XP-endoフィニッシャーは、EndoActivatorよりも治療後の歯根端歯周炎症例に対する腔内細菌に対する有効性において優れた治療法であるか？

Is XP-endo Finisher a better treatment option for its efficacy against intracanal bacteria for post-treatment apical periodontitis cases than EndoActivator?

抄録

根管治療済みの根尖性歯周炎患者を対象に、回転攪拌法［XP-endo Finisher（XPF）］と音波灌流法［EndoActivator（EA）］の併用による細菌量の減少効果を、液滴デジタルPCR法（ddPCR）を用いて検討した。治療後の根尖性歯周炎患者20名を、使用した潅注活性化方法によって2群に割り付けた：XPF群とEA群である。総細菌負荷量およびEnterococcus faecalis（E.faecalis）量を、化学機械的前処置前（S1）、化学機械的前処置後（S2）、および最終的な灌流活性化後（S3）にddPCRを用いて測定した。細菌コピー数は、フリードマン検定（ノンパラメトリック反復測定ANOVA）を用いて群間で比較した。性別、年齢、根管数、periapical index score、無菌コントロール総菌数（SCTB）、S1-およびS2-総菌数コピー数の観点から各群を検討したところ、XPF群とEA群の間に統計学的な差は認められなかった（p>0.05）。その後の活性化（S3）では、XPF群、EA群ともに、化学機械的インスツルメンテーション（S2）よりも有意に多くの細菌が減少した（p<0.0001）。逆に、EA群のS3-総細菌コピー数はXPF群より少なかった（p<0.0147）。E.faecalisのコピー数に関しては、XPF群とEA群の間に統計的な差はなかった（p>0.05）。XPFとEAは、根管治療済みの根尖性歯周炎歯において、ケモメカニカルプレパレーションの抗菌効率を最適化したが、EAの方がXPFよりも総細菌コピー数が少なかった。

To investigate the efficacy of the supplementary use of a rotary agitation method [XP-endo Finisher (XPF)] and sonically-activated irrigation [EndoActivator (EA)], using droplet digital PCR (ddPCR) on reducing the bacterial load in previously root canal treated teeth with apical periodontitis. Twenty patients with post-treatment apical periodontitis were allocated into two groups according to the irrigation activation method used: XPF and EA group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation, and after final irrigation activation (S3) by means of ddPCR. The bacterial copy numbers were compared between groups using the Friedman test (Nonparametric Repeated Measures ANOVA). When the groups were examined in terms of gender, age, number of root canals, periapical index score, sterility control total bacteria (SCTB), S1- and S2-total bacteria copy number, it was found that there was no statistical difference between the XPF group and the EA group (p > 0.05). Subsequent activation (S3) resulted in a significant microbial reduction in both XPF and EA groups, both of which reduced significantly more bacteria than chemomechanical instrumentation (S2) (p < 0.0001). On the contrary, S3-total bacteria copy number of the EA group was lower than the XPF group (p < 0.0147). There was no statistical difference between the XPF group and the EA group in terms of E. faecalis copy number (p > 0.05). Although both the XPF and the EA optimised the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis, a lower total bacterial copy number was achieved with the EA application than the XPF application.