59 - 看起来不错的根管治疗……但干净吗？– 第59集

欢迎收听《牙髓之声》，本节目由美国牙髓病学协会为您呈现。

Welcome to Endo Voices brought to you by the American Association of Endodontists.

在这个节目中，我们致力于推动牙髓病学的艺术与科学发展，并与当今顶尖专家一起，促进最高标准的患者护理。

The show where we are advancing the art and science of endodontics and promoting the highest standards of patient care with today's top experts in the field.

现在，有请我们的主持人，医生。

Now here's your host, Doctor.

马库斯·D.

Marcus D.

约翰逊。

Johnson.

非常感谢您加入我们。

Thank you so much for joining us.

这是《牙髓之声》的又一期节目。

Another episode of Endo Voices.

一如既往，我们努力为您带来牙髓病学领域中最非凡、真正创新的最新进展。

As always, we are trying to bring you the most extraordinary and really innovative new updates within endodontics.

我得说，能请到我们下一位嘉宾，真是非常荣幸，医生。

And I must say it is an extreme pleasure to have our next guest, Doctor.

兰迪·克罗斯，稍后我会让他多介绍自己一些，但他确实深入思考了牙髓病学的基础问题。

Randy Cross, who I'll let introduce himself a little bit more in a minute, but really has considered the basics of endodontics.

根管到底清没清干净？

Is the canal clean or not?

而接下来他要和我讨论的这个发明，真的是革命性的，几乎是颠覆性的变化。

And with this next, invention that he's gonna be, discussing with me, It's really a a revolutionary and pretty much a seismic change.

它有可能真正改变我们处理牙髓病的方式。

Has the ability to really revolutionize how we approach endodontics.

所以，兰迪，克罗斯医生，见到你真是非常高兴。

So, Randy, Doctor Cross, it is an absolute pleasure.

请介绍一下你自己吧。

Please introduce yourself.

非常感谢你加入我们，能在皇后区见到你真是太棒了。

Thank you so much for joining us, and it's just an amazing to to meet you at Queens.

嘿，马库斯。

Hey, Marcus.

这个介绍真的很棒，非常感谢你。

That's, a really great introduction, and and thank you so much for that.

我只想说……

I just wanna say the...

我也有同样的感觉。

I I feel the same here.

我住院医师培训期间就是听你的播客度过的。

So I I went to residency listening to your podcast.

你帮我在开车去培训的路上保持清醒。

You helped me stay awake on those drives to my residency.

所以能真的上这个播客，感觉太酷了。

So it's really cool to actually be on this podcast.

我每一集都在听。

I've been listening to every episode.

所以，是的，能来这里真是太好了。

So, yeah, it's a pleasure to be on here.

但为了保持伦理上的公开透明，我们想披露你可能存在的任何潜在利益冲突，因为你是这项新技术的所有者。

But just to be ethically open and transparent, we just wanted to disclose any potential conflict that you may have since you are the owner of this new technology.

没错。

That's correct.

我的公司叫Endocator，我拥有多项涉及根管内ATP检测和生物标志物检测的知识产权专利。

So my company is Endocator, and I have several intellectual patents that involve ATP testing and biomarker testing inside of a root canal.

所以在这次讨论中，我们会更多地谈到这些，但我想完全明确的是，我在这个领域拥有知识产权，我的公司也是基于此建立的。

So on this discussion, we're talking more about it, but just wanna be totally clear that I have intellectual property in this area and that my company is based off of.

是的，真的，谢谢你。

Yeah, really, you know, thank you for that.

我们只是想以更容易理解的形式，为牙髓病医生以及对牙科感兴趣的人提供信息。

It's something that we just wanted to provide information in a more digestible format for the endodontists and those who are interested in dentistry in general.

上次在AAE会议上我们有机会见面，你主动来找我，你展示给我的东西真的让我大为震撼。

And when we had the chance to meet last AAE and you approached me, I was literally blown away by what you presented to me.

那我就直接说了，这个技术叫Endocator，具体是什么意思，我让你来详细解释一下。

And I'll just go ahead and say it's the Endocator, and I'll let you get into that a little bit more what that means.

但本质上，你是在使用生物标志物。

But, essentially, you are using biomarkers.

对于不了解的人来说，生物标志物就是一些可测量的物质和生物体，我们可以用它们来指示疾病、感染、某种暴露或其他情况的水平，然后利用这项技术帮助我们判断，根管能不能填充。

For those of you who don't know, those are kinda measurable substances and organisms that we can kinda use to indicate a level of disease, infection, some sort of exposure or what have you, and using that technology to help us determine, can we fill the canal or not?

是的。

Yes.

所以，这算是一个很好的介绍。

So so that's that's a great kinda intro to it.

那么……

So...

而且，是的，背景是这样的，我相信很多在住院医师培训期间听这个的人，我们总是会听到，根管够不够干净？

And, yeah, kinda the background is, I'm sure, like a lot of people listening here during residency, we'd always hear, is a canal clean enough?

你确定可以填充了吗？

Are you sure you're ready to fill?

这个有大的病变。

This has a big lesion.

你应该分两次来做。

You should do it in two visits.

我脑子里一直有个想法，因为我有生物化学背景，还在生物技术公司工作过一年。

In the back of my mind, because I'm a biochem background, I worked in a biotech company for a year.

我在想，有很多方法可以判断根管是否干净。

I'm thinking there's lots of ways to see if it's clean.

