不同冲洗方法对粪肠球菌感染根管的抗菌性研究

doi:10.3877/cma.j.issn.1674-1366.2019.04.003

目的

比较超声、Er，Cr：YSGG激光及Er：YAG激光辅助1%次氯酸钠（NaOCl）溶液冲洗对人离体牙根管表面粪肠球菌生物膜及根尖区不同深度牙本质小管内粪肠球菌的杀灭效果。

方法

单直根管下颌前磨牙42颗，建立粪肠球菌生物膜感染的根管模型，采用随机字表法随机抽取2颗确定建成粪肠球菌生物膜感染根管模型，剩余40颗牙采用随机数字表法按随机对照原则分为5组，每组8颗。A组：5.25% NaOCl联合17%乙二胺四乙酸（EDTA）注射器冲洗；B组：0.9%氯化钠溶液注射器冲洗；C组：1% NaOCl溶液超声荡洗；D组：1% NaOCl溶液Er：YAG激光活化冲洗；E组：1% NaOCl溶液Er，Cr：YSGG激光活化冲洗。按分组进行处理后取样菌落计数，计算灭菌率。使用SPSS 17.0统计软件对实验数据进行方差齐性及正态性检验比较各组间和组内的灭菌率。

结果

（1）组间比较：对根管壁表面，各组冲洗方法灭菌率比较，B组（5.74%）<C组（69.70%）<D组（90.14%）<E组（99.25%），均小于A组（阳性对照组99.95%），各组间比较差异均具有统计学意义（P<0.05）；（2）组内比较：对根尖4 mm不同深度牙本质相对灭菌率比较，A组和C组不同深度抗菌率比较差异均具有统计学意义（P<0.05）。

结论

超声荡洗、Er：YAG激光、Er，Cr：YSGG激光均可增强根管消毒效果，而两种激光根管消毒效果差异无统计学意义，均优于1% NaOCl溶液超声荡洗。

关键词: 根管冲洗剂, 激光疗法, 超声疗法, 激光活化冲洗, 超声荡洗

Objective

To compare the ultrasonic, Er, Cr: YSGG laser and Er: YAG laser-assisted 1% sodium hypochlorite (NaOCl) solution on the bactericidal effect of Enterococcus faecalis (E.faecalis) biofilm on the root canal surface and E.faecalis in different depth from dentinal tubules in the apical region.

Methods

Forty-two single mandibular premolars were used to establish a root canal model of E.faecalis biofilm infection. Two teeth were determined by digital randomization method to establish the model of infection of E.faecalis. The remaining 40 teeth were divided into 5 groups according to the principle of random comparison by digital random method as well as 8 in each group. The groups were: Positive Control: group A: 5.25% NaOCl + 17% EDTA springed, Negative Control: group B: physiologic saline springed, group C: ultrasound + 1% NaOCl, group D: Er: YAG laser + 1% NaOCl, group E: Er, Cr: YSGG + 1% NaOCl. The data from each group were compared using the SPSS 17.0 statistical software for the homogeneity of the experimental data and the normality test to compare the relative sterilization rates between groups and groups.

Results

(1) Comparison between groups: The sterilization rate of each group was compared. Group B (5.74%) <C group (69.70%) <D group (90.14%) <E group (99.25%) , All of which were lower than group A (99.95% of the positive control group) , and the differences between the groups were statistically significant (P<0.05) . (2) Comparison within the group: Compared with the relative sterilization rate of dentin at different depths of 4 mm, the difference of antibacterial rate in different depths of group A and group C was statistically significant (P<0.05) .

Conclusions

Ultrasound, Er: YAG laser, Er, Cr: YSGG laser can enhance the root canal disinfection effect, and the difference between the two laser root canal disinfection effects is not statistically significant, both of which are better than 1% NaOCl ultrasonic washing.

Key words: Root canal irrigants, Laser therapy, Ultrasonic therapy, Laser-activated irrigation, Passive ultrasonic irrigation

图1 根管预备模式图

图2 粪肠球菌形态镜下观（革兰氏染色　× 400）

图3 粪肠球菌感染根管模型扫描电镜下观　A：根管表面的细菌；B：牙本质小管内的细菌；C：放大50 000倍的根管表面细菌，可见大小700 ~ 800 nm的圆形细菌，单个或数个短链状分布

图4 不同冲洗方法根管壁表面粪肠球菌灭菌率　注：各组间比较差异均具有统计学意义（P<0.001）

表1 各组间根尖4 mm区不同深度牙本质样本中细菌残留量比较（lgCFU/ml，±s）

组别	样本量	0 ~ 100 μm	100 ~ 200 μm	200 ~ 300 μm
A组	8	4.545 ± 0.197^a	4.737 ± 0.284^a	2.061 ± 0.160^a
B组	8	7.844 ± 0.351^b	5.702 ± 0.567^b	3.039 ± 0.245^b
C组	8	7.315 ± 0.316^c	5.513 ± 0.488^c	2.961 ± 0.232^b
D组	8	6.823 ± 0.465^d	4.741 ± 0.449^a	2.031 ± 0.313^a
E组	8	5.716 ± 0.239^e	3.663 ± 0.308^d	1.785 ± 0.416^c

表1 各组间根尖4 mm区不同深度牙本质样本中细菌残留量比较（lgCFU/ml，±s）

组别	样本量	0 ~ 100 μm	100 ~ 200 μm	200 ~ 300 μm
A组	8	4.545 ± 0.197^a	4.737 ± 0.284^a	2.061 ± 0.160^a
B组	8	7.844 ± 0.351^b	5.702 ± 0.567^b	3.039 ± 0.245^b
C组	8	7.315 ± 0.316^c	5.513 ± 0.488^c	2.961 ± 0.232^b
D组	8	6.823 ± 0.465^d	4.741 ± 0.449^a	2.031 ± 0.313^a
E组	8	5.716 ± 0.239^e	3.663 ± 0.308^d	1.785 ± 0.416^c

表2 各组根尖4 mm不同深度牙本质样本相对灭菌率比较（%，±s）

组别	样本量	0 ~ 100 μm	100 ~ 200 μm	200 ~ 300 μm
A组	8	99.95 ± 4.73^a	91.39 ± 4.91^b	86.39 ± 4.04^c
C组	8	68.91 ± 5.65^a	59.15 ± 3.75^b	2.75 ± 3.41^c
D组	8	89.95 ± 3.47^a	90.15 ± 3.82^a	86.65 ± 5.52^b
E组	8	99.21 ± 5.92^a	99.22 ± 5.64^a	95.56 ± 2.89^b

表2 各组根尖4 mm不同深度牙本质样本相对灭菌率比较（%，±s）

组别	样本量	0 ~ 100 μm	100 ~ 200 μm	200 ~ 300 μm
A组	8	99.95 ± 4.73^a	91.39 ± 4.91^b	86.39 ± 4.04^c
C组	8	68.91 ± 5.65^a	59.15 ± 3.75^b	2.75 ± 3.41^c
D组	8	89.95 ± 3.47^a	90.15 ± 3.82^a	86.65 ± 5.52^b
E组	8	99.21 ± 5.92^a	99.22 ± 5.64^a	95.56 ± 2.89^b

图5 各组内在根尖4 mm不同深度牙本质相对灭菌率变化趋势

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Antibacterial efficacy of different irrigation methods on Enterococcus faecalis infected root canals in vitro

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Antibacterial efficacy of different irrigation methods on Enterococcus faecalis infected root canals in vitro