Gambarini G, Di Nardo D, Miccoli G, Guerra F, Di Giorgio R, Di Giorgio G, Glassman G, Piasecki L, Testarelli L
Department of Oral and Maxillo Facial Sciences, Sapienza University of Rome, Rome.
University of Toronto, Faculty of Dentistry, Graduate Department of Endodontics, Canada.
Clin Ter. 2017 Jan-Feb;168(1):e23-e27. doi: 10.7417/CT.2017.1977.
Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain.
100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test.
For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique.
Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation.
以往研究表明,操作动作在确定根尖部碎屑挤出方面起着重要作用。因此,有人提出了一种新的临床操作方法(MIMERACI)。其基本理念是缓慢推进(每次推进1毫米),每推进1毫米后,将器械从根管中取出,清理器械的凹槽并进行冲洗。本研究的目的是证明MIMERACI技术的临床应用是否会影响术后疼痛。
选择100颗需要进行根管治疗的牙齿用于本研究,并根据牙齿解剖结构、术前症状和活力、根尖周病变的有无,将其分为两个相似的组。所有牙齿均由同一名操作人员使用相同的镍钛器械进行预备、清理和充填。两组之间唯一的区别在于器械操作技术:传统技术(A组)与MIMERACI技术(B组)。治疗后3天对术后疼痛进行评估。使用先前研究中验证过的视觉模拟评分法(VAS)记录疼痛的有无及程度。收集的数据采用单因素方差分析和事后Tukey检验进行统计学分析。
对于VAS疼痛评分,MIMERACI技术的结果明显优于A组(p = 0.031)。总体而言,症状的发生率和严重程度均显著更低。有3例患者出现了疼痛加剧,但采用MIMERACI技术治疗的患者中无一例出现。
由于挤出的碎屑会引发更多的术后疼痛,使用MIMERACI技术获得的结果可能是由于多种因素:更好的机械清理、更少的碎屑产生以及器械操作过程中更有效的冲洗。