Comparison of the Effects of Four Methods on the Removal of Calcium Hydroxide Paste in Root Canals by Three-dimensional Reconstruction of Mimics Software
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摘要:
目的 比较4种方法对根管内氢氧化钙糊剂的清除效果。 方法 将40个45°单弯树脂根管随机分成4组，进行根管预备后用玻璃离子水门汀封闭根尖孔，在根管内填充氢氧化钙糊剂，硬蜡封闭根管口。37˚C恒温水浴放置14 d后，分别使用针头冲洗法、Er: YAG激光荡洗法、EDDY工作尖荡洗法和超声荡洗法4种方式消除根管内氢氧化钙糊剂。利用锥形束CT对氢氧化钙清除前后的树脂根管进行扫描，将扫描结果导入Mimics软件，通过Mimics软件对每个根管进行三维重建，并计算各根管内的氢氧化钙体积。氢氧化钙清除前体积为V1，清除后体积为V2，清除率 = （V1-V2）/V1×100%。使用秩和检验进行统计学分析。 结果 清除前各组氢氧化钙糊剂的初始体积差异无统计学意义（P > 0.05）。清除后Er: YAG激光组氢氧化钙糊剂剩余体积为0.1296（0.0920,0.1743） mm³，小于其他3组，差异有统计学意义（P < 0.05），氢氧化钙糊剂清除率为99.63%（99.53%，99.70%），高于其他3组，差异有统计学意义（P < 0.05）。EDDY组和超声荡洗组的清除率分别是99.08%（98.85%，99.19%）和99.04%（98.51%，99.15%），二者差异无统计学意义（P > 0.05），但均高于针头冲洗组74.99%（64.43%，88.07%），差异有统计学意义（P < 0.05）。 结论 Er：YAG激光荡洗、EDDY荡洗、超声荡洗对根管内氢氧化钙糊剂的清除效果均优于针头冲洗法。其中，Er：YAG激光荡洗清除效率最高，EDDY荡洗和超声荡洗的清除效果接近，但4种方法均无法完全清除弯曲根管内的氢氧化钙糊剂。 Abstract:Objective To compare the efficacy of four methods on removal of calcium hydroxide in root canals. Methods Forty simulated resin root canals with 45° curvature were randomly divided into four groups. After root canal preparation, the apical foramen were sealed with glass-ionomer cement, the root canals were filled with calcium hydroxide, and the root canal orifices were sealed with hard wax. After being placed in a constant temperature water bath at 37 ℃ for 14 days, four methods including needle irrigation, Er: YAG laser irrigation, EDDY working tip irrigation and ultrasonic irrigation were used to remove the calcium hydroxide. The resin root canals before and after calcium hydroxide removal were scanned by cone-beam CT, and the scanning results were imported into Mimics software. Three-dimensional reconstruction of each root canal was performed by Mimics software, and the volume of calcium hydroxide in each root canal was calculated. The volume of calcium hydroxide was V1 before removal and V2 after removal, and the clearance rate was （V1-V2）/V1 * 100%. Rank sum test was used for statistical analysis. Results There was no significant difference in the initial volume of calcium hydroxide paste among the groups before removal （P > 0.05）. After removal, the residual volume of calcium hydroxide paste in Er: YAG laser group was 0.1296 （0.0920, 0.1743） mm3, which was less than the other three groups, and the difference was statistically significant （P < 0.05）. The reduction rate of calcium hydroxide paste was 99.63 % （99.53%, 99.70%） in Er: YAG laser group, which was higher than the other three groups, and the difference was statistically significant （P < 0.05）. The reduction rates of EDDY group and ultrasonic group were 99.08% （98.85%, 99.19%） and 99.04% （98.51%, 99.15%）, respectively. There was no significant difference between the two groups （P > 0.05）, but they were higher than needle group 74.99% （64.43%, 88.07%） （P < 0.05）, and the difference was statistically significant. Conclusions In this study, Er: YAG laser-activated irrigation, EDDY irrigation and ultrasonic irrigation have better removal effects on calcium hydroxide paste in root canals than traditional needle irrigation. Compared with other four methods, Er: YAG laser-activated irrigation has the highest removal efficiency, EDDY irrigation and ultrasonic irrigation have similar removal efficiency, but none of the four methods could completely remove calcium hydroxide paste from the curved root canals. -
图 1 4种方法清除弯曲根管内氢氧化钙的三维重建图
注：a～d：氢氧化钙清除前图像；e～h：氢氧化钙清除后图像; a、e：针头冲洗组（A组）；b、f：Er：YAG激光荡洗组（B组）；c、g：EDDY荡洗组（C组）；d、h：超声荡洗组（D组）
Figure 1. Three-dimensional reconstruction of calcium hydroxide removal in curved root canals by four methods
图 2 4种方法对氢氧化钙糊剂的清除情况
*P < 0.05。
Figure 2. Removal of of calcium hydroxide by four methods
表 1 4组清除前后体积对比（mm3） [n = 10，M（P25，P75）]
Table 1. Volume comparison of four groups before and after removal （mm3） [n = 10，M（P25，P75）]
体积 A组 B组 C组 D组 H P V1 37.8930（35.0619，39.8430） 35.6483（30.3059，38.4624） 35.7387（31.7397，37.5094） 35.4451（31.7987，36.8102） 5.283 0.152 V2 9.1759（4.3191，12.6670） 0.1296（0.0920，0.1743） 0.3216（0.2644，0.4176） 0.3392（0.2939，0.4784）
32.830
< 0.001*Z −3.780 −3.780 −3.780 −3.780 P < 0.001* < 0.001* < 0.001* < 0.001* *P < 0.05。 
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表 2 4种方法对氢氧化钙糊剂的清除情况[n = 10，M（P25，P75）]
Table 2. Removal of calcium hydroxide by four methods [n = 10，M（P25，P75）]
分组 剩余氢氧化钙体积（mm） 氢氧化钙清除率（%） A组 9.1759（4.3191，12.6670） 74.99（64.43，88.07） B组 0.1296（0.0920，0.1743） 99.63（99.53，99.70） C组 0.3216（0.2644，0.4176） 99.08（98.85，99.19） D组 0.3392（0.2939，0.4784） 99.04（98.51，99.15） H 32.830 33.045 P < 0.001* < 0.001* *P < 0.05。
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