器械及冲洗液对根管预备效果影响的实验研究
|
摘要
根管预备是根管治疗成败的关键步骤，根管预备的好坏直接影响根管治疗的效果。根管预备包括根管清理和根管成形。目前多采用机械预备并配合使用各种冲洗液的方法，以达到根管清理成形和去除玷污层的目的。本文通过体外实验比较不同扩锉器械和含表面活性剂的冲洗液与常用冲洗液根管预备的效果。
研究分两部分：第一部分：将60颗离体牙随机分为6组，分别为空白对照组、扩大针组、扩与K型锉组、扩与H型锉组、K型锉组和超声扩锉组，采用逐步后退法预备根管。扫描电镜观察根管内壁，比较碎屑面积大小。第二部分在2％SDS、1％tween-80,3.4％AEO三种表面活性剂中筛选出3.4％AEO溶液后，采取分层随机的方法，将不同牙龄的样本随机分为6组，分别为蒸馏水组、3.4％AEO溶液组、10％EDTA组；10％EDTA与1％氯亚明交替冲洗组、1％氯亚明与3％双氧水交替冲洗组、10％EDTA与3.4％AEO的混合组。采用逐步后退法预备根管。扫描电镜观察根管内壁，比较碎屑面积大小。实验同时比较了感染根管及非感染根管经相同处理后的碎屑面积，
结果表明：1、形态学观察：根管壁碎屑面积比较：K型锉组＞扩大针组＞扩与K型锉组＞空白对照＞扩与H型锉组＞超声扩锉组，且前三组与各组之间具有显著性差异(P＜0.05)，而后三者之间无显著性差异(P＞0.05)。2、AEO组根管内壁牙本质小管开口情况明显优于SDS及Tween－80组，AEO组碎屑分布面积也明显少于SDS及Tween-80组。3、蒸馏水组的根管内壁
碎屑面积最大，牙本质小管开放程度最低，EDTA与AEO混合组次之，
氯亚明双氧水交替冲洗组有部分碎屑产生，牙本质小管大部分开放。此三
组与其它各组比较均有显著性差异叩m．05人AEO组、EDTA组、氯亚
明与EDTA交替冲洗组根管预备效果均较好，牙本质小管口清楚，碎屑
面积少。三组间无显著性差异（P＞0．05）。4、感染根管与非感染根管经相
同处理后的碎屑面积无显著性差异（P＞0．05）。
结论：二、超声扩挫与扩与H型挫效果最好；扩与K型挫交替使用次
之；单纯扩或挫不能有效进行根管清理。建议临床采用扩与N型挫交替预
备根管。2、使用AEO进行根管清理的效果优于SDS和TWeen．80。3、单
独使用AEO根管冲洗液根管预备效果较好，由于AEO对人体无毒，作为
根管冲洗液具有一定前景。4、在扫描电镜观察根管冲洗液的效果的研究
时，选择基线一致的离体牙，既可以选择感染根管、也可以选择非感染根
管。珐污层的形成情况与预备器械、预备方法和冲洗液密切相关。
Background: root canal preparation is crucial step of root canal therapy, including cleaning and shaping of root canal by mechanical instrumentation and irrigation.
Objective: to investigate the effects of root canal preparation by different instrumentation and irrigation containing surface active agent(SAA).
Methods: Part I : The fresh extracted 60 single-rooted teeth were collected,then random distributed in 6 groups of 10 each. Group 1, the negative control; group 2, reaming instrumentation with reamers only; group 3, reaming and filing instrumentation with reamers and K files; group 4, reaming and filing instrumentation with reamers and H files; group 5, filing instrumentation with K files only; group 6, the ultrasonic instrumentation. The effects of canal preparation were evaluated by Scanning electron microscopic photomicrographs.
Part II :Screen the best SAA irrigation from the 3.4%AEO, 2%SDS, l%tween-80. The fresh extracted 60 teeth were random stratified distributed in 6 groups of 10 each. Group 1, the negative control; group 2, screening SAA irrigation; group 3, 10%EDTA; group 4, 10% EDTA+ screening SAA irrigation; groupS, 10% EDTA and 1% NaCLO in turn. Group 6, 1% NaCLO and 3%H2O2 in turn. The effects of canal preparation were evaluated by Scanning electron microscopic photomicrographs.At the same time, the effects of infected and uninfected root canal which have the same baseline were compared.
