Kök kanal dezenfeksiyonunda lazer ve ozon kullanımının antimikrobiyal etkinliğinin değerlendirilmesi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı; kök kanal dezenfeksiyonunda lazer ve ozon kullanımının Enterococcus faecalis’e (E. faecalis) karşı antimikrobiyal etkinliğinin değerlendirilmesidir.
Çalışmada, 132 adet çekilmiş insan dişi (tek kanallı alt çene daimi küçük azı) kullanılmıştır. Çekilen dişler çalışma süresine kadar +4°C steril serum fizyolojik solüsyonunda (Eczacıbaşı, İstanbul, Türkiye) bekletilmiştir. Çekilmiş dişler mine-sement birleşiminden, kök boyları 16±1 mm olacak şekilde belirlenip su soğutması altında elmas fissür frezlerle prepare edilmiştir. Apikal foramenden 1 mm geride olacak şekilde çalışma boyu ayarlanmış ve kök kanallarını şekillendirmek amacı ile Reciproc döner aletleri (Dentsply Maillefer, Ballaigues, İsviçre) kullanılmıştır. Kök kanallarının şekillendirilmesi sırasında oluşan smear tabakasını uzaklaştırmak için, kök kanalları 10 ml %2,5’lik NaOCl (Werax, İzmir, Türkiye), 10 ml %17’lik EDTA (Werax, İzmir, Türkiye) ve 10 ml distile suyla yıkanmış, takiben steril kâğıt konlarla kurulanmıştır. Çalışmada kullanılan kökler 121°C’de 20 dk süreyle otoklavda sterilize edilmiş ve rastgele 11 gruba (n=10) ayrılmıştır. Tüm gruplar E. faecalis (ATCC 29212) suşu kullanılarak 24 saat boyunca 37°C sıcaklıkta etüvde inkübasyon için bekletilmiştir. Deney gruplarında uygulanan tedavi protokolleri ise şu şekildedir; Grup 1: %2,5’lik sodyum hipoklorit (NaOCl) (5 ml) (Pozitif kontrol); Grup 2: %2’lik Klorheksidin (CHX) (5 ml); Grup 3: %2,5’lik NaOCl (5ml)+lazer (Foton kaynaklı fotoakustik akış) (PIPS) (3x20s.); Grup 4: %2’lik CHX (5 ml)+lazer (PIPS) (3x20s); Grup 5: Ozon; Grup 6: %2,5’lik NaOCl (5 ml)+ozon (24s); Grup 7: %2’lik CHX (5 ml)+ozon (24s); Grup 8: %2,5’lik NaOCl (5 ml)+EndoActivator (60s); Grup 9: % 2’lik CHX (5 ml)+EndoActivator (60s); Grup 10: Kontrol grubu (Negatif kontrol); Grup 11: Sterilite kontrol grubu. Dezenfeksiyon protokollerinden sonra kök kanallarından mikrobiyolojik örnek toplamak için kanalların hepsine 5 ml %0,9’luk steril salin solüsyonu uygulanarak steril kağıt konlar kök kanallarında 60 saniye bekletilmiş ve ilgili nötralizan solüsyonlar bulunan eppendorf tüplerine aktarılmıştır. Alınan örnekler mikroorganizma sayılarındaki değişimin değerlendirilmesi için mikrobiyoloji laboratuvarına gönderilmiştir. Mikrobiyolojik değerlendirme sonrası her kanal örneği için koloni oluşturan birimler (CFU) sayılmış, elde edilen veriler SPSS 20.0 bilgisayar programına aktarılarak tek yönlü Anova (p<0.05) testi ile istatistiksel olarak değerlendirilmiştir. Her gruba ait örnekler taramalı elektron mikroskobu (SEM) (JEOL_JSM 5200 Tokyo, Japonya) ile de incelenerek bakteri birikimi ve yüzey özelliklerinin değerlendirmesi amacıyla fotoğrafları alınmıştır.
