3种动能冲洗技术对管间峡区内碎屑的清理作用

doi:10.7518/hxkq.2022.05.008

摘要/Abstract

摘要：

目的比较声波、超声和激光3种动能冲洗技术对管间峡区的清理能力。方法选取32颗具有管间峡区的人上颌第一前磨牙，Reciproc Blue机用镍钛器械预备根管后，通过简单随机抽样分成4组（n=8），分别进行如下冲洗处理：传统冲洗器组（对照组）使用27号侧方开口冲洗器、声波组使用EDDY连接气动马达、超声组使用IRRI Safe连接超声P5手柄、激光组使用9 mm光纤头连接Er:YAG激光器，每根管冲洗20 s。每组前4个样本冲洗80 s，后4个样本冲洗120 s。将所有样本进行固定、脱钙、包埋、切片和苏木精-伊红染色。在显微镜下采集图像，利用Image J软件测量峡区和根管的清洁度，SPSS 25.0软件对数据进行统计学分析。结果冲洗80 s时，传统冲洗器组、声波组、超声组、激光组的峡区清洁度分别为30.91%±3.14%、52.22%±0.31%、83.77%±5.64%、77.97%±7.97%，3个实验组均优于传统冲洗器组（P<0.05），超声组、激光组优于声波组（P<0.01，P<0.05），但超声组和激光组间的差异无统计学意义（P>0.05）。冲洗120 s时，传统冲洗器组、声波组、超声组、激光组的峡区清洁度分别为75.72%±2.38%、85.66%±4.42%、88.07%±4.09%、89.12%±3.63%，3个实验组均优于传统冲洗器组（P<0.05），但各实验组间的差异无统计学意义（P>0.05）。4组间的根管清洁度差异均无统计学意义（P>0.05）。冲洗120 s时的峡区清洁度和根管清洁度均优于冲洗80 s时（P<0.01，P<0.001）。结论声波、超声和激光3种动能冲洗技术对管间峡区的清理作用均优于传统冲洗器法，超声和激光动能冲洗技术优于声波，冲洗120 s的清洁度优于冲洗80 s。

关键词: 动能冲洗, 管间峡区, 碎屑, 超声, 激光

Abstract:

Objective This study aimed to compare the capabilities of sonic, ultrasonic, and laser-activated irrigation for debris removal in the root canal isthmus. Methods A total of 32 human maxillary first premolars with root canal isthmus were prepared by Reciproc Blue, and were randomly divided into four groups (n=8, each group). The groups were subsequently subjected to different regimens as follows: the conventional syringe group (control group) was irrigated by No.27 side opening syringe, the sonic group with EDDY connected pneumatic motor, the ultrasonic group with IRRI Safe connected to a ultrasonic P5 handle, and the laser group with Er:YAG laser device connected to a 9 mm fiber tip for 20 s in each root canal. The first and last four samples in each group were irrigated for 80 and 120 s, respectively. All samples were fixed, decalcified, embedded, sectioned, and stained with hematoxylin-eosin. Image J software was used for measurement analysis of the isthmus and canal debridement efficacy, and SPSS 25.0 was utilized for statistical analysis of all data. Results The isthmus debridement efficacy of conventional syringe irrigation, sonic, ultrasonic, and laser groups after 80 s irrigation were 30.91%±3.14%, 52.22%±0.31%, 83.77%±5.64%, and 77.97%±7.97%, respectively. The isthmus debridement efficacy of the three experimental groups were better than the conventional syringe irrigation group (P<0.05). The isthmus debridement efficacies of ultrasonic and laser groups after 80 s were better than that of the sonic group (P<0.01, P<0.05). However, no significant difference was observed between the ultrasonic and laser groups. The isthmus debridement efficacy of conventional syringe irrigation, sonic, ultrasonic, and laser groups after 120 s were 75.72%±2.38%, 85.66%±4.42%, 88.07%±4.09%, and 89.12%±3.63%, respectively. The isthmus debridement efficacies of the three experimental groups were better than that of the conventional syringe irrigation group (P<0.05), but no significant difference was observed among the groups (P>0.05). The root canal debridement efficacy among the four groups also exhibited no significant difference (P>0.05). The debridement efficacies of the root canal and isthmus after 120 s irrigation were better than those after 80 s irrigation (P<0.01, P<0.001). Conclusion Ultrasonic, sonic, and laser-activated irrigation have better results in removing debris from the isthmus than conventional syringe irrigation. The isthmus debridement efficacy of sonic- and laser-activated irrigation are slightly better than that of ultrasonic activated irrigation. The debridement efficacies of 120 s irrigation are better than those of 80 s irrigaion.