Results: Part I : the debris area of the root canal wall of group 5 was the largest, followed by group 2, group 3, group 1, group 4 and group 6. There was significant difference between the group5/group2/group3 and the other groups(P<0.05). However, there was no significant difference among the last three groups(l,4&6) (P <0.05).
Part II: the dentin tuble opening degree of 3.4%AEO is superior to 2%SDS and l%tween-80,and the debris area of AEO group is smaller than the other. The second experiment show that the area of bebris of H2O group is the largest,followed by the mixture of EDTA and AEO, NaCLO and H2O2 in
turn, .there was significant difference between any of the above three group and the others. AEO, EDTA; EDTA and NaCLO in turn show good effect. There was no significant difference among the three groups. There was no significant difference between the infected root canal and the uninfected root canal.
Conclusion: Part I : the effect of the ultrasonic treatment and the reamer and H file treatment were the best. K file or reamer file can not effectively remove the debris. The result is useful for the canal preparation in endodontic therapy.
PartII:the effect of root canal cleaning by 3.4%AEO is superior to 2%SDS and l%tween-80. 3.4%AEO alone is harmless to human and maybe the promising root canal irrigation. When study the effect of the root canal irrigation by SEM, there is no difference between the infected root canal and the uninfected root canal. The smear layer is dramatic relative to mstruments,irrigations, and preparing methods.
研究分两部分：第一部分：将60颗离体牙随机分为6组，分别为空白对照组、扩大针组、扩与K型锉组、扩与H型锉组、K型锉组和超声扩锉组，采用逐步后退法预备根管。扫描电镜观察根管内壁，比较碎屑面积大小。第二部分在2％SDS、1％tween-80,3.4％AEO三种表面活性剂中筛选出3.4％AEO溶液后，采取分层随机的方法，将不同牙龄的样本随机分为6组，分别为蒸馏水组、3.4％AEO溶液组、10％EDTA组；10％EDTA与1％氯亚明交替冲洗组、1％氯亚明与3％双氧水交替冲洗组、10％EDTA与3.4％AEO的混合组。采用逐步后退法预备根管。扫描电镜观察根管内壁，比较碎屑面积大小。实验同时比较了感染根管及非感染根管经相同处理后的碎屑面积，
结果表明：1、形态学观察：根管壁碎屑面积比较：K型锉组＞扩大针组＞扩与K型锉组＞空白对照＞扩与H型锉组＞超声扩锉组，且前三组与各组之间具有显著性差异(P＜0.05)，而后三者之间无显著性差异(P＞0.05)。2、AEO组根管内壁牙本质小管开口情况明显优于SDS及Tween－80组，AEO组碎屑分布面积也明显少于SDS及Tween-80组。3、蒸馏水组的根管内壁
碎屑面积最大，牙本质小管开放程度最低，EDTA与AEO混合组次之，
氯亚明双氧水交替冲洗组有部分碎屑产生，牙本质小管大部分开放。此三
组与其它各组比较均有显著性差异叩m．05人AEO组、EDTA组、氯亚
明与EDTA交替冲洗组根管预备效果均较好，牙本质小管口清楚，碎屑
面积少。三组间无显著性差异（P＞0．05）。4、感染根管与非感染根管经相
同处理后的碎屑面积无显著性差异（P＞0．05）。
结论：二、超声扩挫与扩与H型挫效果最好；扩与K型挫交替使用次
之；单纯扩或挫不能有效进行根管清理。建议临床采用扩与N型挫交替预
备根管。2、使用AEO进行根管清理的效果优于SDS和TWeen．80。3、单
独使用AEO根管冲洗液根管预备效果较好，由于AEO对人体无毒，作为
根管冲洗液具有一定前景。4、在扫描电镜观察根管冲洗液的效果的研究
时，选择基线一致的离体牙，既可以选择感染根管、也可以选择非感染根
管。珐污层的形成情况与预备器械、预备方法和冲洗液密切相关。
Background: root canal preparation is crucial step of root canal therapy, including cleaning and shaping of root canal by mechanical instrumentation and irrigation.
Objective: to investigate the effects of root canal preparation by different instrumentation and irrigation containing surface active agent(SAA).
