一次性根管治疗与多次法根管治疗在牙体牙髓病患者中的疗效观察

Single-visit versus multiple-visit root canal treatments for patients with dental pulp disease

目的分析一次性根管治疗与多次法根管治疗在牙体牙髓病中的疗效。方法选取2020年3月至2023年3月在聊城市第三人民医院接受治疗的80例牙体牙髓病患者进行随机对照试验,按照随机数字表法分为观察组和对照组,各40例。对照组男21例、女19例,年龄(40.37±8.30)岁,病程(8.60±3.15)个月,接受多次法根管治疗;观察组男20例、女20例,年龄(40.22±8.45)岁,病程(8.55±3.20)个月,接受一次性根管治疗。对比两组患者治疗后临床疗效、疼痛程度[运用视觉模拟评分量表(VAS)评估]、使用镇痛药次数、治疗前及治疗后2周炎症因子[白细胞介素-6(IL-6)、白细胞介素-2(IL-2)、高敏C-反应蛋(hs-CRP)、血清骨保护素、可溶性核因子κB受体激活因子配体(RANKL)]、牙齿咀嚼功能(牙齿咬合力、出血指数、牙龈指数)、并发症发生情况。统计学方法采用t检验、χ^(2)检验。结果观察组治疗后总有效率为92.50%(37/40),高于对照组的72.50%(29/40),差异有统计学意义(χ^(2)=5.541,P=0.019)。观察组治疗后VAS评分、镇痛药使用率均低于对照组[(2.64±0.58)分比(3.24±0.67)分、0比10.00%(4/40)],差异均有统计学意义(t=4.282,χ^(2)=4.211;均P<0.05)。治疗前,两组患者IL-6、IL-2、hs-CRP、血清骨保护素、RANKL比较,差异均无统计学意义(均P>0.05);治疗后2周,观察组IL-6、IL-2、hs-CRP、RANKL均低于对照组[(1.16±0.34)ng/L比(1.34±0.35)ng/L、(0.29±0.04)ng/L比(0.33±0.06)ng/L、(1.14±0.11)mg/L比(1.65±0.22)mg/L、(0.35±0.06)ng/L比(0.39±0.08)ng/L],血清骨保护素高于对照组[(0.43±0.08)µg/L比(0.36±0.07)µg/L],差异均有统计学意义(t=2.233、3.508、13.114、2.530、4.165,均P<0.05)。治疗前,两组患者牙齿咬合力、出血指数、牙龈指数比较,差异均无统计学意义(均P>0.05);治疗后2周,观察组出血指数、牙龈指数均低于对照组[(0.48±0.10)分比(0.90±0.19)分、(0.47±0.09)分比(0.76±0.15)分],牙齿咬合力高于对照组[(140.18±11.85)lbs比(116.75±9.97)lbs],差异均有统计学意义(t=12.372、10.485、9.569,均P<0.05)。观察组治疗后并发症发生率为5.00%(2/40),低于对照组的22.50%(9/40),差异有统计学意义(χ^(2)=5.165,P=0.023)。结论一次性根管治疗相较于多次法根管治疗效果较好,能有效减少牙体牙髓病患者疼痛,降低炎症水平及并发症发生率。

Objective To analyze the effects of single-visit and multiple-visit root canal treatments for patients with dental pulp disease.Methods Eighty patients with dental pulp disease treated in Liaocheng Third People's Hospital from March 2020 to March 2023 were selected for the randomized controlled trial.They were divided into an observation group and a control group by the random number table method,with 40 cases in each group.There were 21 males and 19 females in the control group;they were(40.37±8.30)years old;their disease course was(8.60±3.15)months.There were 20 males and 20 females in the observation group;they were(40.22±8.45)years old;their disease course was(8.55±3.20)months.The control group received multiple-visit root canal treatment,while the observation group single-visit root canal treatment.The Visual Analogue Scale(VAS)was used to assess the patients'pain level after the treatment.The analgesics-used rates,levels of inflammatory factors[interleukin-6(IL-6),interleukin-2(IL-2),high-sensitivity C-reactive protein(hs-CRP),serum osteoprotegerin,and receptor activator of nuclear factor-κB ligand(RANKL)]before and after the treatment,dental chewing function(dental occlusal force,bleeding index,and gingival index)and incidences of complications were compared between the two groups.t and χ^(2) tests were applied.Results After the intervention,the score of VAS and analgesics-used rate in the observation group were lower than those in the control group[(2.64±0.58)vs.(3.24±0.67)and 0 vs.10.00%(4/40)],with statistical differences(t=4.282;χ^(2)=4.211;both P<0.05).Before the treatment,there were no statistical differences in the levels of IL-6,IL-2,hs-CRP,osteoprotegerin,and RANKL between the two groups(all P>0.05).After the treatment,the levels of IL-6,IL-2,hs-CRP,and RANKL in the observation group were lower than those in the control group[(1.16±0.34)ng/L vs.(1.34±0.35)ng/L,(0.29±0.04)ng/L vs.(0.33±0.06)ng/L,(1.14±0.11)mg/L vs.(1.65±0.22)mg/L,and(0.35±0.06)ng/L vs.(0.39±0.08)ng/L];the level of osteoprotegerin in the observation group were higher than that in the control group[(0.43±0.08)μg/L vs.(0.36±0.07)μg/L];there were statistical differences(t=2.233,3.508,13.114,2.530,and 4.165;all P<0.05).Before the treatment,there were no statistical differences in the dental occlusal force,bleeding index,and gingival index between the two groups(all P>0.05).After the treatment,the bleeding index and gingival index in the observation group were lower than those in the control group[(0.48±0.10)vs.(0.90±0.19)and(0.47±0.09)vs.(0.76±0.15)];the dental occlusal force in the observation group was higher than that in the control group[(140.18±11.85)lbs vs.(116.75±9.97)lbs];there were statistical differences(t=12.372,10.485,9.569;all P<0.05).After the intervention,the total incidence of complications in the observation group was lower than that in the control group[5.00%(2/40)vs.22.50%(9/40)],with statistical difference(χ^(2)=5.165,P=0.023).Conclusion Single-visit root canal treatment is more effective in reducing pain and decreasing inflammation levels in patients with dental pulp disease than multiple-visit treatment.