Er:YAG激光联合次氯酸钠对粪肠球菌杀菌效果及一次性根管治疗的研究

发布时间：2018-04-26 12:42

本文选题：Er:YAG激光 + 次氯酸钠　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:比较掺铒钇铝-石榴石脉冲(Er:YAG)激光联合不同浓度次氯酸钠对根管内粪肠球菌的杀菌效果以及一次性根管治疗的效果,为临床治疗方式的选择提供参考。方法:体外实验选择新鲜拔除的人单根管离体前磨牙75个,开髓并用镍钛机用器械冠向下法预备根管后,灭菌处理。粪肠球菌菌种复苏以后平板划线法接种在牛心脑浸液(BHI)的琼脂培养皿中,24H后用BHI液体增菌培养基制成粪肠球菌悬液并用比浊仪调整其浓度为1.5×108CFU/m L,然后将所有牙根置于盛有100ml上述菌液的瓶中,37℃需氧条件下静置培养4w,每4d换1次重新配制的菌液,建立粪肠球菌的感染根管模型。随机分为5组,每组15个,分别进行如下处理:A组:5.25%次氯酸钠单独冲洗;B组:Er:YAG激光+5.25%次氯酸钠冲洗;C组:1%次氯酸钠单独冲洗;D组:Er:YAG激光+1%次氯酸钠冲洗。E组:空白对照。处理完成后用无菌吸潮纸尖沾取0.9%生理盐水伸入根管内采集5组根管内的细菌,将每根采集细菌后的纸尖放入盛有5ml无菌蒸馏水的离心管中振荡5秒,混匀后在BHI培养基上进行接种,培养24H后计数。使用SPSS19.0统计软件对结果进行卡方检验(Chi-square test),取P0.05具有统计学差异。体内实验选择急性牙髓炎及外伤露髓的上下颌前牙及前磨牙病例共113例,随机分为Er:YAG激光联合1%次氯酸钠激光荡洗组(A组)56例及1%次氯酸钠注射器冲洗组(B组)57例。局麻下开髓,拔髓。10号C锉结合X线片确定工作长度后用pathfile+TF锉预备根管至25#,08锥度。根管预备完成后A组上橡皮障并将Er:YAG激光的参数设定为功率0.3 W、脉宽50μs,脉冲能量20m J、频率15Hz。将激光工作尖置于根管口处,用1%浓度的次氯酸钠冲洗的同时照射60s,再用生理盐水冲洗并照射60s。B组上橡皮障,用1%次氯酸钠和生理盐水交替注射器冲洗各60s。然后摄主尖片并用侧压针行根管充填。最后再次拍摄X线片确认未发生欠填或超填,完成一次性根管治疗。术后3天、7天及1个月随访。整理数据后采用SPSS 19.0软件进行统计分析。计数资料采用卡方检验。以P0.05为差异显著。结果:体外实验中A、B、D三组的处理方式均能完全杀灭粪肠球菌;所有培养皿中均未见菌落。C组处理方式未能完全杀灭根管内的粪肠球菌,15个培养皿中有11个可见菌落。E组每个模型都可培养出大量粪肠球菌菌落。A、B、D三组间杀菌效果无差异且均显著优于C组(P0.05)。体内实验中A组56例中成功54例,成功率96.4%。出现咬合痛的1例已行降合治疗,仍在观察。根尖阴影的1例2个月后就诊外院失访。B组57例中成功51例,成功率89.4%。术后3天肿胀疼痛的3例经抗炎止痛治疗后症状随即消失,其余三例1个月后随访仍有不适。转诊外院后失访。A组治疗效果明显优于B组(P0.05)(表1)。结论:高浓度次氯酸钠可以完全杀灭根管内的粪肠球菌,低浓度次氯酸钠不能完全杀灭根管内的粪肠球菌;Er:YAG激光可以显著增强低浓度次氯酸钠的杀菌作用,联合低浓度次氯酸钠在一次性根管治疗中的效果比注射器冲洗更好,具有良好的临床应用前景。
[Abstract]:Objective: To compare the bactericidal effect of erbium aluminum oxide pulsed (Er:YAG) laser combined with different concentrations of sodium hypochlorite on Enterococcus faecalis in root canal and the effect of one-off root canal therapy in order to provide reference for the selection of clinical treatment methods. Methods: in vitro, 75 freshly extracted human premolars were extracted from single root canal, and the pulp was opened and nickel titanium was used. After the root canal was prepared with the instrument crown, it was sterilized. After the resuscitation of the Enterococcus faecalis, the plate line was inoculated in the agar culture dish of BHI. After 24H, the Enterococcus faecalis suspension was made with the BHI liquid increasing medium and the concentration was 1.5 * 108CFU /m L with turbidimetry, and all the roots were placed in the above 100ml bacteria. In the liquid bottle, 4W was incubated at 37 DEG C on aerobic condition, and the bacteria solution was reprepared 1 times per 4D to establish the infection root canal model of Enterococcus faecalis. It was randomly divided into 5 groups, each group was treated as follows: group A: 5.25% sodium hypochlorite flushing alone; B group: Er:YAG laser +5.25% sodium hypochlorite flushing; C group: 1% sodium hypochlorite flushing alone; D group: Er:YAG exciting Light +1% sodium hypochlorite flushed.E group: blank control. After finishing the treatment, 0.9% physiological saline was applied to the root canal to collect bacteria within the root canal, and the paper tips after each collection of bacteria were put into the centrifuge tube