| ObjectiveIn clinical,we often encountered patients with fistula chronic periapical periodontitis,which experienced the routine treatment of root canal therapy,such as mechanical preparation and chemical irragation,are still difficult to be cured.The fistula is repeated or not eliminated,in need of long-stage medication observation or apical operation or even removal.The major etiology of chronic periapical periodontitis with fistula is caries,and the tooth has undergone caries,pulpitis,acute periapical periodontitis and other periods,the infection time is long,and the infection bacteria are complex and diverse.After the occurrence of fistula,it is chronically infected which connected with the oral environment.The bacteria are mainly anaerobic bacteria,involving multiple bacteria genera,including clostridium,porphyrins and actinomycetes,etc.Sometimes a large amount of enterococcus faecalis can be detected in retreatment canal.With the application of CBCT and microscopy,we found that the root canal system was complex and variable,and there was a large number of bacteria in the collateral pulp canal,the root tip,and the dentin tubule.Therefore,the sterilization effect of conventional treatment is not ideal.Sodium hypochlorite plus ultrasonic washing was often used in the infected root canal disinfection clinically to destroy the root canal bacteria decomposition and metabolites,such as bacterial endotoxin,enzymes,organic acids,etc.In recent years,laser has been widely used in oral medicine,not only in periodontitis and caries,but also in root canal therapy.Er:YAG laser and semiconductor laser are two commonly used lasers.The mechanism of Er:YAG laser is to remove the canal infection,stain layer of the root canal wall and increase the disinfection activity of sodium hypochlorite.The optical fiber of the semiconductor laser could go deep into the root canal,and the high temperature can not only dissolve and seal the dentin tube,but also remove the bacteria to achieve the purpose of sterilization of the root canal.In this study we compared the clinical effect of two different working principle of laser and ultrasonic root canal disinfection,in order to play a guiding role in the clinical treatment of chronic apical periodontitis with fistula.Methods and materials1.Patient Selection:Total of 120 patients with chronic periapical diseases were selected into the investigation and divided into three groups at random,(Group I:ultrasound group;Group II:Diode laser group;Group III:Er:YAG laser group);2.Root canal therapy(RCT):To explain the etiology,condition,treatment process and possible prognosis to the patients,and sign the informed consent of the root canal therapy of the People's Hospital of Liaocheng.After pre-operation X-ray,routine root canal therapy was followed,involving root canal machinery,chemical preparation and medication.The closure of the fistula was recorded at 7 days and 14 days,and the root canal was filled when the fistula was closed.3.Therapeutic evaluation:Clinical effects were evaluated according to levels of pain,fistula healing and X-ray condition 1 and 6 months after root canal filling.p<0.05 wasconsidered statistically significant.Results1.120 cases were treated by perfect RCT.2.In the 120 cases,6 cases were lost,2 cases in each group,the follow-up rate was 95%.3.There were two cases of failure in the follow-up patients,one in group I and one in group III respectively.4.The treatment efficiency of the ultrasonic group on the four time observation points was 60%,70%,78.94%and 78.94%respectively.5.The treatment efficiency of Diode laser group was 62.5%,72.5%,76.92%and 81.57%respectively.6.The treatment efficiency of Er:YAG laser group was 70%,76.92%and 84.61%.89.47%.Conclusion1.In the treatment of chronic apical periodontitis with fistula,three types of disinfection can be very effective.2.Er:YAG laser is much more effective than Diode laser and ultrasonic irrigation.3.There was no statistically significant difference in the efficacy of disinfection between Diode laser and ultrasound. |
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