牙髓血运重建术治疗年轻恒牙根尖周病变的临床及影像学评估

doi:10.13701/j.cnki.kqyxyj.2020.07.006

口腔医学研究 ›› 2020, Vol. 36 ›› Issue (7): 630-634.DOI: 10.13701/j.cnki.kqyxyj.2020.07.006

牙髓血运重建术治疗年轻恒牙根尖周病变的临床及影像学评估

刘学军^*, 徐家敏

郑州大学第一附属医院,郑州大学口腔医学院河南郑州 45000

收稿日期:2019-10-31 出版日期:2020-07-28 发布日期:2020-07-24
通讯作者: 刘学军,E-mail:lxj@zzu.edu.cn
作者简介:刘学军(1964~),女,吉林省吉林市人,硕士,副教授,主要从事龋病、牙髓病学的病因学、治疗学的研究及临床教学诊疗工作。
基金资助:
河南省医学科技攻关计划省部共建项目(编号:SB201901022)

Clinical and Radiological Evaluation of Pulp Revascularization for Immature Permanent Teeth with Apical Periodontitis

LIU Xuejun^*, XU Jiamin

The Fist Affiliated Hospital of Zhengzhou University,School of Stomatology Zhengzhou University,Zhengzhou 450000,China

Received:2019-10-31 Online:2020-07-28 Published:2020-07-24

摘要/Abstract

摘要： 目的: 评价牙髓血运重建术治疗根尖发育不成熟年轻恒牙的疗效。方法: 选择诊断为根尖周炎或牙髓坏死的患牙28颗,术前拍摄X线片,记录根尖周病变和牙根发育状况,进行牙髓血运重建术。术后对每颗患牙进行临床和X线评价,对数据进行统计学分析,总结疗效及与牙根发育相关因素。结果: 28颗患牙(29例根管)平均复查时间15.44(12~30)个月;牙根继续发育21例,根管壁厚度增加20例,根管钙化4例;牙根发育类型分为4类:A:牙根增长,根尖聚拢(变小或闭合),B:牙根未增长,根尖封闭,C:根管腔钙化封闭,D:根冠内出现钙化屏障,E:治疗前后牙根无变化;牙髓血运重建术成功16例,好转13例,失败0例,有效率为100%;年龄及引血程度与牙根是否继续发育相关,根尖孔大小、根尖周病变面积、牙根发育分期与牙根是否继续发育无明显相关性。结论: 牙髓血运重建术治疗根尖发育不成熟的患牙具有可行性,但其远期疗效仍需要继续追踪随访。

关键词: 年轻恒牙, 牙髓血运重建术, 根尖周炎

Abstract: Objective: To evaluate the treatment effectiveness of revascularization in necrotic immature teeth. Methods: Twenty-eight immature teeth which were diagnosed as periodontitis or pulp necrosis were recruited. X-ray was taken before revascularization. Clinical and radiographic data were collected. Statistical analysis was conducted to summarize the clinical factors which were related to root development. Results: The average follow-up time was 15.44 (12-30) months, among which 21 root canals achieved increase of root length, 20 root canals showed increase of dental wall thickness, and 4 root canals had calcification. Five types of responses were observed: type A, continued root maturation (apical foramen closure/narrow); type B, no significant continuation of root development with the root apex becoming closed; type C, severe calcification (obliteration); type D, a hard tissue barrier formed in the canal between the coronal MTA plug and the root apex; type E, there was no change compared before. The increase of root length was significantly different between the age and degree of bleeding, however, no significant different in the size of the root apical, the lesion area around the root apical, and the stage of root development. Conclusion: Pulp revascularizafion could be an effective treatment for immature permanent teeth, but its long-term effect still needs to be followedup

Key words: immature permanent teeth, pulp revascularization, apical periodontitis

刘学军, 徐家敏. 牙髓血运重建术治疗年轻恒牙根尖周病变的临床及影像学评估[J]. 口腔医学研究, 2020, 36(7): 630-634.

