本文選題：Er:YAG激光 + 次氯酸鈉��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較摻鉺釔鋁-石榴石脈沖(Er:YAG)激光聯(lián)合不同濃度次氯酸鈉對(duì)根管內(nèi)糞腸球菌的殺菌效果以及一次性根管治療的效果,為臨床治療方式的選擇提供參考。方法:體外實(shí)驗(yàn)選擇新鮮拔除的人單根管離體前磨牙75個(gè),開(kāi)髓并用鎳鈦機(jī)用器械冠向下法預(yù)備根管后,滅菌處理。糞腸球菌菌種復(fù)蘇以后平板劃線法接種在牛心腦浸液(BHI)的瓊脂培養(yǎng)皿中,24H后用BHI液體增菌培養(yǎng)基制成糞腸球菌懸液并用比濁儀調(diào)整其濃度為1.5×108CFU/m L,然后將所有牙根置于盛有100ml上述菌液的瓶中,37℃需氧條件下靜置培養(yǎng)4w,每4d換1次重新配制的菌液,建立糞腸球菌的感染根管模型。隨機(jī)分為5組,每組15個(gè),分別進(jìn)行如下處理:A組:5.25%次氯酸鈉單獨(dú)沖洗;B組:Er:YAG激光+5.25%次氯酸鈉沖洗;C組:1%次氯酸鈉單獨(dú)沖洗;D組:Er:YAG激光+1%次氯酸鈉沖洗。E組:空白對(duì)照。處理完成后用無(wú)菌吸潮紙尖沾取0.9%生理鹽水伸入根管內(nèi)采集5組根管內(nèi)的細(xì)菌,將每根采集細(xì)菌后的紙尖放入盛有5ml無(wú)菌蒸餾水的離心管中振蕩5秒,混勻后在BHI培養(yǎng)基上進(jìn)行接種,培養(yǎng)24H后計(jì)數(shù)。使用SPSS19.0統(tǒng)計(jì)軟件對(duì)結(jié)果進(jìn)行卡方檢驗(yàn)(Chi-square test),取P0.05具有統(tǒng)計(jì)學(xué)差異。體內(nèi)實(shí)驗(yàn)選擇急性牙髓炎及外傷露髓的上下頜前牙及前磨牙病例共113例,隨機(jī)分為Er:YAG激光聯(lián)合1%次氯酸鈉激光蕩洗組(A組)56例及1%次氯酸鈉注射器沖洗組(B組)57例。局麻下開(kāi)髓,拔髓。10號(hào)C銼結(jié)合X線片確定工作長(zhǎng)度后用pathfile+TF銼預(yù)備根管至25#,08錐度。根管預(yù)備完成后A組上橡皮障并將Er:YAG激光的參數(shù)設(shè)定為功率0.3 W、脈寬50μs,脈沖能量20m J、頻率15Hz。將激光工作尖置于根管口處,用1%濃度的次氯酸鈉沖洗的同時(shí)照射60s,再用生理鹽水沖洗并照射60s。B組上橡皮障,用1%次氯酸鈉和生理鹽水交替注射器沖洗各60s。然后攝主尖片并用側(cè)壓針行根管充填。最后再次拍攝X線片確認(rèn)未發(fā)生欠填或超填,完成一次性根管治療。術(shù)后3天、7天及1個(gè)月隨訪。整理數(shù)據(jù)后采用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)數(shù)資料采用卡方檢驗(yàn)。以P0.05為差異顯著。結(jié)果:體外實(shí)驗(yàn)中A、B、D三組的處理方式均能完全殺滅糞腸球菌;所有培養(yǎng)皿中均未見(jiàn)菌落。C組處理方式未能完全殺滅根管內(nèi)的糞腸球菌,15個(gè)培養(yǎng)皿中有11個(gè)可見(jiàn)菌落。E組每個(gè)模型都可培養(yǎng)出大量糞腸球菌菌落。A、B、D三組間殺菌效果無(wú)差異且均顯著優(yōu)于C組(P0.05)。體內(nèi)實(shí)驗(yàn)中A組56例中成功54例,成功率96.4%。出現(xiàn)咬合痛的1例已行降合治療,仍在觀察。根尖陰影的1例2個(gè)月后就診外院失訪。B組57例中成功51例,成功率89.4%。術(shù)后3天腫脹疼痛的3例經(jīng)抗炎止痛治療后癥狀隨即消失,其余三例1個(gè)月后隨訪仍有不適。轉(zhuǎn)診外院后失訪。A組治療效果明顯優(yōu)于B組(P0.05)(表1)。結(jié)論:高濃度次氯酸鈉可以完全殺滅根管內(nèi)的糞腸球菌,低濃度次氯酸鈉不能完全殺滅根管內(nèi)的糞腸球菌;Er:YAG激光可以顯著增強(qiáng)低濃度次氯酸鈉的殺菌作用,聯(lián)合低濃度次氯酸鈉在一次性根管治療中的效果比注射器沖洗更好,具有良好的臨床應(yīng)用前景。
[Abstract]:Objective: To compare the bactericidal effect of erbium aluminum oxide pulsed (Er:YAG) laser combined with different concentrations of sodium hypochlorite on Enterococcus faecalis in root canal and the effect of one-off root canal therapy in order to provide reference for the selection of clinical treatment methods. Methods: in vitro, 75 freshly extracted human premolars were extracted from single root canal, and the pulp was opened and nickel titanium was used. After the root canal was prepared with the instrument crown, it was sterilized. After the resuscitation of the Enterococcus faecalis, the plate line was inoculated in the agar culture dish of BHI. After 24H, the Enterococcus faecalis suspension was made with the BHI liquid increasing medium and the concentration was 1.5 * 108CFU /m L with turbidimetry, and all the roots were placed in the above 100ml bacteria. In the liquid bottle, 4W was incubated at 37 DEG C on aerobic condition, and the bacteria solution was reprepared 1 times per 4D to establish the infection root canal model of Enterococcus faecalis. It was randomly divided into 5 groups, each group was treated as follows: group A: 5.25% sodium hypochlorite flushing alone; B group: Er:YAG laser +5.25% sodium hypochlorite flushing; C group: 1% sodium hypochlorite flushing alone; D group: Er:YAG exciting Light +1% sodium hypochlorite flushed.E group: blank control. After finishing the treatment, 0.9% physiological