Sofer Patrick, Tahmasbi Mehrnaz, Wang Feng-Ming, Nair Madhu, Kesterke Matthew, Jalali Poorya
Department of Endodontics, Texas A&M College of Dentistry, Dallas, Texas, USA.
Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, Texas, USA.
Clin Oral Investig. 2025 Jan 24;29(1):81. doi: 10.1007/s00784-025-06165-z.
The objective of this study is to evaluate the incidence and volume of contrast medium extrusion when activated with a laser and to compare these outcomes with those of other irrigation techniques.
Sixteen cadaver mandibles containing 116 single-rooted teeth were prepared using conventional rotary instrumentation. The teeth were randomly assigned to four irrigation groups: side-vented needle, sonic irrigation, laser activation at the orifice, and laser activation at the middle third of the canal. Gastrografin, an iodinated contrast medium, was used to simulate irrigants. Cone Beam Computed Tomography (CBCT) scans were obtained pre- and post-irrigation to assess the incidence and volume of extrusion. Two blinded observers evaluated the images for the presence or absence of extrusion. Data were statistically analyzed using ANOVA and chi-square tests.
The observers reached a consensus on 116 out of 116 cases, resulting in a percent agreement of 100%. None of the experimental groups, side-vented needle (n = 29), sonic irrigation (n = 29), laser activation at the orifice (n = 29), and laser activation in the middle third (n = 29), demonstrated any radiographic evidence of extrusion.
This cadaver-based model, combined with CBCT, provides a clinically relevant assessment of irrigant behavior during endodontic treatment. While the findings from this study suggest that LAI at the orifice or in the middle third of the canal may be a safe method for enhancing irrigation in endodontics, clinicians should remain cautious regarding the potential risks of irrigant extrusion.
本研究的目的是评估激光激活时造影剂挤出的发生率和体积，并将这些结果与其他冲洗技术的结果进行比较。
使用传统旋转器械制备16个含有116颗单根牙的尸体下颌骨。将牙齿随机分为四个冲洗组：侧孔针冲洗、超声冲洗、根管口激光激活和根管中三分之一处激光激活。使用碘造影剂泛影葡胺模拟冲洗液。在冲洗前后进行锥形束计算机断层扫描（CBCT）以评估挤出的发生率和体积。两名盲法观察者评估图像中是否存在挤出。使用方差分析和卡方检验对数据进行统计学分析。
观察者在116例病例中的116例上达成共识，一致率为100%。侧孔针冲洗组（n = 29）、超声冲洗组（n = 29）、根管口激光激活组（n = 29）和根管中三分之一处激光激活组（n = 29）均未显示出任何造影剂挤出的影像学证据。
这种基于尸体的模型与CBCT相结合，为牙髓治疗过程中冲洗液行为提供了临床相关评估。虽然本研究结果表明根管口或根管中三分之一处的激光辅助冲洗可能是牙髓病学中增强冲洗的一种安全方法，但临床医生应谨慎对待冲洗液挤出的潜在风险。