我们可以做布拉德福德蛋白测定。

We can do a Bradford assay.

我们可以做分析测定，可以检测DNA。

We could analyze assay, we can look for DNA.

所以有很多不同的方法，但我们在牙髓治疗中一个都没用。我觉得我们花了太多时间研究清洁方法、器械设计之类的，但有一个方面我们完全没关注，那就是根管到底干不干净。

So there's lots of different ways, but we're not using any of them in endodontics, and I think we spent so much time looking at cleaning methods and file design and stuff like that, but one part we had not looked at at all is, is the canal clean or not?

所以带着这个想法，我就去研究了ATP。

And so kind of with that in mind, I went ahead and looked into ATP.

ATP就是三磷酸腺苷。

ATP is adenosine triphosphate.

地球上每个细胞里都有它，神经、血液、细菌，全都一样。

It's present in every cell on planet Earth nerve, blood, bacteria, everything.

所以我就开始检查根管，看看这玩意儿到底能不能检测出东西来。

And so I went ahead and started checking the root canals to see, man, is this can this detect anything?

因为按理说里面应该只有一个细胞、两个细胞，这仪器应该没那么灵敏，根本检测不到。

Because there should only be one cell in here, two cells, like this thing shouldn't be sensitive enough to see it.

但我们的根管里，ATP含量简直爆表。

But in our root canals, the things are just exploding with ATP.

根本不是什么微量水平。

It's not even like micro levels.

含量非常高。

It's very high levels.

果然，你可以用它来判断根管是否干净。

And sure enough, you can use this to determine if it's clean or not.

所以现在我们正在把一款产品推向市场，它能通过ATP检测来判断你的根管是否清洁。

So right now we're in the process of getting a product to market that can see when your canal is clean or not based off ATP testing.

而且操作非常简单，很容易上手。

And it's very simple, very easy to do.

我们待会儿会聊到这个。

And we'll talk about that.

我有机会用过这项技术，真的很感谢你让我参与进来，能实时操作体验。

I've had the ability to use the technology and I really appreciate you allowing me to engage and really, you know, work with that in real time.

但这看起来太……

But it seems so...

感觉就像基础常识一样，对啊，为什么之前没人想到这个呢？

It's just like elementary in the sense that, yes, why hasn't someone thought of this before?

所以根管到底干不干净？

So is the canal clean or not?

用生物标志物来精准检测这一点。

And using a biomarker to really detect that.

所以我真的得向你致敬，因为这就是牙髓治疗的全部基础，就是清除根管内的所有微生物，预防和消除根尖周炎。

So I just gotta take my hats off to you because that is the whole basis of endodontics is to remove any microbes within the canal, prevent and eliminate apical periodontitis.

而且我们经常说，在牙髓治疗中，我们是在黑暗中操作，真的看不到我们的锉在做什么。

And so often we say in endodontics, we do it in the dark in terms of the work that we're doing, we really can't see what we're doing with our files.

但最终，我们必须超越那些白线，因为如果看起来不错，但根管不干净，那还有什么意义呢？

But ultimately, we have to move beyond the white lines because if it looks good, but the canal is not clean, what's the point?

我觉得你刚才说了几个非常好的点。

I think you said a couple really good points there.

就像现在，每当我看到这些图片，对我来说，我会检查每一颗牙，确保它干净了才封起来。

It's like whenever I see these pictures now, for me, I check every tooth, every, you know, every tooth to make sure it's clean before I close it.

所以当我看到那些AAE早间邮件和那些很酷的病例图片，看到白线、根尖，

So when I get in these AAE morning emails and these pictures of these really cool cases, see the white lines, apex.

我就想，谁在乎呢？

I'm like, who cares?

对，谁在乎呢？

Like, who cares?

更重要的是你有没有清理干净，而不是X光片上看起来怎么样。

What the more important part is if you cleaned it or not, not not what it looks like in the x rays.

这是你说的第一点。

So that was one point you said.

第二点就是，哦，你看它看起来挺干净的。

And the second was like, oh, you see it looks clean.

确实就是这样。

And that's that's exactly it.

这些东西看起来干净，但除非你去测试，否则你根本不知道。

Like these things look clean, but you have no idea unless you test it.

当然，有些看起来发黑，你能看到黑色的，说明它已经坏死很久了。

And granted, some of these look dark and you can see black, you know, it's been necrotic for a long time.

你能看得出来。

You can see it.

但大多数情况下，每个病例看起来都很完美，只有用生物标志物检查后，你才能真正分辨出来。

But for the most part, every case looks perfect and it's only until you check with a biomarker that you can really tell.

所以，是的，这确实是个很酷的点，即使X光片看起来完美，你到底有没有清理干净？

So, yeah, that's, yeah, that's that's really kind of cool points is that even though it looks perfect in the x-ray, did you clean it or not?

而且不测试的话，你根本看不出来。

And you can't tell unless you test it.

而ATP测试的结果真是五花八门，什么情况都有。

And these the results are just all over the place with the ATP testing.

再多讲讲ATP的使用吧。

Talk a little bit more about using ATP.

你刚才也提到了，它存在于牙齿里的微生物中，等等。

And you kind of alluded to just its presence within, I guess, microorganisms throughout the tooth and what have you.

那这项技术是怎么...

So how did that technology...

是什么让你想到把它专门应用到你的发明，也就是Endocator上的？

What made you think to apply that specifically, you know, to your invention, the Endocator?

