螯合剂去除根管玷污层的作用及其影响因素

背景：根管玷污层可影响根管药物进行消毒,同时可降低充填材料与根管壁的密合性,还可使根尖微渗漏显著增加,造成根管治疗的失败,而能否有效去除玷污层是临床上成功进行根管治疗的前提和关键.目的：从螯合剂基本结构出发对其去除根管玷污层作用进行叙述,深入解析影响螯合剂去除玷污层效果的各种因素.方法：第一作者利用计算机检索 Medline数据库（1999年1月至2011年12月）,以“Chelating agent, smear layer, root canal irrigation, root canal preparation”为检索词进行文献初检,筛选后纳入50篇文章进行综述.结果与结论：影响玷污层去除的因素还有冲洗液的浓度、温度、冲洗量、作用时间、冲洗液的输送方式、与其他冲洗液的协同作用等,其中影响螯合剂去除玷污层的因素主要是冲洗时间和冲洗液的配伍问题,螯合剂对牙本质小管的侵蚀,作用时间越长对其破坏越大.超声的震荡方式也可以增强螯合剂的作用能力,更快的速度到达根尖区,其与次氯酸钠联合应用可提高效能,至于最佳组合仍有待进一步探讨。

Chelating agent effects on root canal smear layer removal and relevant impact factors

BACKGROUND： Presence of smear layer can reduce the efficiency of the root canal irrigants used for canal disinfection, simultaneously reduce the adhesion of the fil ing materials to the root canal wal , and increase the apical microleakage, leading to root canal treatment failure. Thus, the prerequisite for a clinical y successful root canal treatment is the effective removal of smear layers. OBJECTIVE： To assess the factors affecting the efficiency of chelating agents starting from its basic structure and action mechanism. METHODS： The first author searched Medline （1999-01/2011-12） with the key words of ＂chelating agent, smear layer, root canal irrigation, root canal preparation＂ for the initial retrieval of relevant articles. After reviewing and quality assessment, a total of 50 articles were included. RESULTS AND CONCLUSION： The factors affecting the efficiency of chelating agents for smear layer removal are as fol ows： the concentration of the fluid, volume used for irrigation, duration of irrigation, method of irrigation and other irrigating agents used in combination. Among these, time and the other irrigating agents used in combination are found to be the important factors affecting the efficiency with longer duration of irrigation responsible for the erosion of the dentin. Ultrasonic vibration is found to enhance the efficiency of chelating agent by al owing it to reach the apical third within the shortest duration. The combination of sodium hypochlorite and chelating agent is found to enhance the efficient smear layer removal although the best combination is yet to be determined.