近来在工作之余浏览国外网站，学习国外大咖的一些病例分享时，发现一篇关于根管治疗前后一些细节方面的文章，感觉非常好，特来跟大家分享一下。尝试翻译了一下，如有错误欢迎大家指正。

        原文章地址https://styleitaliano.org/good-manners-for-good-endodontists/

        Good Manners for Good Endodontists

        优秀牙髓病专家的良好习惯

        Not one dentist I know who doesn’t find, in his daily practice, teeth that are earmarked for RCT (e.g. emergency, destructive caries, prothesis treatment planning) or that have had an RCT and need further treatment (e.g. post-endodontic build-up, fiber post positioning, prosthetic abutment preparation, orthodontic extrusion and so on).

        我认识的每一位牙医，在他们的日常工作中，总能遇到一些需要做根管治疗的牙齿(例如急性期、破坏性龋坏、修复治疗计划)或者已经做过根管治疗需要进一步治疗的牙齿(例如根管治疗后重建，打纤维桩，牙齿预备，正畸挤压等等)。

        For this reason even if Endodontics is a specialty that requires a lot of studying, long learning curve and specific armamentarium, each one of us has to deal with this discipline following some simple basic rules, in order to increase the success rates in RCT and the patient’s comfort, while decreasing the operative times of the endodontic treatment together with the patient’s stress.出于这个原因，即使牙髓病学是一门需要大量学习，长期学习和特定装备的专业，我们每个人都必须遵循一些简单的基本规则来处理这个学科，以提高RCT的成功率和 患者的舒适度，同时减少牙髓治疗的手术时间以及患者的压力。

        On the other hand, it’s advisable for the endodontist to be able to doa proper composite restoration, crown lengthening, etc…and he mustfacilitate the work of the colleagues that will follow the patient after the endodontic treatment.

        另一方面，牙髓病医生建议能够进行适当的联合修复，牙冠延长等......并且他必须有利于同事在患者牙髓治疗后的后续治疗。

        In order to facilitate a comprehensive treatment, it is very important to follow these simple rules.为了促进联合治疗，遵循这些简单的规则是非常重要的。

        Img. 1–Presence of plaque and calculus. Patients come into the dental office, sometimes to begin a restorative treatment or with pain. Obviously, even when it come to endodontics, working with healthy tissues is better than inflamed tissues; working in a clean manner without plaque is even better. Placement of the rubber dam and restoration procedures are much easier in a healthy mouth thus providing a cleaner and safer environment for the operator. In case of emergencies, even if the primary aim of the appointment is, obviously, to eliminate the pain, we always have to think of the next steps to be taken: scaling of the area only requires a few minutes and improves workflow. Of course, an appointment with the hygienist is mandatory to decrease the amount of bacteria. This simple step plays a fundamental role in the following restorative procedures.

        图1-菌斑和结石的存在。患者进入牙科诊所，有时已经开始有所缓解或者仍然疼痛。显然，即使是因牙髓病而来，健康的组织总比发炎组织更好;在干净没有菌斑的方式下工作更好。在健康的188体育平台论坛 中放置橡皮障和修复工作更容易，因此要为操作者提供更清洁和更安全的环境。在紧急情况下，即使患者的主诉是消除痛苦，我们也必须考虑下一步要采取的措施：洁治工作区域只需要几分钟时间并大大改善工作流程。当然，预约洁牙师来减少细菌的数量也是必需的，这个简单的步骤在以后修复过程中起着重要作用。

        Img. 2–Caries elimination. It’s imperative to remove caries prior to performing an endodontic treatment. A thorough cleaning of the cavity before starting an RCT is mandatory in order to work in an environment that is as clean as possible.

        图2-去净腐质。在进行牙髓治疗之前必须去除腐质。在开始RCT之前彻底清洁髓腔是必需的，以便在尽可能干净的环境中工作。

        Img. 3–Pre-endodontic restoration. In general pre-endodontic restorations can be avoided if you complete the treatment in one visit. If you think that you can’t finish the endodontic therapy in one session or a complication occurs during treatment, you must create a perfect sealing of the access. Schilder said:“it’s more important what you keep out than what you put in”; the evolution of this concept is: it’s better to protect the endodontic space than putting a paste inside it.

        图3-牙髓前修复。 一般来说，如果您在一次就诊中完成治疗，可以避免牙髓前修复。 如果您认为您无法在一次治疗中完成牙髓治疗或治疗期间出现并发症，您必须创建一个完美的通道密封。 施里尔说：“你所保留的比你投入的更重要”;这个概念的演变是：保护牙髓空间比在其内部粘贴更好。

        Img. 4–Leaving a tooth open only in case of pulpitis or necrosis is a really wrong approach; bacteria can enter the Root Canal System and the biofilm can be then very hard to remove.

        图4-在牙髓炎或坏死的情况下保持根管开放是一种非常错误的方法;细菌可以进入根管系统，然后形成很难去除生物膜。

        Img. 5–A poor temporary restoration is the same as leaving a tooth open.

        图5-不良的临时修复跟保持根管开放一样。

        Img. 6–Cuspal reduction is mandatory in case of cracks, and it is the first step. The risk of crack creation and/or propagation between two appointments is very high. In general, all endodontically treated teeth require an indirect restoration or a crown: for this reason, having a flat surface as a reference point may make it easier to young colleagues to measure the working length, when compared to cuspidate teeth.

