Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
Department of Endodontics, Faculty of Dentistry, The British University, Cairo, Egypt.
Clin Oral Investig. 2022 Feb;26(2):2155-2163. doi: 10.1007/s00784-021-04196-w. Epub 2021 Oct 25.
This clinical trial aimed to evaluate the effect of nano-silver and nano-calcium hydroxide intracanal medicaments (ICM) during retreatment regarding their antibacterial effect and their effect on post-operative pain and flare-ups.
Sixty-nine patients scheduled for endodontic retreatment were included in this randomized clinical trial and randomly allocated to 3 equal groups (n = 23) according to the type of ICM used. The first microbial sampling (S1) representing the original microbiota was obtained after the removal of the old canal filling. After chemo-mechanical debridement, another sample (S2) was obtained representing the microbial state before ICM application. Patients were randomly allocated to receive either nano-silver (nano-Ag), nano-calcium hydroxide (nano-CH), or calcium hydroxide (CH) as ICM. Patients rated their pain pre-operatively and then after 6, 12, 24, 48, and 72 h. During the second visit (7 days later), the last microbial sample (S3) was obtained after removal of the ICM. Reduction of total bacterial and total E. faecalis counts and the biofilm-forming capability of the existing microbiota were determined.
Results showed reduction in total bacterial count, total E. faecalis count and the biofilm-forming,capability of the existing microbiota after chemo-mechanical debridement (S1-S2) and after the application of ICM (S3-S2). However, the reduction after cleaning and shaping was significantly more pronounced (p < 0.001) compared to the effect of ICM application, with no difference between the 3 ICM (p > 0.05). Post-operative pain was significantly reduced at the 48- and 72-h intervals after the application of nano-Ag and nano-CH only (p < 0.001), with no significant difference between these two ICM (p > 0.05). The incidence of flare-ups in all groups was similar (p > 0.05).
The antibacterial effect of the nano-Ag and nano-CH was equivalent to that of CH, but they contributed to better pain control.
Nanoparticles may have a positive impact on post-endodontic pain.
本临床试验旨在评估纳米银和纳米氢氧化钙根管内药物（ICM）在再治疗中的效果，包括其抗菌效果以及对术后疼痛和炎症的影响。
本随机临床试验纳入了 69 名计划接受根管再治疗的患者，并根据使用的 ICM 类型将其随机分为 3 组（n=23）。第一次微生物采样（S1）代表原始微生物群，在去除旧的根管填充物后获得。经过化学机械清创后，在应用 ICM 之前获得另一个样本（S2），代表微生物状态。患者随机接受纳米银（nano-Ag）、纳米氢氧化钙（nano-CH）或氢氧化钙（CH）作为 ICM。患者在术前、术后 6、12、24、48 和 72 小时进行疼痛评分。在第二次就诊（7 天后），在去除 ICM 后获得最后一个微生物样本（S3）。测定总细菌和总粪肠球菌计数的减少以及现有微生物群落的生物膜形成能力。
结果表明，经过化学机械清创（S1-S2）和应用 ICM（S3-S2）后，总细菌计数、总粪肠球菌计数和现有微生物群落的生物膜形成能力均降低。然而，与应用 ICM 相比，清洁和成形后的减少更为显著（p<0.001），而 3 种 ICM 之间没有差异（p>0.05）。仅在应用 nano-Ag 和 nano-CH 后 48 和 72 小时，术后疼痛明显减轻（p<0.001），这两种 ICM 之间无显著差异（p>0.05）。所有组的炎症发作发生率相似（p>0.05）。
纳米银和纳米氢氧化钙的抗菌效果与氢氧化钙相当，但它们有助于更好地控制疼痛。
纳米颗粒可能对根管治疗后的疼痛有积极影响。
