filling material should be selected;

It also includes: Intelligent design monitoring platform: use oral CBCT (cone beam CT) and computer-aided design/computer-aided manufacturing (CAD/CAM) technology to evaluate the affected teeth and plan the operation process before treatment; provide medical advice and nursing guidance to patients after surgery and arrange regular follow-up and reexaminations, and at the same time have intraoperative emergency treatment and pain management measures during the treatment process.

2. A method for retreatment of intramedullary cavity resin sealing after root canal treatment as described in claim 1, characterized in that: in S1, the patient's medical history is collected and analyzed, oral examination and imaging review are performed, and psychological counseling and informed consent are given to the patient before the operation; including in the medical history collection and analysis steps, detailed inquiries are made to the patient's root canal treatment history, general health status and allergy history, and the information is analyzed to assess the risk of retreatment and special preparation needs, oral examination and imaging review include a comprehensive examination of the affected tooth and adjacent teeth and a variety of imaging examinations, and the indications, contraindications and treatment plan are determined based on the results, and the patient's psychological counseling and informed consent is to explain the treatment process and situation to the patient and ensure that he understands and signs the consent form.

3. A method for re-treatment of the pulp cavity with resin sealing after root canal treatment as described in claim 1, characterized in that: in S2, the grinding device with a sensor sends out an alarm when it approaches the safe thickness of the tooth during the grinding process, and the doctor adjusts the operating parameters accordingly to reduce damage to the tooth tissue, especially the tooth neck and the area close to the pulp cavity. The new laser technology sets parameters according to the characteristics of the resin material to reduce the thermal impact and mechanical damage to the surrounding tooth tissue to handle complex restorations and resin sealing situations.

4. A method for resin sealing retreatment of the pulp cavity after root canal treatment as described in claim 1, characterized in that: in S3, the rubber dam isolation technology completely isolates the affected tooth from saliva and bacteria in the oral cavity, creates a relatively sterile environment for root canal cleaning and disinfection operations, reduces the possibility of root canal reinfection, and the nanosilver particles, due to their small particle size, penetrate deep into the tiny structure of the root canal system and exert a sustained antibacterial effect.

5. A method for resin sealing and retreatment of the pulp cavity after root canal treatment as described in claim 1, characterized in that: in said S4, before filling the pulp cavity, the color of the resin is prepared using computer color matching technology, and the color of the prepared resin is matched with the surrounding tooth tissue by accurately analyzing the color parameters of the patient's surrounding tooth tissue, thereby improving the aesthetics of the restored teeth, and the self-curing resin and light-curing resin are filled according to the corresponding operations, and the root canal preparation quality and the selection of appropriate materials are ensured when re-filling the root canal.

6. A method for retreatment of intraendodontic resin sealing after root canal treatment as described in claim 1, characterized in that: in said S5, oral CBCT (cone beam CT) and computer-aided design/computer-aided manufacturing (CAD/CAM) technology are used to evaluate the affected tooth and plan the operation process before treatment, and unnecessary operation steps are reduced by CAD/CAM technology based on CBCT display information.

7. A method for retreatment of intramedullary cavity resin sealing after root canal treatment as described in claim 1, characterized in that: in the intelligent design monitoring platform, postoperative medical instructions and nursing guidance include informing the patient to avoid chewing hard food on the affected side, maintaining oral hygiene, avoiding bad habits and explaining methods to alleviate postoperative reactions, and regular follow-up and reexamination include performing oral and imaging examinations at specific time intervals and dealing with problems found.

8. A method for retreatment of the pulp cavity with resin sealing after root canal treatment as described in claim 1, characterized in that: in the intelligent design monitoring platform, intraoperative emergency treatment includes treatment methods for pulp cavity perforation and root canal instrument breakage, and pain management includes selection of appropriate anesthesia methods and drugs, intraoperative and postoperative pain control and treatment measures.