        图6-如果出现隐裂降低牙尖高度是必须的，这是第一步。两个高耸的牙尖咬合会使产生裂纹和/或使裂纹蔓延的风险非常高。一般而言，所有经牙髓治疗的牙齿都需要间接修复或冠修复：因此，与尖耸牙齿相比，以平坦表面作为参考点可能使年轻同事更容易测量工作长度。

        Img. 7–Pulp chamber cleaning. It sometimes happens that, when I restore teeth treated by a colleague, I find a dirty pulp chamber. My only thought about these situations is: WHY?

        图7-髓室清洁。有时候，当我恢复由同事治疗的牙齿时，我会发现一个脏的牙髓腔。我对这些情况的唯一想法是：为什么?

        Img. 8–Pulp chamber walls have to be cleaned by instruments, air abrasion or burs. The prosthodontist or the following colleague has to work in a clean space. It's necessary to pass a simple silicone tip to renew the surface. The tooth is then ready for adhesion procedures. About post placement, please follow the endodontist’s instructions.

        图8-髓室壁必须通过仪器、空气喷砂或毛刷清洁。188体育平台论坛 修复医生或者接手后续治疗的同事必须在干净的空闲工作。通过一个简单的硅胶尖来抛光表面是必须的。然后牙齿准备用于粘结操作。关于根管桩的放置，请遵循口内医生的建议。

        Img. 9–It's advisable to prepare the post space after Root Canal Treatment; in this manner, prosthodontists only have to try the post and, only if necessary, renew the dentin and start with adhesive procedures.

        建议在根管治疗后预备出根管桩道，以这种方式，修复医生只需要进行试桩操作就可以了，并且在必要时抛光牙本质，并开始粘结步骤。

        Img. 10–In this case, my advice was to place only one post. After the appointment with the prosthodontist, the patient came back because of pain. I noticed a perforation in the MB2 canal, due to incorrect post space preparation. I treated this perforation with MTA and the pain was resolved in one week.

        图10-在这种情况下，我建议只放置一根纤维桩。在与188体育平台论坛 修复医生会诊后，患者因疼痛复诊，我注意到由于不正确的桩道预备，MB2根管有穿孔。我用MTA修补了这个穿孔，疼痛在一周内消退。

        Img. 11–Cotton Pellets and temporary materials. About 90% of my cases end with a definitive restoration that allows the colleagues that will follow to prepare the tooth for a composite restoration or a prosthetic crown. In the other 10% of the cases, I only use cured materials that are able to perfectly adapt to margins thus preventing plaque from entering the prepared space.

        图11-棉球和暂封材料。大约90%的病例会明显治愈，允许后续同事进行修复治疗。在另外10%的情况下，我会只使用固化材料进行封闭，从而防止牙菌斑侵入。

        Img. 12–Outer sealing of the endodontic space. The most common mistake at the end of the endodontic treatment, even if a second session scheduled, is the lack of sealing of your own work.

        图12-牙髓腔的外部密封。根管治疗结束时最常见的错误是密封不严密，即使是已经根充完成。

        Img. 13–Temporary margin adaptation. The same concept is to be taken into consideration for the restorative phase: overlapping and invasion of the operative space by the gingiva and rough surface adaptation with the temporary restoration create an ideal hollow for bacterial growth.

        图13-暂封材料的调整。恢复期也要有同样的观念：暂封材料不要覆盖和侵犯牙龈，粗糙的临时材料表面为细菌的生长提供良好的附着面。

        Img. 14–Together with a cured temporary sealing, I prefer teflon as a temporary filling, as it is easier than cottons pallets to completely remove before adhesive procedures.

        图14-我更喜欢用特氟龙(也就是生胶带)和固化的暂封材料进行双层暂封，因为特氟龙比棉球更容易去除。(而且特氟龙不缠车针)

        Img. 15–Even if you’re not an endodontist, as a dentist you have to know the basic rules for treating a patient with pain, by respecting the endodontic space and correctly (from an endodontic perspective, obviously) opening the pulp chamber and by not laving the tooth with a poor restoration.

        即使你不是一个口内医生，作为一个牙医你也必须遵循解除患者病痛的基本原则，通过掌握髓腔的解剖形态和正确地(从牙髓学角度来看)开髓和不留下修复不良的牙齿

Img. 16–If you, in fact, are an Endodontist, you have to know which the next clinical step will be. In this case the tooth was prepared for a crown the day after, so there was non sense in creating an accurate occlusal anatomy during restoration, nor a correct contact point with the neighboring teeth. After the endodontic treatment, only 15 minutes were needed to restore the tooth properly for prosthodontics.

        事实上，如果你是一个口内医生，你必须知道下一个临床步骤是什么。这个病例中的牙齿在第二天要进行冠预备，所以恢复精确的咬合解剖形态，或者恢复与邻牙的正确接触点是没有意义的。根管治疗后只需要15分钟对牙齿进行适当的直接修复就可以了。

        Conclusions

        Dentists sometimes work hard but forget the basic rules to decrease the operative time, forthemselves and for theother colleagues. In the next article we will describe, step by step, the clinical procedures to increase success in these steps of the treatment.

        总结：

        牙医有时工作很努力但是忽视了一些为自己或者其他同事减少治疗时间的基本规则。在下一篇文章中，我们将一步一步地描述在这些治疗步骤中增加成功的临床程序。