Er:YAG激光PIPS/SWEEPS去除复杂根管内氢氧化钙的效果研究

Efficacy of Er:YAG Laser PIPS/SWEEPS in Removal of Calcium Hydroxide Paste from Anatomically Complex Root Canals

目的:评价两种Er:YAG激光活化冲洗技术光子引导光声流(photon-initiated photoacoustic streaming,PIPS)和光波增强光声流(shock wave enhanced emission photoacoustic streaming,SWEEPS)去除复杂根管内氢氧化钙的效果。方法:选取75颗人新鲜拔除单根管前磨牙,WaveOne Gold Primary根备后纵向劈开,在2个半片牙根尖段分别制备凹沟和半球,根管注满氢氧化钙。样本随机分为5组,分别应用PIPS、SWEEPS、EDDY、被动超声冲洗(passive ultrasonic irrigation,PUI)和传统注射器冲洗(conventional needle irrigation,CNI)去除根管内氢氧化钙。冲洗前后显微镜下拍照,计算残余氢氧化钙面积百分比,不规则区(凹沟与半球)采用计分法评价去除效果。结果:氢氧化钙整体去除率由高到低依次为:SWEEPS、PIPS、EDDY/PUI、CNI,EDDY与PUI无明显差异(P>0.05);不规则区:SWEEPS最佳,PIPS/EDDY次之,PUI/CNI最差,PIPS与EDDY、PUI与CNI无明显差异(P>0.05)。结论:两种Er:YAG激光活化冲洗技术均可高效去除复杂根管内氢氧化钙,SWEEPS效果最佳。

Objective:To evaluate the efficacy of two Er:YAG laser-activated irrigation techniques,i.e.photon-initiated photoacoustic streaming(PIPS)and shock wave enhanced emission photoacoustic streaming(SWEEPS),in removing calcium hydroxide from anatomically complex root canal systems.Methods:Seventy-five human freshly extracted single-canal premolars were selected and the root canals were instrumented with WaveOne Gold Primary.Each tooth was split longitudinally into 2 halves,with a groove made in the apical segment of one half and a semicircular cavity on the other half.The root canals were then filled with calcium hydroxide paste.The teeth were randomly assigned to 5 groups to remove calcium hydroxide from root canals using PIPS,SWEEPS,EDDY,passive ultrasonic irrigation(PUI),and conventional needle irrigation(CNI),respectively.Before and after irrigation,photographs were taken under microscope to calculate the percentages of residual calcium hydroxide,and the amount of remaining medicament in the irregular areas(grooves and semicircular cavities)were evaluated using a scoring system.Results:The ranking of the effectiveness of calcium hydroxide removal from the most to the least was:SWEEPS,PIPS,EDDY/PUI,and CNI,with no statistical difference between PUI and EDDY(P>0.05).SWEEPS showed the best removal efficacy in irregular areas,PIPS and EDDY less,and PUI and CNI the least,with no significant difference between PIPS and EDDY,and between PUI and CNI(P>0.05).Conclusion:Both Er:YAG laser-activated irrigation techniques were effective in removing calcium hydroxide from anatomically complex root canal systems.The best efficacy is obtained by SWEEPS.