歯髄疾患の治療における3種類の根管シーラントと温ガッタパーチャ垂直圧縮法の併用効果

The efficacy of 3 root canal sealers combined with warm gutta-percha vertical compression technique in the treatment of dental pulp disease.

抄録

歯髄疾患治療におけるAH Plus、GuttaFlow、iRoot SPの3種類の根管シーラントと温ガッタパーチャ垂直圧縮法の併用効果を検討する。本研究は単一施設での後方視的研究である。180名の歯髄疾患患者を治療法の違いにより、AH Plus群（n=60）、GuttaFlow群（n=60）、iRoot SP群（n=60）に分けた。各群の患者には、対応する根管シーラントと温ガッタパーチャ垂直圧縮法を組み合わせて治療を行った。根管充填の質，充填時間，充填面積比，術後の疼痛発生率，血清インターロイキン-6（IL-6）および腫瘍壊死因子-α（TNF-α），術後6ヵ月の有効性を3群間でそれぞれ比較した．GuttaFlow群およびiRoot SP群の充填時間はAH Plus群より有意に短かった（P<.001）。疼痛グレード（P=.015）と疼痛率（P=.016）は3群間で有意差があり、GuttaFlow群とiRoot SP群の疼痛率はAH Plus群より有意に低かった（P=.016）。血清TNF-αとIL-6の時点効果、群間効果、時間群効果は有意差があり（P<.001）、治療後の3群の値は治療前より有意に低く（P<.05）、GuttaFlow群とiRoot SP群で有意に低かった（P<.05）。有効性の評点と有効率は3群間で有意差があり（P=.028）、iRoot SP群の有効率はAH Plus群より有意に高かった（P<.05）。歯髄疾患治療における根管シーラントとしてのiRoot SPまたはGuttaFlowと温ガッタパーチャ垂直圧縮法の併用は、AH Plusよりも優れており、前者は充填時間の短縮、術後疼痛の緩和、炎症反応の改善が可能であるが、iRoot SPの長期的な根尖封鎖効果はGuttaFlowよりも優れている。

To investigate the efficacy of 3 root canal sealants such as AH Plus, GuttaFlow and iRoot SP combined with warm gutta-percha vertical compression technique in the treatment of dental pulp disease. This was a single-center retrospective study. 180 patients with dental pulp disease were divided into AH Plus group (n = 60), GuttaFlow group (n = 60) and iRoot SP group (n = 60) according to the different treatment methods. Patients in different groups were treated with corresponding root canal sealant combined with warm gutta-percha vertical compression technique. The quality of root canal filling, filling time, filling area ratio, the incidence of pain after operation, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) and efficacy at 6 months after operation were compared among the 3 groups, respectively. The filling time in the GuttaFlow group and the iRoot SP group was significantly shorter than that in the AH Plus group (P < .001). There were significant differences in pain grade (P = .015) and pain rate (P = .016) among the 3 groups, and the pain rate in the GuttaFlow group and the iRoot SP group was significantly lower than that in the AH Plus group (P = .016). The time-point effect, intergroup effect and time-groups effect of serum TNF-α and IL-6 were significantly different (P < .001), and the levels of the 3 groups after treatment were significantly lower than those before treatment (P < .05), and the levels were significantly lower in the GuttaFlow group and the iRoot SP group (P < .05). There were significant differences in efficacy grading and effective rate among the 3 groups (P = .028), and the effective rate of iRoot SP group was significantly higher than that of AH Plus group (P < .05). The iRoot SP or GuttaFlow as root canal sealant combined with warm gutta-percha vertical compression technique in the treatment of dental pulp disease is better than AH Plus, and the former one can shorten the filling time, relieve the postoperative pain and improve the inflammatory response, but the long-term apical sealing effect of iRoot SP is better than GuttaFlow.