常温流动牙胶应用于根尖诱导成形术后根管充填

doi:10.19723/j.issn.1671-167X.2022.01.012

摘要/Abstract

摘要：

目的: 评价常温流动牙胶应用于年轻恒牙根尖诱导成形术后根管充填的临床效果。方法: 选择2020年4—10月在北京大学口腔医院门诊部儿童口腔科就诊因年轻恒牙牙髓坏死或根尖周病变经过完善的根尖诱导成形术治疗的病例,共收集到病例90例,随机分为两组,试验组和对照组各45例。试验组采用常温流动牙胶充填系统,对照组采用热牙胶充填系统进行根管充填,记录每根管的根管充填时间,由患儿监护人填写VAS(visual analog scales)视觉模拟评分量表评估治疗疼痛程度,术后即刻拍摄X线片,评价根管充填效果,并分别对根管下段、中段、上段的三维充填严密程度进行分析,术后6个月、12个月进行临床检查并拍摄X线片判断治疗成功率。结果: 试验组平均每根管充填时间明显低于对照组,分别为51 s和 74 s,组间比较差异有统计学意义(P<0.05);两组疼痛发生率分别为26.67%和40.00%;试验组和对照组的根管充填恰填且三维充填严密率分别为71.11%和60.00%;根尖1/3区域三维充填严密率为86.67%和66.67%,组间差异有统计学意义(P<0.05),根中1/3及根上1/3根管充填的三维严密性两组间差异无统计学意义;1年复查期内两组均未见根尖病变。结论: 常温流动牙胶应用于年轻恒牙根尖诱导成形后根管充填可取得良好的根管充填效果,根尖1/3区域的根管充填效果优于热牙胶,常温流动牙胶能够缩短临床治疗时间,改善患儿的舒适度。

关键词: 常温流动牙胶, 根管充填, 年轻恒牙, 根尖诱导成形术

Abstract:

Objective: To evaluate the clinical effect of root canal obturation therapy using cold flowable gutta-percha on young permanent teeth after apexification. Methods: Ninety cases of young permanent teeth with pulp necrosis or periapical periodontitis treated by apexification were randomly divided into two groups. The cases in each group were divided into single root canal and multiple root canal according to the number of the root canal, and divided into classifications Ⅰ, and Ⅱ/Ⅲ/Ⅳ according to Frank’s classification of root development after apexification. Cold flowable gutta-percha and warm gutta-percha obturation techniques were used for root canal obturation of the two groups. The operation time was recorded, and the patients’ therapy pain degree was evaluated by visual analog scale (VAS) immediately after operation. Periapical X-ray was performed after operation to evaluate the effect of the root canal filling. The total length of the root was divided into equal three parts on the X-ray film, and three-dimensional tightness of the apical, middle, and coronal region of the root canals were statistically analyzed respectively. Clinical examinations and X-ray examination were performed 6 and 12 months after the operation to evaluate the treatment success rate. Results: The operation time of cold flowable gutta-percha group was significantly lower than that of the control group, which were 51 s and 74 s (P<0.05); The percentages of pain and discomfort in the two groups were 26.67% and 40.00%, respectively. There were two cases of underfilling and no overfilling in both groups. The percentages of proper filling and tight three-dimensional obturation in the experimental and control groups were 71.11% and 60.00% respectively; and the percentages of tight three-dimensional obturation in the apical third areas were 86.67% and 66.67%, the difference was significant (P<0.05). There was no significant difference in the three-dimensional tightness between the two groups in the middle and coronal third areas. The percentages of tight three-dimensional obturation in classification Ⅰ groups were 86.67%, 83.33%, 93.33% and 76.67%, 90.00%, 96.67% in experimental and control group, respectively; The percentages of classification Ⅱ/Ⅲ/Ⅳ groups were 86.67%, 86.67%, 100.00% and 46.67%, 86.67%, 100.00%, respectively, and the difference was significant (P<0.05). There were no apical lesions that occurred in either group during the one-year review period. Conclusion: The application of cold flowable gutta-percha on young permanent teeth root canal obturation after apexification can achieve good obturation effect. The root obturation effect in the apical third area is significantly better than that of warm gutta-percha obturation techniques. Cold flowable gutta-percha can shorten the clinical treatment time and ameliorate the patients’ therapy comfort.

