【作者】 张艳；

【导师】 宋文斌；

【作者基本信息】 青岛大学 ， 口腔内科学（专业学位）， 2019， 硕士

【摘要】 目的:研究Er:YAG激光对弯曲根管内粪肠球菌的清除效果,探讨Er:YAG激光是否是一种简单有效的消毒方式,为临床工作中针对弯曲根管消毒方式的选择提供参考。方法:根据纳入与排除标准,选取含中度弯曲(10-20°)牙根的磨牙62颗,含重度弯曲(25-40°)牙根的磨牙62颗,总计124颗离体磨牙纳入实验,分别记为A、B组。所有离体牙常规开髓,复合树脂封闭非研究根管口及根尖孔,使用K锉将弯曲根管疏通至20#,TFA机用镍钛器械预备至25#,06锥度,高压蒸汽灭菌。将粪肠球菌标准菌株(Ef ATCC-29212)接种于弯曲根管内,培养4周,成功建立粪肠球菌感染弯曲根管模型。从A、B组中各随机抽取8个样本作为检测A、B组根管壁表面细菌数的参考线,将A、B组中的剩余样本随机分为5个子组(A1、A2、A3、A4、A5,B1、B2、B3、B4、B5,n=10),分别进行如下处理:A1、B1组:PIPS-Er:YAG激光+5.25%NaCIO;A2、B2组:超声荡洗+5.25%NaCIO;A3、B3组:PIPS-Er:YAG激光+NS;A4、B4组:根管冲洗器+5.25%NaCIO;A5、B5组:根管冲洗器+NS。处理结束后,从各子组中随机抽取2个用于扫描电镜观察,剩余8个用于检测根管壁表面的细菌数。最后采集各组样本处理后根管壁表面的细菌进行培养计数,参照基线样本计算各组的清除率,采用SPSS23软件包对数据进行统计分析,比较各组的细菌清除效果。结果:A组的清除率均高于B组的清除率;A、B组内两两比较,除1组和2组之间无统计学差异(P>0.05)外,其余各组差异显著,结果具有统计学意义(P<0.05)。扫描电镜结果显示,1、2组根管清理效果明显优于3、4、5组。结论:Er:YAG激光本身对粪肠球菌没有很强的杀菌效果,但它可以显著增强NaCIO对于粪肠球菌的杀菌效果,对于中、重度弯曲根管而言,Er:YAG激光和超声对于粪肠球菌的清除效果相当。更多还原

【Abstract】 Objective: To study the effect of the Er:YAG laser on the elimination of Enterococcus faecalis in curved root canals,to evaluate whether Er:YAG laser is a simple and effective disinfection method,aiming to provide a better strategy to choose irrigating methods for curved root canals in clinical work.Methods: According to the inclusion and exclusion criteria,62 moderately curved molars(10-20 °)and 62 severe curved molars(25-40 °)were selected,and a total of 124 extracted human molars were recorded as A and B groups.All teeth were routinely pulp-open,and composite resin was used to seal non-study the root canal orifice and the apical foramina.The curved root canal were enlarged with K-file to size 20,were shaped with TFA(Dentsply)to an apical size # 25,taper 06,Then all teeth were autoclaved at 121℃,1.5 MPa,for 15 min.The standard strain of Enterococcus faecalis(ATCC-29212)was inoculated into the curved root canal and cultured for 4 weeks to establish the curved root canal model of Enterococcus faecalis infection.Then eight samples were randomly selected from group A and group B,for bacteria base line on the surface of the root canal wall of group A and B.The remaining 100 samples were randomly divided into 5 groups(A1/A2/A3/A4/A5;B1/B2/B3/B4/B5;n=10)and treated as fallows:A1/B1:PIPS-Er:YAG laser+5.25%NaCIO;A2/B2:Passive Ultrasonic Irrigation+5.25%NaCIO;A3/B3: PIPS-Er:YAG laser +NS;A4/B4:Two-hole root canal washer +5.25%NaCIO;A5/B5:Two-hole root canal washer +NS.After the treatment,two samples were randomly selected from each subgroup for scanning electron microscope observation,and the remaining 8 were used to detect the number of bacteria on the surface of the root canal wall.Finally,the bacteria on the surface of root canal wall were collected and counted.The antimicrobial rate of each group was calculated by reference to the baseline samples.The data were statistically analyzed with SPSS23 software package to compare the bactericidal effect of each group.Results: The clearance rate of group A was higher than that of group B(p < 0.05);With the exception of 1 and 2(p(29)0.05),there was a significant difference between the other groups in comparison with each other,(p < 0.05).Scanning electron microscopy(SEM)revealed that the effect of root canal cleaning in group 1 and 2 was better than that in group 3;4 and 5.Conclusion: Er:YAG laser itself has no strong germicidal effect on Enterococcus faecalis,but it can significantly enhance the bactericidal effect of NaCIO on Enterococcus faecalis,and for moderate and severe curved root canals,Passive Ultrasonic Irrigation and PIPS-Er:YAG laser have the same effect on Enterococcus faecalis.更多还原