Endodontic interappointment mergers (EIAEs) during root canal treatment refer to the occurrence of varying degrees of pain or discomfort in the affected tooth area, and in severe cases, local swelling or even acute cellulitis, which often occurs after root canal preparation. At present, it is widely recognized that microbial infection is the main cause of EIAE, therefore, infection control has become a very important part of the root canal treatment process. To control infection and prevent the occurrence of EIAE, doctors need to perform their operations in a sterile environment while removing residual infectious substances in the root canal as much as possible. Rubber barrier moisture barrier surgery can completely isolate the affected tooth from the oral cavity, and is currently the most thorough moisture barrier method for root canal treatment. Among commonly used irrigation solutions, sodium hypochlorite has antibacterial and dissolving effects on necrotic pulp tissue, making it one of the most effective root canal irrigation solutions currently available. This study aims to investigate the clinical effect of using sodium hypochlorite flushing combined with rubber barriers for moisture isolation in root canal treatment to reduce the incidence of emergencies during the treatment period.
1. Data and Methods
1.1 Clinical data
287 patients (287 teeth) diagnosed with pulpitis, pulp necrosis, and chronic periapical periodontitis requiring root canal treatment at the Stomatology Department of the Affiliated Hospital of the Armed Police Logistics College from September 2014 to September 2015 were collected. The patients ranged in age from 18 to 60 years, with an average age of 36.5 years and a male to female ratio of approximately 1.1:1. Patients included in the trial are required to participate in the trial on a voluntary and informed basis and sign an informed consent form.
In this study, patients were randomly divided into three groups according to the order of their visit, based on the different methods of moisture isolation and flushing medication: the sodium hypochlorite rubber barrier group (experimental group), the hydrogen peroxide rubber barrier group (control group 1), and the hydrogen peroxide group (control group 2). The age, gender, and condition of the three groups of patients were generally equal, with no significant differences (P>0.05), indicating comparability of the samples. Inclusion criteria: (1) Patient age ≥ 18 years old; (2) Healthy, free from immune system diseases and diabetes; (3) According to the diagnostic criteria of the third edition of the textbook "Endodontics" planned by the Ministry of Health, the diagnosis is pulpitis, pulp necrosis, and chronic periapical periodontitis; (4) After X-ray examination, no calcification of the affected root canal, perforation of the pulp floor, lateral perforation of the root canal, incomplete development of the apical foramen, or damage to the apical stenosis area were found; (5) Not using antibiotics within one week prior to the visit.
Exclusion criteria: (1) Cases with obvious percussion pain in the affected tooth, as well as acute periapical periodontitis symptoms such as redness, swelling, and tenderness in the apical area; (3) Cases with severe periodontal disease that may interfere with the assessment of pain levels; (3) Cases that cannot be followed up on time.
1.2 Equipment and Methods
1.2.1 Rubber Barrier System (Swiss Conte Dental Group)
Including rubber barriers, rubber barrier frames, rubber barrier clips, punchers, rubber barrier clamps, and other auxiliary materials such as lubricants, straps, dental floss, sealants, etc.
1.2.2 Treatment methods
Before treatment, the experimental group and control group 1 applied rubber barriers, first cleaned the tooth surface, selected suitable rubber barrier clips according to the tooth position, and drilled holes according to the rubber barrier punching template; Place the selected rubber barrier clip into the hole of the rubber barrier, use the wings of the rubber barrier clip on both sides to open the rubber barrier hole, and place the rubber barrier pliers in the hole of the rubber barrier clip; Use rubber band pliers to place the rubber band and rubber band clamp on the treated teeth, ensuring that they do not clamp on soft tissue, and guide the rubber band clamp in place with your fingers; After the rubber barrier clip is fully in place, remove the rubber barrier pliers, and finally lower the rubber barrier from the wing of the rubber barrier clip, insert it into the neck of the tooth, use dental floss to press the rubber barrier on the adjacent gap into the tooth gap, and then fix the rubber barrier on the rubber barrier frame. The installation of the rubber barrier is complete. Each group of cases underwent routine pulp opening, extraction, and root canal dredging to determine the working length of the root canal. The stepwise deepening method was used to prepare the Protaper root canal. The experimental group alternately rinsed the root canal with 5.25% sodium hypochlorite and 0.9% sodium chloride; Both control group 1 and control group 2 were alternately rinsed with 3% hydrogen peroxide and 0.9% sodium chloride. The amount of flushing solution for each tube in each group is 1ml. After flushing, the root tube is dried with a paper tip, and calcium hydroxide paste is introduced using a screw conveyor. The cavity is temporarily sealed with zinc oxide clove oil adhesive powder. Within 24 hours after surgery, follow-up will be conducted by phone to record in detail any changes in the patient's symptoms. For those who experience EIAE during the medication period, prompt follow-up visits will be advised. All cases will be revisited one week later, during which the patient's condition will be inquired about, clinical examinations will be conducted, and records will be kept. The above treatment and follow-up work were all completed by the same physician.
1.3 Evaluation Criteria
According to the pain criteria proposed by Sulong et al., the occurrence of EIAE is judged as follows: level 0: painless; Grade I: Only mild pain or discomfort, not requiring emergency treatment; Grade II: Pain can be relieved with medication or reduction of bite; Grade III: Severe pain accompanied by local or facial swelling. Level II and III are classified as EIAE.
1.4 Statistical analysis
Using SPSS18.0 statistical software, a chi square test was applied to compare the incidence of EIAE among three groups of cases. P<0.05 was considered statistically significant.