铒激光对不同长度与弯曲度根管玷污层的清理效果研究

doi:10.13591/j.cnki.kqyx.2023.05.007

摘要/Abstract

摘要：

目的比较3种功率Er:YAG激光对不同长度、弯曲度根管的玷污层清理效果及根管内壁的损伤情况。方法将144颗恒磨牙上的某一单根管牙根,按根长不同分为短根组和长根组,每组按根管弯曲度不同分为轻弯组、中弯组和重弯组3个亚组,每亚组依据根管清理方法不同分为超声对照组及0.3 W、0.6 W、0.9 W PIPS组4组(n=6)进行根管清理。完成后将牙根一劈为二,随机选取一份于扫描电镜下( ×1 000)观察玷污层,按评分标准进行玷污层评估。结果实验组(Er:YAG激光)玷污层清理效果明显优于对照组(超声)(P<0.05)。实验组中,①短根冠方,0.3 W时可见各组绝大多数牙本质小管开放;0.6 W时中、重度弯组清理效果明显增强(P<0.05);在0.9 W时各组清理效果不变,而重弯组出现微裂纹;短根根方,随能量增加清理效果增强,但明显弱于冠方(P<0.05)。②长根冠方,0.3 W时仍可实现轻、中弯组绝大多数牙本质小管开放,但根方较差,当达到0.9 W时可见轻、中弯组牙本质小管清理效果明显增强(P<0.05),但重弯组无明显改善同时于冠方再次出现微裂纹。结论 0.3 W可使短根轻度弯曲根管获得良好清理效果;中度弯曲根管则需达到0.9 W;长根在0.9 W时可达到较好的轻、中度弯曲根管清理效果;而对于重度弯曲根管不论长短,即使功率增加到0.9 W仍不能达到良好清理效果。

关键词: Er:YAG激光, 玷污层, 根管冲洗, 弯曲根管

Abstract:

Objective To compare the cleaning effect of three kinds of Er:YAG laser power parameters on smear layer and damage on root canals with different length and curvature. Methods One root of 144 extracted permanent teeth with single root canal were divided into short group and long group according to different root length, and each group was divided into 3 subgroups according to different root canal curvature: straight, moderate and severe. Each subgroup was divided into 4 groups according to different root canal cleaning methods: ultrasonic group, 0.3 W PIPS group, 0.6 W PIPS group, 0.9 W PIPS group (n=6). After the final irrigation, the root were split longitudinally into two parts and observed under a scanning electron microscope ( ×1 000). The laser's cleaning ability was evaluated according to the smear layer score and damage. Results The cleaning effect of the experimental groups (Er: YAG laser) was significantly better than that of the control group (ultrasonic) (P<0.05). ①At the coronal section of short root, while the power was set at 0.3 W, most of the dental tubules were opened; at 0.6 W, moderate and severe curvature groups' cleaning efficiency were significant improved; at 0.9 W, the cleaning efficiency had no difference with 0.6 W. However, micro-cracks were found on the dentin wall. At the apical section, the cleaning efficiency were improved by the increase of laser power, but it was worse than the coronal section (P<0.05). ②For the long root, most of the straight and moderate groups' dentin tubules at coronal section were opened at 0.3 W while the cleaning efficiency at the apical section was worse than that at coronal section. At 0.9 W, the cleaning efficiency of straight and moderate groups were improved (P<0.05), but the coronal micro-cracks appeared again without significant improvement of smear layer removal ability in the severe curvature group. Conclusion 0.3 W can be an appropriate power for short straight root while for the short moderate root, the power needs to reach 0.9 W. 0.9 W is fit for long straight and moderate root, but neither short nor long severe curvature root can achieve a good cleaning effect at 0.9 W.

Key words: Er:YAG laser, smear layer, root canal irrigation, curved canal

中图分类号:

R319.9

曲超杰,郭威. 铒激光对不同长度与弯曲度根管玷污层的清理效果研究[J]. 口腔医学, 2023, 43(5): 427-433.