我觉得这得追溯到牙髓病学的历史研究。

So I think it it kinda goes back into historical research with endodontics.

以前，你总是会做细菌培养，如果结果是阴性，那就没问题。

In the past, you'd always culture and if it was gram, if it if it cultured negative, you were fine.

如果培养结果是阳性，你就得进一步消毒。

And if it cultured positive, you have to sterilize more.

问题在于，这些结果要等两周才能出来。

The problem is those results take two weeks.

所以，你填充的时候，结果总是很重要的。

And so it always mattered when you fill it.

培养结果是阳性还是阴性？

Is it culturing positive or negative?

人们等不了那么久。

People can't wait that long.

每次就诊都需要处理两三个病例。

It requires every visit to be two or three cases.

所以这种方法就慢慢被淘汰了，你知道，就消失了。

So just that kind of fell off the, you know, died.

现在没人这么做了。

No one does that anymore.

另一个出现的是钙烯，钙烯是一种可以注射到牙齿里的酶，五分钟内就能看到细菌水平是高还是低。

Another one that came up was calcene, and calcene is an enzyme that you can inject in the tooth, and in five minutes you can see if the levels of bacteria or not.

但同样，这需要五分钟。

But again, that takes five minutes.

你得往牙齿里注射东西，而且它最终也没真正推广开来。

You have to inject things in the tooth and it just never really panned out.

一直在背后比较容易实现的是ATP，之前有文献表明，高水平的ATP与细菌阳性相关，低水平则与细菌阴性相关。

The one that's been kind of the low hanging fruit in the background has been ATP, and there's been previous literature to show that high levels of ATP correlate with bacteria positive, low levels bacteria negative.

而且这个东西比单纯阳性或阴性要敏感得多得多。

And then this thing is much, much, much more sensitive than just plus or minus.

它不仅仅是细菌阳性或细菌阴性。

It's not just bacteria positive, bacteria negative.

ATP有成千上万种灰度。

There's 10,000 shades of gray to ATP.

即使培养结果是阴性，用这个东西你也能测出来，你知道的，你可以……

And even though you're gonna be culturing negative, you can get it, you know, with this thing, you can...

用这个ATP检测，你能测出远低于培养阳性或阴性的水平。

With this ATP testing, you can determine well below the culture positive, culture negative.

到底干不干净？

Is it clean or not?

ATP最大的好处就是只要十秒钟。

And the great thing about ATP is it's ten seconds.

每次测试也就几块钱。

It's a couple bucks a test.

它很快。

It's it's quick.

又简单，还能在椅旁操作。

It's easy and it's chairside.

所以对我来说，每个病例都能用，因为只要十秒钟，而且除了水，什么都不用往牙齿里放。

So you can just, you know, for me, it's it's every case because it only takes ten seconds and there's nothing going in the tooth at all except for water.

所以对牙齿没有任何损伤，非常快，而且非常便宜。

So nothing nothing damaging in the tooth, very quick, and it's very cheap.

嗯，你知道，我觉得这很关键，因为作为牙髓病医生，我们很看重成本效益。

Well, you know, I I think that's key because as endodontists, it is about the bottom line.

当我们真正尝试引入新技术时，会不会打乱我们的工作流程，拖慢我们的速度，有时候这可能会转化为生产力的损失或提升。

And when we're really trying to introduce new technology, is it gonna disrupt our workflow, slow us down, which sometimes may translate into, you know, lost productivity or improvement.

但这项技术，我有机会在椅旁使用过。

But this technology, I've had the chance to to use it chairside.

对，真的花不了我一分钟。

And, yeah, it literally takes me no more than a minute.

而且我觉得操作很简单，你一会儿可以再详细说说，就是冲洗根管，取样，放进那个检测器里，然后等个十秒钟，就能得到读数了。

And I think the simple application, you know, I'll let you get into a little bit more, but just the rinsing of the canal, go ahead and taking the sample, putting it in the the applicator, and then just giving it literally, like, ten seconds, and then you have your reading.

有了这个读数，我想我们可以聊聊那个范围的问题。

And with that reading, I think we'll get into the conversation of that range.

那个读数到底在清洁度上意味着什么？它怎么帮助我们决定要不要填充，或者我们是不是应该分两步来处理这些病例？

What does that really indicate in terms of cleanliness and how does that help us to determine when or not to fill, or should we be two stepping these cases?

对，我觉得这对病人来说也很好，因为我不确定你有没有遇到过这样的问题，比如，你怎么知道这次根管治疗会成功，如果第一次没成功的话？

Yeah, and I think that's great for patients too, because I'm not sure if you've gotten this question like, well, how do you know this root canal is gonna work if the first one didn't?

你怎么知道它

How do you And know it was

干净了

clean or

所以对我来说，我可以直接说，听着，我们检查了它的ATP，这是感染的生物标志物。

so for me, I can go ahead and say, listen, we checked it for ATP, a biomarker for infection.

它完全干净了。

It's perfectly clean.

这颗牙里面已经没有别的办法可以再清理了。

There's nothing else we can do to the inside of this tooth to clean it up.

我们准备好封牙了。

We are ready to close it.

而且很多时候对我来说，就是，你知道，我们...

And a lot of times for me, it's it's, you know, we're...

这还是很……

This is still...

我听过一个说法，有前沿技术，还有尖端技术。

There's like, I've heard the expression there's, cutting edge and there's bleeding edge.