Methods: Part I : The fresh extracted 60 single-rooted teeth were collected,then random distributed in 6 groups of 10 each. Group 1, the negative control; group 2, reaming instrumentation with reamers only; group 3, reaming and filing instrumentation with reamers and K files; group 4, reaming and filing instrumentation with reamers and H files; group 5, filing instrumentation with K files only; group 6, the ultrasonic instrumentation. The effects of canal preparation were evaluated by Scanning electron microscopic photomicrographs.
Part II :Screen the best SAA irrigation from the 3.4%AEO, 2%SDS, l%tween-80. The fresh extracted 60 teeth were random stratified distributed in 6 groups of 10 each. Group 1, the negative control; group 2, screening SAA irrigation; group 3, 10%EDTA; group 4, 10% EDTA+ screening SAA irrigation; groupS, 10% EDTA and 1% NaCLO in turn. Group 6, 1% NaCLO and 3%H2O2 in turn. The effects of canal preparation were evaluated by Scanning electron microscopic photomicrographs.At the same time, the effects of infected and uninfected root canal which have the same baseline were compared.
Results: Part I : the debris area of the root canal wall of group 5 was the largest, followed by group 2, group 3, group 1, group 4 and group 6. There was significant difference between the group5/group2/group3 and the other groups(P<0.05). However, there was no significant difference among the last three groups(l,4&6) (P <0.05).
Part II: the dentin tuble opening degree of 3.4%AEO is superior to 2%SDS and l%tween-80,and the debris area of AEO group is smaller than the other. The second experiment show that the area of bebris of H2O group is the largest,followed by the mixture of EDTA and AEO, NaCLO and H2O2 in
turn, .there was significant difference between any of the above three group and the others. AEO, EDTA; EDTA and NaCLO in turn show good effect. There was no significant difference among the three groups. There was no significant difference between the infected root canal and the uninfected root canal.
Conclusion: Part I : the effect of the ultrasonic treatment and the reamer and H file treatment were the best. K file or reamer file can not effectively remove the debris. The result is useful for the canal preparation in endodontic therapy.
PartII:the effect of root canal cleaning by 3.4%AEO is superior to 2%SDS and l%tween-80. 3.4%AEO alone is harmless to human and maybe the promising root canal irrigation. When study the effect of the root canal irrigation by SEM, there is no difference between the infected root canal and the uninfected root canal. The smear layer is dramatic relative to mstruments,irrigations, and preparing methods.
引文
1． 王晓仪主编．现代根管治疗学．北京：人民卫生出版社，2001
2． Pashley DH, Michelich V, Kehl T. Dentin permeability:effects of smear layer removal. J Prosthet Dent, 1981,46:531-537
3． Wu S. Polymer interface and adhesion. New York;Dekker Marcel. 1982
4． Cergneux M, Ciucchi B, Dietschi JM, et al. The influence of the smear layer on the sealing ability of the canal obturation. Int Endod J, 1987,20:228-232
5． Gettkeman BH, Messer HH, ElDeeb ME. Adhesion of sealer cements to dentin with and without smear layer. J Endodon, 1991,17:15-20
6． Bystrom A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res, 1981,89:321-328
7． Shilder H. Cleaning and shaping the root canal. Dent Clin North Arm, 1974,18:269-296
8． Mentz Tcf. The use of sodium hypochiorite as a general endodontic medicamentlnt Endod J, 1982,15:132-136
9． Martin.Canningham WT. Endosonics-the ultrasonic synergistic system of endodontics. Endod Dent Traumatil, 1985,1:201-206
10． Ciucchi B, Khettabi M, Holz J. The effectiveness of different endodontic irrigation procedures on the smear layer: a scanning electron microscopic study. Int Endod J, 1989,22:21-28
