三种充填技术根管封闭能力的研究

目的:利用葡萄糖定量法检测根管微渗漏模型,评价侧向加压充填技术、垂直加压充填技术及固核载体充填技术对根管微渗漏的影响.方法:选取71颗直根管上前牙,根管预备后随机分为7组,A组(14颗)用热牙胶垂直加压加AH Plus充填;B组(8颗)仅用热牙胶垂直加压充填;C组(13颗)用侧方加压加AH Plus充填;D组(8颗)仅用侧方加压充填技术;E组(11颗)用Thermafil加AH Plus充填;F组(7颗)仅用Thermafil充填;G组(10颗)为阴性对照组,用粘蜡充填根管.牙根外表面、根管口及根尖孔处涂二层指甲油.于第7 d、14 d、21 d、28 d用葡萄糖氧化酶法检测从冠方向根方漏出的葡萄糖量.结果:采用重复测量方差分析,发现第7 d、14 d、21 d、28 d A、C组及C、E组微渗漏值有显著性差异(P＜0.001),但A、E组无显著性差异(P＞0.05).各时间点C、D组比较有显著性差异(P＜0.001),但A、B组与E、F组比较无显著性差异(P＞0.05).第7 d、14 d及第21 d、28 d各组内比较无显著性差异(P＞0.05),但各组第14 d与第21 d比较有显著性差异(P＜0.05).结论:侧方加压充填技术封闭根管的能力优于垂直加压充填技术及固核载体充填技术,而后两种充填技术封闭根管的能力相当.     

Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy

AIM: The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. METHODS: A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. RESULTS: Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 +/- 3.71 vs 90.95 +/- 5.73 min, P < 0.001; 87.76 +/- 25.48 vs 152.63 +/- 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. CONCLUSION: EBVS was found to be less time-consuming and caused less bleeding when compared with HS.     

不同填充材料在一次性根管治疗中的应用分析

目的对比口腔内科3种不同的根管填充材料在一次性根管治疗中的临床效果。方法 2010年1月～2011年1月于笔者所在门诊收治的各类牙髓炎、根尖周炎需进行根管治疗的患者共213例,330颗牙。随机分为3组,分别采用Vitapex糊剂(A组)、Cortisomol糊剂(B组)以及碘仿氧化锌丁香油糊剂(C组)进行根管填充,比较3组根管填充治疗1周后患者疼痛情况及术后1年的治愈率。结果根管治疗1周后,A组疼痛发生率为13.6%,B组为16.4%,C组为28.2%,C组疼痛发生率明显高于A、B组(P<0.05);C组疼痛评分明显高于A、B组(P<0.05);1年后A组治愈率为91.2%,B组为90.0%,C组为79.1%,C组明显低于A、B组(P<0.05);A、B组比较,差异无统计学意义(P>0.05)。结论在同等的操作条件下Vitapex糊剂、Cortisomol糊剂比碘仿氧化锌丁香油糊剂有更好的疗效,是较为理想的根充材料。     

Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial

IntroductionThe incidence of immediate postobturation pain associated with 2 sealer techniques was compared and potential prognostic factors identified.MethodsPatients referred for endodontic treatment were recruited with informed consent. Root canals were debrided and teeth rendered asymptomatic before random allocation to receive TotalFill BC (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) or AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland). Patients blinded to the sealer reported their postobturation pain experience 1, 3, and 7 days after treatment. Blinded and calibrated assessors independently reviewed treatment quality, sealer extrusion, and radiographic data under standardized conditions.ResultsOne hundred sixty eligible patients (163 teeth, 95.3%) returned their pain diary. No postobturation pain difference was found between the 2 sealers (P > .05), although the AH Plus sealer technique was significantly associated with extrusion beyond the apex (P < .05; odds ratio [OR] = 3.02; 95% confidence interval [CI], 1.39–6.57). Thirty-three (20.6%) patients reported pain on day 1 (median 1 = very mild pain), 16 (10.0%) on day 3 (median 1 = very mild pain), and 9 (5.6%) on day 7 (median 2 = mild pain). The prognostic factors were as follows:(1) moderate/severe preoperative pain (OR = 4.41; 95% CI, 1.42–13.76 on day 3 and OR = 5.16; 95% CI, 1.17–22.78 on day 7),(2) provoked preoperative pain (OR = 4.24; 95% CI, 1.40–12.78 on day 3 and OR = 5.35; 95% CI, 1.27–22.51 on day 7),(3) pulpless tooth (OR = 0.11; 95% CI, 0.02–0.57 on day 3), and(4) sonic activation during treatment (OR = 3.02; 95% CI, 1.39–6.57 on day 1 and OR = 3.01; 95% CI, 1.05–8.59 on day 3).ConclusionsThere was no significant difference in pain experience between teeth filled using AH Plus or TotalFill BC Sealer 1, 3, and 7 days after obturation. Patient- and treatment-related factors could influence postobturation pain.     