这是尖端技术，所以能上你的播客真是太好了。

This is bleeding edge technology, which is which is why it's great to be on your podcast.

所以如果这能启发住院医生、教师或者研究项目，我的意思是，它非常量化、非常快速、非常便宜。

So if this inspires any residents or faculty or any research projects, I mean, is a very quantitative, very quick, very cheap.

所以，你知道，我很希望能有更多研究来确切了解这意味着什么。

So, you know, I would love to get some more research on exactly what this means.

以前的生物标志物，根据高水平或低水平，失败率高出4.5倍。

Previous biomarkers have had a 4.5 times higher failure rate depending on high levels and low levels.

我觉得我们会发现类似ATP的东西，如果ATP水平高，你可能需要再清理一下病例，但如果水平低，你就可以放心了，牙齿内部已经没有别的可以清理的了。

And I think we're going to find something with like similar to ATP that if it has high levels of ATP, you know, you probably wanna clean up the case a little bit more, but if it has low levels, you're good to go and there's nothing else you can do inside the tooth to clean it up anymore.

你提到实时反馈，这在使用时确实非常有利。

You you speak on that real time feedback and that has been so advantageous when was using it.

你知道，在慢性病例中，当然，我们知道它会有一定水平的细菌在牙冠里。

Know, in a chronic case, of course, we know it's gonna have a certain level of, you know, bacteria within the cow.

清理起来会稍微困难一些。

It's a little bit harder to clean.

我们都知道，数据表明，通常整体上大约有百分之十的下降，尤其是在坏死病例中，甚至比病毒性病例更明显。

We all know the the data suggests that usually about ten percent decrease overall just with necrotic cases, even more in compared to viral cases.

所以我在处理坏死病例时真的觉得它很有用，但你也提到了个性化护理的想法。

So I really found it useful when I was applying it to necrotic cases, but you alluded to also the idea of individualized care.

你知道，每个病例都是独特的。

You know, each case is specific.

所以我有我的方案，我的清理和塑形方案，但我需要根据病例和患者的情况来调整吗？

So I have my protocol, my clinging and shaped protocol, but do I need to adjust it based upon the case and the person's?

这就是真正酷的地方。

And so that's what's really cool.

所以很多时候我已经准备好了。

So a lot of times I'm I'm ready to go.

我觉得我准备结束了，但有时候读数会偏高，虽然不是经常，但确实会发生。

I think I'm ready to finish, but I'll get a high reading or not not a lot of times, but it happens.

到了那个时候，我不会紧张。

And then at that point, I don't get nervous.

我不会慌。

I don't freak out.

我就直接再把次氯酸盐放回去，用我的EndoActivator，或者再用激光做一轮消毒。

I just go ahead and I put the hypochlorite back in and I use my, you know, EndoActivator or maybe I'll use my laser for another round of laser disinfection.

我就利用这个机会再清洁一次。

And I just use that opportunity to give it one more clean.

我觉得有了这项技术，并不意味着你要丢掉在住院医师期间学到的所有东西。

And I think that with this technology, this doesn't mean you throw away everything you learned during residency.

比如你遇到一个坏死病例，有大面积的根尖周透射影，你肯定想确保它完全彻底干净，但现在你有机会在封起来之前做最后一次检查。

Like if you have a necrotic case with the big parapical radiolucency, you know, you want to make sure that's totally, totally, totally clean, but now you have this opportunity to give it one last check before you close it up.

嘿，这挺好的，或者，哎呀，我的分数比我想要的稍微高了一点。

Hey, this is good and or, Oh man, I had a little bit higher score than I wanted to do.

让我再做最后一轮激活。

Let me go ahead and give it one last round of activation.

再说，大多数情况下，这能让你根据病人提供个性化的护理，而且我过去一千多、两千、三千个病例，每一个我都知道清洁程度如何。

And again, for the most, so it lets you get individualizable care based on the patient, but also every single one of my cases for the last thousand plus 2,000, 3,000 cases, I know how clean it's getting.

所以我对自己的技术已经非常熟练，知道需要做什么来清洁干净。

So I've gotten really dialed in to my skills to know what do I need to do to clean it up.

而且有不同的方法可以做到。

And there's there's different ways of doing it.

对我来说，就是用EndoActivator到达根尖。

For me, it's the EndoActivator to get the Apex.

还有激光。

It's the laser.

它能在里面进行非常好的消毒。

It just gets some really good disinfection in there.

而且这也只是时间问题。

And also it's just time too.

确实是这样……

Like it does...

就像研究里说的，如果我在根管治疗时草草了事，五分钟就冲到根尖，然后直接放上牙胶尖，那肯定不干净。

Like the research has said, if if I blitz through the root canal in one...

你知道的，五分钟就到根尖，然后把牙胶尖放进去，那肯定不干净。

You know, five minutes to get to the apex and put my gutta percha in, you know, it's not clean.

就像Apisola研究里关于染料渗透的那些发现一样。

Just like all the, research in, Apisola's study of, dye penetration.

就是说，它需要一点时间才能发挥作用。

Like, it needs a little bit of time to work.

所以对我来说，我的方法基本上已经练得很熟了。

So for me, I've gotten my method dialed in for the most part.

最后再检查一下确保干净，但这样也能根据患者情况提供个性化的治疗。

It's just a final check to make sure it's clean, but it lets you individualize patient care for the patient.

而且这也能让我得到反馈，从而不断完善我的技术。

And also it lets me get feedback on what I'm doing so I can perfect my technique.

