生物小分子制剂在根管化学消毒中的研究进展

Research progress on small biomolecule formulations for chemical disinfection of root canals

摘要

牙髓病及根尖周病的治疗关键为清除根管内细菌及生物膜。以次氯酸钠作为冲洗液，配合使用注射器和超声冲洗，是目前临床首选的根管冲洗方式；氢氧化钙是诊间根管封药的主要选择。然而，常规根管化学消毒存在药物渗透能力欠佳以及产生耐药性等不足。近年来，新型生物小分子制剂如M33D、LL-37等抗菌肽，反义RNA分子ASwalR/ASvicR，纳米银、介孔硅酸钙、壳聚糖等纳米颗粒，因其良好的渗透性及生物调节能力，可在根管复杂解剖结构和牙本质小管深处发挥抗菌、抗生物膜的功效，并促进根尖周病变的愈合。然而，生物小分子制剂的体内稳定性、生物安全性及临床价值等仍需进一步研究。传统药物的改良、多种药物的联合使用仍是研究关注重点，未来还需开发新型小分子制剂和理想消毒药物。本文对生物小分子制剂在感染根管化学消毒中的研究新进展进行综述。

Abstract

Successful treatment of endodontic and periapical diseases requires the elimination of bacteria and microbial biofilms from root canals. Currently, the most preferred irrigation method involves the delivery of sodium hypochlorite via the combination of a syringe and ultrasonic activation. Calcium hydroxide is the main choice for intracanal medicament between endodontic appointments and treatment. However, conventional chemical disinfection of root canals is controversial due to drug permeability and drug resistance. New small biomolecule formulations with high penetrability and bioremediatory capacity, including antimicrobial peptides such as M33D and LL-37, antisense RNA ASwalR/ASvicR and nanoparticles such as silver nanoparticles, mesoporous calcium-silicate nanoparticles and chitosan nanoparticles, have effective antibacterial and antibiofilm properties for use in root canal systems and dentinal tubules, thereby promoting the healing of apical lesions. However, the in vivo drug stability, biosafety, and clinical efficacy of small biomolecule formulations need further investigation. Future research will still focus on the improvement and combination of traditional drugs, as new small molecule formulations and ideal disinfectant drugs need to be developed. In the present paper, we reviewed the development of new antibacterial agents and application of small biomolecule formulations for chemical disinfection of infected root canals.

关键词

根管治疗 / 根管消毒 / 细菌生物膜 / 根管冲洗 / 诊间封药 / 生物小分子 / 抗菌肽 / 纳米粒子

Key words

root canal therapy / root canal disinfection / bacterial biofilm / root canal irrigation / intracanal medicaments / small biomolecules / antimicrobial peptides / nanoparticle

Author summay

程怡婷，医师，硕士研究生，Email：[e-mail]