Development and establishment of diagnostic and treatment methods for fiberscope application to endodontic and periodontal disease

本研究调查了一种新设计的具有内置通道的精细纤维内窥镜(FS)，用于灌溉或仪器仪表。通过对病变根面和根尖周/牙周组织的观察，评价器械的设计、结构、使用方法和临床应用方法。结果表明：1.采用内置式通道进行器械固定，可采用激光纤维、K-型或带刺的长柄拉针和放射刀。特别是，激光照射去除肉芽组织和止血，以及使用K-锉穿透根管被发现是有效的。在外科手术中应用FS是有效的。由于术中、术后均可观察到刮除的对象和手术野，因此采用新型的根尖周刮治术，可通过鼻窦道、小切口或牙周袋进行刮除。方法应用FS减少…术后临床症状。手术损伤小，疼痛、肿胀多，愈合快。侧视FS在观察牙周袋中的根管或根面时有很好的发现。FS具有更多的图像纤维(10000像素)和一个灌水通道，用于通过鼻窦道或根管的颈部和中部观察根尖周病变的内部时，图像更清晰。在FS手术前注射吲哚红或亚甲基蓝染料时，肉芽组织和牙齿组织易于区分，根面结构清晰可见。比较了FS和显微镜下的结果，明确了锥度和根管直径的影响以及每种方法的特点。使用一种新的模型来验证FS演示和训练的有效性，该模型复制了带有牙周袋的牙周病变和带有窦道的根尖周病变。较少

The present study investigated a newly designed fine fiberscope (FS) with built-in channel for water irrigation or instrumentation. The FS was utilized to observe the root surface and periapical/periodontal tissues in lesions, in order to evaluate the design, structure, use of instruments and methods of clinical application.The following results were obtained :1. Nd : YAG laser fiber, K-file or barbed broach with long grip and radio-knife were applicable to the FS using the built-in channel for instrumentation. In particular, laser irradiation to remove granulation tissue and arrest bleeding, and penetration of root canal using K-file were found to be useful.2. Application of the FS to surgical procedures was effective. Periapical curettage using the new FS enabled curettage by sinus tract, minimum incision or periodontal pocket, because objects for curettage and the operation field can be observed during and after operation. Methods using FS reduced postoperative clinical symptoms suc … More h as pain and swelling, and rapid healing was exhibited, as surgical damage was small.3. Side-viewing FS has enabled good findings when observing the sides of root canals or root surfaces in periodontal pocket. FS with more image fibers (10 000 pixels) and a channel for water irrigation was effective in providing sharper images when applied to observation of the inside of periapical lesions through sinus tract, or the cervical and middle parts of root canal.4. When indigocarmine or methylene blue dye was injected prior to FS procedures, granulation and tooth tissues were easily differentiated and the structure of the root surface was clearly illustrated.5. We compared FS and microscope findings, and clarified the influence of the taper and diameter of the root in addition to the peculiarities of each method.6. The effectiveness of FS demonstrations and training was determined using a new model to reproduce periodontal lesions with periodontal pocket and periapical lesions with sinus tract. Less