氢氧化钙糊剂联合根管治疗牙髓炎或根尖炎的效果观察

氢氧化钙糊剂联合根管治疗牙髓炎或根尖炎的效果观察

孟娜 姜梅荣

聊城市东昌府区中医院口腔科 山东聊城 252000

摘要：目的观察氢氧化钙糊剂联合根管治疗术治疗牙髓炎或根尖炎的临床疗效。方法选取2018年7月一2021年6月在我院诊治的200例牙髓炎或根尖炎患者为研究对象，采用随机数字表法分为对照组和观察组，各100例。对照组采用氢氧化锌碘仿糊剂联合根管治疗，观察组采用氢氧化钙糊剂联合根管治疗，比较两组临床治疗总有效率、疼痛(VAS)评分、填充时间、牙周指数。结果观察组治疗总有效率为92％，高于对照组的82％(p<0．05)；观察组疼痛评分和填充时间低于对照组(p<0．05)，观察组茵斑指数、探诊后出血指数、牙周袋探诊深度、牙龈指数均低于对照组(P<0．05)。结论 氢氧化钙糊剂联合根管治疗术治疗牙髓炎或根尖炎效果确切，可提高总有效率，减轻疼痛度，改善牙周指数抑制炎症反应，是一种可行性强的治疗方案。

关键词：氢氧化钙糊剂；根管治疗；牙髓炎；根尖炎

Effect of calcium hydroxide paste combined with root canal in the treatment of pulpitis or apicitis

Gao cuicui1, Su HUI2, Yu Xiao3, Lu Qianqian 3

(1. Department of nutrition, Liaocheng people's Hospita; 2. Department of oncology, Liaocheng people's Hospital; 3. Department of radiotherapy, Liaocheng people's Hospital, Liaocheng, Shandong, 252000)

Abstract: Objective To observe the clinical effect of calcium hydroxide paste combined with root canal therapy in the treatment of pulpitis or apicitis. Methods 200 patients with pulpitis or apicitis treated in our hospital from July 2018 to June 2021 were selected as the research objects. They were randomly pided into control group and observation group, with 100 cases in each group. The control group was treated with zinc hydroxide iodoform paste combined with root canal therapy, and the observation group was treated with calcium hydroxide paste combined with root canal therapy. The total effective rate, pain (VAS) score, filling time and periodontal index of the two groups were compared. Results the total effective rate in the observation group was 92%, higher than 82% in the control group (P < 0.05); The pain score and filling time in the observation group were lower than those in the control group (P < 0.05). The plaque index, bleeding index after probing, probing depth of periodontal pocket and gingival index in the observation group were lower than those in the control group (P < 0.05). Conclusion calcium hydroxide paste combined with root canal therapy is effective in the treatment of pulpitis or apicitis. It can improve the total effective rate, reduce pain, improve periodontal index and inhibit inflammatory response. It is a feasible treatment scheme.

Key words: calcium hydroxide paste; Root canal therapy; Pulpitis; Apicitis

牙髓炎和根尖炎是临床常见的疾病，均为细菌感染牙髓所致。患者多伴有牙齿疼痛、咀嚼功能障碍，严重影响患者的日常生活[1, 2]。目前，根管治疗是急性和慢性牙髓炎及根尖炎的常规方法，其中根管消毒、根管填充是根管治疗过程中重要的环节，填充剂质量直接影响临床治疗效果，但是不同填充剂填充效果不同[3, 4]。只有选择生物相容性良好的填充材料，对根管进行严密填充，彻底消除死腔，封闭根尖孔，隔断根管与根尖周围组织，才能避免感染的复发，实现理想的治疗效果[5-7]。为了解氢氧化钙糊剂联合根管治疗术对牙髓炎或根尖炎的应用效果，本研究结合2018年7月一2021年6月在我院诊治的200例牙髓炎或根尖炎患者临床资料，观察氢氧化钙糊剂联合根管治疗术治疗牙髓炎或根尖炎的临床治疗效果，现报道如下。

1资料与方法

1．1一般资料 选取2018年7月一2021年6月在我院诊治的200例牙髓炎或根尖炎患者为研究对象，采用随机数字表法分为对照组和观察组，各100例。对照组男性56例，女性44例；年龄20—70岁，平均年龄(46．37±5．78)岁；其中牙髓炎58例，根尖炎43例。观察组男性57例，女性43例；年龄22—77岁，平均年龄(46.73±5.21)岁；牙髓炎55例，根尖炎45例。两组年龄、性别比较，差异无统计学意义(P＜0．05)，具有可比性。患者自愿参加本研究，并签署知情同意书。