Yapılan istatistiksel analiz sonucunda, %2,5'lik NaOCl+lazer (Grup 3)’in E. faecalis'e karşı en etkili antibakteriyel özelliği gösterdiği bulunmuş ve tam eliminasyon elde edilmiştir. %2’lik CHX+lazer (Grup 4), %2,5’lik NaOCl+ozon (Grup 6) ve %2,5’lik NaOCl+EndoActivator (Grup 8) uygulanan gruplardaki CFU/ml değerleri arasındaki fark istatistiksel olarak anlamlı değildir (p=0.56 ve p=0.855).
Çalışmanın SEM analizinde, lazer uygulaması sonrasında, lazer ışığına bağlı olarak çok düzensiz bir yapının oluştuğu ve kök kanallarındaki smear tabakasının uzaklaştığı gözlenmiştir. Lazer uygulamasının kök kanal duvarlarından smear tabasını kaldırması, tekniğin önemli bir avantajı olarak düşünülmektedir.
%2,5'lik NaOCI'in lazer ile etkinleştirilmesi, solüsyonun tek başına kullanılmasına göre antibakteriyel etkiyi arttırdığı sonucuna varılmıştır. Ozon ve EndoActivator uygulamasının irrigan ajanlar ile birlikte kullanımının lazer kullanımına iyi bir alternatif olabileceği; ancak konu ile ilgili daha çok çalışmaya ihtiyaç olduğu düşünülmektedir.
The aim of this study was to evaluate the antimicrobial efficacy of laser and ozone against Enterococcus faecalis (E. faecalis) in root canal disinfection. In our study, 132 human root with single canal (permanent mandibular premolars) were used. The teeth were kept in sterile saline solution at 4 degrees until the study was performed. Crowns and roots of the teeth were separated and root length were set as 16±1 mm. The working length was adjusted 1 mm back from the apical foramen. Reciproc rotary instruments were used for instrumentation. The smear layer, which was produced by preparation, was removed by 10 ml 17% EDTA, 10 ml 2,5% NaOCl solutions and 10 ml distilled water irrigation. Dried with sterile paper cones. Thereafter specimens were sterilized by autoclaving the specimens at 121°C for 20 minutes. Roots were randomly divided into 11 groups (n =10). All groups were incubated with E. faecalis (ATCC 29212) strain for 24 hours in a 37°C. The treatment protocols applied in the experimental groups are as follows; Group 1: 2,5% NaOCL (5 ml); Group 2: 2% CHX (5ml); Group 3: 2,5% NaOCl (5 ml)+laser (PIPS) (3x20 sec); Group 4: 2% CHX (5 ml)+laser (PIPS) (3x20 sec); Group 5: ozone; Group 6: 2,5% NaOCl (5 ml)+ozone (24 sec); Group 7: 2% CHX (5 ml)+ozone (24 sec); Group 8: 2,5% NaOCl (5 ml)+EndoActivator (60 sec); Group 9: 2% CHX (5ml)+EndoActivator (60 sec); Group 10: Control group; Group 11: Sterility control group. After disinfection protocols, 5 ml of 0,9% sterile saline solution was applied to collect microbiological samples from root canals. Sterile paper cones were placed in root canals for 60 seconds and transferred to eppendurf tubes with neutralizing solutions. The samples were sent to the microbiology laboratory to evaluate the change in the number of microorganisms. After microbiological evaluation, colony forming units (CFU) were counted from each specimen and the obtained data were evaluated statistically. Samples were also evaluated by scanning electron microscopy (SEM). After microbiological evaluation, colony forming units (CFU) were counted for each channel sample and the obtained data were transferred to SPSS 20.0 computer program and evaluated statistically by one-way Anova (p <0.05) test. Samples of each group were also examined by scanning electron microscopy (SEM) (JEOL_JSM 5200 Tokyo, Japan) and photographed for evaluation of bacterial accumulation and surface properties. As a result of statistical analysis, 2,5% NaOCl+laser group (Group 3) showed the most effective antibacterial properties against E. faecalis and complete elimination was achieved. The difference between CFU / ml values in the 2% CHX + laser (Group 4), 2,5% NaOCl + ozone (Group 6) and 2,5% NaOCl + EndoActivator (Group 8) groups was not statistically significant (p = 0.56 and p = 0.855). In the SEM analysis of the study, it was observed that after the laser application, a very irregular structure was formed due to the laser light and the smear layer in the root canals was removed. Laser removal of the smear layer from the root canal walls is considered to be an important advantage of the technique. With in the limitations of these results, it was concluded that 2,5% NaOCI activation by Er:YAG laser increase the antibacterial effect when used alone. Application of ozone and EndoActivator in combination with the respective irrigant agents may be an alternative of choice to laser but more studies are needed on this subject.