with 5ml aseptic distilled water for 5 seconds. After mixing, the inoculation was carried out on the BHI medium, and the count after 24H was used. SPSS19.0 statistical software was used to test the results with a chi square test (Chi-square test), and P0.05 had statistical differences. In the body, 113 cases of upper and lower mandibular anterior teeth and anterior molar were selected for acute pulpitis and trauma, and were randomly divided into 56 cases of Er:YAG laser combined with 1% sodium hypochlorite laser washing group (group A) and 1% sodium hypochlorite syringe irrigation group (group B). ) 57 cases under local anesthesia, open pulp under local anesthesia, pulpio.10 C file combined with X ray to determine the length of work and use pathfile+TF file to prepare root canal to 25#, 08 taper. After the root canal was prepared, the rubber barrier on A group was set to power 0.3 W, pulse width 50 mu, pulse energy 20m J, frequency 15Hz. to the root canal at the root canal and 1% concentration times. At the same time, 60s was irradiated with sodium chlorate, then the rubber barrier was flushed and irradiated in group 60s.B with saline, and the 60s. was flushed with 1% sodium hypochlorite and physiological saline, then the main slice was taken and the root canal was filled with the lateral pressure needle. After 1 months of follow-up, the data were analyzed with SPSS 19 software. The counting data were tested with chi square test. P0.05 was significant. Results: in vitro experiments, A, B, D three groups could completely kill the Enterococcus faecalis; no colony.C group did not completely kill the Enterococcus in the root canal, 15 In a Petri dish, there were 11 colonies in group.E, each of which could cultivate a large number of colonies of Enterococcus faecalis.A, B, and D three groups had no difference in germicidal efficacy and significantly better than group C (P0.05). In group A, 54 cases were successful in 56 cases in group A and 1 cases of occlusal pain in 96.4%. had been treated with descending treatment, and 1 cases of root apical shadow were still observed after 2 months. 51 cases were successful in 57 cases of.B group, and 3 cases of swelling and pain in 3 days after 89.4%. were disappearing after anti inflammatory and analgesic treatment. The rest three cases were still discomfort after 1 months of follow-up. The treatment effect of.A group after referral to external hospital was obviously superior to group B (P0.05) (Table 1). Conclusion: high concentration of sodium hypochlorite can completely kill the feces in the root canal. Enterococcus, low concentration of sodium hypochlorite can not completely kill the Enterococcus in the root canal; Er:YAG laser can significantly enhance the bactericidal effect of low concentration sodium hypochlorite. The effect of combined low concentration of sodium hypochlorite in the treatment of one-time root canal is better than that of the syringe, and it has a good application prospect.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

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