根管內(nèi)感染防治新技術(shù)的相關(guān)研究
發(fā)布時(shí)間：2018-08-12 18:48
【摘要】：根管治療首先是去除根管內(nèi)感染組織,然后對(duì)根管系統(tǒng)進(jìn)行預(yù)備成型和消毒,最后再用生物惰性材料(如牙膠尖)和根管封閉劑對(duì)根管系統(tǒng)進(jìn)行三維的嚴(yán)密充填。完全清除根管內(nèi)感染對(duì)根管治療成功至關(guān)重要。目前,實(shí)現(xiàn)這一目標(biāo)主要借助各種各樣的物理-化學(xué)根管消毒技術(shù)。然而,由于牙根解剖結(jié)構(gòu)的復(fù)雜性,應(yīng)用現(xiàn)有的根管消毒技術(shù)完全去除根管及牙本質(zhì)小管內(nèi)的細(xì)菌幾乎是不可能的。殘存在根管內(nèi)的細(xì)菌有可能引起根管再感染的發(fā)生,從而導(dǎo)致根管治療的失敗。這就要求不斷發(fā)展更多更有效的根管消毒技術(shù)。此外,作為根管治療的最后一個(gè)步驟,理想的根管封閉材料應(yīng)該能對(duì)根管內(nèi)殘存的細(xì)菌起到有效的殺滅作用或者抑制作用。因此,本課題的主要目的是探索和發(fā)展一些新的根管內(nèi)感染防治技術(shù),為提高根管治療成功率、維持根管治療遠(yuǎn)期療效和預(yù)防根管治療失敗提供新的思路和技術(shù)理論支持。為此,我們進(jìn)行了如下探索:1.激光輔助根管消毒技術(shù)在體外離體牙根管感染模型中消毒作用的相關(guān)研究首先,我們構(gòu)建了糞腸球菌離體牙根管感染模型并在此基礎(chǔ)上比較研究了【Nd:YAG激光,Er:YAG激光,Er,Cr:YSGG激光和光動(dòng)力殺菌治療技術(shù)】等激光輔助根管消毒技術(shù)的消毒作用。結(jié)果證實(shí)以上幾種根管消毒技術(shù)都能在糞腸球菌離體牙根管感染模型中取得有效的消毒效果;其中又以Er:YAG激光輔助次氯酸鈉(NaOCl)的效果最好。但是,同時(shí)我們也發(fā)現(xiàn)Er:YAG激光輔助NaOCl只能清除根管壁表面和侵入牙本質(zhì)小管內(nèi)200微米以內(nèi)深度的糞腸球菌,而不能清除侵入牙本質(zhì)小管內(nèi)300微米以上的細(xì)菌。因此,我們又對(duì)Er:YAG激光的工作參數(shù)進(jìn)行了優(yōu)化研究,即比較了不同輸出功率(0.3、0.5和1.0 W)和不同照射時(shí)間(20和30 s)條件下Er:YAG激光輔助NaOCl根管消毒技術(shù)在體外離體牙根管感染模型中消毒作用。結(jié)果發(fā)現(xiàn)0.5 W/30s是最優(yōu)化的參數(shù)組合;它可以清除侵入牙本質(zhì)小管內(nèi)500微米左右深度的糞腸球菌。2.季銨鹽化二氧化硅生物玻璃納米微球抗菌根管封閉劑基質(zhì)材料的合成及其相關(guān)特性研究首先,我們使用溶膠-凝膠法合成了二氧化硅生物玻璃納米微球(SBG-NS)并使用門舒特金反應(yīng)法合成了四種不同側(cè)鏈烷基長(zhǎng)度的甲基丙烯酸酯季銨鹽(QAMs)。然后使用硅烷偶聯(lián)劑(KH-570)對(duì)SBG-NS進(jìn)行表面修飾,目的是將碳碳雙鍵引入SBG-NS表面以獲得中間產(chǎn)物SBG-NS/KH-570。最后,QAMs與SBG-NS/KH-570表面的KH-570發(fā)生聚合反應(yīng)得到季銨鹽化二氧化硅生物玻璃納米微球抗菌根管封閉劑基質(zhì)材料(SBG-QAPMs)。然后,我們測(cè)定了(1)SBG-QAPMs的水溶性及離子釋放能力;(2)SBG-QAPMs對(duì)感染根管內(nèi)常見頑固性致病菌的殺菌作用;(3)SBG-QAPMs的生物安全性(體外細(xì)胞毒性作用和體內(nèi)炎癥反應(yīng)作用)。結(jié)果發(fā)現(xiàn),SBG-QAPMs在PBS溶液中的穩(wěn)定性極好并可以釋放微量礦化相關(guān)離子(Si4+和Ca2+)、具備長(zhǎng)期穩(wěn)定有效的殺菌作用和良好的生物安全性。綜上所述,我們可以得出以下結(jié)論:(1)Er:YAG激光輔助NaOCl根管消毒技術(shù)(0.5 W/30s)可以考慮用作常規(guī)根管消毒技術(shù);(2)SBG-QAPMs可以用于新型長(zhǎng)效抗菌根管封閉劑的研發(fā)。
[Abstract]:Root canal therapy begins with the removal of infected tissues in the root canal, then the preparation and disinfection of the root canal system, and then the three-dimensional filling of the root canal system with bio-inert materials (such as gutta-percha tip) and root canal sealants. Complete removal of root canal infections is crucial to the success of root canal therapy. However, due to the complexity of root anatomy, it is almost impossible to completely remove bacteria from root canals and dentinal tubules by using existing root canal disinfection techniques. In addition, as the last step of root canal therapy, ideal root canal sealing materials should be able to effectively kill or inhibit the remaining bacteria in the root canal. Therefore, the main purpose of this project is to explore and develop some new root canal infection prevention and treatment. In order to improve the success rate of root canal therapy, maintain the long-term efficacy of root canal therapy and prevent the failure of root canal therapy, we have made the following explorations: 1. Relevant studies on the disinfection effect