掺钕钇铝石榴石激光辅助次氯酸钠治疗长期窦道慢性根尖周炎的临床效果

Clinical efficacy of sodium hypochlorite therapy with adjuvant neodymium: yttrium-aluminum-perovskite laser for chronic periapical periodontitis with long-term sinus

目的探讨掺钕钇铝石榴石(Nd:YAP)激光辅助次氯酸钠治疗长期窦道慢性根尖周炎的疗效。方法将152例长期窦道慢性根尖周炎患者(共155颗患牙)随机分为观察组(76例,77颗患牙)和对照组(76例,78颗患牙)。在根管预备后,观察组采用Nd:YAP激光辅助3%次氯酸钠和19%乙二胺四乙酸糊剂对根管进行消毒,对照组仅采用3%次氯酸钠和19%乙二胺四乙酸糊剂对根管进行消毒。对照组使用次氯酸钠冲洗窦道后常规封闭、根管填充;观察组使用次氯酸钠联合Nd:YAP激光行窦道治疗后,采用AH-Plus材料进行根管填充,再行3次激光治疗,最后采用SybronEndo系统行根管填充。比较两组患者术后48 h、7 d疼痛情况,治疗后7 d、14 d窦道愈合情况,窦道愈合后填充次数,治疗前和治疗3个月后根管内细菌数量,以及根管填充后12个月的疗效。结果观察组治疗48 h后疼痛分级低于对照组,治疗7 d后窦道愈合情况优于对照组(P<0.05),根管填充次数少于对照组(P<0.05)。治疗后两组患者中间普式菌、牙龈卟啉菌、福塞斯坦纳菌、伴放线放线杆菌、齿垢密螺旋体数量均较治疗前减少,且观察组患者上述细菌数量少于对照组(均P<0.05)。随访1年,观察组疗效优于对照组,临床有效率高于对照组(P<0.05)。结论 Nd:YAP激光辅助次氯酸钠治疗长期窦道慢性根尖周炎疗效显著,能够明显减轻患者疼痛,促进窦道愈合,且杀菌作用强。

Objective To explore the efficacy of sodium hypochlorite therapy with adjuvant neodymium: yttrium-aluminum-perovskite(Nd:YAP) laser for chronic periapical periodontitis with long-term sinus. Methods A total of 152 patients with chronic periapical periodontitis with long-term sinus(155 affected teeth in total) were randomly divided into observation group(76 cases with 77 affected teeth) and control group(76 cases with 78 affected teeth). After root canal preparation, the observation group used 3% sodium hypochlorite and 19% ethylenediamine tetraacetic acid paste with adjuvant Nd:YAP laser to disinfect root canal, whereas the control group only used 3% sodium hypochlorite and 19% ethylenediamine tetraacetic acid paste to disinfect root canal. The control group undertook conventional sealing and root canal filling following sinus flushing using sodium hypochlorite;the observation group received sinus treatment using sodium hypochlorite combined with Nd:YAP laser prior to root canal filling with AH-Plus sealer, then undertook three laser treatments, finally root canal filling was performed using SybronEndo system. The two groups were compared with respect to pain state at hour 48 and day 7 postoperatively, sinus healing, and filling frequency after sinus healing seven and 14 days after treatment, bacteria counts in the root canal before and three months after treatment, as well as efficacy 12 months after root canal filling. Results Compared with the control group, the observation group had lower pain degree at hour 48 after treatment, superior sinus healing on day 7 after treatment(P<0.05), and fewer frequency of root canal filling(P<0.05). After treatment, the counts of Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans, and Treponema denticola were decreased in both groups as compared with those before treatment, and the counts of the bacteria mentioned above were lower in the observation group than in the control group(all P<0.05). After one year of follow-up, the observation group obtained superior efficacy and a higher clinical effective rate than the control group(P<0.05). Conclusion Sodium hypochlorite therapy assisted by Nd:YAP laser achieves a remarkable effect on chronic periapical periodontitis with long-term sinus, which can significantly alleviate patients’ pain and promote sinus healing, exerting a strong bactericidal effect.