Er:YAG激光活化冲洗技术对根管内氢氧化钙清除效果和根尖封闭性能的影响

Effect of Er:YAG laser activation irrigation technique on removal effect of calcium hydroxide in root canals and apical sealing ability

目的:探讨2种Er∶YAG激光活化冲洗技术对根管内氢氧化钙[Ca(OH)_(2)]清除效果和根尖封闭性能的影响,阐明该技术在根管冲洗过程中的临床应用价值。方法:80颗离体单根管前磨牙截冠后预备至35#,Ca(OH)_(2)糊剂充填根管。所有样本根据不同冲洗技术随机分为4组(n=20),分别为超声荡洗组、光子诱导光声流(PIPS)组、冲击波增强发射光声流(SWEEPS)组和阴性对照组。各组随机选择10个样本纵剖,采用扫描电子显微镜(SEM)观察并评分。各组剩余样本进行根管充填,染料渗透实验。比较不同冲洗技术对残留Ca(OH)_(2)的清除效果,并分析各组染料渗透长度。结果:3个实验组均无法完全去除根管内残留Ca(OH)_(2),与冠1/3和根中1/3比较,根尖1/3残留Ca(OH)_(2)评分明显升高(P<0.05);在冠1/3,与超声荡洗组比较,PIPS组和SWEEPS组残留Ca(OH)_(2)评分降低(P<0.05);而在根中1/3,与超声荡洗组比较,SWEEPS组残留Ca(OH)_(2)评分降低(P<0.05);在根尖1/3,3组残留Ca(OH)_(2)评分比较差异无统计学意义(P>0.05);PIPS组和SWEEPS组在冠1/3、根中1/3和根尖1/3残留Ca(OH)_(2)评分比较差异无统计学意义(P>0.05)。各组之间的染料渗透长度比较差异无统计学意义(P>0.05)。结论:PIPS和SWEEPS技术对Ca(OH)_(2)的清除能力相当。与超声荡洗比较,2种Er∶YAG激光活化冲洗技术对根管中上部的Ca(OH)_(2)清除效果较好,且应用3种冲洗技术后,根管内残留的Ca(OH)_(2)短期内对根管充填材料的根尖封闭性能无明显影响。

Objective:To explore the effects of two Er:YAG laser activation irrigation techniques on the removal of calcium hydroxide[Ca(OH)_(2)]in the root canals and the apical sealing ability,and to clarify the clinical application value of this technique in root canal irrigation.Methods:A total of 80 isolated single Ca(OH)_(2)premolars were prepared to 35#after crown cut,and the root canals were filled with hydroxide paste.According to different irrigation techniques,all samples were randomly divided into 4 groups(n=20):ultrasonically activated irrigation group,photon initiated photoacoustic streaming(PIPS)group,shock wave enhanced emission photoacoustic streaming(SWEEPS)group,and negative control group.First,10samples of each group were randomly selected for longitudinal sections,then they were observed with scanning electron microscepe(SEM)and scored.Secondly,the remaining samples of each group were subjected to root canal filling and dye penetration experiments.The effects of different irrigation techniques on the removal Ca(OH)_(2)were compared,and the dye penetration lengthes in various groups were analyzed.Results:The three experimental groups were unable to completely remove Ca(OH)_(2)in the root canal;compared with cervical third and middle third,the residual Ca(OH)_(2)score in the apical third was significantly increased(P<0.05).Compared with ultrasonically activated irrigation group,the residual Ca(OH)_(2)scores in PIPS group and SWEEPS group were increased in the cervical third(P<0.05).While in the middle third,compared with ultrasonically activated irrigation group,the residual Ca(OH)_(2)score in SWEEPS group was increased(P<0.05).The apical third did not show significant differences among experimental groups(P>0.05).There were no significant differences between PIPS and SWEEPS in the residual Ca(OH)_(2)scores in the cervical,middle and apical thirds(P>0.05).There was no significant difference in the dye penetration length among various groups(P>0.05).Conclusion:PIPS and SWEEPS techniques have the similar ability to remove Ca(OH)_(2),and compared with ultrasonically actirated irrigation,the removal effects of Ca(OH)_(2)in the middle and upper part of the root canal are better,and after the three irrigation techniques are applied,the residual Ca(OH)_(2)hardly affect the apical sealing ability of the root canal filling material in the short term.