常温流动牙胶封闭剂GuttaFlow2单尖充填弯曲根管的封闭效果

doi:10.19723/j.issn.1671-167X.2024.01.016

摘要/Abstract

摘要：

目的: 评估常温流动牙胶封闭剂单尖充填法对弯曲根管的封闭效果。方法: (1) 3D打印轻、中、重度弯曲根管模型各20例, 分别采用热垂直加压技术(warm vertical compaction, 以AH-Plus为封闭剂, 以下称WVC组, n = 10)和单尖充填技术(以GuttaFlow2为封闭剂, 以下称GF2组, n = 10)充填根管, 在距根尖2 mm(根尖部)、4 mm和6 mm(根中部), 以及距根尖8 mm(根冠部)处切片, 使用体视显微镜观察计算根管截面的空隙面积百分比。(2)选取离体恒磨牙轻、中、重度弯曲根管各16例, 同样分别采用热垂直加压技术(WVC组, n = 8)和GuttaFlow2单尖充填技术(GF2组, n = 8)充填根管, 使用激光共聚焦显微镜观察计算距根尖2 mm(根尖部)、5 mm(根中部)和8 mm(根冠部)处各个截面上封闭剂渗入牙本质小管区域的渗透百分比。结果: (1) 根管空隙面积百分比: GF2组和WVC组轻、中、重度弯曲根管根尖部均无明显空隙, 两组间差异无统计学意义(P＞0.05);根中部两种充填方法产生的空隙面积百分比差异也没有统计学意义; 但在根冠部GF2组相较于WVC组在轻度弯曲根管中出现了更多的空隙, 差异有统计学意义(P = 0.009)。(2)封闭剂对牙本质小管渗透百分比:GF2组在轻、中、重度弯曲根管根尖部, 封闭剂对牙本质小管渗透百分比分别为36.10%、55.80%、65.08%, 重度弯曲根管显著高于轻度弯曲根管(P = 0.001);组间比较提示, 根尖部GF2组轻、中、重度弯曲根管牙本质小管渗透百分比均明显高于WVC组(分别为15.78%、20.70%、15.61%, P = 0.001), 根中部GF2组轻、中度弯曲根管牙本质小管渗透百分比也明显高于WVC组(P = 0.001), 但根冠部两组间差异没有统计学意义(P＞0.05)。结论: 常温流动牙胶封闭剂单尖法充填弯曲根管在根尖和根中段对根管的封闭效果和热垂直加压技术相同, 而对牙本质小管则具有更好的渗透封闭效果, 尤其对于重度弯曲根管。

关键词: 根管充填材料, 弯曲根管, 单尖充填, 热垂直加压技术

Abstract:

Objective: To evaluate the sealing ability of GuttaFlow2 single cone obturation in curved root canals. Methods: (1) Slight, moderate and severe curved 3D printed root canals were made. After instrumentation, these samples were randomly divided into 2 groups (n = 10) according to different root canal filling techniques: GuttaFlow2 single cone group (GF2) and AH-Plus warm vertical compation group (WVC). All the samples were sectioned at 2 mm to apex (the apical of the root), 4 mm, 6 mm to apex (the middle of the root) and 8 mm to apex (the coronal of the root). The filling void areas were observed by stereomicroscope, and the percentages of void areas in each section were calculated by ImageJ 1.52a. (2) Forty-eight roots of extracted adult molars were selected. After instrumentation, they were randomly divided into 2 groups (n = 8): GF2 group and WVC group. Before root canal filling, the sea-lers were mixed with Rhodamine B dye for visualization under confocal laser scanning microscope. All samples were sectioned at 2 mm to apex (the apical of the root), 5 mm to apex (the middle of the root) and 8 mm to apex(the coronal of the root). Then, the percentages of sealer penetration into dentinal tubules in each section were calculated. Results: At the apical of the root, there were no obvious voids in slight, moderate and severe curved canals in the GF2 group and the WVC group. There was no significant difference between the two groups (P > 0.05). At the middle of the root, there was no significant difference in the percentages of void areas between the two filling methods, but at the coronal of the root, there were more voids in the slight curved root canal in the GF2 group than in the WVC group, and the difference was significant (P = 0.009). The percentages of sealer penetration into dentinal tubules of slight, moderate and severe curved root canals in the GF2 group were 36.10%, 55.80%, 65.08%, respectively. And they were all higher than those in the WVC group (15.78%, 20.70%, 15.61%), respectively, the difference between the two groups was significant (P = 0.001). At the middle of the root, the percentages of sealer penetration into dentinal tubules of slight and moderate curved root canals in GF2 group were also significantly higher than those in the WVC group (P = 0.001). At the coronal of the root, there was no significant difference between the two groups (P > 0.05). Conclusion: GuttaFlow2 filling technique has the same sealing effect on the root canal at the apical and middle of the root as the warm vertical technique, but has a better sealing effect on the dentin tubules, especially for severe curved root canal.

Key words: Root canal filling materials, Curved root canal, Single cone obturation, Warm vertical compaction

中图分类号:

R781.3

何佩瑶,包旭东. 常温流动牙胶封闭剂GuttaFlow2单尖充填弯曲根管的封闭效果[J]. 北京大学学报（医学版）, 2024, 56(1): 99-105.

Peiyao HE,Xudong BAO. Sealing effect of GuttaFlow2 in curved root canals[J]. Journal of Peking University (Health Sciences), 2024, 56(1): 99-105.