嗯，你知道，我确实喜欢的一点是，对个体化治疗的重视，但如果大规模采用，它几乎可以在不同平台之间提供一种标准化的评估方式。

Well, you know, one thing I do like is, yeah, the approach to individualized care, but it does, if adopted on a larger scale, can almost provide a standardization across platforms for how we can actually assess.

我觉得这太有必要了。

And I think that's so needed.

你知道，我请过很多嘉宾，我们讨论过不同的研究技术和方法，甚至包括牙髓治疗的修复方面，以及我们如何把它分诊给全科牙医或其他人，而实际上可能应该由我们自己来修复，因为到那个时候，我们知道牙齿已经尽可能干净了。

Know, I've had a lot of guests on and we were talking about just different research techniques and methods, and even looking at the restorative aspect of, you know, endodontics and how we're kind of triaging that out to the general dentist or someone else when we should probably be the ones who restore it because at that point, we know the tooth is as clean as it can be.

现在我们可以自信地说出这一点。

And now we can actually say that with confidence.

所以，我觉得这正好说明了一个很好的观点，那就是，你知道吗？

So, I mean, that's just like a great point to say, well, you know what?

这才是真正应该修复牙齿的时候，因为我有保证数据表明，这颗牙齿可能是它最干净的状态了，因为我们知道，一旦他们离开停车场，如果用的是临时修复材料，他们一踩到路面，它就开始渗漏了。

This is really when we should be restoring the tooth because I have guarantee data that this tooth is probably the cleanest it's ever gonna be because we know as soon as they hit the parking lot, if it's in a temporary restorative material, it's leaking as soon as they hit the pavement.

我知道，我觉得有了这个设备，我变得有点多疑了，一旦我完成根管治疗，我至少会放上临时屏障，因为我最不希望的就是在我确认无菌之后，有任何东西碰到它。

I know I feel like with this device, I've gotten paranoid about once I'm done with my root canal, I'm at least putting intraorphis barrier on there because like the last thing I want is to have anything touching it after I've like confirmed it's sterile.

所以我完全同意你的看法，一旦完成，就要把它密封起来，因为你最不希望的就是根管治疗因为之后唾液接触到它而失败。

So I totally agree with you this once it's done sealing it off because, you know, the last thing you want to do is have your root canal fail from saliva hitting it afterwards.

你刚才还提到一个挺有意思的点，就是这东西非常量化。

So one other thing that you did mention that's kind of neat is that this is extremely quantitative.

也就是说，如果你做一个台架研究，用离体牙来做实验，就能得到激光、温和波、超声和声波这些不同方法的很准确的读数。

So what that means is like if you have a benchtop study and you look at extracted teeth, you can get really good readings on a laser versus gentle wave versus ultrasonic versus sonic.

这个领域已经有一些研究了，特别是来自一位博士的研究。

We've already had some research into this area, especially from Doctor.

印度的那格什·博拉博士。

Nagesh Bola in India.

他做了一项一千名患者的研究，比较了5%次氯酸钠和3%次氯酸钠。

He did a thousand patient study and he looked at 5% hypochlorite versus 3% hypochlorite.

他比较了超声、声波和不激活，最后发现，浓度更高的次氯酸盐能降低ATP数值，超声比声波略好，而声波又比完全不激活好得多，而且时间也很重要。

He looked at ultrasonic versus sonic versus no activation, and at the end of the day, he found that higher higher strength hypochloric gets you lower ATP numbers, that ultrasonic is slightly better than sonic, which is much, much better than than nothing at all, and that time is really important as well.

所以他的研究对我们确定根管治疗的可接受标准非常有帮助。

So his research has been really extremely helpful for guiding us into what levels are acceptable for a root canal.

而且考虑到这一点，Endocator...

And also with that in mind, the Endocator that...

我们用的那个ATP测试，它有一个指示器，按0到100的等级来评分。

The ATP test that we have indicator, it grades it on a zero to 100 scale.

0是最干净的，100是最脏的。

So zero being the cleanest and 100 being the dirtiest.

这样这些数字就有意义了，也能给你一个更好的参考，知道你的病例应该达到什么水平。

So that way it makes sense of these numbers and, you know, and gives you a better reference what you want your cases to end at.

再说一遍，你在研究和实验里不想浪费数据，比如你看到一个有大的病变的牙齿，对我来说，我希望那些数字在20或以下，然后我才封这个病例。

And again, you don't want to throw away in your studies and your research, like if you see an experience, if you see a tooth with a big lesion, for me, I want those numbers to be about 20 or below before I close that case.

而如果是活髓病例，你知道，那些通常都能处理好，所以我对用较高的数字封这些牙齿会更放心一些。

While if it's a vital case, you know, I know those tend to work out, so I'm a little bit more comfortable sealing those teeth with higher numbers.

好的。

Okay.

你知道，我很高兴你提到了这个范围，关于确定样本无菌性的问题。

You know, I'm glad you brought up the range, in terms of determining the sterility of the sample.

任何新技术总有改进的空间。

With any new technology, there's always gonna be areas of improvement.

所以我觉得那是我有点不太清楚的地方，就是到底怎么判断什么时候可以说这是干净的。

And so I think that was one area I was a little bit, you know, just not clear on is how to really know at which point I can say this is clean.

但你是说通常根据这些研究，低于20就可以了，是博士说的。

But you're saying usually you say under 20 based on these studies by Doctor.

博拉。

Bola.

