摘要: | 根管治療的主要目標為清除根管系統中的感染,維護根尖組織的健康。但由於根管系統的型態複雜,手動或機動銼針難以清潔的解剖構造需仰賴沖洗液進行消毒。次氯酸鈉目前為主要的根管治療沖洗液,具廣效殺菌能力與組織溶解力,然而在受感染的根管中細菌常以生物膜形式存在,其所分泌之胞外聚合物造成生物膜不易被清除。雖然研究指出以次氯酸鈉作為沖洗液配合音波震盪、超音波震盪或雷射激盪可以減少生物膜,但目前尚無有效方法清除根管內生物膜。 奈米粒子近年被廣泛運用在生醫領域及牙醫科學。本研究團體已完成奈米鑽石沖洗液對去除管壁上塗抹層以及根管中牙本質硬組織碎屑之研究,結果顯示奈米鑽石沖洗液在音波與超音波的輔助下具有去除塗抹層與牙本質硬組織碎屑之能力,因此本研究欲更進一步探究奈米鑽石是否有移除生物膜之能力。 本研究的目的是進一步探討利用音波或超音波驅動次微米鑽石根管沖洗液對根管生物膜移除效力。糞腸球菌(Enterococcus faecalis )經常被發現於根管治療失敗的案例中,本研究使用100個拔除之單根管小臼齒以鎳鈦旋轉銼針修形至ProtaperGold? F2/#25,浸泡在糞腸球菌菌液中1×10^8(CFU/mL)培養21天形成生物膜,再使用500nm鑽石混合生理食鹽水或次氯酸鈉作為沖洗液,輔以音波或超音波盪洗,以菌落形成單位檢測、生物膜生成能力檢測、掃描式電子顯微鏡觀察並量化根管內對糞腸球菌產生的生物膜移除效力與抑菌能力之定性與定量分析。統計方法使用Kruskal-Wallis test以及Mann-Whitney U test,顯著性水平設定為0.05。 研究結果顯示當今主流的沖洗方式為次氯酸鈉配合音波或超音波盪洗,約可降低糞腸球菌生物膜生成能力82%,而3%次氯酸鈉次微米鑽石沖洗液可顯著降低86%糞腸球菌生物膜生成能力(p<0.05)。次氯酸鈉配合音波或超音波盪洗無法有效移除生物膜且易堆積塗抹層,尤其在關鍵的根尖部清除率低於34%,而次微米鑽石沖洗液在根管冠部、中部與根尖部有效移除95%以上塗抹層與生物膜,結果具顯著差異(p<0.05)。 微奈米鑽石次氯酸鈉沖洗液相較於未添加微奈米鑽石的組別,可在一劑式沖洗過程中殺菌清潔,去除塗抹層、硬組織碎屑與生物膜達到更為穩定的效果,加上奈米鑽石生物相容性佳等優點,可期待未來更多實驗測試使其具有商品化的潛力。 The main goal of root canal treatment is to remove infection from the root canal system and maintain the health of the periapical tissues. Due to the complex anatomy of the root canal system, cleaning inaccessible areas is difficult with instruments alone, necessitating the use of irrigants. Sodium hypochlorite is the primary irrigant in root canal treatment, known for its broad-spectrum antimicrobial activity and tissue-dissolving capability. However, bacteria in infected root canals often form biofilms, making them hard to eliminate due to the extracellular polymers they secrete. While sodium hypochlorite with sonic, ultrasonic, or laser activation can reduce biofilms, no method completely removes root canal biofilms. Nanoparticles are widely used in biomedical and dental fields. Prior studies have shown nano diamond irrigants can remove smear layers and dentin debris when assisted by sonic and ultrasonic activation. This study aims to further investigate nano diamond particles' ability to remove biofilms. The purpose of this study is to further investigate the efficacy of sub-micron diamond irrigants driven by sonic and ultrasonic agitation in the removal of root canal biofilms. Enterococcus faecalis is frequently found in cases of failed root canal treatments. In this study, 100 extracted single-rooted premolars were shaped to ProtaperGold? F2/#25 using nickel-titanium rotary files and soaked in Enterococcus faecalis suspension at a concentration of 1x10^8 CFU/mL for 21 days to form a biofilm. The samples were then irrigated with 500nm diamond mixed with saline or sodium hypochlorite solutions, aided by sonic or ultrasonic agitation. The effectiveness of biofilm removal and antibacterial capabilities were qualitatively and quantitatively analyzed using colony-forming unit detection, biofilm formation ability assays, scanning electron microscopy observations, and quantification. The statistical methods used were the Kruskal-Wallis test and the Mann-Whitney U test, with the significance level set at 0.05. The study results show that the current mainstream irrigation method, which uses sodium hypochlorite combined with sonic or ultrasonic oscillation, can reduce the biofilm formation ability of Enterococcus faecalis by approximately 82%. In contrast, 3% sodium hypochlorite sub-micron diamond irrigation solution significantly reduces it by 86% (p<0.05). The current mainstream irrigation methods cannot effectively remove biofilms and tend to accumulate smear layers, especially in critical apical areas where the removal rate is below 34%. The sub-micron diamond irrigation solution, however, effectively removes more than 95% of the smear layer and biofilm in the coronal, middle, and apical parts of the root canal with significant difference (p<0.05). The sub-micron diamond sodium hypochlorite irrigation solution can achieve sterilization and cleaning, as well as the removal of smear layers, hard tissue debris, and biofilm in a single-stage irrigation process, performing more consistently than the group without sub-micron diamonds. Given its excellent biocompatibility, nano-diamonds hold promise for future experimental testing and commercialization potential. |