根管内残留氢氧化钙及根管充填方法对根尖封闭性的影响

doi:10.3969/j.issn.1674-8115.2025.02.006

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (2): 179-185.doi: 10.3969/j.issn.1674-8115.2025.02.006

• 论著 · 临床研究 • 上一篇

根管内残留氢氧化钙及根管充填方法对根尖封闭性的影响

孙皓宇¹^,²(), 杨楠³, 单晓阳¹, 王月月¹, 孙慧斌¹^,²()

^1.青岛大学附属医院口腔内科，青岛 266003
^2.青岛大学口腔医学院，青岛 266023
^3.中国人民解放军海军第九七一医院口腔科，青岛 266071

收稿日期:2024-08-15 接受日期:2024-10-15 出版日期:2025-02-28 发布日期:2025-02-28
通讯作者: 孙慧斌 E-mail:grsunhy0321@163.com;shb353.qindao@163.com
作者简介:孙皓宇（1999—），女，研究生；电子信箱：grsunhy0321@163.com。
基金资助:
2023年山东省中医药科技项目重点课题(Z-2023049);青岛大学医学部临床医学3+X课题（3406）

Impact of residual intracanal calcium hydroxide and the root canal filling techniques on apical sealant integrity

SUN Haoyu¹^,²(), YANG Nan³, SHAN Xiaoyang¹, WANG Yueyue¹, SUN Huibin¹^,²()

^1.Department of Stomatology, the Affiliated Hospital of Qingdao University, Qingdao 266003
^2.School of Stomatology, Qingdao University, Qingdao 266023, China
^3.Department of Stomatology, The 971 Hospital of the Chinese Navy, Qingdao 266071, China

Received:2024-08-15 Accepted:2024-10-15 Online:2025-02-28 Published:2025-02-28
Contact: SUN Huibin E-mail:grsunhy0321@163.com;shb353.qindao@163.com
Supported by:
Key Project of Traditional Chinese Medicine Science and Technology in Shandong Province in 2023(Z-2023049);Clinical Medicine 3+X Project of Qingdao University School of Medicine(3406)

摘要/Abstract

摘要：

目的·比较根管内氢氧化钙（calcium hydroxide，CH）残留与根管充填方法对根尖封闭性的影响，为临床选择根管封闭药物及充填方法提供参考。方法·收集于青岛大学附属医院口腔颌面外科因正畸治疗或牙周问题拔除的下颌单根管恒前磨牙75颗，截冠，根管预备，随机分3组：水溶性氢氧化钙组（A组，n=30）、油溶性氢氧化钙组（B组，n=30）、未封药组（C组，n=15）。封闭2周后，A、B组使用35#K锉手动预备，并进行超声荡洗及冲洗根管，确保氢氧化钙残留位置大致位于根尖，且残留量为15%~20%。将A、B、C组的组内再各随机分为3组：爱汝特SP根管充填材料（injectable root canal sealant，iRoot SP）单尖法组（1组）、热压胶组（2组）、冷侧压组（3组），分别使用iRoot SP单尖法、热牙胶垂直加压充填法，以及冷牙胶侧方加压充填法进行根管充填。使用染料渗入试验评价根尖微渗漏情况，使用扫描电子显微镜观察各组牙本质与根管封闭剂界面的微观形态。采用两因素方差分析进行统计分析。结果·根管封闭药物与根管充填方式均会对根尖封闭性产生影响，且二者存在交互作用。分析残存氢氧化钙对根尖封闭性的影响，油溶性氢氧化钙组（B组）和未封药组（C组）仅在iRoot SP单尖法组（1组）的差异有统计学意义；水溶性氢氧化钙组（A组）与未封药组（C组）在热压胶组（2组）以及冷侧压组（3组）的差异有统计学意义；并且无论采用何种根充方式，水溶性氢氧化钙组（A组）和油溶性氢氧化钙组（B组）之间的差异都具有统计学意义。观察3种根充方式对根尖封闭性的影响，未封药组（C组）中iRoot SP单尖法组（1组）和冷侧压组（3组）相比，差异具有统计学意义（P=0.013）；在水溶性氢氧化钙组（A组）和油溶性氢氧化钙组（B组）中，热压胶组（2组）、冷侧压组（3组）与iRoot SP单尖法组（1组）的差异均具有统计学意义（P<0.001）。结论·残留在根管内的水溶性氢氧化钙对于根尖封闭性有不良影响，但残留的油溶性氢氧化钙对根尖封闭性的消极影响较小；iRoot SP能减少残存的水溶性氢氧化钙药物对于根管封闭性的不良影响。

关键词: 根管充填, 氢氧化钙, 根管充填材料, 根尖封闭性, 单尖充填, 热牙胶充填, 冷侧压

Abstract:

Objective ·To compare the effects of calcium hydroxide (CH) residues in root canals and root canal filling methods on apical closure, and to provide reference for clinical selection of root canal sealing drugs and filling methods. Methods ·Seventy-five permanent mandibular premolar teeth with single root canals that were extracted due to orthodontic treatment or periodontal problems were collected from the Department of Oral and Maxillofacial Surgery of the Affiliated Hospital of Qingdao University. The crowns were removed, the root canals were prepared, and the specimens were randomly assigned into 3 groups: a water-soluble calcium hydroxide group (Group A, n=30), an oil-soluble calcium hydroxide group (Group B, n=30), and an unsealed control group (Group C, n=15). After 2 weeks of sealing, Groups A and B underwent manual preparation with a #35 K-file, followed by ultrasonic agitation and irrigation of the root canal to ensure that the calcium hydroxide residue was located roughly at the root apex and that the residue was 15% to 20%. Groups A, B, and C were randomly divided into 3 groups: the iRoot SP single-tip group (Group 1), the hot compression group (Group 2), and the cold compression group (Group 3), and root canals were filled using the iRoot SP single-tip method, the hot adhesive vertical compression filling method, and the cold adhesive lateral compression filling method, respectively. A dye penetration test was used to evaluate apical microleakage, and scanning electron microscopy was used to observe the microscopic morphology of the dentin-root canal sealer interface in each group. Statistical analysis was performed using two-way ANOVA. Results ·Both root canal sealing drugs and root canal filling methods affected the apical sealing, and there was an interaction between them. The effects of residual calcium hydroxide on apical closure were analyzed. The difference between Group B and Group C was statistically significant only in Group 1. There were statistically significant differences between Group A and Group C in Group 2 and Group 3, and statistically significant differences between Group A and Group B regardless of the root filling method. Among the three root filling methods, there was a statistically significant difference between Group 1 and Group 3 in Group C (P=0.013). In Group A and Group B, there were statistically significant differences between Group 2, Group 3 and Group 1 (P<0.001). Conclusion ·The residual water-soluble calcium hydroxide in the root canal has a negative effect on the apical closure, but the residual oil-soluble calcium hydroxide has a small negative effect on the apical closure. iRoot SP can reduce the negative effect of residual water-soluble calcium hydroxide on root canal closure.

Key words: root canal filling, calcium hydroxide, root canal sealant, apical closure, single-cone obturation, hot gutta-percha filling, cold lateral condensation

中图分类号:

R783.1

孙皓宇, 杨楠, 单晓阳, 王月月, 孙慧斌. 根管内残留氢氧化钙及根管充填方法对根尖封闭性的影响[J]. 上海交通大学学报（医学版）, 2025, 45(2): 179-185.

SUN Haoyu, YANG Nan, SHAN Xiaoyang, WANG Yueyue, SUN Huibin. Impact of residual intracanal calcium hydroxide and the root canal filling techniques on apical sealant integrity[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(2): 179-185.

图/表 6

图1 显微镜下CH样本的残留（×10）Note： A. Water-soluble CH group. B. Oil-soluble CH group.

Fig 1 Residuals of CH samples under microscopy（×10）

图2 各组根尖染料渗入情况（×10）Note： A. Water-soluble CH group. B. Oil-soluble CH group. C. Unsealed group. 1—iRoot SP single-tip method; 2—hot gutta-percha technique; 3—cold gutta-percha technique.

Fig 2 Dye penetration into the root apices of each group（×10）

图3 不同根管填充物的填充效果（×200）Note： A. Water-soluble CH group. B. Oil-soluble CH group. C. Unsealed group. 1—iRoot SP single-cone method; 2—hot gutta-percha technique; 3—cold gutta-percha technique. a—dentin surface; b—bonding interface; c—gingival interface within the root canals.

Fig 3 Filling effect of different root canal fillers（×200）

表1 根管封闭药物及根管填充方式的双因素方差分析

Tab 1 Two-way ANOVA analysis of root canal sealing drugs and root canal filling methods

Item	Degree of freedom	Mean square	F value	P value
Type of CH	2	2.274	68.40	<0.001
Method of root filling	2	2.866	86.19	<0.001
Type of CH×Method of root filling*	4	0.173	5.203	0.001

表2 各组染料渗入长度的单因素方差分析

Tab 2 One-way ANOVA of dye penetration length in each group

Item

Unsealed group

(Group C,

n=15)

Water-soluble

CH group

(Group A,

n=30)

Oil-soluble

CH group

(Group B,

n=30)

iRoot SP single-tip

(Group 1)/mm

0.773±0.124^①

0.944±0.123^②

0.467±0.144

Hot gutta-percha

(Group 2)/mm

0.960±0.158^③

1.616±0.147^④

1.140±0.200

Cold gutta-percha

(Group 3)/mm

1.111±0.169^⑤

1.834±0.213^⑥

1.301±0.267

图4 3种根管充填方法对根尖封闭性的影响Note： ①P =0.013; ②P <0.001.

Fig 4 Effect of three root canal filling methods on apical closure

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根管内残留氢氧化钙及根管充填方法对根尖封闭性的影响

Impact of residual intracanal calcium hydroxide and the root canal filling techniques on apical sealant integrity

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