而且我觉得你还让博士参与了。

And I think you also had, you involved Doctor.

甘贝里尼也做了一些工作。

Gamberini in doing some work as well.

那我们就来聊聊这个，这样我们能更好地实时理解怎么实际使用它，并且有信心这些数值确实在告诉我们真相。

So let's kind of talk about that so we can better understand in real time how we can actually use this and feel confident that these values that we receive are actually telling us, you know, the truth.

第一轮研究，有点像试点项目，是和纳格什·博拉在西伯利亚牙科科学研究所做的，他拿了一千个病人，每个病例都检查了手用锉、旋转锉、清洁后，有些病例还检查了第二轮清洁后的情况。

So the first round of research, kind of like the pilot project was with Nagesh Bola in, Siberian Institute of Dental Science, and he took a thousand patients and just checked every case from hand file after rotary, after, cleaning and after second round of cleaning on some cases.

他发现这些ATP数值在刚进入手用锉时是几千，旋转锉后还是几千，然后，你知道，在最终清洁后逐渐下降，降到非常低的数值。

And what he found is these ATP numbers are in the thousands, right when you enter the hand file and then the rotary goes to a thousands and then, you know, going going down after the final cleaning, it goes down to very low numbers.

但问题是，这个数值变化非常大。

But the thing is, it's incredibly variable.

有很多低值，也有很多高值。

There's lots of lows, lots of highs.

即使你用的是完全相同的锉刀，完全相同的操作流程，不同病例之间的结果还是会有很大的差异。

And even though you've done the exact same file, the exact same routine, you can still get so much variability among those cases.

所以这项技术真的很棒，能帮你找出哪些病例还没清洁干净，这样你就可以再进行一轮消毒，确保彻底干净。

And so it's really cool for this technology to be able to find out which ones are still dirty, so you get another round of sterilization in to make sure it's totally clean.

所以在那项初步研究之后，我们……

So after that first pilot study, we're...

我们已经有了第一轮的原型产品。

We have, the first round of prototypes out there.

我们有阿达姆·阿齐姆医生，

So we have Doctor.

还有弗雷德·巴内特、甘博里尼、豪尔赫·维拉、贾斯汀·科尔尼克，以及克利夫·拉特尔医生。

Adam Azim, we have Fred Barnett, we have Gamborini, we have Jorge Vera, we have, Justin Kolnick, we have, Cliff Ruttle, Doctor.

韦斯特。

West.

所以我们有一批关键意见领袖来提供反馈，同时还有第二轮研究。

So we have a slew of key opinion leaders to get feedback from and also, the second round of research.

这正是我特别期待的……

And that's what I'm really exciting...

期待进入第二轮研究。

Excited for just to get to the second round of research.

你知道，这种不带偏见的……

You know, this unbiased...

他们可以发表他们想发表的内容，这样我们就能得到一些真实的反馈。

They they can publish what they wanna publish, and that way we can actually get some real feedback.

因为目前，我们有初步研究、我的研究反馈，还有我们的关键意见领袖，但我觉得从每个人那里获得不带偏见的反馈会非常有帮助，然后我们就可以决定……

Because at this point, we have that initial study and we have my study feedback, we have our key opinion leaders, but I think just getting unbiased feedback from everybody is just going be super helpful, And then we can kind of decide...

作为专业人士，弄清楚到底该……

Figure out as a profession, like what do...

我们的目标是什么？

What's our goal to get...

为了让这些牙齿在封闭时获得更高的成功率，我们需要达到怎样的无菌程度？

How sterile do we get these teeth, in order to get a better success rate when we close it.

我同意。

I agree.

我同意。

I agree.

那么接下来，我们花点时间听听赞助商的发言。

So what we're gonna do, let's just take a brief moment to hear from our sponsors.

回来后，我们会讨论这在牙髓病学中可能带来的范式转变。

And when we come back, we're gonna get into how this is a potential paradigm shift within endodontics.

牙髓病实践合作伙伴团队很高兴在盐湖城与这么多朋友交流。

The team at Endodontic Practice Partners loved connecting with so many of you in Salt Lake City.

在那里，EPP的医生...

While there EPP's Doctor.

特雷尔·普罗珀录制了一期特别的《牙髓之声》节目，分享了她几十年经验中的领导力心得。

Terrell Proper recorded a special episode of Endo Voices sharing leadership lessons from her decades of experience.

这期节目将于6月19日上线，记得收听，获取见解、灵感，还有不少笑点。

That episode is available June 19 so be sure to tune in for insight, inspiration and a few laughs.

你看到今年“为你最爱的T恤投票”比赛中，住院医师们提交的那些超棒的牙髓主题设计了吗？

Have you seen the incredible endo themed designs submitted by residents for this year's root for your fave t shirt contest?

你可以在Instagram上查看决赛入围作品，就在Endo Practice Partners的Instagram页面。

You can check out the finalists on Instagram on the Endo Practice Partners Instagram page.

获胜的T恤将在圣路易斯的APICES大会上分发。

The winning T shirt will be distributed at APICES in St.

排名前三的设计将获得资金支持，用于他们的住院医师项目，满足住院医师的需求。

Louis and the top three designs will win funding for their residency program to use for resident needs.

EPP与各种规模的牙髓病医生合作，提供人员配备、薪资、IT、资质认证和运营方面的支持，这样你就可以专注于提供优质的患者护理。

EPP partners with endodontists of all sizes, providing support in staffing, payroll, IT, credentialing, and operations so you can focus on delivering excellent patient care.