LIU Xuejun, XU Jiamin. Clinical and Radiological Evaluation of Pulp Revascularization for Immature Permanent Teeth with Apical Periodontitis[J]. Journal of Oral Science Research, 2020, 36(7): 630-634.

参考文献

[1] Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures[J]. J Endod, 2009, 35(10):1343-1349.
[2] 刘金凤,牛雪微,超博,等.牙髓再生的研究现状[J].口腔医学研究,2017,33(1):108-111.
[3] 杨媛,彭楚芳,秦满,等.牙髓血运重建术治疗年轻恒牙根尖周病变的临床效果观察[J].中华口腔医学杂志,2013,48(2):81-85.
[4] Bukhari S, Kohli MR, Setzer F, et al. Outcome of revascularization procedure: A retrospective case series[J]. J Endod, 2016, 42(12):1752-1759.
[5] Chen MY, Chen KL, Chen CA, et al. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures[J]. Int Endod J, 2012, 45(3):294-305.
[6] Shah N, Logani A, Bhaskar U, et al. Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: A pilot clinical study[J]. J Endod, 2008, 34(8):919-925.
[7] Alobaid AS, Cortes LM, Lo J, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study[J]. J Endod, 2014, 40(8):1063-1070.
[8] Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: A pilot clinical study[J]. J Endod, 2012, 38(12):1581-1587.
[9] 黄定明, 杨懋彬, 周学东.牙髓再生治疗的临床操作管理及疗效评价 [J]. 中华口腔医学杂志,2019,54(9): 584-590.
[10] 凌均棨,曾倩,林家成.牙髓血运重建术治疗年轻恒牙根尖周病的研究进展[J]. 中华口腔医学研究杂志(电子版), 2014,(5):353-356.
[11] 徐静晨.三联抗生素糊剂在年轻恒牙牙髓再生中的应用[J]. 口腔医学研究,2017,35(7):629-631.
[12] Ruparel NB , Teixeira FB , Ferraz CCR , et al. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla[J]. J Endod, 2012, 38(10):1372-1375.
[13] Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal may increase risk of root fracture[J]. Dent Traumatol, 2002, 18(3):134-137.
[14] Andreasen JO , Kristerson L, Andreasen FM. Damage of the Hertwig's epithelial root sheath: effect upon root growth after autotransplantation of teeth in monkeys[J]. Endod Dent Traumatol, 1988, 4(4):145-151.
[15] Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case[J]. J Endod, 2012, 38(10):1428-1434.
[16] Andreasen JO, Borum MK, Jacobsen HL, et al. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing[J]. Endod Dent Traumatol, 1995, 11(2):76-89.
[17] Estefan BS, Batouty KME, Nagy MM, et al. Influence of age and apical diameter on the success of endodontic regeneration procedures[J]. J Endod, 2016, 42(11):1620-1625.
[18] Thibodeau B, Teixeira F, Yamauchi M, et al. Pulp revascularization of immature dog teeth with apical periodontitis[J]. J Endod, 2007, 33(6):680-689.
[19] 张明,冯岩.牙髓血运重建术用于根尖孔宽大的年轻恒牙临床疗效分析[J].口腔医学研究,2017,33(2)∶175-178.
[20] 包志凡, 陈旭.年轻恒牙牙髓血管再生治疗[J]. 中国实用口腔科杂志, 2015, 8(9):522-526.
[21] Kun X, Bei L, Hao G, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth[J]. Sci Transl Med, 2018, 10(455):eaaf3227.
[22] Song M, Cao Y, Shin SJ, et al. Revascularization-associated intracanal calcification: assessment of prevalence and contributing factors[J]. J Endod, 2017, 43(12):2025-2033.

牙髓血运重建术治疗年轻恒牙根尖周病变的临床及影像学评估

Clinical and Radiological Evaluation of Pulp Revascularization for Immature Permanent Teeth with Apical Periodontitis

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