iRoot SP联合骨缺损区覆盖口腔修复膜在慢性根尖炎根尖暗影治疗中的效果分析

The efficacy of iRoot SP combined with oral repair membrane for covering bone defect area in the treatment of chronic apical periodontitis with periapical shadows

摘要:

目的 探讨iRoot SP联合骨缺损区覆盖口腔修复膜在慢性根尖炎根尖暗影治疗中的效果。方法 选取2020年1月—2022年12月天津市口腔医院收治的120例慢性根尖炎根尖暗影患者，分为对照组和观察组，每组60例。对照组采用iRoot SP根管封闭剂配合热牙胶垂直加压根管充填，观察组在对照组基础上联合骨缺损区覆盖口腔修复膜治疗。所有患者术后行X射线检查，比较两组根管填充1周内急症反应程度（0、Ⅰ、Ⅱ、Ⅲ级）、治疗3和6个月时的有效率、根尖周暗影变化、通过回访及视觉模拟评分（VAS）记录两组组患者在治疗后1、3和7 d的疼痛情况；于微渗漏检测装置中分别在1、2、4、7、14、21和28 d以葡萄糖氧化酶比色法检测葡萄糖渗出浓度，进而评价根尖微渗漏情况；对比两组患牙封闭剂超填率。结果 观察组根管充填1周内急症反应程度轻于对照组（P <0.05）。观察组根管治疗后3和6个月的有效率均高于对照组（P <0.05）。观察组术后均未出现自发痛和咬合痛，临床检查未显示叩痛、触痛等阳性体征。对照组X射线显示29颗患牙根尖暗影完全消失，19颗减小，12颗无变化，总有效率为80.0%；观察组X射线显示47颗患牙根尖暗影完全消失，13颗减小，总有效率为100.0%。对照组与观察组术后1、3和7 d的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②对照组与观察组VAS评分比较，差异有统计学意义（P <0.05）；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。对照组与观察组1、2、4、7、14、21和28 d的葡萄糖渗出浓度比较，结果 ①不同时间点葡萄糖渗出浓度比较，差异有统计学意义（P <0.05）；②对照组与观察组葡萄糖渗出浓度比较，差异有统计学意义（P <0.05）；③两组葡萄糖渗出浓度变化趋势比较，差异有统计学意义（P <0.05）。两组牙根管封闭剂超填率比较，差异无统计学意义（P >0.05）。结论 iRoot SP联合骨缺损区覆盖口腔修复膜在慢性根尖炎根尖暗影治疗中可显著提高根尖暗影治疗效果，改善疼痛程度，有效降低根尖微渗漏程度。

Abstract:

Objective To explore the efficacy of iRoot SP combined with oral repair membrane for covering bone defect area in the treatment of chronic apical periodontitis with periapical shadow.Methods The patients with chronic apical periodontitis (120 teeth) admitted to Tianjin Stomatological Hospital from January 2020 to December 2022 were selected. Based on different types of treatment, the affected teeth were divided into a control group and an observation group, with 60 cases in each group. The control group was treated with iRoot SP root canal sealer combined with root canal obturation by warm vertical condensation, while the observation group was additionally treated with oral repair membrane for covering bone defect area. All patients underwent postoperative X-ray examination. The severity of acute response (grade 0, grade Ⅰ, grade Ⅱ, and grade Ⅲ), effective rates 3 and 6 months after treatment, changes in periapical shadows, and pain conditions 1, 3, and 7 d after treatment recorded by follow-up and Visual Analogue Scale (VAS) were compared between the two groups. The concentration of leaked glucose was detected via colorimetric assays based on glucose oxidase in the microleakage detection device 1, 2, 4, 7, 14, 21, and 28 d after treatment, and thus evaluating the condition of apical microleakage. The rate of dental sealants overfilling was compared between the two groups.Results The observation group showed milder acute response within one week after root canal filling compared with the control group (P < 0.05). The effective rates of root canal filling 3 and 6 months after treatment in the observation group were higher than those in the control group (P < 0.05). No patients in the observation group experienced spontaneous pain or biting pain, and clinical examination did not show positive signs such as percussion pain and tenderness. The X-ray imaging of the control group exhibited that the periapical shadows of 29 affected teeth completely disappeared, 19 decreased, and 12 remained unchanged, with a total effective rate of 80.0%. In contrast, the X-ray imaging of the observation group demonstrated that the periapical shadows of 47 affected teeth completely disappeared, and 13 decreased, with a total effective rate of 100.0%. The VAS scores of the control group and the observation group 1, 3, and 7 d after surgery were compared, which showed that they were different among the time points (P < 0.05) and between groups (P < 0.05), and that the change trends of them were also different between groups (P < 0.05). In terms of the concentration of leaked glucose, the comparison between the control group and the observation group 1, 2, 4, 7, 14, 21, and 28 d after treatment suggested that the concentration of leaked glucose was different among the time points (P < 0.05) and between the groups (P < 0.05), and that the change trend of the concentration of leaked glucose was different between the two groups (P < 0.05). There was no difference in the rate of dental sealants overfilling between the control group and the observation group (P > 0.05).Conclusion The combination of iRoot SP and oral repair membrane for covering bone defect area can significantly improve the therapeutic efficacy for periapical shadows in chronic apical periodontitis by alleviating the pain and effectively reducing the apical microleakage.