新型三重抗生素糊剂对再治疗根管内粪肠球菌的抗菌效果及近期疗效

目的 观察并比较新型三重抗生素（奥硝唑、环丙沙星和米诺环素）糊剂单独及与氢氧化钙糊剂联合应用对再治疗根管内粪肠球菌的杀灭效果及近期临床疗效。方法 收集根管治疗失败病例需根管再治疗的单根管患牙149颗。随机分为5组，分别为氢氧化钙糊剂组（CH组）、传统三重抗生素（甲硝唑、环丙沙星和米诺环素）糊剂组（TAP组）、新型三重抗生素糊剂组（NTAP组）、氢氧化钙＋新型三重抗生素糊剂组（CH＋NTAP组）、樟脑酚组（CP组）。取出根管内充填物后，分别于根管预备前、根管预备后及根管封药7 d后检测根管内粪肠球菌数量，并于封药7 d后进行近期临床疗效评定。结果 各组根管预备后及根管封药7 d后根管内粪肠球菌数量均较根管预备前下降（P均<0.05），根管封药7 d后根管内粪肠球菌数量均较根管预备后下降（P均<0.05）。根管封药7 d后CH组、TAP组、NTAP组、CH＋NTAP组根管内粪肠球菌数量均低于CP组（P均<0.05），NTAP组和CH＋NTAP组均分别低于CH组和TAP组（P均<0.05），TAP组低于CH组（P<0.05）。根管封药7 d后CH组、TAP组、NTAP组、CH＋NTAP组的临床疗效均优于CP组（P均<0.05），TAP组、NTAP组及CH＋NTAP组的疗效均优于CH组（P均<0.05），但TAP组、NTAP组及CH＋NTAP组3组间差异无统计学意义（P>0.05）。结论 氢氧化钙糊剂、三重抗生素糊剂、氢氧化钙联合三重抗生素糊剂作为根管消毒药物，均对再治疗根管内粪肠球菌有较好的抗菌效果和近期临床疗效，特别是新型三重抗生素糊剂，值得临床上推广应用。

Evaluation of antibacterial effect and short-term clinical effect of new triple antibiotic paste against Enterococcus faecalis for root canal retreatment

Objective To compare the antibacterial effect and short-term clinical effect of new triple antibiotic paste (ornidazole, ciprofloxacin and minocycline) used alone and in combination with calcium hydroxide paste against Enterococcus faecalis in root canal retreatment. Methods A total of 149 single rooted teeth with failed endodontic treatment were selected in the present study. The samples were randomly divided into 5 groups:calcium hydroxide paste group (CH group), triple antibiotic paste (metronidazole, ciprofloxacin and minocycline) group (TAP group), new triple antibiotic paste group (NTAP group), the combination group of calcium hydroxide paste and new triple antibiotic paste (CH+NTAP group), and camphor phenol group (CP group). After removal of the root-filling material, the quantities of Enterococcus faecalis in the root canals were determined before and after root canal preparation and 7 d after root dressing. The short-term clinical effects were evaluated 7 d after root dressing in each group. Results After root canal preparation and root dressing of 7 d, the quantities of Enterococcus faecalis in root canals in each group were significantly decreased versus before root canal preparation (all P<0.05). After 7 d root dressing, the quantities of Enterococcus faecalis of each group were significantly lower versus after root canal preparation (all P<0.05). The quantities of Enterococcus faecalis were significantly lower in the CH, TAP, NTAP and CH+NTAP groups than that in the CP group (all P<0.05), those in the NTAP group and CH+NTAP group were significantly lower than those in the CH group and TAP group (all P<0.05), and that in the TAP group was significantly lower than that in the CH group (P<0.05). After 7 d root dressing, the CH, TAP, NTAP and CH+NTAP groups had better clinical effects than the CP group (all P<0.05), and the clinical effects of the TAP group, NTAP group and CH+NTAP group were better than that of the CH group (all P<0.05), while there was no significant difference between the TAP group, NTAP group and CH+NTAP group (P>0.05). Conclusion Calcium hydroxide paste and triple antibiotic paste alone or in combination have better antibacterial effect for root canal disinfection against Enterococcus faecalis in root canal retreatment. They also have better short-term clinical effect, especially the new triple antibiotic paste, which can be considered as an effective alternative intracanal medicament and is worthy of clinical application.