不同方法根管治疗对慢性根尖周炎患者填充物的清除效果
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摘要
目的研究三种方法根管治疗对慢性根尖周炎患者填充物的清除效果。方法选取宝鸡市口腔医院2017年11月至2018年11月因慢性根尖周炎拔除的上颌切牙69颗进行根管预备、冷侧压法充填、玻璃离子封闭1个月,按照治疗方法分成A、B、C三组,每组23颗。A组应用Reciproc单只镍钛锉清理根管内充填材料,B组应用Protaper再治疗镍钛锉清理根管内充填材料,C组应用G钻+不锈钢手动H锉清理根管内充填材料。观察并比较三组样本牙根管治疗后根管内残留充填物效果、根管治疗后根管壁残留碎屑评分情况、去除根管内充填物所用时间、推出根尖孔碎屑量以及并发症发生情况。结果 A组根尖1/3和根中1/3根管壁残留碎屑评分[(2.91±0.43)分、(2.31±0.46)分]和B组根尖1/3和根中1/3根管壁残留碎屑评分[(3.31±0.55)分、(2.71±0.64)分]均明显优于C组[(4.11±0.74)分、(3.26±0.79)分],且A组根管壁残留碎屑评分又明显优于B组,差异均具有统计学意义(P<0.05);A组和B组颊舌向根中、根尖根管内留充填物占比和近远中根中、根尖根管内留充填物占比均优于C组,差异均具有统计学意义(P<0.05),但A、B两组间比较差异均无统计学意义(P>0.05);A组预备完成总时间和到达工作长度所用时间分别为(422.22±135.40) s、(158.32±69.30) s,B组的预备完成总时间和到达工作长度所用时间分别为(401.09±91.55) s、(204.58±83.48) s,均明显少于C组的(821.15±164.11) s和(256.21±125.66) s,差异均具有统计学意义(P<0.05),但A、B组间比较差异均无统计学意义(P>0.05);A组推出根尖孔碎屑量为(0.07±0.01) mg,少于B组的(0.13±0.02) mg,B组又少于C组的(0.31±0.03) mg,差异均具有统计学意义(P<0.05);A组、B组和C组的并发症发生率分别为17.39%、21.74%和26.09%,差异无统计学意义(P<0.05)。结论 Reciproc单只镍钛锉、Protaper再治疗镍钛锉以及G钻+不锈钢手动H锉均不能完全清除根管内填充物,但镍钛器械在操作时间、清除效果、并发症发生情况以及推出根尖孔碎屑量方面均明显优于手动器械,而镍钛器械中单只锉在牙齿保护和填充物清除效果中更具优势。
Objective To study the effect of three methods of root canal therapy on filler clearance in patients with chronic apical periodontitis. Methods A total of 69 patients who underwent maxillary incisors extraction due to chronic apical periodontitis in the Stomatological Hospital of Baoji City from November 2017 to November 2018 were selected and treated with root canal preparation, cold lateral pressure filling, and glass ion blocking for 1 month. According to the treatment method, they were divided into three groups of A, B and C, with 23 pieces in each group. Group A used Reciproc single nickel-titanium tantalum to clean the filling material in the root canal, group B was treated with Protaper re-treatment of nickel-titanium tantalum to clean the filling material in the root canal, and group C used G drill and stainless steel materials H series to clean the filling material in the root canal. The effects of residual filler in the root canal after root canal treatment in three groups were observed and compared, as well as the residual debris score of the root canal wall after root canal treatment, the time taken to remove the filler from the root canal, the amount of apical debris in the sharp hole, and the occurrence of complications. Results The residual debris score of the root wall at 1/3 of the root tip and 1/3 of the root wall was respectively(2.91±0.43) points and(2.31±0.46) points in group A, and(3.31±0.55) points and(2.71±0.64) points in group B, significantly better than corresponding(4.11±0.74) points and(3.26±0.79) points of group C; and the residual debris score of the root canal wall of group A was significantly better than that of group B; all differences were statistically significant(P<0.05). The proportion of residual fillings near the distal root and root tips at the buccolingual dimension and on the mesial and distal surfaces of group A and group B were better than those of the group C(P<0.05); however, there were no statistically significant differences between group A and group B(P>0.05). The total preparation time and the time taken to reach the working length in group A were respectively(422.22±135.40) s and(158.32±69.30) s, and the corresponding time in group B were respectively(401.09±91.55) s and(204.58 ± 83.48) s, which were significantly less than corresponding(821.15 ± 164.11) s and(256.21 ± 125.66) s in group C(P<0.05); but there was no statistically significant difference between the group A and group B(P>0.05). The amount of apical hole debris in group A was(0.07±0.01) mg, which was less than(0.13±0.02) mg in group B; while that of group B was less than(0.31±0.03) mg in group C(P<0.05). The complication rates in group A, group B, and group C were 17.39%, 21.74% and 26.09%, respectively(P<0.05). Conclusion Reciproc single nickel-titanium tantalum, Protaper re-treatment of nickel-titanium tantalum, G drill and stainless steel materials H series cannot completely remove the root canal filling. However, the nickel-titanium instruments are significantly better than manual instruments in terms of operation time, removal effect, complications, and the amount of apical hole debris. Moreover, the use of a single one in nickel-titanium instruments has an advantage in tooth protection and filler removal.
