不同声能冲洗激活器辅助清理弯曲根管玷污层的扫描电镜研究

doi:10.13591/j.cnki.kqyx.2023.07.005

摘要/Abstract

摘要：

目的比较不同声能冲洗激活器对弯曲根管玷污层的辅助清理效果。方法收集人成熟恒磨牙66颗,均含Vertucci Ⅰ型根管的L形弯曲牙根。ProTaper Next预备后,L形根管平均弯曲的角度、半径和长度分别为39.9°±8.4°、(2.5±1.1)mm和(4.7±0.5)mm。随机分为对照组(n=6)和5个实验组(n=12)进行如下终末冲洗:无额外冲洗、手动激活冲洗(manual dynamic irrigation,MDI)、超声-K15/.02(ultrasonic,U-K)、超声-Irrisafe20/.00(ultrasonic,U-IRR)、声波EndoActivator25/.04(EA)、声波EDDY20/.04(ED)。截取含有根方6 mm根管的牙根部分并暴露其弯曲内外侧根管壁,扫描电镜(scanning electron microscopy,SEM)观察每侧上、中、下3个2 mm段的玷污层残留情况,采用5级评分法评估并行统计分析。结果实验组在根管弯曲段不同位置水平处的管壁洁净度均优于对照组(P<0.05)。在上段外侧壁,U-IRR和ED玷污层评分低于其他组,与MDI和EA有统计学差异(P<0.05);上段内侧壁,U-K评分最大,管壁清洁度不如U-IRR和声波组(P<0.05)。在中段2 mm即弯曲最明显处,ED优于U-K且在内侧壁优于EA(P<0.05)。在下段外侧壁,U-IRR和ED优于MDI(P<0.05);下段内侧壁,组间差异无统计学意义。MDI和声波组在上段内侧壁优于下段外侧壁,超声波组在下段内侧壁优于中下段外侧壁(P<0.05)。结论 EDDY和Irrisafe对根管弯曲段玷污层的辅助清理效果整体较优,根管下段外侧壁的清洁度有待提高。

关键词: 动能冲洗, 玷污层, 弯曲根管

Abstract:

Objective To evaluate the efficacy of different acoustic irrigation activators assisted with smear layer removal in curved root canals. Methods Sixty-six extracted human mature molars with L-shaped root canals in Vertucci type Ⅰ configuration system were chosen. The mean angles of curvature, radius and curve length after ProTaper Next instrumentation were 39.9°±8.4°, (2.5±1.1) mm and (4.7±0.5) mm respectively. They were randomly assigned to one control group(n=6) and five experimental groups(n=12) for final irrigation as follows: no additional irrigation, Manual dynamic irrigation (MDI), Ultrasonic activation with a K-type file size 15/.02 (U-K) and Irrisafe20/.00 (U-IRR), Sonic activation with EndoActivator25/.04 (EA) and EDDY20/.04 (ED). The apical 6 mm of root canals were cleaved in half as the curved outer and inner sidewalls, and observed with scanning electron microscopy (SEM) in three 2 mm segments each as coronal-middle-apical thirds. The smear layer was evaluated using a five-score scale and a statistical analysis was conducted. Results All tested groups had a cleaner canal wall than the control group at any level of the root canal curved portion (P<0.05). At the coronal-third of outer canal wall, both U-IRR and ED scored smaller than others, and had a significant difference with MDI and EA (P<0.05); at the inner wall, U-K scored the highest and was inferior to both U-IRR and the two sonic activators (P<0.05). At the middle-third part and also the most curved canal area, ED was superior to U-K at two sidewalls and to EA at the inner wall (P<0.05). At the apical-third of outer canal wall, U-IRR and ED were superior to MDI (P<0.05); at the inner wall, there was no statistical difference among them. The cleanliness at apical outer wall was unsatisfactory, which was inferior to coronal inner wall in MDI/EA/ED and to apical inner wall in U-K/U-IRR (P<0.05). Conclusion ED and U-IRR assisted with smear layer removal have better performance in curved root canal, and the cleanliness at apical outer canal wall needs to be enhanced.

Key words: irrigant activation, smear layer, canal curvature

中图分类号:

R781.05

王艳茹, 陆亚倩, 赵麒桐, 李谨. 不同声能冲洗激活器辅助清理弯曲根管玷污层的扫描电镜研究[J]. 口腔医学, 2023, 43(7): 608-613.

WANG Yanru, LU Yaqian, ZHAO Qitong, LI Jin. Efficacy of different acoustic irrigation activators assisted with smear layer removal in curved root canals: A SEM evaluation[J]. Stomatology, 2023, 43(7): 608-613.

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组别	弯曲角度α/(°)	弯曲半径r/mm	弯曲长度L/mm
MDI	39.5±9.1	2.6±0.9	4.7±0.5
U-K	39.8±8.9	2.3±1.2	4.5±0.4
U-IRR	39.6±8.9	2.3±1.2	4.8±0.4
EA	40.3±7.9	2.5±0.9	4.7±0.5
ED	40.4±8.3	2.8±1.2	4.8±0.7
合计	39.9±8.4	2.5±1.1	4.7±0.5

组别	上段2 mm		中段2 mm		下段2 mm
组别	外侧壁	内侧壁	外侧壁	内侧壁	外侧壁	内侧壁
MDI	4.0(3.1,4.4)^a	3.5(2.5,4.0)^ab*	4.0(3.5,4.4)^ab	2.8(2.0,4.0)^ab*	4.3(4.0,4.9)^a	2.8(1.6,4.9)
U-K	4.0(1.8,4.5)^abc	4.0(3.5,4.5)^a#	4.0(3.5,4.4)^a#	4.0(3.1,4.5)^a	4.0(3.1,4.4)^ab#	3.0(1.1,3.9)
U-IRR	3.0(2.1,3.9)^bc	3.0(2.5,3.5)^b	3.0(2.0,4.0)^ab#	2.5(1.5,4.4)^ab	3.8(2.8,4.0)^b#	2.0(1.5,3.0)
EA	4.0(3.5,4.0)^ab	2.8(2.1,3.9)^b	4.0(3.1,4.4)^ab&	3.8(3.0,4.0)^a	4.0(3.1,4.5)^ab&	3.5(2.0,4.5)
ED	2.0(1.5,3.3)^c*	3.0(2.1,3.2)^b*	3.0(2.1,3.5)^b*	2.5(2.0,3.0)^b*	4.0(3.1,4.0)^b	3.0(2.1,3.5)^*