A Novel Polyurethane Expandable Root Canal Sealer

IntroductionEndodontic sealers play a vital role in the obturation of root canal space. The aim of this study was to evaluate the utility of a recently developed polyurethane expandable sealer (PES), along with its cytotoxicity and dimensional changes.MethodsL929 fibroblasts and an cell viability assay (MTS assay) were used to determine the cytotoxicity of dental sealers (AH Plus [Dentsply Maillefer, Ballaigues, Switzerland], Sure-Seal Root [Sure Dent Corporation, Gyeonggi-do, South Korea], and the PES) at 24, 48, 72, and 96 hours. An advanced choroidal neovascularization model was used to assess the effect of these sealers on angiogenesis. Thirty-six extracted single-rooted human teeth were prepared and randomly divided into 3 groups (n = 12). Obturation was performed with gutta-percha and a sealer using lateral compaction as follows: group 1, AH Plus; group 2, Sure-Seal; and group 3, PES. The average depth of sealer penetration into dentinal tubules was measured with a scanning electron microscope. Data were analyzed using 1-way analysis of variance and post hoc Tukey tests (level of significance, P < .05).ResultsThe values of MTS, choroidal neovascularization, and the penetration depth of PES were significantly higher than in other experimental groups (P < .05). The lowest values were noted in specimens of AH Plus, whereas the highest were detected in the PES group.ConclusionsPES showed promising results in terms of biocompatibility and dentinal tubule adaptation and penetration.     

Drug-Silica Coassembled Particles Improve Antimicrobial Properties of Endodontic Sealers

IntroductionThe purpose of this study was to assess the antimicrobial activity and flow of root canal sealers after incorporating novel highly loaded antimicrobial drug-silica coassembled particles (DSPs).MethodsDSPs were synthesized through coassembly of silica and octenidine dihydrochloride (OCT) antimicrobial surfactant. DSPs were loaded (1% and 2% wt) into epoxy resin sealer (AH Plus [AH]; Dentsply DeTrey GmbH, Konstanz, Germany) or calcium silicate–based sealer (EndoSequence Bioceramic Sealer (BC); Brasseler, Savannah, GA). OCT release from DSP-modified sealers was determined using liquid chromatography. Antimicrobial activity of sealers against planktonic or biofilm form Enterococcus faecalis was assessed using direct contact and membrane restricted tests. Sealer flow was tested according to ISO6876:2012.ResultsOCT release from BC + 1% or 2% DSPs was above the minimum inhibitory concentration following 2 days throughout the 30-day experiment, whereas OCT release from AH + 1% or 2% DSP was significantly below the minimum inhibitory concentration against E. faecalis (4 μg/mL) over the whole 30-day experimental period. All materials (with or without DSPs) killed planktonic bacteria initially. AH ± 1% or 2% DSPs had no antimicrobial activity after 7 days. BC + 1% or 2% DSPs maintained antibacterial activity over the 30-day period. Both modified and unmodified sealers completely inhibited the growth of E. faecalis biofilms after 24 hours of contact. DSPs decreased the flow of AH and BC sealers; for AH, the reduction was proportional to the amount of DSPs added. All modified and unmodified sealers, except for AH + 2% DSPs, were within the acceptable limits of ISO 6876 flow tests.ConclusionsDSPs enhanced the antimicrobial performance of BC but not AH, whereas the material’s flow remained compliant with ISO 6876 standards. Depending on the sealer, DSPs may enhance antimicrobial efficacy in root canal treatment and potentially improve treatment outcome.     

Antimicrobial and physicochemical characterization of endodontic sealers after exposure to chlorhexidine digluconate

ObjectivesAssess the antibacterial, physical and chemical properties of AH Plus, BioRoot RCS and Pulp Canal Sealer (PCS) in contact with 2% chlorhexidine digluconate (CHX) used as final irrigant prior to root canal obturation.MethodsThe antimicrobial properties were investigated by direct contact tests for planktonic and biofilm growth of E. faecalis, S. mutans, S.epidermidis and S.aureus in vitro. The setting time, wettability, microhardness and surface roughness were also assessed. The sealers were studied in no contact, 1-minute (short-term) and continuous contact (long-term) with CHX. Chemical characterization of sealers was performed by scanning electron microscopy, X-ray diffraction analysis and Fourier-transform infrared spectroscopy after CHX or saline used as the last irrigant in an ex vivo tooth model and in endo training blocks.ResultsCHX increased the antibacterial activity of all the sealers investigated against planktonic bacteria and biofilms with PCS exerting the highest antimicrobial activity with and without the presence of CHX. The setting of AH Plus and BioRoot RCS was retarded, while for PCS accelerated in the presence of CHX. AH Plus and PCS were more hydrophilic after contact with CHX, whilst BioRoot RCS was hydrophobic in a time-dependent manner. The microhardness of sealers was compromised and the surface roughness increased after CHX exposure for AH Plus and BioRoot RCS, and decreased for PCS. CHX did not affect the sealers’ chemistry, but PCS that exhibited two extra phases.SignificanceCHX improved the antibacterial efficacy of endodontic sealers but further evidence is needed to confirm its suitability as a final irrigant prior to root canal obturation.     