1．2纳入和排除标准纳人标准：①符合临床牙髓炎或根尖炎诊断标准阿；②经X线检查确诊嘲；③患牙无间隙感染、无瘘道。排除标准：①合并重度牙髓炎；②根尖囊肿；③多脏器功能衰竭；④依从性较差，不能配合者。

1．3方法 对照组采用氢氧化锌碘仿糊剂联合根管治疗，具体方法：依据X线检查结果，选择合适的根管，局部麻醉，进行备洞、开髓、扩髓网，采用扩大针扩大根管，清除根管内、牙髓残留相关细胞坏死组织，并采用0．1％氯酸钠和0．9％氯化钠溶液清洗根管，最后试验一次性棉捻吸干根管内残留溶液。采用氢氧化锌碘仿糊剂进行封洞。观察组采用氢氧化钙糊剂联合根管治疗，操作方法同对照组，仅采用氢氧化钙糊剂进行封洞。两组患者均于1周后复查，若患者牙龈红肿完全消失、患牙炎症清除，不存在叩痛，对照组依据根管具体情况选择合适的主尖锉，在根管壁上涂一薄层封闭剂，然后导入氢氧化锌碘仿糊剂使根管填塞紧密，完成填充根管操作，观察组则导人氢氧化钙根管消毒糊剂完成填充。

1．4观察指标 比较两组临床治疗总有效率、疼痛(VAS)评分、填充时间、牙周指数。

（1）疗效标准 显效：X线检查可见牙根尖低密度影显著减小，无自发疼痛，咀嚼功能基本正常，牙龈无红肿，根管干燥无渗液；有效：x线可见低密度影有变化，封洞后有轻度疼痛，牙龈有轻微肿胀，根管内存在少量渗液；无效：以上指标均未达到，甚至有加重趋势，总有效率=(显效+有效)，总例数×100％。

（2）VAS评分 采用数字模拟分级VAS评分量表，评分范围0～10分，其中O～3分轻度疼痛、4～6分中度疼痛、6分以上重度疼痛。

（3）牙周指数包括菌斑指数、探诊后出血指数、牙周袋探诊深度、牙龈指数，均采用Liken 4级评分，分为正常、轻度、中度、重度，并依次记为0、1、2、3分，评分越低效果越佳。

1．5 统计学方法 采用统计软件包SPSS 21．0版本对本研究的数据进行处理，计量资料采用(x±s)表示，组间比较采用t检验；计数资料采用【n(％)】表示，组间比较采用X²检验；P<0．05说明差异有统计学意义。

2结果

2．1两组临床治疗疗效 比较观察组治疗总有效率为92%，高于对照组的82%，差异有统计学意义(P<0．05)，见表1。

表1 两组临床治疗疗效

2．2两组疼痛评分、填充时间 比较观察组疼痛评分低于对照组，差异有统计学意义(P<0．05)，两组填充时间与对照组比较，但差异无统计学意义(P<0．05)， 见表2。

表2 两组疼痛评分、填充时间

2．3两组牙周指数比较 观察组菌斑指数、探诊后出血指数、牙周袋探诊深度、牙龈指数均低于低于对照组，差异有统计学意义(P

表3 两组牙周指数比较

3讨论

研究显示[8, 9]，在根管治疗牙髓炎和根尖炎过程中，使用不同填充物临床治疗效果存在较大差异。如何科学合理选择填充物是临床根管治疗的关键。本研究选择的氢氧化钙糊剂具有良好水溶性，并且具有消毒作用，可降解细菌脂多糖，抑制牙齿的吸收，一定程度降低生物学效应[10, 11]。同时氢氧化钙糊剂具有较强的抗菌效果，在填充后可对根尖区细菌起到杀菌作用。此外，氢氧化钙糊剂容易形成硬组织屏障，可对牙齿、牙周发挥一定保护作用，但是具体应用于牙髓炎或根尖炎的临床疗效如何，尚未完全明确，需要临床大样本数据进一步证实[12, 13]。

本研究结果显示，观察组治疗总有效率为92％，高于对照组的82％(P<0．05)，提示氢氧化钙糊剂联合根管治疗可提高治疗效果，具有显著的应用优势，值得临床应用，该结论与研究学者的研究结果相似，分析认为氢氧化钙糊剂与根管联合治疗，在填充过程中可有效发挥杀菌作用，预防根管系统清除不彻底，导致的充填物感染，影响牙周愈合，进而有效提升了临床治疗疗效，促进了牙周愈合[14, 15]。同时研究结果发现，观察组疼痛评分低于对照组(P<0．05)，但两组填充时间与对照组比较，差异无统计学意义(P＞0．05)，表明采用根管和氢氧化钙糊剂联合治疗可降低疼痛评分，减轻患者痛苦，一定程度改善患者治疗耐受性，促进临床的顺利治疗，在填充时间方面无显著影响[16-18]。治疗后，观察组菌斑指数、探诊后出血指数、牙周袋探诊深度、牙龈指数均低于对照组(P

综上所述，氢氧化钙糊剂联合根管治疗术对治疗牙髓炎或根尖炎临床疗效具有积极的影响，可实现较好的疗效，且可改善牙周指数指标和疼痛评分。

References:

[1]. Hasegawa, T., et al., A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ? Osteoporos Int, 2017. 28(8): p. 2465-2473.