Objective To study the effect of three methods of root canal therapy on filler clearance in patients with chronic apical periodontitis. Methods A total of 69 patients who underwent maxillary incisors extraction due to chronic apical periodontitis in the Stomatological Hospital of Baoji City from November 2017 to November 2018 were selected and treated with root canal preparation, cold lateral pressure filling, and glass ion blocking for 1 month. According to the treatment method, they were divided into three groups of A, B and C, with 23 pieces in each group. Group A used Reciproc single nickel-titanium tantalum to clean the filling material in the root canal, group B was treated with Protaper re-treatment of nickel-titanium tantalum to clean the filling material in the root canal, and group C used G drill and stainless steel materials H series to clean the filling material in the root canal. The effects of residual filler in the root canal after root canal treatment in three groups were observed and compared, as well as the residual debris score of the root canal wall after root canal treatment, the time taken to remove the filler from the root canal, the amount of apical debris in the sharp hole, and the occurrence of complications. Results The residual debris score of the root wall at 1/3 of the root tip and 1/3 of the root wall was respectively(2.91±0.43) points and(2.31±0.46) points in group A, and(3.31±0.55) points and(2.71±0.64) points in group B, significantly better than corresponding(4.11±0.74) points and(3.26±0.79) points of group C; and the residual debris score of the root canal wall of group A was significantly better than that of group B; all differences were statistically significant(P<0.05). The proportion of residual fillings near the distal root and root tips at the buccolingual dimension and on the mesial and distal surfaces of group A and group B were better than those of the group C(P<0.05); however, there were no statistically significant differences between group A and group B(P>0.05). The total preparation time and the time taken to reach the working length in group A were respectively(422.22±135.40) s and(158.32±69.30) s, and the corresponding time in group B were respectively(401.09±91.55) s and(204.58 ± 83.48) s, which were significantly less than corresponding(821.15 ± 164.11) s and(256.21 ± 125.66) s in group C(P<0.05); but there was no statistically significant difference between the group A and group B(P>0.05). The amount of apical hole debris in group A was(0.07±0.01) mg, which was less than(0.13±0.02) mg in group B; while that of group B was less than(0.31±0.03) mg in group C(P<0.05). The complication rates in group A, group B, and group C were 17.39%, 21.74% and 26.09%, respectively(P<0.05). Conclusion Reciproc single nickel-titanium tantalum, Protaper re-treatment of nickel-titanium tantalum, G drill and stainless steel materials H series cannot completely remove the root canal filling. However, the nickel-titanium instruments are significantly better than manual instruments in terms of operation time, removal effect, complications, and the amount of apical hole debris. Moreover, the use of a single one in nickel-titanium instruments has an advantage in tooth protection and filler removal.
