近來在工作之餘瀏覽國外網站，學習國外大咖的一些病例分享時，發現一篇關於根管治療前後一些細節方麵的文章，感覺非常好，特來跟大家分享一下。嚐試翻譯了一下，如有錯誤歡迎大家指正。
原文章地址https://styleitaliano.org/good-manners-for-good-endodontists/
Good Manners for Good Endodontists
優秀牙髓病專家的良好習慣
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).
我認識的每一位牙醫，在他們的日常工作中，總能遇到一些需要做根管治療的牙齒(例如急性期、破壞性齲壞、修複治療計劃)或者已經做過根管治療需要進一步治療的牙齒(例如根管治療後重建，打纖維樁，牙齒預備，正畸擠壓等等)。
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.出於這個原因，即使牙髓病學是一門需要大量學習，長期學習和特定裝備的專業，我們每個人都必須遵循一些簡單的基本規則來處理這個學科，以提高RCT的成功率和 患者的舒適度，同時減少牙髓治療的手術時間以及患者的壓力。
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.
另一方麵，牙髓病醫生建議能夠進行適當的聯合修複，牙冠延長等......並且他必須有利於同事在患者牙髓治療後的後續治療。
In order to facilitate a comprehensive treatment, it is very important to follow these simple rules.為了促進聯合治療，遵循這些簡單的規則是非常重要的。
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.
圖1-菌斑和結石的存在。患者進入牙科診所，有時已經開始有所緩解或者仍然疼痛。顯然，即使是因牙髓病而來，健康的組織總比發炎組織更好;在幹淨沒有菌斑的方式下工作更好。在健康的口腔中放置橡皮障和修複工作更容易，因此要為操作者提供更清潔和更安全的環境。在緊急情況下，即使患者的主訴是消除痛苦，我們也必須考慮下一步要采取的措施：潔治工作區域隻需要幾分鍾時間並大大改善工作流程。當然，預約潔牙師來減少細菌的數量也是必需的，這個簡單的步驟在以後修複過程中起著重要作用。
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.
圖2-去淨腐質。在進行牙髓治療之前必須去除腐質。在開始RCT之前徹底清潔髓腔是必需的，以便在盡可能幹淨的環境中工作。
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.
圖3-牙髓前修複。 一般來說，如果您在一次就診中完成治療，可以避免牙髓前修複。 如果您認為您無法在一次治療中完成牙髓治療或治療期間出現並發症，您必須創建一個完美的通道密封。 施裏爾說：“你所保留的比你投入的更重要”;這個概念的演變是：保護牙髓空間比在其內部粘貼更好。
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.
圖4-在牙髓炎或壞死的情況下保持根管開放是一種非常錯誤的方法;細菌可以進入根管係統，然後形成很難去除生物膜。
Img. 5–A poor temporary restoration is the same as leaving a tooth open.
圖5-不良的臨時修複跟保持根管開放一樣。
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.
圖6-如果出現隱裂降低牙尖高度是必須的，這是第一步。兩個高聳的牙尖咬合會使產生裂紋和/或使裂紋蔓延的風險非常高。一般而言，所有經牙髓治療的牙齒都需要間接修複或冠修複：因此，與尖聳牙齒相比，以平坦表麵作為參考點可能使年輕同事更容易測量工作長度。
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?
圖7-髓室清潔。有時候，當我恢複由同事治療的牙齒時，我會發現一個髒的牙髓腔。我對這些情況的唯一想法是：為什麼?
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.
圖8-髓室壁必須通過儀器、空氣噴砂或毛刷清潔。口腔修複醫生或者接手後續治療的同事必須在幹淨的空閑工作。通過一個簡單的矽膠尖來拋光表麵是必須的。然後牙齒準備用於粘結操作。關於根管樁的放置，請遵循口內醫生的建議。
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.
建議在根管治療後預備出根管樁道，以這種方式，修複醫生隻需要進行試樁操作就可以了，並且在必要時拋光牙本質，並開始粘結步驟。
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.
圖10-在這種情況下，我建議隻放置一根纖維樁。在與口腔修複醫生會診後，患者因疼痛複診，我注意到由於不正確的樁道預備，MB2根管有穿孔。我用MTA修補了這個穿孔，疼痛在一周內消退。
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.
圖11-棉球和暫封材料。大約90%的病例會明顯治愈，允許後續同事進行修複治療。在另外10%的情況下，我會隻使用固化材料進行封閉，從而防止牙菌斑侵入。
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.
圖12-牙髓腔的外部密封。根管治療結束時最常見的錯誤是密封不嚴密，即使是已經根充完成。
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.
圖13-暫封材料的調整。恢複期也要有同樣的觀念：暫封材料不要覆蓋和侵犯牙齦，粗糙的臨時材料表麵為細菌的生長提供良好的附著麵。
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.
圖14-我更喜歡用特氟龍(也就是生膠帶)和固化的暫封材料進行雙層暫封，因為特氟龍比棉球更容易去除。(而且特氟龍不纏車針)
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.
即使你不是一個口內醫生，作為一個牙醫你也必須遵循解除患者病痛的基本原則，通過掌握髓腔的解剖形態和正確地(從牙髓學角度來看)開髓和不留下修複不良的牙齒
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.
事實上，如果你是一個口內醫生，你必須知道下一個臨床步驟是什麼。這個病例中的牙齒在第二天要進行冠預備，所以恢複精確的咬合解剖形態，或者恢複與鄰牙的正確接觸點是沒有意義的。根管治療後隻需要15分鍾對牙齒進行適當的直接修複就可以了。
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.
總結：
牙醫有時工作很努力但是忽視了一些為自己或者其他同事減少治療時間的基本規則。在下一篇文章中，我們將一步一步地描述在這些治療步驟中增加成功的臨床程序。