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参考文献 17

1	Clinton K , Himel VT . Comparison of a warm gutta-percha obturation technique and lateral condensation[J]. J Endod, 2001, 27 (11): 692- 695. doi: 10.1097/00004770-200111000-00010
2	Libonati A , Montemurro E , Nardi R , et al. Percentage of gutta-percha-filled areas in canals obturated by 3 different techniques with and without the use of endodontic sealer[J]. J Endod, 2018, 44 (3): 506- 509. doi: 10.1016/j.joen.2017.09.019
3	Jafarzadeh H , Abbott PV . Dilaceration: Review of an endodontic challenge[J]. J Endod, 2007, 33 (9): 1025- 1030. doi: 10.1016/j.joen.2007.04.013
4	Iglecias EF , Freire LG , de Miranda Candeiro GT , et al. Presence of voids after continuous wave of condensation and single-cone obturation in mandibular molars: A micro-computed tomography analysis[J]. J Endod, 2017, 43 (4): 638- 642. doi: 10.1016/j.joen.2016.11.027
5	Collado-Gonzalez M , Tomas-Catala CJ , Onate-Sanchez RE , et al. Cytotoxicity of GuttaFlow Bioseal, GuttaFlow2, MTA Fillapex, and AH Plus on human periodontal ligament stem cells[J]. J Endod, 2017, 43 (5): 816- 822. doi: 10.1016/j.joen.2017.01.001
6	Pedullà E , Abiad RS , Conte G , et al. Root fillings with a matched-taper single cone and two calcium silicate-based sealers: An analysis of voids using micro-computed tomography[J]. Clin Oral Investig, 2020, 24 (12): 4487- 4492. doi: 10.1007/s00784-020-03313-5
7	Akcay M , Arslan H , Durmus , et al. Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and GuttaFlow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study[J]. Lasers Surg Med, 2016, 48 (1): 70- 76. doi: 10.1002/lsm.22446
8	Zheng QH , Zhou XD , Jiang Y , et al. Radiographic investigation of frequency and degree of canal curvatures in Chinese mandibular permanent incisors[J]. J Endod, 2009, 35 (2): 175- 178. doi: 10.1016/j.joen.2008.10.028
9	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
10	Wu MK , Wesselink PR . A primary observation on the preparation and obturation of oval canals[J]. Int Endod J, 2001, 34 (2): 137- 141. doi: 10.1046/j.1365-2591.2001.00361.x
11	Eymirli A , Sungur DD , Uyanik O , et al. Dentinal tubule penetration and retreatability of a calcium silicate-based sealer tested in bulk or with different main core material[J]. J Endod, 2019, 45 (8): 1036- 1040. doi: 10.1016/j.joen.2019.04.010
12	Kumar NS , Prabu PS , Prabu N , et al. Sealing ability of lateral condensation, thermoplasticized gutta-percha and flowable gutta-percha obturation techniques: A comparative in vitro study[J]. J Pharm Bioallied Sci, 2012, 4 (Suppl 2): S131- S135.
13	张琛. 根管充填的难点和误区[J]. 华西口腔医学杂志, 2017, 35 (3): 232- 238.
14	Elyassi Y , Moinzadeh AT , Kleverlaan CJ . Characterization of leachates from 6 root canal sealers[J]. J Endod, 2019, 45 (5): 623- 627. doi: 10.1016/j.joen.2019.01.011
15	Zhong XY , Shen Y , Ma JZ , et al. Quality of root filling after obturation with gutta-percha and 3 different sealers of minimally instrumented root canals of the maxillary first molar[J]. J Endod, 2019, 45 (8): 1030- 1035. doi: 10.1016/j.joen.2019.04.012
16	Oguntebi BR . Dentine tubule infection and endodontic therapy implications[J]. Int Endod J, 1994, 27 (4): 218- 222. doi: 10.1111/j.1365-2591.1994.tb00257.x
17	Tuncer AK , Tuncer S . Effect of different final irrigation solutions on dentinal tubule penetration depth and percentage of root canal sealer[J]. J Endod, 2012, 38 (6): 860- 863. doi: 10.1016/j.joen.2012.03.008

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Curved root canals	2 mm			4 mm
Curved root canals	GF2	WVC	P	GF2	WVC	P
Slight	0 (0-0.23)	0 (0-0)	0.317	0.02 (0-0.31)	0 (0-0.21)	0.398
Moderate	0 (0-0.43)	0 (0-0.46)	0.903	0 (0-0.21)	0 (0-0.14)	0.344
Severe	0 (0-0.49)	0 (0-0.44)	0.890	0.05 (0-0.45)	0 (0-0.19)	0.671
P	0.648	0.303		0.719	0.495

Curved root canals	6 mm			8 mm
Curved root canals	GF2	WVC	P	GF2	WVC	P
Slight	0.14 (0-0.31)	0 (0-0.36)	0.571	0.25 (0-0.71)	0 (0-0.20)	＜0.05
Moderate	0.08 (0-0.48)	0 (0-0.37)	0.305	0.23 (0-0.66)	0.12 (0-0.55)	0.289
Severe	0.23 (0-0.65)	0.12 (0-0.64)	0.112	0.31 (0-0.88)	0.17 (0-0.75)	0.203
P	0.420	0.974		0.938	0.408

Curved root canals	Apical		Middle		Coronal
Curved root canals	GF2	WVC	GF2	WVC	GF2	WVC
Slight	36.10 (31.29-51.50)	15.78^# (4.28-26.04)	79.81 (69.40-96.34)	44.26^# (17.51-49.90)	83.36 (73.91-99.67)	85.71 (63.55-87.91)
Moderate	55.80 (37.08-70.30)	20.70^# (5.81-30.13)	62.75 (50.73-84.04)	28.87^# (10.63-45.73)	84.05 (55.80-93.32)	58.97 (47.39-69.93)
Severe	65.08^* (52.74-87.72)	15.61^# (7.54-41.78)	72.15 (67.11-99.10)	66.75 (41.57-76.80)	93.34 (72.31-99.84)	95.80 (64.20-99.16)

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