- 學位論文
不同逆充填材料與處理方式對根尖封閉性之影響
Comparison of Sealing Ability among Different Root End Filling Materials and Different Mixing Methods
摘要
中文摘要 根尖封閉性是影響手術性根管治療成功與否最重要的因素。自1993年MTA被引進根管治療領域，成為最貼近理想的材料之一，2004年學者Stowe探討MTA和0.12﹪chlorhexidine gluconate (CHX)調拌混合的抗菌能力，顯著優於MTA和無菌水混合組。若MTA和CHX混合調拌具有較優良之抗菌能力，將可避免細菌在材料硬化前污染逆充填製備之空間，因此，本實驗即探討以CHX代替無菌水是否影響ProRoot MTA®之根尖逆充填封閉性，並和玻璃離子體黏合劑與不施行根尖逆充填的組別做比較，以期日後探尋ProRoot® MTA與CHX調拌混合，在臨床運用之可行性。本實驗包含四個實驗組，每組20個人類單根管牙齒做為樣本，在利用GT鎳-鈦旋轉器械（System GT®）以冠端向下法（crown–down technique）對根管加以修形後，將牙齒隨機分為MTA、MTAⅡ、GIC、GP四組，其中MTA、MTAⅡ、GIC三組施行根尖切除、根尖逆修形與逆充填，GP組於根管充填與釘柱製備後，施行根尖切除術，但是不作逆充填。本實驗使用三種逆充填之材料，分別為:MTA組 MTA和無菌水、MTAⅡ組 MTA和CHX、GIC組 Ketac® Silver。根尖滲漏採用液體過濾測定法，分別於逆充填完成後之第一週和第一、二、三個月進行測量，並將結果以統計軟體加以分析。經過X2 testing for trend分析後顯示，同種材料在三個月測量期間的根尖滲漏比較，並沒有達到顯著之差異性。經調整根尖封閉材料的影響後，時間對於根尖封閉性仍然是沒有達到顯著之差異性(P=0.7391)。而在四個測量時間點的不同材料間則具有顯著之差異性，經Bonferroni adjustment進一步探討組間之差異性，第一週之組間差異在GIC與MTA(P=0.0014)、GIC和MTAⅡ (P=0.0001)，第一、二、三個月則在GP與MTA、MTAⅡ組和GIC與MTA、MTAⅡ組之間有統計學上的差異性(P<0.0001)。經調整時間因素的影響後，四種逆充填材料在根尖封閉性方面仍具有顯著之差異性(P<0.0001)。由以上結果可得到結論:以0.12﹪chlorhexidine gluconate或無菌水與ProRoot® MTA混合調拌，其根尖封閉性並無顯著差異。MTA和無菌水或CHX調拌作為逆充填材料的根尖封閉性，顯著優於Ketac® Silver和不作逆充填只以馬來膠根管充填的封閉性。同種逆充填材料在三個月觀察期間，其根尖封閉性並未達顯著差異。
並列摘要
Abstract The apical seal is the most important factor in achieving success in surgical endodontics. In 1993, Mineral trioxide aggregate (MTA) was introduced to endodontics and has been used as an ideal root end filling material. Stowe et al. reported that substituting 0.12% chlorhexidine gluconate (CHX) for water enhanced the antimicrobial activity of tooth-colored ProRoot® MTA.The purpose of this study was to determine whether the substitution of 0.12% CHX for sterile water as a mixing agent would influence the sealing ability of ProRoot® MTA. Another purpose was to compare the sealing ability of different root end filling materials. Eighty single-root human teeth were randomly divided into four groups which were MTA, MTAII, GIC and GP after root canal preparation with crown-down technique by System GT® rotary files. After each root apex of MTA, MTAII, GIC groups was resected , root end preparation and filling were done. The teeth of GP group were filled with GP and Kerr sealer and finished post space preparation. Then, root end resection was performed without retrograde filling. There were three root end filling materials in our study. They were MTA which were mixed with sterile water, MTAII which used 0.12% CHX as a mixing agent, and Ketac® Silver. Fluid filtration model was used to measure the apical leakage at the 1st week, 1st month, 2nd month and 3rd month. There was no significant difference during the interval of 3 months in the same group. However, there was significant difference among four materials in different time interval. Statistical analysis of the data after adjusting by Bonferroni adjustment indicated that apical leakage in the MTA group (P=0.0014) as well as MTAII group (P=0.0001) were significantly less than GIC group at 1st week. We also found that apical leakage in the MTA group and MTAII group (P=0.0001) were significantly less than GIC group and GP group at the 1st, 2rd and 3nd month. After adjusting the factor of time, there was significant difference among four root end filling materials (p<0.0001). In conclusion, there was no significant difference of apical leakage between MTA group which were mixed with sterile water and MTAII which used 0.12% CHX as a mixing agent. The apical leakage of MTA groupand MTAII group were significantly less than GIC group and GP group. At the same group , there was no significant difference of apical leakage in different time interval.