Key words: activated irrigation, isthmus, debris, ultrasonic, laser

中图分类号:

R 781.05

丛鑫禹, 薛明. 3种动能冲洗技术对管间峡区内碎屑的清理作用[J]. 华西口腔医学杂志, 2022, 40(5): 554-559.

Cong Xinyu, Xue Ming.. Evaluation of root-canal isthmus debridement efficacy of 3 kinds of activated irrigation technique[J]. West China Journal of Stomatology, 2022, 40(5): 554-559.

图/表 6

图 1

图 2

图 3

图 4

表 1

表 2

参考文献 19

1	Paqué F, Ganahl D, Peters OA. Effects of root canal preparation on apical geometry assessed by Micro-computed tomography[J]. J Endod, 2009, 35(7): 1056-1059.
2	Chubb DWR. A review of the prognostic value of irrigation on root canal treatment success[J]. Aust Endod J, 2019, 45(1): 5-11.
3	Portenier I, Haapasalo H, Orstavik D, et al. Inactivation of the antibacterial activity of iodine potassium iodide and chlorhexidine digluconate against Enterococcus faecalis by dentin, dentin matrix, type-Ⅰ collagen, and heat-killed microbial whole cells[J]. J Endod, 2002, 28(9): 634-637.
4	Pereira TC, Boutsioukis C, Dijkstra RJB, et al. Biofilm removal from a simulated isthmus and lateral canal during syringe irrigation at various flow rates: a combined expe-rimental and computational fluid dynamics approach[J]. Int Endod J, 2021, 54(3): 427-438.
5	Ahmad IA, Alenezi MA. Root and root canal morphology of maxillary first premolars: a literature review and clinical considerations[J]. J Endod, 2016, 42(6): 861-872.
6	Verstraeten J, Jacquet W, De Moor RJG, et al. Hard tissue debris removal from the mesial root canal system of mandibular molars with ultrasonically and laser-activa-ted irrigation: a micro-computed tomography study[J]. Lasers Med Sci, 2017, 32(9): 1965-1970.
7	Hsu YY, Kim S. The resected root surface. The issue of canal isthmuses[J]. Dent Clin North Am, 1997, 41(3): 529-540.
8	后岷红, 陈敏, 李蕾, 等. 次氯酸钠冲洗方式、温度和冲洗时间影响根管玷污层的清除效果[J]. 中国组织工程研究, 2015, 19(43): 6918-6923.
	Hou MH, Chen M, Li L, et al. Flushing methods, temperature and flushing time of sodium hypochlorite affect the clearance effect on the smear layer of root canal[J]. J Clin Rehabil Tissue Eng Res, 2015, 19(43): 6918-6923.
9	Swimberghe RCD, De Clercq A, De Moor RJG, et al. Efficacy of sonically, ultrasonically and laser-activated irrigation in removing a biofilm-mimicking hydrogel from an isthmus model[J]. Int Endod J, 2019, 52(4): 515-523.
10	Haupt F, Meinel M, Gunawardana A, et al. Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: a SEM evaluation[J]. Aust Endod J, 2020, 46(1): 40-46.
11	Virdee SS, Seymour DW, Farnell D, et al. Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systema-tic review and Meta-analysis[J]. Int Endod J, 2018, 51(6): 605-621.
12	Klyn SL, Kirkpatrick TC, Rutledge RE. In vitro comparisons of debris removal of the EndoActivator system, the F file, ultrasonic irrigation, and NaOCl irrigation alone after hand-rotary instrumentation in human mandibular molars[J]. J Endod, 2010, 36(8): 1367-1371.
13	Gutarts R, Nusstein J, Reader A, et al. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars[J]. J Endod, 2005, 31(3): 166-170.
14	Ahmad M, Pitt Ford TR, Crum LA, et al. Ultrasonic debridement of root canals: acoustic cavitation and its relevance. 1988[J]. Int Endod J, 2009, 42(5): 391-398.
15	Urban K, Donnermeyer D, Schäfer E, et al. Canal cleanliness using different irrigation activation systems: a SEM evaluation[J]. Clin Oral Investig, 2017, 21(9): 2681-2687.
16	Yoo YJ, Lee W, Kim HC, et al. Multivariate analysis of the cleaning efficacy of different final irrigation techniques in the canal and isthmus of mandibular posterior teeth[J]. Restor Dent Endod, 2013, 38(3): 154-159.
17	Boutsioukis C, Verhaagen B, Versluis M, et al. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model[J]. J Endod, 2010, 36(5): 875-879.
18	Yang Q, Liu MW, Zhu LX, et al. Micro-CT study on the removal of accumulated hard-tissue debris from the root canal system of mandibular molars when using a novel laser-activated irrigation approach[J]. Int Endod J, 2020, 53(4): 529-538.
19	Linden D, Boone M, De Bruyne M, et al. Adjunctive steps for the removal of hard tissue debris from the anatomic complexities of the mesial root canal system of mandibular molars: a micro-computed tomographic study[J]. J Endod, 2020, 46(10): 1508-1514.

