Clinical Efficacy Evaluation Of Simultaneous Working Length Control During Root Canal Preparation Combined With Ultrasonic Washing In Root Canal Treatment Of Diabetic Patients

Background:Perapical Periodontitis(AP)is one of the most common oral diseases.Root Canal Therapy(RCT)is the most effective treatment for periapical inflammation.At present,the conventional clinical root canal preparation is to measure the length of the root canal before preparation,often because of the error in the operation process caused by overpreparation,and then lead to the instrument stimulation of the periapical tissue to cause postoperative pain;Syringe irrigation is the most commonly used irrigation method in clinic,but its cleaning effect on root canal infection is limited.Compared with normal patients,diabetes mellitus(DM)patients have decreased immune function,poor tissue repair and anti-infection ability,difficulty in infection control during root canal treatment,higher incidence and degree of postoperative pain,and poor long-term efficacy.Therefore,in the root canal treatment of diabetic patients with chronic periapical inflammation,we need to reduce the stimulation of the periapical tissue by mechanical preparation,and adopt more effective irrigation methods to remove the bacteria in the root canal,so as to reduce postoperative pain,control infection and promote healing.At present,the synchronous root canal length measurement preparation method can control the working length during the preparation.That is,the VDW Gold Reciproc root canal motor is adopted for the root canal preparation,which can display the position of the instrument in the root canal during the preparation,and the motor will stop automatically when the instrument reaches the apical point,so as to reduce the stimulation of the periapical overpreparation;Ultrasonic swaging can effectively clean root canal infection by microacoustic flow,hole and thermal effect.Therefore,we hope to effectively improve the efficacy of root canal therapy in diabetic patients by combining the two methods.Objective:In this study,patients with diabetes mellitus were taken as the research object,and synchronous root measurement preparation combined with ultrasonic flushing was used to treat periapical inflammation in such patients,in order to reduce postoperative pain and improve long-term curative effect.In addition,inflammatory factors were detected to observe the infection control of root canal therapy,so as to provide a more effective and comfortable treatment method for periapical inflammation in diabetic patients.Method:A total of 100 patients with chronic periapical inflammation were selected from the general Department of Hefei Stomatological Hospital from October 2020 to December 2021,all of whom suffered from type II diabetes.They were randomly divided into study group and control group.In the study group,27 males and 23 females,aged 36-70 years,32 molar teeth and 18 non-molar teeth,fasting blood glucose range of6.9±1.5mmol/L;In the control group,28 males and 22 females,aged 38-75 years,30molar teeth and 20 non-molar teeth,fasting blood glucose range 7.1±1.1mmol/L.There were no significant differences in gender,age,tooth type,blood glucose range and other general information between the two groups(P>0.05),which was comparable.Patients in the study group received root canal treatment with VDW Gold Reciproc root canal motor(controlling the working length during root canal preparation)combined with ultrasonic washing,while the control group received conventional root canal motor combined with syringe irrigation for root canal therapy.The incidence of pain and Visual Analogue Scale(VAS)were compared between the two groups at 6h,12h,24h,48h and 72h after initial treatment;The two groups were treated with warm vertical compaction technique at return visit.Serum levels of interleukin-6(IL-6),interleukin-8(IL-8),and tumor necrosis factor-α(TNF-α)were compared by IMMULITE1000 Siemens chemiluminescence analyzer one week after completion of root canal filling,and the clinical efficacy was evaluated one year after surgery,namely the effective rate of root canal therapy in the two groups.Pain scores and inflammatory factor levels were expressed as (?)±s at different time points before and after surgery.Independent sample t test was used for comparison among groups,and paired t test was used for comparison before and after surgery within groups.The incidence rate and effective rate of pain were n(%),andχ~2test was used for comparison.P<0.05 indicated statistically significant difference.Results:At different time points after the initial treatment,the pain incidence and VAS score of the study group were lower than those of the control group,but the differences were statistically significant only at 6h and 12h after surgery(P<0.05).One week after the completion of root canal filling,the serum levels of IL-6,IL-8,TNF-αand other inflammatory factors in 2 groups were decreased,and the levels of each inflammatory factor were significantly different between 2 groups,the study group was significantly lower than the control group(P<0.05);A year later,through clinical examination and X-ray examination,it was found that the overall effective rate was 94%in the study group and 90%in the control group,which was higher in the study group than in the control group but had no significant difference(P>0.05).Conclusion:Simultaneous working length control during root canal preparation combined with ultrasonic washing and conventional root canal preparation combined with syringe irrigation can effectively treat diabetic patients with periapical inflammation,but the former can effectively reduce postoperative pain and control inflammation in diabetic patients,and is more worthy of clinical promotion.