MTA(矿物三氧化物)在口腔临床的应用研究(综述)

目的:评价MTA在口腔临床中的应用.方法:收集近年来各种医学杂志已报道的有关研究资料.结果:MTA应用于牙科治疗中的直接盖髓术、活髓切断术、根尖成形、髓室底穿孔及根管侧穿修补、根尖倒充填术等多个领域,有着较好疗效.结论:在以上各种疾病治疗中,应用MTA,疗效确切,生物相容性好,在临床上有着良好的治疗前景.     

牙本质非胶原蛋白诱导牙髓-牙本质复合体反应的动物实验观察

目的：观察提取的猪牙本质非胶原蛋白对修复性牙本质形成的诱导活性。方法：用提取的猪EDTA可溶性牙本质非胶原蛋白作盖髓剂,对Wistar大鼠的健康第一磨牙进行直接盖髓实验,采用氢氧化钙（Dycal）和空白组为对照,通过组织学实验观察牙髓-牙本质复合体的反应。结果：盖髓术后7 d,各组之间软、硬组织反应的差异无统计学意义。术后14 d,NCPs组和Dycal组的修复反应均明显优于空白对照组（P〈0.01）,且NCPs组对牙髓的刺激小于Dycal组（P〈0.05）。结论：NCPs对牙髓刺激性小,可以诱导牙髓细胞分化为成牙本质细胞样细胞,形成修复性牙本质,其诱导活性至少与常规盖髓剂相当。     

树脂粘结剂用于间接盖髓的短期评价

目的：评价3种树脂粘结剂直接应用于健康犬牙深层牙本质的短期牙髓反应。方法：局麻下在48个健康犬牙的颊面颈部预备深V类洞，随机分为4组，对照组使用氢氧化钙（Dycal组）间接盖髓，其他组使用三种树脂粘结剂：U-Bond（UB组）、Adper Prompt（AP组）和Prime＆BondNT（PB组）间接盖髓，所有窝洞使用复合树脂Z100充填。分别于术后7d和30d拔牙，常规组织病理切片，HE、Mallory三色法和Gram快速细菌染色，镜下评价牙髓反应。结果：术后7d，大部分牙齿均出现轻度到中度的牙髓炎症反应，随着剩余牙本质厚度（remaining dentin thickness，RDT）减少炎症反应程度增大。术后30d，大部分样本牙髓组织结构正常，PB组炎症细胞反应和修复性牙本质多于UB、AP和Dycal组，后三组之间没有显著性差异。结论：在深洞近髓时，避免使用全酸蚀粘结剂PB间接盖髓，自酸蚀粘结剂UB和AP则较为安全。     

中药膜形盖髓剂临床及实验研究

运用自拟方,制成中药膜形盖髓剂,临床对102只恒牙酌情作直接盖髓或活髓切断术后盖髓,经1年以上观察,成功率为82.4%。动物实验:健康羊牙人工穿髓后直接盖髓45天,光镜见穿髓孔完全封闭;狗牙直接盖髓2个月,牙髓组织正常。对10例深龋人牙,作盖髓剂应用前后的牙本质细菌培养,用药2周后,培养均由阳性转为阴性。     

Electron microscope characteristics of dentin repair after hydroxylapatite direct pulp capping in rats

In order to study the osteogenic action of hydroxylapatite (HA) on the dental pulp, a pulp capping experiment was designed using the rat upper molar. Under general anesthesia, molar teeth in 14 male Sprague-Dawley rats were pulp capped with Osteogen (HA) or with Dycal as a control material. After pulp capping, the maxillary molars cavities were restored with amalgam and a pedodontic steel crown was adjusted and sealed over the molar teeth on either side of the maxilla. After 7 days, the areas of necrosis and acute inflammation were more evident in the pulps treated with Dycal than with Osteogen. Hard tissue formation began to appear around dentinal chips in the pulp and extended from the cavity walls into the pulp regardless of the material that was used. Furthermore, this calcified material was scattered throughout the pulp when Osteogen was used, but was not observed in the Dycal treated pulps. The hard tissue formation was thought to be due to the putative fibroblasts and odontoblasts found in the pulp. After 28 days dense dentinal tissue was observed bridging the exposure site when Dycal was used. The dentinal tissues formed with Osteogen was always of a globular type, and showed an irregular distribution. Since Osteogen tends to cause areas of dystrophic calcification in the pulp, its use is not be recommended for pulp capping purposes in humans, because these areas of calcification would make future endodontic treatment difficult.     