QU Chaojie,GUO Wei. The effect of smear layer removal after cleaning root canals in different length and curvature with Er: YAG laser irrigation[J]. Stomatology, 2023, 43(5): 427-433.

图/表 11

图1

表1

图2

图3

图4

图5

图6

表2

图7

图8

表3

参考文献 25

[1]	周学东. 牙体牙髓病学[M]. 5版. 北京: 人民卫生出版社, 2020: 116-197.
[2]	Teja KV, Janani K, Alqahtani AA, et al. Herbal agents versus ethylene diamine Tetra acetic acid on removal of the smear layer-A systematic review of in vitro studies[J]. Int J Environ Res Public Health, 2022, 19(11):6870. doi: 10.3390/ijerph19116870
[3]	Căpută PE, Retsas A, Kuijk L, et al. Ultrasonic irrigant activation during root canal treatment: A systematic review[J]. J Endod, 2019, 45(1):31-44.e13. doi: S0099-2399(18)30625-3 pmid: 30558797
[4]	Lukač N, Jezeršek M. Amplification of pressure waves in laser-assisted endodontics with synchronized delivery of Er: YAG laser pulses[J]. Lasers Med Sci, 2018, 33(4):823-833. doi: 10.1007/s10103-017-2435-z
[5]	DiVito E, Peters OA, Olivi G. Effectiveness of the erbium: YAG laser and new design radial and stripped tips in removing the smear layer after root canal instrumentation[J]. Lasers Med Sci, 2012, 27(2):273-280. doi: 10.1007/s10103-010-0858-x
[6]	Akcay M, Arslan H, Mese M, et al. Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: A confocal microscopic study[J]. Clin Oral Investig, 2017, 21(7):2205-2212. doi: 10.1007/s00784-016-2013-y
[7]	Meire MA, Havelaerts S, de Moor RJ. Influence of lasing parameters on the cleaning efficacy of laser-activated irrigation with pulsed erbium lasers[J]. Lasers Med Sci, 2016, 31(4):653-658. doi: 10.1007/s10103-016-1892-0
[8]	王惠芸. 我国人牙的测量和统计[J]. 中华口腔科杂志, 1959, 7(3):149-155.
[9]	Ahmed HMA, Ibrahim N, Mohamad NS, et al. Application of a new system for classifying root and canal anatomy in studies involving micro-computed tomography and cone beam computed tomography: Explanation and elaboration[J]. Int Endod J, 2021, 54(7):1056-1082. doi: 10.1111/iej.v54.7
[10]	Sousa-Neto MD, Silva-Sousa YC, Mazzi-Chaves JF, et al. Root canal preparation using micro-computed tomography analysis: A literature review[J]. Braz Oral Res, 2018, 32(suppl 1):e66.
[11]	Haupt F, Meinel M, Gunawardana A, et al. Effectiveness of different activated irrigation techniques on debris and smear layer removal from curved root canals: A SEM evaluation[J]. Aust Endod J, 2020, 46(1):40-46. doi: 10.1111/aej.12342 pmid: 30907051
[12]	Schneider SW. A comparison of canal preparations in straight and curved root canals[J]. Oral Surg Oral Med Oral Pathol, 1971, 32(2):271-275. doi: 10.1016/0030-4220(71)90230-1
[13]	Peters OA, Barbakow F. Effects of irrigation on debris and smear layer on canal walls prepared by two rotary techniques: A scanning electron microscopic study[J]. J Endod, 2000, 26(1):6-10. doi: 10.1097/00004770-200001000-00002
[14]	Alamoudi RA. The smear layer in endodontic: To keep or remove-an updated overview[J]. Saudi Endod J, 2019, 9: 71-81.
[15]	Shi L, Wan J, Yang YF, et al. Evolution of the combined effect of different irrigation solutions and activation techniques on the removal of smear layer and dentin microhardness in oval-shaped root canal—An in-vitro study[J]. Biomol Biomed, 2023, 23(1):126-136. doi: 10.17305/bjbms.2022.7440 pmid: 35880401
[16]	Vianna ME, Gomes BPFA, Berber VB, et al. In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004, 97(1):79-84. doi: 10.1016/S1079-2104(03)00360-3
[17]	谭青松, 彭彬, 边专, 等. 不同浓度次氯酸钠根管超声冲洗的实验研究[J]. 口腔医学研究, 2007, 23(4):388-390.
[18]	Kurzmann C, Meire MA, Lettner S, et al. The efficacy of ultrasonic and PIPS (photon-induced acoustic streaming) irrigation to remove artificially placed dentine debris plugs out of an artificial and natural root model[J]. Lasers Med Sci, 2020, 35(3):719-728. doi: 10.1007/s10103-019-02912-3
[19]	何新宇, 彭丽莉, 王众, 等. 光子引导的光声流效应在根管治疗术中的研究进展[J]. 牙体牙髓牙周病学杂志, 2018, 28(11):673-676, 679.
[20]	Luca R, Todea C, Balabuc C, et al. Alternative techniques in root canal debridement[C]// SPIE Proceedings", "Fifth International Conference on Lasers in Medicine: Biotechnologies Integrated in Daily Medicine. Timisoara, Romania. SPIE, 2014: 89250 F1-89250F7.
[21]	Hoteit M, Nammour S, Zeinoun T. Evaluation ofenamel topography after debonding orthodontic ceramic brackets by different Er, Cr: YSGG and Er: YAG lasers settings[J]. Dent J (Basel), 2020, 8(1):6.
[22]	林欣欣. 采用铒激光荡洗技术清理根管玷污层的体外研究[D]. 北京: 北京协和医学院, 2019.
[23]	苏征, 白雨豪, 侯晓玫. 不同技术对弯曲根管根尖气锁去除效果的锥形束CT研究[J]. 北京大学学报(医学版), 2017, 49(1):76-80.
[24]	何蓉, 刘学军, 周宇琨. 光子引导的光声流效应在根管荡洗中应用的系统评价[J]. 国际口腔医学杂志, 2021, 48(6):644-655.
[25]	苏征, 侯本祥, 方厂云, 等. S形根管经往复运动单支锉系统预备后的形态对冲洗效果的影响[J]. 中南大学学报(医学版), 2014, 39(11):1181-1185.