[2]. Lee, J., et al., Accelerated oral wound healing using a pre-vascularized mucosal cell sheet. Sci Rep, 2017. 7(1): p. 10667.

[3]. Gul, M., A. Gunay and A. Tanik, An evaluation of the effects of caffeic acid phenethyl ester and Ankaferd blood stopper on secondary wound healing of oral mucosal tissue. Turk J Med Sci, 2020. 50(1): p. 248-257.

[4]. Sethi, K.S. and C.P. Raut, Antimicrobial photodynamic therapy using indocyanine green as a photosensitizer in treatment of chronic periodontitis: A clinico-microbial study. Indian J Dent Res, 2019. 30(6): p. 870-876.

[5]. Shams, A., et al., Biomechanical behavior of endodontically treated premolar teeth restored with novel endocrown system: 3D Finite Element and Weibull analyses. J Mech Behav Biomed Mater, 2021. 124: p. 104853.

[6]. Nunez, J., et al., Cellular therapy in periodontal regeneration. Periodontol 2000, 2019. 79(1): p. 107-116.

[7]. Soares, L.G., E.B. Carvalho and E. Tinoco, Clinical effect of Lactobacillus on the treatment of severe periodontitis and halitosis: A double-blinded, placebo-controlled, randomized clinical trial. Am J Dent, 2019. 32(1): p. 9-13.

[8]. Xue, D., et al., Clinical efficacy of photodynamic therapy adjunctive to scaling and root planing in the treatment of chronic periodontitis: A systematic review and meta-analysis. Photodiagnosis Photodyn Ther, 2017. 18: p. 119-127.

[9]. Yan, Y., et al., Clinical evaluation of ultrasonic subgingival debridement versus ultrasonic subgingival scaling combined with manual root planing in the treatment of periodontitis: study protocol for a randomized controlled trial. Trials, 2020. 21(1): p. 113.

[10]. Sawaya, A.P., et al., Deregulated immune cell recruitment orchestrated by FOXM1 impairs human diabetic wound healing. Nat Commun, 2020. 11(1): p. 4678.

[11]. Reymus, M., et al., Development and evaluation of an interdisciplinary teaching model via 3D printing. Clin Exp Dent Res, 2021. 7(1): p. 3-10.

[12]. Al-Shammari, N.M., S.M. Shafshak and M.S. Ali, Effect of 0.8% Hyaluronic Acid in Conventional Treatment of Moderate to Severe Chronic Periodontitis. J Contemp Dent Pract, 2018. 19(5): p. 527-534.

[13]. Invernici, M.M., et al., Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol, 2018. 45(10): p. 1198-1210.

[14]. Kavaz, E., et al., Effects of Oral Propolis on Mucosal Wound Healing after Endoscopic Nasal Surgery in a Rabbit Model. Turk Arch Otorhinolaryngol, 2019. 57(2): p. 68-74.

[15]. Anusha, D., et al., Efficacy of a mouthwash containing essential oils and curcumin as an adjunct to nonsurgical periodontal therapy among rheumatoid arthritis patients with chronic periodontitis: A randomized controlled trial. Indian J Dent Res, 2019. 30(4): p. 506-511.

[16]. DesJardins-Park, H.E., et al., Endogenous Mechanisms of Craniomaxillofacial Repair: Toward Novel Regenerative Therapies. Front Oral Health, 2021. 2: p. 676258.

[17]. Shanmugam, D. and N. Dominic, Evaluation of Bovine-Derived Collagen Membrane in Oral Surgical Mucosal Defects. J Maxillofac Oral Surg, 2019. 18(3): p. 466-473.

[18]. Kumar, S., Evidence-Based Update on Diagnosis and Management of Gingivitis and Periodontitis. Dent Clin North Am, 2019. 63(1): p. 69-81.

[19]. Zhuang, R., et al., Exogenous hydrogen sulfide inhibits oral mucosal wound-induced macrophage activation via the NF-kappaB pathway. Oral Dis, 2018. 24(5): p. 793-801.

[20]. Sjoqvist, S., et al., Exosomes derived from clinical-grade oral mucosal epithelial cell sheets promote wound healing. J Extracell Vesicles, 2019. 8(1): p. 1565264.