Kováč Ján, Kováč Daniel
Klinika stomatólgie a maxilofacilnej chirurgie LFUK a OÚSA Bratislava, Slovenská republika.
Epidemiol Mikrobiol Imunol. 2012 Dec;61(4):87-97.
The primary goal of endodontic therapy is the reduction or elimination of microorganisms and their by-products from the root canal system. Although a number of instrumentation and irrigation techniques exist, debris is often left behind in the root canal system and proper canal cleaning, shaping, and irrigation are needed to reduce significantly or sometimes even eliminate microorganisms from the canals. Residual microbes in the root canal system are the primary cause of post-treatment apical periodontitis that may persist in both poorly and properly treated cases. Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system to the periapical tissue. It results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. When the root canal treatment is carried out properly, healing of the periapical lesion usually follows, with bone regeneration. In certain cases, post-treatment apical periodontitis still persists, the condition being commonly referred to as endodontic failure. It is widely acknowledged that such post-treatment apical periodontitis occurs when root canal treatment has not adequately controlled and eliminated the infection. However, complete elimination of microorganisms is not always achieved in clinical practice due to the anatomical complexities of root canals and consequent limitations in access by instruments and irrigants. The use of antimicrobial medication has been advocated to disinfect the root canal system. The recovery of Candida albicans and Enterococcus faecalis is common after failed root canal treatment. Therefore, when testing different antimicrobial agents for efficacy in endodontic treatment, 100% inhibition of the growth of the two microorganisms is required. The purpose of this article is to assess the antimicrobial action of intracanal medicaments and relevance of the root canal irrigation in endodontic therapy of devitalized teeth.
牙髓治疗的主要目标是减少或消除根管系统中的微生物及其副产物。尽管存在多种根管预备和冲洗技术，但根管系统中常常会残留碎屑，因此需要进行适当的根管清理、塑形和冲洗，以显著减少甚至有时消除根管内的微生物。根管系统中残留的微生物是治疗后根尖周炎的主要原因，无论治疗效果好坏，这种炎症都可能持续存在。根尖周炎是牙髓感染的后遗症，表现为机体对根管系统中微生物向根尖周组织发起的挑战所产生的防御反应。它会导致局部炎症、硬组织吸收、其他根尖周组织破坏，最终形成各种组织病理学类型的根尖周炎，通常称为根尖周病变。当根管治疗操作得当，根尖周病变通常会随之愈合，并伴有骨再生。在某些情况下，治疗后根尖周炎仍然持续存在，这种情况通常称为牙髓治疗失败。人们普遍认为，当根管治疗未能充分控制和消除感染时，就会发生这种治疗后根尖周炎。然而，由于根管解剖结构复杂，器械和冲洗液难以完全到达，在临床实践中并不总能完全消除微生物。有人主张使用抗菌药物对根管系统进行消毒。根管治疗失败后，白色念珠菌和粪肠球菌的检出很常见。因此，在测试不同抗菌剂在牙髓治疗中的疗效时，需要对这两种微生物的生长有100%的抑制作用。本文的目的是评估根管内药物的抗菌作用以及根管冲洗在死髓牙牙髓治疗中的相关性。
