Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook mall, Vancouver, BC, Canada.
Synthetic Biology Group, MIT Synthetic Biology Center, Research Laboratory of Electronics, Department of Biological Engineering, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Clin Oral Investig. 2019 Feb;23(2):913-920. doi: 10.1007/s00784-018-2515-x. Epub 2018 Jun 15.
The purpose of this in vitro study was by using quantitative real-time PCR and culturing to determine the effectiveness of two irrigation and cleaning systems in removing multispecies oral biofilms from root canals.
Twenty extracted human molars were instrumented to size #15/.02 and then cleaned with the GentleWave (GW) System. The teeth were autoclaved to provide the same sterile baseline. The molars were filled with mixed plaque suspended in BHI and centrifuged to inoculate the biofilms. After 2 weeks of incubation, the teeth were randomly divided into two treatment groups. In GW group (26 canals), the teeth were further instrumented to size #15/04, and in PiezoFlow (PF) group (30 canals) to #35/.04. The teeth were then cleaned either with GW System or ProUltra PiezoFlow Active Ultrasonic System using 3% sodium hypochlorite NaOCl, 8% EDTA, and sterile water as irrigants. Samples (S1, S2, and S3) for bacterial cultures were taken from 13 canals before and after instrumentation and after final cleaning. Quantitative real-time PCR was performed from all 56 canals, and universal bacterial, one genus, and one species-specific primers were used to determine the presence of microorganisms in samples from root canals before and after instrumentation and after final cleaning. Statistical analyses were performed using the Mann-Whitney U test with the significance level set at P < 0.05.
Bacterial culturing from the canal samples revealed strong reduction of bacteria from S1 to S2 in both groups after instrumentation and irrigation with water only. No growth was detected in any of the S3 samples after cleaning in either group. A highly significant reduction in bacterial DNA was recorded by qPCR for both groups (P < 0.001). GW System showed more constant and a significantly higher reduction of total microbial DNA (P = 0.007), Enterococcus faecalis DNA (P = 0.011) and Streptococcus spp. DNA (P = 0.029) than the Ultrasonic System. The amount of residual microbial DNA calculated as an average of residual DNA in each individual canal in PF group was 1.99% and in GW group 0.09%.
While both systems demonstrated a highly effective reduction of intracanal bacterial DNA, the final total amount and variation in the number of residual bacterial DNA was significantly smaller in the GW group.
Elimination of microbes from the infected root canal system is regarded as the key for long-term clinical success. While both GentleWave and Ultrasonic Systems used with NaOCl and EDTA demonstrated a highly effective reduction of intracanal bacterial DNA; GW produced higher reduction and better predictability.
本体外研究通过实时定量 PCR 和培养来确定两种冲洗和清洁系统从根管中去除多物种口腔生物膜的效果。
对 20 颗提取的人磨牙进行 #15/.02 大小的器械处理，然后使用 GentleWave（GW）系统进行清洁。牙齿经过高压灭菌以提供相同的无菌基线。将磨牙填充混合菌斑悬浮在 BHI 中并离心以接种生物膜。孵育 2 周后，将牙齿随机分为两组。GW 组（26 个根管）进一步器械处理至 #15/04，PiezoFlow（PF）组（30 个根管）至 #35/.04。然后，使用 GW 系统或 ProUltra PiezoFlow 主动超声系统用 3%次氯酸钠 NaOCl、8% EDTA 和无菌水作为冲洗液清洁牙齿。在器械处理前后和最终清洁后，从 13 个根管中取出用于细菌培养的样品（S1、S2 和 S3）。对所有 56 个根管进行实时定量 PCR，使用通用细菌、一个属和一个种特异性引物确定根管样本中微生物的存在情况。在器械处理前、冲洗后和最终清洁后。使用 Mann-Whitney U 检验进行统计分析，显著性水平设置为 P<0.05。
细菌培养显示，两组在器械处理和仅用水冲洗后，从 S1 到 S2 的细菌数量均明显减少。两组中任何 S3 样本在清洁后均未检测到生长。两组的 qPCR 均记录到细菌 DNA 的显著降低（P<0.001）。GW 系统显示出更稳定和显著更高的总微生物 DNA 减少（P=0.007）、粪肠球菌 DNA（P=0.011）和链球菌属 DNA（P=0.029），而超声系统则较低。PF 组中每个个体根管残留微生物 DNA 的平均计算为残留 DNA 的量为 1.99%，GW 组为 0.09%。
虽然两种系统均显示出对根管内细菌 DNA 的高度有效减少，但 GW 组的最终总残留细菌 DNA 数量和变化明显更小。
消除感染根管系统中的微生物被认为是长期临床成功的关键。虽然使用次氯酸钠和 EDTA 的 GentleWave 和超声系统均显示出对根管内细菌 DNA 的高度有效减少，但 GW 产生了更高的减少和更好的可预测性。
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