EDTA對旋轉鎳鈦銼針切削牙齒根管後形成薄膜層的移除效果

Cleaning Effect of EDTA on Smear Layer Removal after Rotary Nickel-titanium Instrumentation of a Root Canal

陳錦(Kam Chan)

《中華牙醫學雜誌》 23卷2期 (2004/04) Pp. 130-138

https://doi.org/10.7105/CDJ.200404.0130

摘要

在根管治療過程中，根管壁經銼針清創擴大形成的薄膜層，不僅細菌繁衍滋生，更影響根管充填緊密度，增加滲漏的機會。近年來，旋轉鎳鈦銼針的修形方式普遍在臨床上應用，其器械設計及切削方式與傳統銼針不同。因此，旋轉鎳鈦銼針修形後根管壁牙本質所形成薄膜層的移除應重新瞭解與探討。本實驗主要使用三種含EDTA的鈣化物螫合劑RC-Prep、Glyde，及File-Eze，在旋轉鎳鈦器械根管修形過程中配合清創步驟，比較其對薄膜層移除的效果。總數40顆的單根管牙齒經髓腔開擴，牙髓移除及工作長度計量後，以隨機抽樣方式分為4組，分別使用RC-Prep、Glyde及File-Eze等EDTA製劑伴隨旋轉鎳鈦銼針完成根管修形至6.0％錐度及根尖直徑25號等步驟。修形過程合併使用生理鹽水及5.25％ NaOC1溶液作根管沖洗。控制組同樣使用旋轉鎳鈦銼針將根管擴大，但是不使用EDTA處理。所有牙齒擴大修形完成後，隨即將牙齒縱裂成為二，兩邊分別對等畫分牙冠，中間，根尖三等分。並以SEM觀察根管壁之碎屑殘留的多少，據此判別三種EDTA鈣化物螫合劑對經過旋轉鎳鈦銼針切削的根管管壁牙本質形成薄膜層的移除與清潔的功效。SEM觀察的結果發現三種EDTA製劑都有薄膜層移除的效果，其中以File-Eze及Glyde較好，依照牙冠，中間，根尖三區域的清潔效果都比不使用EDTA的好；而且在牙冠與中間區域的清潔效果也較根尖明顯，移除薄膜層50％以上的情形約76.6％與68.5％；可是三種EDTA並未發現有100％完全清潔的效力。

關鍵字

薄膜層 ； 旋轉鎳鈦銼針修形 ； 鈣化物螫合劑 ； EDTA製劑

並列摘要

Mechanical instrumentation of a root canal leaves organic and inorganic substances that accumulate into smear layer on the dentinal wall. The most popular chelating agent to remove the smear layer is EDTA, a clear solution of the sodium salt of ethylenediamine tetraacetic acid with a pH of 7.3, first ultilized by Nygaard-Ostby in 1957. Rotary nickel-titanium instrumentation techniques have lately been introduced into endodontics and have become popular in clinical use. It was the aim of the present investigation to compare 3 chelating agents with different compositions in canal preparation using rotary nickel-titanium instruments. In total, 40 single root canal teeth were collected. They were accessed, the working length measured, and the canal shaped and cleaned using a K3 nickel-titanium instrument combined with 5.25% NaOCl and physiological saline irrigation. All samples were randomly divided into 4 groups and treated with different EDTA solutions, respectively. The teeth were then split along the long axis and the buccolingual direction. The separated fragments were sectioned equally into coronal, middle, and apical parts and examined with scanning electronic microscopy to verify the cleanliness. Records were statistically analyzed using the Wilcoxon-Mann-Whitney test and the Kruskal-Wallis test. Results showed that no complete canal cleanliness was found. In the coronal and middle parts of the root canals, the 50% cleaning ability of Glyde and File-Eze were 76.6% and 68.5% that were significant better than RC-Prep; in the apical third no differences were found.

並列關鍵字

smear layter ； rotary nickel-titanium instrumentation ； chelating agent ； EDTA