活髓保存治疗中生物材料的研究和应用

牙髓病治疗中最符合生物学观点的方法是活髓保存治疗，影响活髓保存成功的因而素很多，理想的盖髓剂至关重要。本文就活髓保存治疗中生物材料的研究应用情况作一综述。     

人牙髓细胞诱导牙本质再生的实验观察

目的:观察人成体牙髓细胞体内诱导牙髓组织修复反应的能力.方法:在矿化诱导液作用下,将一定数量级的人牙髓细胞与β-TCP生物陶瓷颗粒进行复合,植入免疫缺陷鼠磨牙穿髓孔处,7 d、14 d后分别取材进行组织学观察.对照组采用氢氧化钙(Oycal)和空白对照组.结果:组织学观察表明,盖髓术后7 d,各组均出现了牙髓细胞向穿髓孔处迁移、聚集.术后14 d,牙髓细胞组炎症反应仅局限于穿髓孔处,有明显的修复性牙本质桥形成;Dycal组炎症反应涉及到少量冠髓,有部分矿化的纤维性屏障形成;空白对照组炎症反应涉及了大部分冠髓,仅有弥散的骨样牙本质形成.结论:在矿化诱导液作用下,牙髓细胞具有向成牙本质细胞样细胞定向分化的能力,将牙髓细胞植入鼠磨牙的穿髓孔处,显示其具有良好的维持牙髓活力和诱导修复性牙本质形成的能力.     

Evaluation of two mineral trioxide aggregate compounds as pulp-capping agents in human teeth

Aim  The present randomized, controlled prospective study evaluated the histomorphological response of human dental pulps capped with two grey mineral trioxide aggregate (MTA) compounds.
Methodology  Pulp exposures were performed on the occlusal floor of 40 human permanent pre-molars. The pulp was capped either with ProRoot (Dentsply) or MTA-Angelus (Angelus) and restored with zinc oxide eugenol cement. After 30 and 60 days, teeth were extracted and processed for histological examination and the effects on the pulp were scored. The data were subjected to Kruskal–Wallis and Conover tests (α = 0.05).
Results  In five out of the 40 teeth bacteria were present in pulp tissue. No significant difference was observed between the two materials ( P  > 0.05) in terms of overall histological features (hard tissue bridge, inflammatory response, giant cells and particles of capping materials). Overall, 94% and 88% of the specimens capped with MTA-Angelus and ProRoot, respectively, showed either total or partial hard tissue bridge formation ( P  > 0.05).
Conclusions  Both commercial materials ProRoot (Dentsply) and MTA-Angelus (Angelus) produced similar responses in the pulp when used for pulp capping in intact, caries-free teeth.     

新型磷酸钙复合盖髓材料的体外抑菌作用

目的研究新型磷酸钙复合盖髓材料(CASBi)对常见致龋菌的体外抑菌作用。方法采用琼脂扩散法,通过测量抑菌圈直径大小,研究并比较CASBi与氢氧化钙糊剂、Dycal、自固化磷酸钙骨水泥(CPC)对变形链球菌(Sm)、粘性放线杆菌(Av)及嗜酸乳杆菌(La)的抑菌效果。结果CASBi对三种细菌都有明显的抑菌作用;氢氧化钙糊剂对3种实验菌有一定抑菌作用,但其抑菌环直径明显小于CASBi抑菌环直径(P<0.05);Dycal对变形链球菌无抑菌作用,对粘性放线菌和乳酸杆菌有较轻微的抑菌作用;CPC对3种细菌均无抑菌作用。结论CASBi对致龋菌有较强的抑菌作用。     

盖髓剂抑菌作用的体外实验观察

本文通过体外抑菌实验观察羟基磷灰石（Ｈｙｄｒｏｘｙａｐａｔｉｔｅ，ＨＡＰ）、氢氧化钙（Ｃａｌｃｉｕｍｈｙｄｒｏｘｉｄｅ，ＣＨ）以及两种盖髓制剂（ＨＡＰ制剂、ＨＡＰ－ＣＨ制剂）对金黄色葡萄球菌、大肠杆菌、化脓性链球菌、变形链球菌、中间普里沃氏菌的抑菌作用。结果显示：ＨＡＰ对各实验菌无抑菌作用，ＣＨ有一定的抑菌作用，ＨＡＰ制剂和ＨＡＰ－ＣＨ制剂具有较强的抑菌作用