引文
[1]YUANITA T,ZUBAIDAH N,KUNARTI S.Expression of osteoprotegrin and osteoclast level in chronic apical periodontitis induced with east java propolis extract[J].Iranian endodontic journal,2018,13(1):42-46.
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[11]胡永青,李雅,李淑娟,等.镍钛机用器械联合超声冲洗对慢性根尖周炎根管内毒素的清除效果[J].口腔医学研究,2018,35(11):1182-1185.
[12]彭宇,李梦园,葛久禹.不同扩根器械拆除根管充填物的效果研究[J].中国全科医学,2016,19(B12):166-168.
[13]王丽娜,刘启成,林志鑫,等.三种机用镍钛器械对推出根尖孔碎屑和冲洗液影响的比较[J].中国组织工程研究,2015,18(3):450-454.
[14]伍婉翠,陈广盛.三种根管预备器械预备根管根尖碎屑推出量和根管清理能力的比较[J].中国组织工程研究,2015,19(34):5443-5447.
[15]HUANG X,SHEN Y,WEI X,et al.Fatigue resistance of nickel-titanium instruments exposed to high-concentration hypochlorite[J].Journal of endodontics,2017,43(11):1847-1851.
[2]孙颖,唐晓丽,周园园,等.根管内器械分离的研究进展[J].海南医学,2018,29(8):1139-1142.
[3]朱琳虹,姜雨然,陆雪莲,等.100例非手术性根管再治疗病因分析[J].宁夏医科大学学报,2017,39(8):950-953.
[4]许志亮.非手术根管再治疗-根尖手术联合治疗难治性根尖周炎[J].首都医科大学学报,2015,36(3):478-482.
[5]刘莹,李纾,陈亮.不同根管再治疗器械与氯仿联合使用去除根管充填材料效果的比较研究[J].牙体牙髓牙周病学杂志,2013,23(7):454-458.
[6]ESPIR CG,NASCIMENTO-MENDES CA,GUERREIRO-TANO-MARU JM,et al.Shaping ability of rotary or reciprocating systems for oval root canal preparation:a micro-computed tomography study[J].Clinical Oral Investigations,2018,22(9):3189-3194.
[7]GOMES BPFA,HERRERA DR.Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology[J].Brazilian Oral Research,2018,32(11):e69.
[8]MARINHO ACS,TO TT,DARVEAU RP,et al.Detection and function of lipopolysaccharide and its purified lipid A after treatment with auxiliary chemical substances and calcium hydroxide dressings used in root canal treatment[J].International Endodontic Journal,2018,51(10):1118-1129.
[9]郭晓琳,彭伟,鲁丽珍,等.临床常用根管预备器械清洁能力的扫描电镜观察[J].牙体牙髓牙周病学杂志,2013,23(9):595-598,601.
[10]陶小玲,赵燕艳.不同镍钛器械对根管内充填材料清理效果比较分析[J].中国现代医学杂志,2013,23(16):71-74.
[11]胡永青,李雅,李淑娟,等.镍钛机用器械联合超声冲洗对慢性根尖周炎根管内毒素的清除效果[J].口腔医学研究,2018,35(11):1182-1185.
[12]彭宇,李梦园,葛久禹.不同扩根器械拆除根管充填物的效果研究[J].中国全科医学,2016,19(B12):166-168.
[13]王丽娜,刘启成,林志鑫,等.三种机用镍钛器械对推出根尖孔碎屑和冲洗液影响的比较[J].中国组织工程研究,2015,18(3):450-454.
[14]伍婉翠,陈广盛.三种根管预备器械预备根管根尖碎屑推出量和根管清理能力的比较[J].中国组织工程研究,2015,19(34):5443-5447.
[15]HUANG X,SHEN Y,WEI X,et al.Fatigue resistance of nickel-titanium instruments exposed to high-concentration hypochlorite[J].Journal of endodontics,2017,43(11):1847-1851.