of laser-assisted root canal disinfection technology in vitro root canal infection model. Firstly, we constructed the faecal-enteroblast. The disinfection effects of laser-assisted root canal disinfection techniques such as Nd:YAG laser, Er:YAG laser, Er, Cr:YSGG laser and photodynamic disinfection therapy were compared and studied on the basis of the model of bacterial root canal infection in vitro. Er:YAG laser-assisted sodium hypochlorite (NaOCl) had the best disinfection effect. However, we also found that Er:YAG laser-assisted NaOCl could only remove Enterococcus faecalis from the surface of root canal wall and from the depth of 200 microns invading dentinal tubules, but could not remove bacteria invading dentinal tubules more than 300 microns. The working parameters of Er:YAG laser were optimized, i.e. the effects of Er:YAG laser assisted NaOCl root canal disinfection on the root canal infection model in vitro were compared under different output power (0.3, 0.5 and 1.0 W) and irradiation time (20 and 30 s). Removal of Enterococcus faecalis invading dentinal tubules at depths of about 500 microns. 2. Synthesis and characterization of quaternary ammonium salt silica Bioglass nanospheres as matrix materials for root canal sealants. Firstly, we synthesized silica Bioglass nanospheres (SBG-NS) by sol-gel method and used Menshutkin reaction method. Four kinds of quaternary ammonium methacrylates (QAMs) with different side chain alkyl lengths were synthesized. Then the SBG-NS was modified by silane coupling agent (KH-570) in order to introduce carbon-carbon double bonds into the surface of SBG-NS to obtain the intermediate SBG-NS/KH-570. Finally, QAMs was polymerized with KH-570 on the surface of SBG-NS/KH-570 to obtain quaternary ammonium salt dimer. Then, we measured (1) the water solubility and ionic release ability of SBG-QAPMs; (2) the bactericidal effect of SBG-QAPMs on common intractable pathogenic bacteria in infected root canals; (3) the biological safety of SBG-QAPMs (cytotoxicity in vitro and inflammatory reaction in vivo). The results showed that SBG-QAPMs were very stable in PBS solution and could release trace mineralization-related ions (Si4+ and Ca2+) with long-term stable and effective bactericidal effect and good biological safety. Root canal disinfection technology; (2) SBG-QAPMs can be used for the development of a new long-acting antibacterial root canal sealer.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.05
，
本文編號(hào)：2179969
[Abstract]:Root canal therapy begins with the removal of infected tissues in the root canal, then the preparation and disinfection of the root canal system, and then the three-dimensional filling of the root canal system with bio-inert materials (such as gutta-percha tip) and root canal sealants. Complete removal of root canal infections is crucial to the success of root canal therapy. However, due to the complexity of root anatomy, it is almost impossible to completely remove bacteria from root canals and dentinal tubules by using existing root canal disinfection techniques. In addition, as