The aim of this study was to evaluate the antimicrobial efficacy of laser and ozone against Enterococcus faecalis (E. faecalis) in root canal disinfection. In our study, 132 human root with single canal (permanent mandibular premolars) were used. The teeth were kept in sterile saline solution at 4 degrees until the study was performed. Crowns and roots of the teeth were separated and root length were set as 16±1 mm. The working length was adjusted 1 mm back from the apical foramen. Reciproc rotary instruments were used for instrumentation. The smear layer, which was produced by preparation, was removed by 10 ml 17% EDTA, 10 ml 2,5% NaOCl solutions and 10 ml distilled water irrigation. Dried with sterile paper cones. Thereafter specimens were sterilized by autoclaving the specimens at 121°C for 20 minutes. Roots were randomly divided into 11 groups (n =10). All groups were incubated with E. faecalis (ATCC 29212) strain for 24 hours in a 37°C. The treatment protocols applied in the experimental groups are as follows; Group 1: 2,5% NaOCL (5 ml); Group 2: 2% CHX (5ml); Group 3: 2,5% NaOCl (5 ml)+laser (PIPS) (3x20 sec); Group 4: 2% CHX (5 ml)+laser (PIPS) (3x20 sec); Group 5: ozone; Group 6: 2,5% NaOCl (5 ml)+ozone (24 sec); Group 7: 2% CHX (5 ml)+ozone (24 sec); Group 8: 2,5% NaOCl (5 ml)+EndoActivator (60 sec); Group 9: 2% CHX (5ml)+EndoActivator (60 sec); Group 10: Control group; Group 11: Sterility control group. After disinfection protocols, 5 ml of 0,9% sterile saline solution was applied to collect microbiological samples from root canals. Sterile paper cones were placed in root canals for 60 seconds and transferred to eppendurf tubes with neutralizing solutions. The samples were sent to the microbiology laboratory to evaluate the change in the number of microorganisms. After microbiological evaluation, colony forming units (CFU) were counted from each specimen and the obtained data were evaluated statistically. Samples were also evaluated by scanning electron microscopy (SEM). After microbiological evaluation, colony forming units (CFU) were counted for each channel sample and the obtained data were transferred to SPSS 20.0 computer program and evaluated statistically by one-way Anova (p <0.05) test. Samples of each group were also examined by scanning electron microscopy (SEM) (JEOL_JSM 5200 Tokyo, Japan) and photographed for evaluation of bacterial accumulation and surface properties. As a result of statistical analysis, 2,5% NaOCl+laser group (Group 3) showed the most effective antibacterial properties against E. faecalis and complete elimination was achieved. The difference between CFU / ml values in the 2% CHX + laser (Group 4), 2,5% NaOCl + ozone (Group 6) and 2,5% NaOCl + EndoActivator (Group 8) groups was not statistically significant (p = 0.56 and p = 0.855). In the SEM analysis of the study, it was observed that after the laser application, a very irregular structure was formed due to the laser light and the smear layer in the root canals was removed. Laser removal of the smear layer from the root canal walls is considered to be an important advantage of the technique. With in the limitations of these results, it was concluded that 2,5% NaOCI activation by Er:YAG laser increase the antibacterial effect when used alone. Application of ozone and EndoActivator in combination with the respective irrigant agents may be an alternative of choice to laser but more studies are needed on this subject.
Açıklama
Anahtar Kelimeler
Enterecoccus Faecalis, Lazer Destekli Aktivasyon, Ozon, EndoActivator, Ozone, EndoActivator, Laser Induced Activation
