不同冲洗方法在C形根管的牙本质小管中渗透性能的体外研究

Comparison of permeability of different irrigation methods in dentin tubules of C shaped root canals in vitro

目的 评价传统冲洗器、超声、声波、激光冲洗方法在C形根管的牙本质小管中渗透能力,为临床治疗提供一定的参考依据。方法 选取2019年12月至2021年3月在中国医科大学附属口腔医院口腔颌面外科门诊因正畸治疗或牙周炎症拔除的32颗具有C形根管的下颌第一前磨牙和下颌第二磨牙作为研究模型,随机分为4组,每组8颗离体牙,分别采用传统冲洗器(CNI组)、超声(PUI组)、声波(EDDY组)、激光(PIPS组)方法进行根管冲洗(1 mL 1%NaClO溶液作为冲洗液),并使用1%亚甲蓝染色液进行终末冲洗。采用硬组织切片机将4组牙齿横向切割成300μm厚切片,体视显微镜下进行观察并采集图像,应用Image J软件进行各组切片渗透深度的测量。结果 采用动能冲洗的PUI组、EDDY组和PIPS组牙本质小管渗透性能明显优于传统冲洗的CNI组,组间差异有统计学意义(P <0.05);各组从根中到根尖区的动能冲洗效果均有所降低,特别是EDDY组与PIPS组,根中与根尖区的差异有统计学意义(P <0.05)。各组C形根管的非峡区牙本质小管渗透深度均明显高于峡区(均P <0.05);在根管非峡区,各动能冲洗组的渗透效果明显优于CNI组(P <0.05);在根管峡区,EDDY组和PIPS组的渗透深度明显高于CNI组(P <0.05),而PUI组的渗透深度与CNI组的差异无统计学意义(P> 0.05)。结论 动能冲洗较传统方法更能取得良好的渗透效果,可显著增强冲洗液在牙本质小管中的渗透能力,改善C形根管清理效果,提高治疗成功率。各冲洗方法渗透能力由高到低排列依次为激光、声波、超声、传统冲洗器。随着根管根向走行,各冲洗方法渗透效果均有所降低,但动能冲洗系统较传统冲洗方法仍能保持优异的渗透能力。在管间峡区,各动能方法冲洗效果均显著降低,超声冲洗的渗透能力大为减弱,而声波和激光冲洗方法仍具有一定的渗透能力。

Objective To evaluate the permeability of syringe irrigation,ultrasonic irrigation,sonic irrigation and laser irrigation in dentin tubules of C-shaped root cannals of isolated tooth,so as to provide a certain reference basis for clinical treatment. Methods Totally 32 mandibular first premolars and mandibular second molars with C-shaped root canals,which were extracted due to orthodontic treatment or periodontal inflammation in the oral surgery outpatient department of the Stomatological Hospital of China Medical University from December 2019 to March 2021,were selected as the study models,and were randomly divided into 4 groups,8 in each group. Syringe(CNI group),ultrasonic(PUI group),sonic(EDDY group)and laser(PIPS group)were used for root canal irrigation(1 mL 1% NaClO was used as irrigation solution),and 1% methylene blue solution was used as the final irrigant. Teeth were sectioned to 300 μm in thickness by hard tissue slicer,and were observed and imaged under the microscope;dye penetration depths were measured by Image J software. Results The penetration depth in dentin tubules of PUI group,EDDY group and PIPS group with activated irrigation were significantly bigger than that of CNI group with traditional irrigation,and the difference between the groups was statistically significant(P < 0.05). The activated irrigation effect from the middle to the apical area of root canal was decreased,especially in EDDY group and PIPS group,the difference between the middle and apical area was statistically significant(P < 0.05). The penetration depth of non-isthmus was significantly bigger than that of isthmus in C-shaped root canals of each group(P < 0.05). In the non-isthmus of root canal,the penetration effect of each activated irrigation group was significantly better than that of CNI group(P < 0.05). In the isthmus of root canal,the penetration depth of EDDY group and PIPS group were significantly bigger than that of CNI group(P < 0.05),but there was no significant difference in the penetration depth between PUI group and CNI group(P >0.05). Conclusion Activated irrigation has better penetration effect than traditional method,which can significantly enhance the permeability of irrigant in dentinal tubules,improve the cleaning effect of C-shaped root canal and improve the success rate of treatment. From high to low,the penetration ability of each irrigation method is laser,sonic,ultrasonic and syringe. From the middle to apical area of canal,the penetration effect of each irrigation method is declined,but the activated irrigation method can still maintain excellent penetration ability compared with traditional irrigation method. In isthmus,the irrigation effect of each activated irrigation method is significantly declined,and the ultrasonic permeability is greatly weakened,while the two activated irrigation methods of sonic and laser can still maintain a certain permeability.