Synthesis of sol–gel derived calcium silicate particles and development of a bioactive endodontic cement

ObjectiveThe aim of this study is to produce sol-gel derived calcium silicate particles (CS) and evaluate the influence of different concentration of calcium tungstate in the physical, chemical, mechanical and biological properties of developed cements.MethodsSol-gel route were used to synthesize calcium silicate particles that were characterized with x-ray difraction, Fourier transformed infrared spectroscopy, scanning electron microscopy, laser diffraction and nitrogen absorption. Cements were formulated with the addition of different concentrations of calcium tungstate (CaWO₄), resulting in four experimental groups according to the CS:CaWO₄ ratio: CS₁₀₀ (100:0), CS₉₀ (90:10), CS₈₀ (80:20), CS₇₀ (70:30). The setting time, radiopacity, compressive strength, pH, calcium release, cell proliferation and cell differentiation were used to characterize the cements.ResultsCS particles were succesfully sinthesized. The addition of CaWO₄ increased the radiopacity and did not influenced the setting time and the mechanical properties of cements. The pH of distilled water was increased for all groups and the CS₁₀₀ and CS₉₀ groups presented incresed calcium release. Reduced cell viability was found for CS₇₀ while CS₁₀₀ and CS₉₀ presented higher ALP activity and % of mineralized nodules after 21 days.SignificanceSol-gel derived CS particles were sucssfully developed with potential to applied for the production of bioactive ceramic cements. The addition of 10% of CaWO₄ resulted in cements with adequate properties and bioactivity being an alternative for regenerative endodontic treatments.     

热牙胶温度对AH-Plus根管糊剂所产生根尖微渗漏的影响研究

目的：分析温度对AH-Plus糊剂临床疗效的影响,为一次性根管治疗术中对温度的控制提供临床依据。方法：将48颗牙编号,按随机数字表法分为3组,采用AH-Plus糊剂在不同温度下对离体牙根管进行填充,使用染料渗入法检测微渗漏发生情况,用扫描电镜观察根管壁与封闭剂之间的结合情况。结果：1)在冠方微渗漏方面,不同温度下冠方微渗漏值均没有显著差异(P>0.05);2)在根尖微渗漏方面,C组(230℃)的根尖微渗漏显著小于A(150℃)、B组(180℃)(P<0.05),A、B两组的根尖微渗漏比较没有显著差异(P>0.05);3)扫描电镜对根尖区观察结果显示A组(150℃)的根管壁与牙胶之间缝隙明显大于B、C组。结论：在采用AH-PLUS热牙胶垂直加压技术充填根管时,设定热牙胶温度可能对根尖微渗漏产生影响,较高温度组(230℃)产生的根尖微渗漏小于较低温度组,冠方微渗漏无显著差异。     

Comparison of Biocompatibility of Calcium Silicate-Based Sealers and Epoxy Resin-Based Sealer on Human Periodontal Ligament Stem Cells

The aim of this study was to evaluate the biocompatibility of calcium silicate-based sealers (CeraSeal and EndoSeal TCS) and epoxy resin-based sealer (AH-Plus) in terms of cell viability, inflammatory response, expression of mesenchymal phenotype, osteogenic potential, cell attachment, and morphology, of human periodontal ligament stem cells (hPDLSCs). hPDLSCs were acquired from the premolars (n = 4) of four subjects, whose ages extended from 16 to 24 years of age. Flow cytometry analysis showed stemness of hPDLSCs was maintained in all materials. In cell viability test, AH-Plus showed the lowest cell viability, and CeraSeal showed significantly higher cell viability than others. In ELISA test, AH-Plus showed higher expression of IL-6 and IL-8 than calcium silicate-based sealers. In an osteogenic potential test, AH-Plus showed a lower expression level than other material; however, EndoSeal TCS showed a better expression level than others. All experiments were repeated at least three times per cell line. Scanning electronic microscopy studies showed low degree of cell proliferation on AH-Plus, and high degree of cell proliferation on calcium silicate-based sealers. In this study, calcium silicate-based sealers appear to be more biocompatible and less cytotoxic than epoxy-resin based sealers.