Nd-YAG激光联合氯己定冲洗根管治疗牙髓炎临床观察

Clinical observation of Nd-YAG laser combined with chlorhexidine root canal irrigation in the treatment of pulpitis

目的探讨Nd-YAG激光联合氯己定根管冲洗在牙髓炎根管预备中的应用效果及对根管渗出液中基质金属蛋白酶2(MMP-2)和MMP-9的影响。方法选择苏州市相城人民医院2020-03-01-2021-01-31收治的104例牙髓炎患者为研究对象。根据患者临床治疗方案将其分为观察组和对照组,观察组54例采用Nd-YAG激光联合氯己定根管冲洗液治疗,对照组50例采用Nd-YAG激光联合生理盐水冲洗液治疗。比较2组患者治疗6个月后的临床效果及根管渗出液中MMP-2及MMP-9水平,并采用视觉模拟评分法(VAS)对2组患者治疗前及治疗后2周的疼痛程度进行评价,观察2组患者根管治疗12个月内炎症、出血等不良反应及复发情况。结果观察组治疗有效率为94.44%,高于对照组的82.00%,差异有统计学意义,χ^(2)=3.939,P=0.047。治疗后,观察组MMP-2水平为(0.418±0.081)ng/mL,对照组为(0.468±0.086)ng/mL,2组患者MMP-2水平降低,且观察组低于对照组,差异有统计学意义,t=3.053,P=0.003;观察组MMP-9水平为(17.314±4.813)ng/mL,对照组为(24.036±3.917)ng/mL,2组患者MMP-9水平降低,且观察组低于对照组,差异有统计学意义,t=7.775,P<0.001。治疗后,观察组VAS评分为(1.04±0.47)分,对照组为(1.47±0.52)分,2组患者VAS评分均降低,且观察组低于对照组,差异有统计学意义,t=4.429,P<0.001。术后12个月,观察组疼痛及炎症反应发生率为5.56%,低于对照组的18.00%,差异有统计学意义,χ^(2) =3.939,P=0.047;观察组间断性出血发生率为3.70%,低于对照组的16.00%,差异有统计学意义,χ^(2)=4.517,P=0.034;观察组复发率为1.85%,低于对照组的12.00%,但差异无统计学意义,χ^(2)=2.796,P=0.095。结论牙髓炎患者在根管治疗中采用Nd-YAG激光联合氯己定根管冲洗,有利于提升临床疗效,调节根管渗出液中MMP-2及MMP-9水平,降低患者术后疼痛程度,且不良反应发生率更低。

Objective To investigate the effect of Nd-YAG laser combined with chlorhexidine root canal irrigation in root canal preparation and its effect on matrix metalloproteinase-2(MMP-2)and MMP-9 in root canal exudate.Methods A total of 104 patients with pulpitis treated in Suzhou Xiangcheng People’s Hospital from March 1,2020 to January 31,2021 were selected as the research objects.According to the clinical treatment plan,the patients were divided into observation group and control group.54 cases in the observation group were treated with Nd-YAG laser combined with chlorhexidine root canal irrigation solution,and 50 cases in the control group were treated with Nd-YAG laser combined with normal saline irrigation solution.The clinical effects and the levels of MMP-2 and MMP-9 in root canal exudate were compared between the two groups after 6 months of treatment.The pain degree of the two groups before and 2 weeks after treatment was evaluated by visual analogue scale(VAS).The adverse reactions such as inflammation,bleeding and recurrence of the two groups within 12 months of root canal treatment were observed.Results The effective rate of the observation group was 94.44%,higher than 82.00%of the control group,the difference was statistically significant,χ^(2)=3.939,P=0.047.After treatment,the level of MMP-2 in the observation group was(0.418±0.081)ng/ml and that in the control group was(0.468±0.086)ng/ml.the level of MMP-2 in the two groups decreased,and the level of MMP-2 in the observation group was lower than that in the control group,the difference was statistically significant,t=3.053,P=0.003;The level of MMP-9 in the observation group was(17.314±4.813)ng/ml and that in the control group was(24.036±3.917)ng/ml.the level of MMP-9 in the two groups decreased,and the level of MMP-9 in the observation group was lower than that in the control group,the difference was statistically significant,t=7.775,P<0.001.After treatment,the VAS score of the observation group was 1.04±0.47 and that of the control group was 1.47±0.52.The VAS score of the two groups decreased,and the VAS score of the observation group was lower than that of the control group,the difference was statistically significant,t=4.429,P<0.001.12 months after operation,the incidence of pain and inflammatory reaction in the observation group was 5.56%,lower than 18.00%in the control group,χ^(2)=3.939,P=0.047.The incidence of intermittent bleeding in the observation group was 3.70%,lower than 16.00%in the control group,χ^(2)=4.517,P=0.034.The recurrence rate in the observation group was 1.85%,lower than 12.00%in the control group,but the difference was not statistically significant,χ^(2)=2.796,P=0.095.Conclusion The use of Nd-YAG laser combined with chlorhexidine root canal irrigation in root canal treatment of patients with pulpitis is conducive to improve the clinical efficacy,adjust the levels of MMP-2 and MMP-9 in root canal exudate,reduce the degree of postoperative pain,and lower the incidence of adverse reactions.