Voegeli Garance, Bella Enrico Di, Mekki Mustapha, Machtou Pierre, Bouillaguet Serge
University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Department of Economics and Business Studies, Faculty of Economics, University of Genoa, Genoa, Italy.
Eur J Dent. 2021 Feb;15(1):90-95. doi: 10.1055/s-0040-1715985. Epub 2020 Oct 1.
This study tested the hypothesis that modifying the sequence of sodium hypochlorite (NaOCl)/ethylene diamine tetra-acetic acid (EDTA) irrigation during root canal shaping would improve apical cleanliness in moderately curved canals.
Forty-five root canals were prepared using Protaper Gold with three irrigation protocols. Standard irrigation (SI) used 0.5 mL 3% NaOCl between each instrument, followed by 5 mL 17% EDTA manually agitated for 30 seconds. Reverse irrigation (RI) used 0.5 mL of 17% EDTA between each instrument, then 5 mL of 3% NaOCl, manually agitated for 30 seconds. Reverse irrigation plus (RI+) was similar to RI, except NaOCl (5 mL), used as a final rinse, was allowed to interact for 3 minutes with dentin before manual agitation (30 seconds).Root canal cleanliness was evaluated under the scanning electron microscope (SEM) (Hulsmann score); the chemical composition of dentin after irrigation was analyzed by energy dispersive X-ray (EDX).
Results were compared using Kruskal-Wallis ANOVA by ranks and Wilcoxon matched paired posthoc tests. A Chi-square test assessed whether the best cleanliness would demonstrate a significant association with one irrigation protocol; odds ratio calculation was performed using score "1" versus score "2 or more" (2+) ( < 0.05).
In the apical region, cleanliness was better in RI+ than SI and both significantly better than RI. Odd ratios indicate that the cleanliness in RI+ was significantly better than RI and SI groups ( < 0.000 and 0.003, respectively). Independently of the irrigation protocol, EDX analyses showed no chemical alteration of root dentin.
Using 17% EDTA during shaping, followed by 3% NaOCl rinse for 3 minutes, improved apical cleanliness without inducing erosion of dentin.
本研究检验了以下假设，即在根管预备过程中改变次氯酸钠（NaOCl）/乙二胺四乙酸（EDTA）冲洗顺序可提高中度弯曲根管的根尖清洁度。
采用三种冲洗方案，使用Protaper Gold对45个根管进行预备。标准冲洗（SI）在每个器械使用后使用0.5 mL 3% NaOCl，随后手动搅拌5 mL 17% EDTA 30秒。反向冲洗（RI）在每个器械使用后使用0.5 mL 17% EDTA，然后使用5 mL 3% NaOCl，手动搅拌30秒。反向冲洗加（RI+）与RI相似，不同之处在于用作最终冲洗的5 mL NaOCl在手动搅拌（30秒）前与牙本质作用3分钟。在扫描电子显微镜（SEM）下评估根管清洁度（胡尔斯曼评分）；通过能量色散X射线（EDX）分析冲洗后牙本质的化学成分。
使用Kruskal-Wallis秩和检验及Wilcoxon配对事后检验比较结果。卡方检验评估最佳清洁度是否与一种冲洗方案存在显著关联；使用评分“1”与评分“2或更高”（2+）进行优势比计算（<0.05）。
在根尖区域，RI+组的清洁度优于SI组，且两者均显著优于RI组。优势比表明，RI+组的清洁度显著优于RI组和SI组（分别为<0.000和0.003）。无论冲洗方案如何，EDX分析均显示牙根牙本质无化学改变。
在预备过程中使用17% EDTA，随后用3% NaOCl冲洗3分钟，可提高根尖清洁度，且不会导致牙本质侵蚀。