saline was applied to the root canal to collect bacteria within the root canal, and the paper tips after each collection of bacteria were put into the centrifuge tube with 5ml aseptic distilled water for 5 seconds. After mixing, the inoculation was carried out on the BHI medium, and the count after 24H was used. SPSS19.0 statistical software was used to test the results with a chi square test (Chi-square test), and P0.05 had statistical differences. In the body, 113 cases of upper and lower mandibular anterior teeth and anterior molar were selected for acute pulpitis and trauma, and were randomly divided into 56 cases of Er:YAG laser combined with 1% sodium hypochlorite laser washing group (group A) and 1% sodium hypochlorite syringe irrigation group (group B). ) 57 cases under local anesthesia, open pulp under local anesthesia, pulpio.10 C file combined with X ray to determine the length of work and use pathfile+TF file to prepare root canal to 25#, 08 taper. After the root canal was prepared, the rubber barrier on A group was set to power 0.3 W, pulse width 50 mu, pulse energy 20m J, frequency 15Hz. to the root canal at the root canal and 1% concentration times. At the same time, 60s was irradiated with sodium chlorate, then the rubber barrier was flushed and irradiated in group 60s.B with saline, and the 60s. was flushed with 1% sodium hypochlorite and physiological saline, then the main slice was taken and the root canal was filled with the lateral pressure needle. After 1 months of follow-up, the data were analyzed with SPSS 19 software. The counting data were tested with chi square test. P0.05 was significant. Results: in vitro experiments, A, B, D three groups could completely kill the Enterococcus faecalis; no colony.C group did not completely kill the Enterococcus in the root canal, 15 In a Petri dish, there were 11 colonies in group.E, each of which could cultivate a large number of colonies of Enterococcus faecalis.A, B, and D three groups had no difference in germicidal efficacy and significantly better than group C (P0.05). In group A, 54 cases were successful in 56 cases in group A and 1 cases of occlusal pain in 96.4%. had been treated with descending treatment, and 1 cases of root apical shadow were still observed after 2 months. 51 cases were successful in 57 cases of.B group, and 3 cases of swelling and pain in 3 days after 89.4%. were disappearing after anti inflammatory and analgesic treatment. The rest three cases were still discomfort after 1 months of follow-up. The treatment effect of.A group after referral to external hospital was obviously superior to group B (P0.05) (Table 1). Conclusion: high concentration of sodium hypochlorite can completely kill the feces in the root canal. Enterococcus, low concentration of sodium hypochlorite can not completely kill the Enterococcus in the root canal; Er:YAG laser can significantly enhance the bactericidal effect of low concentration sodium hypochlorite. The effect of combined low concentration of sodium hypochlorite in the treatment of one-time root canal is better than that of the syringe, and it has a good application prospect.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R781.05

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相關(guān)期刊論文 前7條

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本文編號(hào)：1806069