背景:在某些情况下,采用标准逆行操作的心尖手术可能具有挑战性。简化根尖手术以减少手术时间和简化逆行操作是临床牙髓学的新兴需求。
目的:该研究的目的是比较硅酸钙基密封剂与单锥技术结合根端切除的细菌密封能力,和硅酸钙基密封剂作为逆行填充与MTA回填,并使用共聚焦激光扫描显微镜(CLSM)分析细菌活力。
方法:在这项体外实验研究中,选取50颗上颌切牙,随机分为5组:3个实验组,阳性对照组,阴性对照组(n=10/组)。在实验组中,使用单锥技术(SCT)和硅酸钙基密封剂封闭根。在第1组中,从根尖切除3mm的根,没有进一步的逆行准备或填充。在第2组和第3组中,根被切除,追溯,并用硅酸钙基密封剂或MTA回填,分别。第4组(阳性对照)用不含任何密封剂的单个牙胶胶锥填充。在第5组(阴性对照)中,运河是空的,和根部用蜡和指甲油密封。使用粪肠球菌的细菌渗漏模型用于评估30天期间的密封能力。检查浊度并分析每毫升菌落形成单位(CFU)。使用CLSM检查来自每组的五个样本的细菌活力。使用卡方和Kruskal-Wallis检验对细菌密封能力的数据进行统计分析。
结果:三个实验组在细菌渗漏方面没有显着差异,或细菌计数(CFU)(P>0.05)。然而,当实验组与阳性对照组比较时,观察到显著差异.值得注意的是,硅酸钙基密封剂,当用作回填时,产生了最好的密封能力。CLSM成像显示所有阳性对照组标本中的活细菌渗透,而对于实验组,死亡细菌是可见的突出特征。
结论:在本研究的局限性内,可以得出结论,单锥技术结合根端切除的硅酸钙基密封剂和硅酸钙基密封剂作为逆行填充的细菌密封能力与在牙髓外科手术期间的MTA回填相当。
BACKGROUND: Apical surgery with standard retrograde maneuvers may be challenging in certain cases. Simplifying apical surgery to reduce operating time and streamline retrograde manipulation is an emerging need in clinical endodontics.
OBJECTIVE: The aim of the study was to compare the bacterial sealing ability of a calcium silicate-based sealer with the single cone technique combined with root end resection only, and calcium silicate-based sealer as a retrograde filling versus MTA retrofilling, and to analyze bacterial viability using confocal laser scanning microscope (CLSM).
METHODS: In this in vitro experimental study, 50 extracted human maxillary incisor teeth were instrumented and randomly divided into five groups: three experimental groups, a positive control group, and a negative control group (n = 10/group). In the experimental groups, the roots were obturated using the single cone technique (SCT) and a calcium silicate-based sealer. In group 1, the roots were resected 3 mm from the apex with no further retrograde preparation or filling. In groups 2 and 3, the roots were resected, retroprepared, and retrofilled with either a calcium silicate-based sealer or MTA, respectively. Group 4 (positive control) was filled with a single gutta-percha cone without any sealer. In group 5 (negative control), the canals were left empty, and the roots were sealed with wax and nail varnish. A bacterial leakage model using Enterococcus faecalis was employed to assess the sealing ability over a 30-day period, checking for turbidity and analyzing colony forming units (CFUs) per milliliter. Five specimens from each group were examined using CLSM for bacterial viability. Data for the bacterial sealing ability were statistically analyzed using chi-squared and Kruskal-Wallis tests.
RESULTS: The three experimental groups did not show significant differences in terms of bacterial leakage, or bacterial counts (CFUs) (P > 0.05). However, significant differences were observed when comparing the experimental groups to the positive control group. Notably, the calcium silicate-based sealer, when used as a retrofilling, yielded the best sealing ability. CLSM imaging revealed viable bacterial penetration in all the positive control group specimens while for the experimental groups, dead bacteria was the prominent feature seen.
CONCLUSIONS: Within the limitations of this study, it could be concluded that the bacterial sealing ability of calcium silicate-based sealer with the single cone technique combined with root end resection only and calcium silicate-based sealer as a retrograde filling were comparable with MTA retrofilling during endodontic surgical procedures.