组别	根管清洁度	峡区清洁度
传统冲洗器组	93.32±0.46	30.91±3.14
声波组	93.21±0.90	52.22±0.31
超声组	95.70±1.26	83.77±5.64
激光组	94.93±4.10	77.97±7.97

组别	根管清洁度	峡区清洁度
传统冲洗器	96.08±2.50	75.72±2.38
声波组	98.46±0.72	85.66±4.42
超声组	98.44±0.38	88.07±4.09
激光组	98.54±0.85	89.12±3.63

[1]	汤盟, 崔占琴, 王阳阳, 陈增国, 李文静, 张翠萍. 低能量激光对人牙周膜细胞白细胞介素-6、肿瘤坏死因子-α、骨保护素、核因子-κB受体活化因子配体表达的影响[J]. 华西口腔医学杂志, 2023, 41(5): 521-532.
[2]	温超颖, 左雯鑫, 罗文, 何飞. 3种辅助冲洗方法对离体牙弯曲根管内壁的清洁效果[J]. 华西口腔医学杂志, 2023, 41(5): 554-562.
[3]	朱建宇, 洪菲菲, 何良航, 温玮, 雷贤林, 张志升, 尹路. Er: Yag激光拆除3种材质贴面的实验研究[J]. 华西口腔医学杂志, 2023, 41(5): 568-572.
[4]	林琪, 林昱, 谢云德, 马忠雄. 原子力显微镜分析激光消融对牙本质表面微纳米结构的影响[J]. 华西口腔医学杂志, 2022, 40(2): 155-161.
[5]	把丽根·伯拉提汉null, 林志辉, 满毅. 脉冲式掺铒钇铝石榴石激光与乙二胺四乙酸联合治疗模式处理不同深度天然牙三壁骨缺损同期植入种植体的研究[J]. 华西口腔医学杂志, 2021, 39(6): 718-723.
[6]	靳晓兰, 张亚男, 孙成蕊, 邹朝晖. 低能量激光照射对脂多糖介导人牙周膜成纤维细胞炎性损伤的保护作用[J]. 华西口腔医学杂志, 2021, 39(3): 260-266.
[7]	张蕾, 于旭红, 姚丽萍. Er:YAG激光-氟化钠联合法与亚甲基蓝-光动力疗法防龋效果及安全性的比较[J]. 华西口腔医学杂志, 2020, 38(6): 637-641.
[8]	李媛媛, 吴敏, 刘明曦, 解晨阳, 郑谦, 石冰, 李承浩. CO₂点阵激光早期控制唇裂二期整复术后瘢痕的疗效观察[J]. 华西口腔医学杂志, 2020, 38(6): 657-661.
[9]	张婷, 陈度, 苗雷英, 谢思静, 汤旭娜. 激光熔融数字化导板技术辅助钙化根管的治疗[J]. 华西口腔医学杂志, 2020, 38(5): 525-531.
[10]	姜懿轩, 宫苹, 张亮. 低强度脉冲超声促进骨组织再生相关机制的研究进展[J]. 华西口腔医学杂志, 2020, 38(5): 571-575.
[11]	杨如倩,郭淑娟,肖诗梦,丁一. 激光在牙冠延长术中的临床应用[J]. 华西口腔医学杂志, 2019, 37(5): 551-555.
[12]	辛悦,杨健,宋矿余. XP-endo Finisher锉对根管内壁玷污层清除效果的体外研究[J]. 华西口腔医学杂志, 2019, 37(1): 48-52.
[13]	喻茜茜,郭菁,朱洪水. 不同喷砂条件对选择性激光熔覆钴铬合金金瓷结合强度影响的研究[J]. 华西口腔医学杂志, 2018, 36(5): 539-543.
[14]	魏霆,张欣蔚,孙惠强,毛梦芸. 选择性激光烧结多孔钛种植体及其性能研究[J]. 华西口腔医学杂志, 2018, 36(5): 532-538.
[15]	殷艳丽, 许春梅, 吴亚菲, 赵蕾. 龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价[J]. 华西口腔医学杂志, 2017, 35(6): 618-624.