11． Kazemi-RB,Steninan-E,Spangberg-LS. Machining efficiency and wear resistance of nickel-titanium endodontic files. Oral-Surg-Oral-Med-Oral-Pathol-Oral-Radiol-Endod. 1996 May; 81 (5) : 596-602
12． Dalton,Orstavik D, Phillips c,et al. Bacterial reduction with Nickel-Titanium rotary instrumentation. J endodon 1998;24:763-7
13． Grossman L1． Irrigation of root canals. J Am Dent Assoc, 1943,30:1915-1917
14． Collet R, Massilamoni M, Kettering J,et.al. The biocompatibility of some root canal medicaments and irrigants. Int Endod j 1981; 14:115-20
15． Kozol RA, FGillies C, Elgebaly SA.Effects of Naclo on cells of The wound module Arch Surg,1988,123:420-3
16． Ehrich GD,Brian D,Walker WA. Sodium hypochlorite accident: inadvertent injection into the maxillary sinus. J Endodon, 1993,19:180-182
17． Andersen M,Andreaseb JO,Andreasen FM. In vitro Solubility of human pulp tissre in calcium hydroxide and Naclo Endod Dent Traumatol,1992,8:104-8
18． Elisabath A, John Margelos, Panagiotis Beltes, et.al. cytotoxic Effects of different concentrations of neutral and alkaline EDTA solutions used as root canal irrigants. J endodon 1999;25:21-23
19． Segura JJ, Calvo JR, Guerrero JM, et al. The disodium salt of EDTA inhibites the binding of vasoactive intestinal peptide to macrophage membranes:endodontic inplications J Endod 1996,22:337
20． Marc M.Panighi,Bruno Jacquot. Scanning electron microscopic evaluation of ultrasonic debridement comparing sodium hypochlorite and bardac-22． J Endodon 1995 ;21:272-276
21． Koskinen KP, Meuman JH,Stenvall H. Appearance of chemically treated root canal walls in the scanning electron microscope. Scand J Dent Res 1980;88:397-405
22．肖丹，刘天佳．表面活性剂的防龋机制．国外医学口腔医学分册，1996；5(23)；284-287
23.Zaccaro Scelza MF, Antoniazzi JH, Scelza P. Efficacy of final irrigation-a scanning electron microscopic evaluation. J endodon, 2000,26(6):355-358
24.Panighi-MM, Jacquot-B.Scanning electron microscpic evaluation of ultrasonic debridement comparing sodium hypochlorite and Bardac-22.J-Endodon, 1995,21(5):272-278.
25.Mc Comb d, Smith DC. A preliminary scanning electron microscopy study of root canal after endodontic procedures. J Endodon, 1975,1:238-242
26.Goldman M, Kronman JH, et al.The efficacy of several irrigating solutions for endodontics: a scanning electron microscopic study. Oral Surg,1981,52:197-204
27.Kennedy WA,Walker WA Ⅲ,Gough RW. Smear layer remove effects on apical leakage. J Endodon, 1986,12:21-27.
28.Abou-Rass M,Piccininio MV. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg 1982;54:323-8,
29.Baumgartner JC,Cuenin PR.Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. J Endodon 1992; 18:605-12
30.Yamada RS,Armas A,Goldman M,et al. A scanning electron microscopic study of a high volume final flush with several irrigating solutions. Part Ⅲ.J Endodon 1983;4:137-42.
31．化学工业出版社。中国化工产品大全。北京：化学工业出版社。1994。
32．农药助剂。王早骧。北京：化学工业出版社。1994，27。
33.Rykke M,Rolla G,Sonju T. Effect of sodium laurgl sulfate on protein adsorption to hydroxyapatite in vitro and on pellicle formation in vivo.
Scand J Dent Res,1999;98:135
34． Cynthia T Tatsuta,Leslie A Morgan,Graig Baumgartiner,et al Effect of Ca(OH)2 and Four irrigation regimens on instrumented and uninstrumented canal wall Topography J Endod,1999． 25(2) :93
35． Baumgartner Jc,Ibay AC.The chemical reactions of irrigants used for root canal debridement. J Endodon 1987;13:45-51
2． Pashley DH, Michelich V, Kehl T. Dentin permeability:effects of smear layer removal. J Prosthet Dent, 1981,46:531-537
3． Wu S. Polymer interface and adhesion. New York;Dekker Marcel. 1982
4． Cergneux M, Ciucchi B, Dietschi JM, et al. The influence of the smear layer on the sealing ability of the canal obturation. Int Endod J, 1987,20:228-232
5． Gettkeman BH, Messer HH, ElDeeb ME. Adhesion of sealer cements to dentin with and without smear layer. J Endodon, 1991,17:15-20
6． Bystrom A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res, 1981,89:321-328
