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目的以无机三氧化物聚合物(MTA)修复成年人根尖孔未闭合患牙的疗效做对照,通过临床操作探讨iRoot SP治疗成年人根尖孔未闭合患牙的可行性及其临床疗效。方法选择2014年1月至2015年10月在锦州医科大学附属第二医院显微根管治疗中心因慢性根尖周炎就诊并伴根尖孔未闭合的成年患者45例(患牙45颗,前牙23颗,前磨牙22颗),其中女性22例,男性23例;年龄23~40岁,平均年龄32岁。按照随机数字表法分为2组,即iRoot SP组17例(17颗牙),MTA组28例(28颗牙)。所有患牙拍摄术前X射线片并记录患牙情况。用ProTaper手用镍钛锉联合冠向下法进行根管预备,冲洗,隔湿、干燥后测量工作长度并拍X射线片确认;iRoot SP组用iRoot SP糊剂充填至根尖(厚约4mm),MTA组用MTA糊剂充填至根尖(厚约4mm),热牙胶垂直加压法充填根管中上段;术后拍摄X射线片以查患牙充填情况并记录。术后6、12个月进行常规复诊,并拍摄X射线片记录患牙愈后情况并评价。结果在患牙治疗后第6个月进行随访观察时,因MTA组1例患者失访而立即从iRoot SP组中随机抽出1例患者撤出试验,以减小对最后统计结果的影响。最终MTA组27颗患牙,iRoot SP组16颗患牙。术后12个月iRoot SP组15颗患牙形成根尖屏障,MTA组25颗患牙形成根尖屏障;两组差异无统计学意义(P=1.000>0.05)。iRoot SP组患牙形成根尖屏障所需时间为(6.600±0.737)周;MTA组所需时间为(8.800±0.726)周;两组差异有统计学意义(P=0<0.05)。结论两组材料根尖屏障的平均形成周期差异有统计学意义。提示临床工作者iRoot SP在治疗成年人根尖孔未闭合的患牙中能够有效促进根尖硬组织的形成,提高临床治疗效率。
Objective To compare the curative effect of inorganic trioxide polymer (MTA) for repairing uncorrupted apical foramen of adult patients and to discuss the feasibility and clinical efficacy of iRoot SP in treating unclosed adult apical foramen by clinical operation. Methods From January 2014 to October 2015, 45 cases of adult patients with chronic apical periodontitis and apical foramen that were not closed at the Microsurgery Treatment Center of the Second Affiliated Hospital of Jinzhou Medical University (45 teeth, 23 anterior teeth, 22 premolar teeth), of which 22 were women and 23 were males, aged from 23 to 40 years with a mean age of 32 years. According to the random number table divided into two groups, namely iRoot SP group 17 cases (17 teeth), MTA group 28 cases (28 teeth). All affected teeth photographed preoperative radiographs and recorded the condition of the affected teeth. ProTaper hand nickel-titanium file combined crown-down method for root canal preparation, rinsing, moisture, drying and measuring the length of work and confirmed by X-ray film; iRoot SP group with iRoot SP paste filling to the root tip (thickness of about 4mm ). The MTA group was filled with MTA paste to apical thickness (about 4mm thick). The upper part of the root canal was filled with hot gutta percha vertical pressure method. X-ray film was taken to check the filling of the tooth and recorded. Regular follow-up was performed 6 and 12 months after surgery, and X-ray films were taken to record and evaluate the prognosis. Results At follow-up 6 months after treatment, 1 patient in the MTA group was randomized to withdraw from the iRoot SP group immediately due to loss of follow-up to reduce the impact on the final statistics. The final MTA group had 27 teeth and the iRoot SP group had 16 teeth. At 12 months after operation, 15 teeth of iRoot SP group formed apical barrier, and 25 teeth of MTA group formed apical barrier. There was no significant difference between the two groups (P = 1.000> 0.05). The time required for root apical barrier formation in the iRoot SP group was (6.600 ± 0.737) weeks and that in the MTA group was (8.800 ± 0.726) weeks. The difference between the two groups was statistically significant (P = 0 <0.05). Conclusion The average formation period of root apical barrier of two groups has statistical significance. It is suggested that iRoot SP can effectively promote the formation of apical hard tissue and improve the clinical treatment efficiency in the treatment of non-closed adventitia of adult apical foramen.