根管治疗失败患者感染微生态研究  

Microecological study on infection of patients with failed root canal therapy

作　　者：杜琛 DU Chen(Department of Stomatology,Yanggu People's Hospital,Liaocheng,Shandong,252300,China)

机构地区：[1]阳谷县人民医院口腔科,山东聊城252300

出　　处：《当代医学》2022年第5期1-4,共4页Contemporary Medicine

摘　　要：目的观察未治疗和根管治疗失败慢性根尖周炎患者根尖周病损组织菌群构成和根管内壁及根外生物膜超微结构,为治疗提供理论依据。方法选取2018年4月至2019年4月本院牙体牙髓科收治的未经治疗和根管治疗失败的慢性根尖周炎患者40例,分为未经治疗组和治疗失败组,各20例。采集两组患者牙窝内根尖周病损组织,提取细菌DNA,构建16S rDNA克隆文库,采用高通量测序法分析根尖周病损组织中菌群构成。取两组患者根尖部位,劈开后经扫描电镜观察根管内壁及根外生物膜超微结构。结果两组根尖周病损组织G;菌检出率和克隆比均高于G;菌(P<0.05);未经治疗组根尖周病损组织中具有较高检出率的菌种从高到低依次为具核梭杆菌(Fusobaeterium nueleatum)、隐蔽小杆菌(Dialister invisus)、纤细弯曲杆菌(Campylobacter gracilis)、轻型链球菌(Streptococcus mitis);治疗失败组根尖周病损组织中具有较高检出率的菌种从高到低依次为粪肠球菌(Enterococcus faecalis)、惰性嗜血杆菌(Haemophilus segnis)、纤细弯曲杆菌(Campylobacter gracilis)、具核梭杆菌(Fusobaeterium nueleatum)、隐蔽小杆菌(Dialister invisus);未经治疗组中,有4例根尖孔周围见骨质陷窝,陷窝内有根管生物膜存在,主要由球菌组成,其他16例仅有少量牙骨质吸收,未见根管生物膜形成;治疗失败组中牙根尖外表面均可见不同程度的牙骨质吸收,根管内壁有呈间断岛状或分布连续片状分布的根管生物膜存在,主要由球菌或杆菌组成。结论以粪肠球菌为主的细菌定植和根尖外表面根管生物膜的形成可能是导致根管治疗失败的主要原因。Objective To observe the microflora composition and the ultrastructure of the inner and outer biomembrane of root canal in the periapical lesions of chronic periapical periodontitis patients with untreated and failed root canal treatment,and to provide theoretical basis for the treatment.Methods 40 patients with chronic periapical periodontitis with no treatment and root canal therapy failure from April 2018 to April 2019 admitted to the department of Endodontics of our hospital were enrolled,and they were divided into untreated group and failed group,with 20 cases in each group.Bacterial composition was determined by 16S r DNA cloning and sequencing.The apices of the two groups were dissected and the ultrastructure of the inner and outer biomembrane of the root canal was observed by scanning electron microscope.Results The detection rate and cloning ratio of G;bacteria in periapical lesion tissues of both groups were higher than those of G;bacteria (P<0.05).The bacteria with higher detection rate in the periapical lesion tissues of the untreated group were Fusobaeterium nueleatum,Dialister invisus,Campylobacter gracilis,and Streptococcus mitis;the bacteria with higher detection rate in the periapical lesion tissue in failed group were Enterococcus faecalis,Haemophilus segnis,Campylobacter gracilis,Fusobaeterium nueleatum,and Dialister invisus.In untreated group,4 cases of patients had bony fossae around the apical foramen,and there was root canal biomebrane in the fossae,which was mainly composed of cocci,while only a small amount of cementum resorption was observed in the rest 16 cases,and no root canal biomebrane formation was observed.In the failed group,different degrees of cementous resorption were observed on the outer surface of the root apex,and there were intermittent island-like or continuous sheet-like root canal biomebrane on the inner wall of the root canal,which was mainly composed of coccus or bacillus.Conclusion The main reasons for the failure of root canal therapy are Enterococcus faecalis-domi

关 键 词：慢性根尖周炎 根管治疗失败 根尖周病损组织 根管生物膜 

分 类 号：R781.05[医药卫生—口腔医学]