氢氧化钙封闭剂治疗慢性根尖周病临床疗效评价

目的观察氢氧化钙根管封闭剂治疗慢性根尖周病患牙的两年临床疗效。方法将100例慢性根尖周炎的单根患牙按分层随机法分为两组，每组50例。对第1组患牙使用氢氧化钙根管封闭剂（Sealapex，试验组），第2组采用氧化锌丁香油根管封闭剂（ZOE，对照组），两组患者根管治疗的方法和步骤相同。利用根尖片标准化拍摄技术，将数字减影技术（digital subtraction subtraction radiography，DSR）及根尖周指数（periapical index，PAI）评分方法作为疗效评价手段，追踪两年，观察氢氧化钙封闭剂治疗慢性根尖周病的临床疗效，并对两种评价方法的可行性和相关性进行初步探索。结果试验组与对照组相比，治疗后3个月和两年两组患牙的相对修复骨量和临床有效率差异无统计学意义（P值分别为0．206、0．776）。试验组两年临床有效率为83．7％（PAI）～90．6％（DSR），痊愈率为58％（PAI）。DSR方法比PAI对于病变区骨质变化更敏感，可以较早发现骨的变化。PAI和DSR两种方法间存在相关性（P〈0．01，γ=0．58）。结论提示氢氧化钙根管封闭剂可以获得较好的临床疗效，与ZOE对照组相比，试验组两年临床疗效差异无统计学意义。DSR与PAI临床应用均具有可行性，可以将两种评价方法结合，进行根尖周病疗效分析。

Clinical effects of calcium hydroxide-based sealer on chronic apical periodontitis

OBJECTIVE: To evaluate the results of calcium hydroxide-based sealer Sealapex in the treatment of chronic apical periodontitis. METHODS: A total of 100 cases with chronic apical periodontitis were included and divided into two groups, calcium hydroxide sealer (Sealapex) group and ZOE sealer group, and Sealapex and ZOE sealer were respectively used. All cases were followed up for two years after treatment and the clinical results compared between the two groups. The evaluation was based on clinical examination and radiographic assessment using periapical index (PAI) and digital subtraction radiography (DSR) technique. RESULTS: There was no significant difference between the ZOE group and Sealapex group in overall healing rates and mean quantitative analysis at 3 months and 2 years after treatment (P = 0.206, 0.776). A correlation was found between PAI and DSR (P < 0.01, gamma = 0.58). CONCLUSIONS: Sealapex sealer could obtain satisfactory effects for the treatment of chronic apical periodontitis. The combination of DSR and PAI methods was able to monitor the radiographic bone changes of periapical disease.