Key words: Cold flowable gutta-percha, Root canal obturation, Young permanent teeth, Apexification

中图分类号:

R783.1

闫文娟,钟洁,林碧琛,丁美丽,陈小贤. 常温流动牙胶应用于根尖诱导成形术后根管充填[J]. 北京大学学报（医学版）, 2022, 54(1): 77-82.

YAN Wen-juan,ZHONG Jie,LIN Bi-chen,DING Mei-li,CHEN Xiao-xian. Application of cold flowable gutta-percha in root canal obturation after apexification[J]. Journal of Peking University (Health Sciences), 2022, 54(1): 77-82.

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参考文献 15

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Group		Number of root canals				Frank classification			Total
Group		Single canal	Multiple canals		Classification Ⅰ		Classification Ⅱ/ Ⅲ/ Ⅳ		Total
Experimental	n Time/s	28		17		30		15	45
Experimental	n Time/s	53±11		49±6		52±10		51±11	51±10
Control	n Time/s	22		23		30		15	45
Control	n Time/s	78±18		71±19		76±18		70±20	74±19

Group	VAS scores							Total	Average score and percentage of pain and discomfort cases
Group	0	1	2	3	4	5	6-10	Total	Average score and percentage of pain and discomfort cases
Experimental, n (%)	33 (73.33)	5 (11.11)	3 (6.67)	3 (8.89)	1 (2.22)	0 (0.00)	0 (0.00)	45	0.533 (26.67)
Control, n (%)	27 (60.00)	7 (15.56)	5 (11.11)	4 (11.11)	1 (2.22)	1 (2.22)	0 (0.00)	45	0.844 (40.00)

Group	Tight three-dimensional root canal obturation			Underfilling	Proper filling and tight three-dimensional obturation
Group	In the apical third region of root canal	In the middle third region of root canal	In the coronal third region of root canal	Underfilling	Proper filling and tight three-dimensional obturation
Experimental, n (%)	39 (86.67)	38 (84.44)	43 (95.56)	2 (4.44)	32 (71.11)
Control, n (%)	30 (66.67)	40 (88.89)	44 (97.78)	2 (4.44)	27 (60.00)
P value	0.025^*	0.535	0.557	1.000	0.267

Group	number of root canals	n	Tight three-dimensional root canal obturation			Underfilling	Proper filling and tight three-dimensional obturation
Group	number of root canals	n	In the apical third region of root canal	In the middle third region of root canal	In the coronal third region of root canal	Underfilling	Proper filling and tight three-dimensional obturation
Experimental	Single canal	28	24 (85.71)	24 (85.71)	26 (92.86)	2 (7.14)	20 (71.43)
	Multiple canals	17	15 (88.24)	14 (82.35)	17 (100.00)	0 (0.00)	12 (70.59)
Control	Single canal	22	17 (77.27)	18 (81.82)	22 (100.00)	1 (4.55)	15 (68.18)
	Multiple canals	23	13 (56.52)	22 (95.65)	22 (95.65)	1 (4.35)	12 (52.17)
P value	Single canal		0.441	0.709	0.201	0.701	0.418
	Multiple canals		0.030^*	0.166	0.384	0.384	0.150

Group	Frank classification	N	Tight three-dimensional root canal obturation			Underfilling	Proper filling and tight three-dimensional obturation
Group	Frank classification	N	In the apical third region of root canal	In the middle third region of root canal	In the coronal third region of root canal	Underfilling	Proper filling and tight three-dimensional obturation
Experimental	Ⅰ	30	26 (86.67)	25 (83.33)	28 (93.33)	2 (6.67)	24 (80.00)
	Ⅱ/ Ⅲ/ Ⅳ	15	13 (86.67)	13 (86.67)	15 (100.00)	0 (0.00)	11 (73.33)
Control	Ⅰ	30	23 (76.67)	27 (90.00)	29 (96.67)	2 (6.67)	20 (66.67)
	Ⅱ/ Ⅲ/ Ⅳ	15	7 (46.67)	13 (86.67)	15 (100.00)	0 (0.00)	7 (46.67)
P value	Ⅰ		0.317	0.448	0.554	1.000	0.243
	Ⅱ/ Ⅲ/ Ⅳ		0.020^*	1.000	1.000	1.000	0.136