根管治疗中锉的选择以及使用心得及技巧

<div class="wx_rich_media_content" id="jsWxContainer"><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">这是在论坛看到的这篇文章，觉得挺实用，与大家分享。总有新手问一些在我看来很简单的问题，其实是对器械耗材的不了解，在这里把我的一些经验和对器材的了解写出来，希望能对一些新鲜人有一点点帮助。</span></section><p contenteditable="false" class=""><br></p><section style="text-align: center;line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span class="wxart_image" wx-style="display:inline-block;"> </span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class=""><span style="color: rgb(63, 63, 63);" contenteditable="false" class="">◉mani手动锉，分为扩大针，h锉，k锉</span>扩大针，材质</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">不锈钢，横截面为三角形，切割能力中等，尖端尖锐度强</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用适应症</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">扩大针由于尖端锋利一般用于初探根管，切削能力弱，通过性强</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用手法</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">尽可能用平衡力法旋转，不要向下施加过多的力</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用注意事项</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">提前预弯，手法轻柔，避免出现暴力</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用中容易出现的问题</span></strong></span></section><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class=""><br></span></section><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">由于尖端设计导致使用这根锉遇阻力时不能向下加压，否则容易出现侧穿，由于材质的原因，即使预弯后也会出现拉直根管，根尖偏移等问题。</span></section><p contenteditable="false" class=""><br></p><section style="text-align: center;line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span class="wxart_image" wx-style="display:inline-block;"> </span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉H锉，材质</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">不锈钢，横截面为圆形?，切割能力强，尖端锐度强</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用适应症</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">h锉由于很像老鼠的尾巴我上学的时候老师又管它叫鼠尾锉，切割能力极强，所以一般用于上下提拉</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用方法</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">上下提拉切削，尽可能不旋转</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用注意事项</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">因为刃比较锋利，不要连续向一个方向提拉，容易切削过度，旋转时尽可能轻柔，遇阻力回旋，不要暴力提拉，尽可能不用于弯曲度较大的根管</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用中容易出现的问题</span></strong></span></section><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class=""><br></span></section><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">由于h锉刃切割能力强，遇阻力尽可能不旋转，否则刃非常容易卡在根管壁上，卡住后也不要暴力提拉，否则容易断针，由于刃部设计，h锉尽可能不预弯，减少折断风险</span></section><p contenteditable="false" class=""><br></p><section style="text-align: center;line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span class="wxart_image" wx-style="display:inline-block;"> </span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉k锉，材质</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">不锈钢，横截面为正方形，切割力弱，尖端锐度弱</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用适应症</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">k锉由于通过性和切削力较弱，一般都用来修整根管及根尖孔</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用手法</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">尽可能用平衡力法旋转提拉，不要向下施加过多的力</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用注意事项</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">提前预弯，手法轻柔，避免向下施加压力，同号扩大针疏通后再用来修整根管</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用中容易出现的问题</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">弯曲根管切记不可向下粗暴用力，不然极易出台阶</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">这是我接触的最早的一款不锈钢锉，标准02锥度的。</span><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">优点是价格相对经济.最开始我使用的顺序是，15＃扩大针探查疏通根管，15＃h锉提拉切削，15＃k锉最后修整根管壁和根尖孔，然后换20＃扩大针，h锉，k锉。</span><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">后来发现h锉实在是太危险了，于是省略了h锉这部，后来又发现诸多缺点，感觉mani锉实在是垃圾中的战斗机，</span><span style="letter-spacing: 1px;font-size: 16px;color: rgb(89, 89, 89);" contenteditable="false" class=""><strong>主要缺点有：</strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">1、手柄容易打滑，特别是后牙，每一次没拿住掉入患者口中我都几乎吓出一身冷汗，最后实在没办法，把几个锉后部的小孔都用绳子穿起来，套在手上，这才放心了。</span><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">但实在是太麻烦。</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">2、一开始最小号只有15＃，经常在根尖出现台阶，甚至有时候根中1／3就出现台阶下不去了，后来知道原来mani有小号的，于是进了8＃和10＃，可是价格翻倍不说，基本用不了几下尖就弯曲了，再用手拉直就很容易折断了，很是恼火。</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">3、一般使用8＃10＃的大部分是钙化根管，可是mani锉经常是捻来捻去也下不去，切削效果太差，有时候烦了也就不管不顾的直接上下一号的了</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">4、号数跨度太大，用扩大针扩完直接上下一号锉每次都很费劲，于是必须用同号的k锉彻底通畅后才能换下一号扩大针，实在是太耽搁效率了，于是换了vdw的先锋锉</span></section><p contenteditable="false" class=""><br></p><section style="text-align: center;line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span class="wxart_image" wx-style="display:inline-block;"> </span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉德国vdw先锋锉，材质</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">不锈钢，横截面为三角形，切割力好，尖端锐度强，通过性好</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用适应症</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">用于后牙狭窄钙化细小的根管探察，寻找根管口</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用手法</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">平衡力法</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用注意事项</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">提前预弯，手法轻柔稳定，避免尖撞到壁上</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(89, 89, 89);" contenteditable="false" class=""><strong><span style="letter-spacing: 1px;font-size: 16px;" contenteditable="false" class="">◉使用中容易出现的问题</span></strong></span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">过于硬了，对于弯曲度较大根管的初探，很容易出现台阶，预弯也不行</span></section><p contenteditable="false" class=""><br></p><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">用上了发现这个锉真是不错，CC+改良固位手柄，不易打滑。</span><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">不锈钢材质特别的合金处理技术和加工工艺，尖部强度高，较硬，后部柔韧性好易于疏通钙化根管，并且能沿根管壁方向顺畅下行，并且分为6，8，10，12号四个型号避免了mani由10直接跳到15号，跨度太大，很难预备这个缺点，而且尖端很硬，力反馈明显，也就是我们长说的，手感很准，尖端阻力和侧壁阻力很容易分辨出来。</span><span style="letter-spacing: 1px;color: rgb(63, 63, 63);font-size: 16px;" contenteditable="false" class="">可惜成也萧何败也萧何，尖端硬度高是个优势但也导致在特别狭窄弯曲的根管中，由于硬度太高不易变形，预弯不好，很容易在尖端出现台阶。</span><span style="color: rgb(63, 63, 63);font-size: 16px;letter-spacing: 1px;" contenteditable="false" class="">于是我开始寻找一款特别柔软的，适合异常弯曲根管的产品。</span></section><section style="line-height: 2em;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span style="color: rgb(63, 63, 63);font-size: 16px;letter-spacing: 1px;" contenteditable="false" class=""><br></span></section><section style="text-align: center;margin-left: 32px;margin-right: 32px;" contenteditable="false" class=""><span class="wxart_image" wx-style="display:inline-block;"> </span></section><hr style="border-style: solid; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-color: rgba(0, 0, 0, 0.1); transform-origin: 0px 0px; transform: scale(1, 0.5);"></div><p></p>