Department of Conservative Dentistry and Endodontics, ITS Centre for dental studies and Research, Uttar Pradesh, India.
Department of Oral Pathology, ITS centre for dental studies and Research, Uttar Pradesh, India.
Eur Endod J. 2022 Oct;7(3):210-216. doi: 10.14744/eej.2022.42713.
The present study was conducted to evaluate the presence of aerobic bacteria, anaerobic bacteria, E. faecalis, F. nucleatum, Propionibacteria sp., Actinomyces sp., and their reduction at various stages of endodontic retreatment with the use of conventional protocol (5.25 % Sodium Hypochlorite (NaOCl) as the irrigant along with Calcium Hydroxide (Ca (OH)2) as intracanal medicament and advocated protocol (SmearOFF as the irrigant along with 2% Chlorhexidine (CHX) gel as intracanal medicament).
Twenty eight patients fulfilling the eligibility criteria were selected for root canal retreatment and randomly allocated into two groups. Group 1: Final irrigant as SmearOFF+Chlorhexidine 2% gelas intracanal medicament (n=14). Group 2: Final irrigant as 5.25% NaOCl+Ca(OH)2 as intracanal medicament (n=14). With aseptic environment, access opening was performed followed by Gutta Percha (GP) removal and sample S1 was collected for bacterial analysis. The biomechanical preparation was done by using Reciproc system with additional finishing with XP-Endo Finisher R. Sample S2 was then collected for bacterial analysis after the final irrigation protocol in the respective groups. Intracanal medicaments were placed for one week and sample S3 was collected. All the samples were subjected to qualitative analysis using PCR and quantification was done by Colony Forming Unit (CFU) analysis.
Aerobic [28/28], Anaerobic [28/28], Propionibacterium sp. [20/28] and F. nucleatum [24/28] were the most frequently isolated in S1 sample followed by Actinomyces sp. [16/28] and E. faecalis sp. [19/28]. Chemico-mechanical preparation followed by irrigation (S2 sample) resulted in significant reduction of all types of bacteria in both groups. Group-1 (SmearOFF as the final irrigant) had significantly superior efficacy against aerobic bacteria, E. faecalis and F. nucleatum (P<0.05) as compared to Group-2 (NaOCl). After medicament placement, significant differences between the groups were noted only for the E. Faecalis group. For the S3 samples, the mean bacterial reduction was significant in Aerobic and F. nucleatum in S3 samples for Group 1 and Group 2.
Chemico-mechanical preparation followed by irrigation resulted in significant reduction in bacterial load irrespective of the final irrigant. SmearOFF was significantly better than NaOCl in minimizing bacterial load of E. faecalis and F. nucleatum. 2% Chlorhexidine gel has superior antimicrobial efficacy against E. faecalis and may be recommended in secondary endodontic treatment.
本研究旨在评估在使用常规方案（5.25%次氯酸钠（NaOCl）作为冲洗液，同时使用氢氧化钙（Ca（OH）2）作为根管内药物）和提倡的方案（SmearOFF 作为冲洗液，同时使用 2%洗必泰（CHX）凝胶作为根管内药物）进行根管再治疗的各个阶段，需氧菌、厌氧菌、粪肠球菌、核梭杆菌、丙酸杆菌、放线菌的存在及其减少情况。
选择 28 名符合入选标准的患者进行根管再治疗，并随机分为两组。第 1 组：最终冲洗液为 SmearOFF+2%氯己定凝胶作为根管内药物（n=14）。第 2 组：最终冲洗液为 5.25% NaOCl+Ca（OH）2 作为根管内药物（n=14）。在无菌环境下，进行开口操作，然后取出牙胶（GP）并收集样本 S1 进行细菌分析。采用 Reciproc 系统进行生物力学预备，并用 XP-Endo Finisher R 进行额外的修整。然后在各组完成最终冲洗方案后收集样本 S2 进行细菌分析。将根管内药物放置一周后收集样本 S3。所有样本均采用聚合酶链反应（PCR）进行定性分析，并通过菌落形成单位（CFU）分析进行定量分析。
S1 样本中最常分离的是需氧菌[28/28]、厌氧菌[28/28]、丙酸杆菌[20/28]和核梭杆菌[24/28]，其次是放线菌[16/28]和粪肠球菌[19/28]。化学机械预备后冲洗（S2 样本）导致两组所有类型的细菌均显著减少。第 1 组（SmearOFF 作为最终冲洗液）对需氧菌、粪肠球菌和核梭杆菌的疗效明显优于第 2 组（NaOCl）（P<0.05）。在药物放置后，只有粪肠球菌组在组间有显著差异。对于 S3 样本，第 1 组和第 2 组的 S3 样本中，需氧菌和核梭杆菌的平均细菌减少量显著。
无论最终冲洗液如何，化学机械预备后冲洗均能显著降低细菌负荷。SmearOFF 在减少粪肠球菌和核梭杆菌的细菌负荷方面明显优于 NaOCl。2%洗必泰凝胶对粪肠球菌具有更好的抗菌效果，可推荐用于二次根管治疗。