分组	冲洗方法	参数
对照组	超声	6档
0.3 W组	Er: YAG激光	20 mJ,15 Hz,0.3 W
0.6 W组	Er: YAG激光	40 mJ,15 Hz,0.6 W
0.9 W组	Er: YAG激光	60 mJ,15 Hz,0.9 W

组别	轻度弯曲		中度弯曲		重度弯曲
组别	冠	根	冠	根	冠	根
超声组	3.00±0.63^*	4.00±0.00^*	4.00±0.63^*	4.83±0.41^*	5.00±0.00^*	5.00±0.00^*
0.3 W Er:YAG	1.33±0.52^AB	2.33±0.52^AB	2.17±0.41^①	3.17±0.41^B②	2.17±0.41^①	4.00±0.00^①②
0.6 W Er:YAG	1.17±0.41	2.67±0.52^②	1.33±0.52	2.83±0.41^②	1.33±0.52	3.00±0.00^②
0.9 W Er:YAG	1.00±0.00	2.00±0.00	1.67±0.52	2.17±0.41	1.67±0.52	2.33±0.52

组别	轻度弯曲		中度弯曲		重度弯曲
组别	冠	根	冠	根	冠	根
超声组	4.00±0.63^*	4.83±0.41^*	4.83±0.41^*	5.00±0.00^*	5.00±0.00^*	5.00±0.00
0.3 W Er:YAG	1.67±0.51^A	3.83±0.41^B①②	1.33±0.52^A	3.33±0.52^A②	3.00±0.00^①②	5.00±0.00
0.6 W Er:YAG	1.67±0.52	3.00±0.00^A②	1.67±0.52	2.83±0.41^A	2.33±1.03^②	4.67±0.52
0.9 W Er:YAG	1.00±0.00	2.33±0.52^A	1.17±0.41	2.33±0.52^A	1.33±0.52	4.50±0.55