7． Shilder H. Cleaning and shaping the root canal. Dent Clin North Arm, 1974,18:269-296
8． Mentz Tcf. The use of sodium hypochiorite as a general endodontic medicamentlnt Endod J, 1982,15:132-136
9． Martin.Canningham WT. Endosonics-the ultrasonic synergistic system of endodontics. Endod Dent Traumatil, 1985,1:201-206
10． Ciucchi B, Khettabi M, Holz J. The effectiveness of different endodontic irrigation procedures on the smear layer: a scanning electron microscopic study. Int Endod J, 1989,22:21-28
11． Kazemi-RB,Steninan-E,Spangberg-LS. Machining efficiency and wear resistance of nickel-titanium endodontic files. Oral-Surg-Oral-Med-Oral-Pathol-Oral-Radiol-Endod. 1996 May; 81 (5) : 596-602
12． Dalton,Orstavik D, Phillips c,et al. Bacterial reduction with Nickel-Titanium rotary instrumentation. J endodon 1998;24:763-7
13． Grossman L1． Irrigation of root canals. J Am Dent Assoc, 1943,30:1915-1917
14． Collet R, Massilamoni M, Kettering J,et.al. The biocompatibility of some root canal medicaments and irrigants. Int Endod j 1981; 14:115-20
15． Kozol RA, FGillies C, Elgebaly SA.Effects of Naclo on cells of The wound module Arch Surg,1988,123:420-3
16． Ehrich GD,Brian D,Walker WA. Sodium hypochlorite accident: inadvertent injection into the maxillary sinus. J Endodon, 1993,19:180-182
17． Andersen M,Andreaseb JO,Andreasen FM. In vitro Solubility of human pulp tissre in calcium hydroxide and Naclo Endod Dent Traumatol,1992,8:104-8
18． Elisabath A, John Margelos, Panagiotis Beltes, et.al. cytotoxic Effects of different concentrations of neutral and alkaline EDTA solutions used as root canal irrigants. J endodon 1999;25:21-23
19． Segura JJ, Calvo JR, Guerrero JM, et al. The disodium salt of EDTA inhibites the binding of vasoactive intestinal peptide to macrophage membranes:endodontic inplications J Endod 1996,22:337
20． Marc M.Panighi,Bruno Jacquot. Scanning electron microscopic evaluation of ultrasonic debridement comparing sodium hypochlorite and bardac-22． J Endodon 1995 ;21:272-276
21． Koskinen KP, Meuman JH,Stenvall H. Appearance of chemically treated root canal walls in the scanning electron microscope. Scand J Dent Res 1980;88:397-405
22．肖丹，刘天佳．表面活性剂的防龋机制．国外医学口腔医学分册，1996；5(23)；284-287
23.Zaccaro Scelza MF, Antoniazzi JH, Scelza P. Efficacy of final irrigation-a scanning electron microscopic evaluation. J endodon, 2000,26(6):355-358
24.Panighi-MM, Jacquot-B.Scanning electron microscpic evaluation of ultrasonic debridement comparing sodium hypochlorite and Bardac-22.J-Endodon, 1995,21(5):272-278.
25.Mc Comb d, Smith DC. A preliminary scanning electron microscopy study of root canal after endodontic procedures. J Endodon, 1975,1:238-242
26.Goldman M, Kronman JH, et al.The efficacy of several irrigating solutions for endodontics: a scanning electron microscopic study. Oral Surg,1981,52:197-204
27.Kennedy WA,Walker WA Ⅲ,Gough RW. Smear layer remove effects on apical leakage. J Endodon, 1986,12:21-27.
28.Abou-Rass M,Piccininio MV. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg 1982;54:323-8,
29.Baumgartner JC,Cuenin PR.Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. J Endodon 1992; 18:605-12
30.Yamada RS,Armas A,Goldman M,et al. A scanning electron microscopic study of a high volume final flush with several irrigating solutions. Part Ⅲ.J Endodon 1983;4:137-42.
31．化学工业出版社。中国化工产品大全。北京：化学工业出版社。1994。
32．农药助剂。王早骧。北京：化学工业出版社。1994，27。
33.Rykke M,Rolla G,Sonju T. Effect of sodium laurgl sulfate on protein adsorption to hydroxyapatite in vitro and on pellicle formation in vivo.
Scand J Dent Res,1999;98:135
34． Cynthia T Tatsuta,Leslie A Morgan,Graig Baumgartiner,et al Effect of Ca(OH)2 and Four irrigation regimens on instrumented and uninstrumented canal wall Topography J Endod,1999． 25(2) :93
35． Baumgartner Jc,Ibay AC.The chemical reactions of irrigants used for root canal debridement. J Endodon 1987;13:45-51