the last step of root canal therapy, ideal root canal sealing materials should be able to effectively kill or inhibit the remaining bacteria in the root canal. Therefore, the main purpose of this project is to explore and develop some new root canal infection prevention and treatment. In order to improve the success rate of root canal therapy, maintain the long-term efficacy of root canal therapy and prevent the failure of root canal therapy, we have made the following explorations: 1. Relevant studies on the disinfection effect of laser-assisted root canal disinfection technology in vitro root canal infection model. Firstly, we constructed the faecal-enteroblast. The disinfection effects of laser-assisted root canal disinfection techniques such as Nd:YAG laser, Er:YAG laser, Er, Cr:YSGG laser and photodynamic disinfection therapy were compared and studied on the basis of the model of bacterial root canal infection in vitro. Er:YAG laser-assisted sodium hypochlorite (NaOCl) had the best disinfection effect. However, we also found that Er:YAG laser-assisted NaOCl could only remove Enterococcus faecalis from the surface of root canal wall and from the depth of 200 microns invading dentinal tubules, but could not remove bacteria invading dentinal tubules more than 300 microns. The working parameters of Er:YAG laser were optimized, i.e. the effects of Er:YAG laser assisted NaOCl root canal disinfection on the root canal infection model in vitro were compared under different output power (0.3, 0.5 and 1.0 W) and irradiation time (20 and 30 s). Removal of Enterococcus faecalis invading dentinal tubules at depths of about 500 microns. 2. Synthesis and characterization of quaternary ammonium salt silica Bioglass nanospheres as matrix materials for root canal sealants. Firstly, we synthesized silica Bioglass nanospheres (SBG-NS) by sol-gel method and used Menshutkin reaction method. Four kinds of quaternary ammonium methacrylates (QAMs) with different side chain alkyl lengths were synthesized. Then the SBG-NS was modified by silane coupling agent (KH-570) in order to introduce carbon-carbon double bonds into the surface of SBG-NS to obtain the intermediate SBG-NS/KH-570. Finally, QAMs was polymerized with KH-570 on the surface of SBG-NS/KH-570 to obtain quaternary ammonium salt dimer. Then, we measured (1) the water solubility and ionic release ability of SBG-QAPMs; (2) the bactericidal effect of SBG-QAPMs on common intractable pathogenic bacteria in infected root canals; (3) the biological safety of SBG-QAPMs (cytotoxicity in vitro and inflammatory reaction in vivo). The results showed that SBG-QAPMs were very stable in PBS solution and could release trace mineralization-related ions (Si4+ and Ca2+) with long-term stable and effective bactericidal effect and good biological safety. Root canal disinfection technology; (2) SBG-QAPMs can be used for the development of a new long-acting antibacterial root canal sealer.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.05
，
本文編號(hào)：2179969
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