他们还帮助住院医师找到合适的诊所，让他们自信地开启职业生涯。

They also help residents find the right practice to start their careers with confidence.

想了解更多信息，请访问endopracticepartners.com。

Visit endopracticepartners.com for more information.

牙髓治疗实践伙伴，支持牙髓病医生，赋能诊所，塑造职业生涯。

Endodontic Practice Partners supporting endodontists, empowering practices, shaping careers.

我们回来了。

And we are back.

感谢大家的收听。

Thank you for tuning in.

我得说，这一集真的很有意思，因为我们现在深入探讨的是，怎么判断我们的病例是否已经准备好进行填充？

I must say this is a fascinating episode because we are now really exploring the dynamics of how can we determine are our cases ready to fill?

细菌还在吗？

Is the bacteria still there?

它们存在于什么水平？

At what levels does it exist?

有了这项新技术，医生。

And with this new technology that Doctor.

Randy Cross医生通过Endocator把这一点推到了前沿，这真的变成了一个实时任务，你可以在每一个病例上做。

Randy Cross has brought to the forefront with the Endocator, this really becomes a real time task that you can do on any and every case.

听起来，医生，你几乎每个病例都用它，对吧？

And it sounds like, Doc, you pretty much use it on every case, correct?

哦，我每个病例都用。

Oh, I do it every case.

对，肯定的。

Yeah, guaranteed.

而且我遇到过这种情况，你知道，这个东西有电子部件，还有那个消耗性的测试件。

And I've had it where, you know, there's electronic component to this thing and then the consumable tester item.

所以我遇到过这种情况，我做了一个病例，没带电子部件，所以我就直接封上了，但我保留了样本，之后跑了测试，数值高得离谱，我当时就想，哦不。

So I've had it where I did a case, didn't have my electronic piece with me, so I just kind of closed it anyways, but I kept that sample and ran it afterwards and the numbers were sky high and I'm like, Oh no.

然后果然，同一个病人两周后作为再治疗回来了，牙齿失败了。

And so then sure enough, the same patient as a retreat came back two weeks later and the tooth failed.

所以我们不得不拔掉那颗牙。

And so we had to extract the tooth.

所以，你知道，我大概百分之九十的病例都会用它，不管是活髓还是坏死，但那次之后，我就想，还是查一下吧。

So I was, you know, using it at ninety percent of my cases, vital necrotic, you know, but after that case, I'm like, just check it.

就十秒钟的事。

Like, it's ten seconds.

对。

Yep.

它确实……

It does...

我不知道你有没有同样的感觉，但它不是……

And I'm not sure if you've had the same, feelings, but it doesn't...

花时间的不是检查本身。

That what takes long isn't checking it.

花时间的是，如果数值很高，你得重新处理那颗牙，进行消毒，因为这不像那些公司跟你说的那样。

What takes long is if you get a high number going back in that tooth and sterilizing it because it's it's not like what these companies will tell you.

不是说你把东西放进去，二十秒就搞定了。

It's not like you put it in there, you get a twenty second act.

至少对我来说，我发现我不能只做二十秒的激活就能把那些数值降下来。

At least for me, what I found, I can't just do twenty second round of activation and get those numbers down.

有时候可以，但大多数情况下，每次我做激活和根尖吸引，数值能降一半、一半、一半、一半，差不多就是这样。

Sometimes I can, but for the most part, it's like every round of activation apical suction that I do, you know, I can bring those numbers down a half, a half, a half, a half, something right around there.

所以对我来说，耗时间的不是做测试，因为整个冲洗加上那些操作总共也就十秒一分钟。

So for me, the time consuming part is not doing the test because that's ten seconds a minute total for all the whole rinsing and things like that.

但对我来说，最难的是一旦数值很高，你该怎么办？

But for me, the hardest part is if you get a high number, it's like, what do you do with the case?

你懂吧？

You know?

所以就像……

So that like...

所以对我来说，有趣的地方就在于它……

So that's that's been, the interesting part for me is just that it...

有时候真的很难把那些脏牙彻底弄干净。

It's really can be challenged sometimes to get some of these dirty teeth all the way clean.

如果可以分享的话，你知道，我一开始其实有点慌。

And if I can share, you know, I was a little bit, you know, freaked out originally.

我遇到一个病例，测出来大概60多。

I had a case and I registered about, you know, 60 or so.

然后我就想，你知道吗？

And I said, well, you know what?

也许我肯定能试着把它降下来。

Maybe I can definitely try to get this down.

说实话，我就又做了一遍我的清洁和塑形流程。

And to be honest, I went ahead and did my cleaning and shaping protocol again.

你知道多花了大概十分钟吗？

Do you know what took an extra ten minutes or so?

但当我真的测到低于20的时候，根据我们之前的讨论，我就很有信心，觉得这已经够干净了，可以继续封填了。

But when I actually got a reading below 20, I felt very confident based on the conversations we had that we can feel that this is clean enough to go ahead and seal.

而且我很高兴看到那个病例的结果。

And I'm very happy to see the outcome of that case.

但你能不能带我们走一遍……

But if you can just walk us through...

真希望我们有那个视频，这样大家也能看到你是怎么……

I wish we had the, you know, the the video so someone could also just kinda see how you...

你实际上是在椅旁操作。

You're actually doing this chairside.

