一次性与两次性根管治疗术治疗根尖周炎患牙的疗效比较：一项组织细菌学研究。
One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study.
机构信息
Department of Endodontics, University of Tlaxcala, Tlaxcala, Mexico.
出版信息
J Endod. 2012 Aug;38(8):1040-52. doi: 10.1016/j.joen.2012.04.010. Epub 2012 Jun 12.
INTRODUCTION
This study analyzed the in vivo microbiological status of the root canal systems of mesial roots of mandibular molars with primary apical periodontitis after 1- or 2-visit endodontic treatment.
METHODS
Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instruments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis.
RESULTS
In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed similarly. When filling material was observed in ramifications, it was usually intermixed with necrotic tissue, debris, and bacteria.
CONCLUSIONS
The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1-visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent is necessary to maximize bacterial reduction before filling.
简介
本研究分析了初次就诊和两次就诊根管治疗后下颌第一磨牙近中颊根（MB）内的微生物学状态。
方法
使用 K3 和 LightSpeed 器械（MB 根管）或 ProTaper 系统（ML 根管）组合对近中颊根进行根管预备，并用 5%次氯酸钠冲洗。使用通根锉。去除玷污层，用 5ml 2%洗必泰进行终末冲洗。在 2 次就诊组（7 根，14 个根管）中，根管用氢氧化钙治疗 1 周，然后用连续波压实技术进行根管充填。在 1 次就诊组（6 根，12 个根管）中，根管在化学机械预备后立即进行根管充填。根管预备 1 周后拔牙，进行组织学和细菌学分析。
结果
在 1 次就诊组中，没有完全无菌的病例；主根管（5/6 例）、峡部（5/6 例）、根尖支（4/6 例）和牙本质小管（5/6 例）均有残留细菌。在 2 次就诊组中，有 2 个病例无细菌；仅在 2 个病例中主根管（2/7 例）有残留细菌，在峡部（4/7 例）和根尖支（2/7 例）有残留细菌。两种器械预备技术效果相似。当在根尖支中观察到填充材料时，通常与坏死组织、碎片和细菌混合。
结论
与 1 次就诊方案相比，用氢氧化钙进行 2 次就诊间隔期药物治疗可改善根管系统的微生物状态。如果不使用 2 次就诊间隔期药物治疗，根尖支、峡部和牙本质小管中的残留细菌更频繁且更多。根尖支和峡部从未完全填满。在填充前，使用抗菌 2 次就诊间隔期药物是最大限度减少细菌的必要措施。
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