但在常规病例中，你实际上是怎么处理这种多根牙的？

But just on a regular case, how are you actually doing this multi rooted tooth?

我们选择哪根根管？

Which canal are we choosing?

我们在根管里要进入多深？

How deep are we going in the canals?

然后我们就能更好地理解如何应用这项技术。

And then we'll start to just understand a little bit better how we can apply this technology.

所以确切的方案是，按照你通常的方式做根管治疗。

So the exact protocol is do your root canal exactly how you normally do it.

做完根管治疗后，准备封起来的时候，取两毫升无菌蒸馏水。

You finish off your root canal, you're ready to go close it and, you get your two milliliters of sterile distilled water.

就是取两毫升干净的水，用这个水冲洗根管。

So you just get two milliliters of clean water and you rinse out the canals with that.

这样可以去除消毒剂。

So that's going to remove the disinfectant.

也能清除一些残留的碎屑。

It's going to remove some that debris.

我挺喜欢这一步的，因为相当于最后再快速冲洗一遍，确保一切都干净。

And I kind of like that because it gives one last round of just quick little rinse to make sure everything's clean.

冲洗完之后，根管里就充满了这个水。

So once after you give it that little rinse, you go ahead, you have your canals filled with this water.

然后用30号针头，插到根管大约一半的位置，抽吸出样本。

You just put the 30 gauge needle and put it about halfway down the canals and aspirate out a sample.

接着把样本挤到我们的小管子里，然后按压管子，这样就能把里面的化学物质混合均匀。

And then with that sample, you squirt it in our little tube, and then you push down on the tube, and that's gonna mix everything together in these chemicals.

然后你把它放进我们的读取器里，十秒钟就能看到结果。

And then you put it in our reader and then they could see you in ten seconds of reading.

所以再说一遍，就是用清水冲洗。

So again, it's rinsing with water.

如果是多根牙，我就一次性全部检测。

If you have a multi rooted tooth, I just test everything at once.

我不会分别检测每一根牙根，虽然你也可以这么做。

I don't test into each individual root, although you could.

对我来说，这只是一个最后的检查。

For me, it's just a final check.

所以我直接用水冲洗。

So I go ahead and I rinse with water.

我会从每个根管取样，而不是直接把水倒进垃圾桶。

I sample from each canal as opposed to just squirting that water in the trash can.

我会把它挤进我们的试管里，然后按下去，这样就能激活化学反应，然后电子设备在十秒内读取结果。

I go ahead and squirt it in our tube and then push it down, and that activates the science that then gets read for our electronic device in ten seconds.

这个测试另一个特别棒的地方就是它特别简单。

The other really cool thing about this test is how simple it is.

就是ATP。

It's ATP.

它存在于所有东西里。

It's in everything.

你可以用它来检测活髓、死髓、再治疗，而且它真的无处不在。

You can use it for vital, necrotic, retreat, and it's it's in everything.

它的原理是碰到一种叫荧光素酶的酶，然后就开始发光。

And what it does is it hits this enzyme called luciferase and it starts to brighten.

所以基本上就是，你知道的，那个……

So it's it's basically just, you know, the...

你的生物标志物……

Your biomarker...

里面最重要的生物标志物，加上那个设备里最重要的酶，当然还有其他一些，但最重要的是它用起来特别方便。

The most important biomarker in there with the most important enzyme in that device, and there's some other ones too, but most important is just how easy it is.

就是ATP，从根管里提取出来的能量，你把它喷进试管里，十秒钟就能在0到100的刻度上得到读数。

It's the ATP, the energy that's being pulled out from that canal, you're squirting it into the tube, and then you get a reading in ten seconds on the zero to 100 scale.

我喜欢这项技术的一点是，它也能帮我判断是不是有裂缝，对吧？

What I did like about the technology was, I guess it also helped me identify maybe there's a crack, right?

如果我们一直清理这颗牙，但读数还是很高，那肯定是有某种与牙周组织的连通，让这颗牙的读数一直居高不下。

If we keep cleaning this tooth out, but we still keep getting a high reading, there must be some sort of communication with the periodontium that's still allowing that tooth to have a high reading.

那我们来聊聊这个。

So let's talk about that.

这项测试有哪些细微之处，可能让我们得到……

Where are the nuances of this test where we can maybe get...

我觉得不太可能出现真正的假阳性，但读数持续偏高是可能的。

I I don't think it's possible we really get a false positive, but a continually high reading.

那这和市面上那些新型的先进冲洗技术又是怎么配合的呢？

And how does that really work with the new advanced irrigation technologies that we're seeing on the market?

好的。

Okay.

所以，你确实提了一个好观点。

So, I mean, you do bring up a good point too.

这不是一个关于它能不能成功的零到一百的评分。

This isn't a zero to 100 scale on if it's gonna work or not.

这是一个关于它干不干净的零到一百的评分。

This is a zero to 100 scale on if it's clean or not.

所以我遇到过一些人，而且再说一遍，这比细菌培养要敏感得多。

So I've had people that, and again, this is much more sensitive than bacteria culturing.

所以如果你得到20的读数，有时候人们就会不高兴。

So if you get a reading of 20, sometimes people just get upset.

比如，你说它有什么是什么意思？

Like, what do you mean it got something?

比如，你说它得了30分是什么意思？

Like, what do you mean it got a score of 30?

比如，这个东西在测量ATP，所以它超级敏感，你不应该……

Like, this thing is measuring ATP, so it's super sensitive and you should not...