牙髓血运重建治疗年轻恒牙根尖周病变的临床观察

目的 观察年轻恒牙进行牙髓血运重建术后牙根发育及根尖周病变愈合情况.方法 选取慢性根尖周炎或慢性根尖周炎急性发作的单根管年轻恒牙16例,要求牙根发育Nolla分期7～9期.行牙髓血运重建术治疗,随访观察2年,定期进行临床检查并拍摄X线片观察牙根发育及根尖周病变的愈合情况.结果 16例单根管年轻恒牙牙髓血运重建术后12例牙根继续发育.其中13例在定期复查时牙髓电活力测试结果表现为阳性;16例术后根尖周病变均完全愈合,愈合时间因病变大小而不同,平均愈合时间为4.1个月.疗效评价为成功12例,好转4例,失败0例.结论 牙髓血运重建术治疗年轻恒牙根尖周病变,取得良好的治疗效果.     

年轻恒牙牙髓血运重建术临床效果初步观察

目的:评价因外伤、发育畸形所致根尖周炎或牙髓坏死的年轻恒牙牙髓血运重建术后的疗效及影响因素.方法:回顾分析66例因根尖周炎或牙髓坏死行血运重建治疗的年轻恒牙,采用Mimics软件重建患牙治疗前后的根尖周病损三维模型并测量体积,采用Dolphin软件测量患牙治疗前后的牙根长度、根管壁厚度及根尖孔大小,评估治疗后患牙根尖周...     

牙髓血运重建术治疗年轻恒牙牙髓坏死伴根尖周病变临床疗效及锥形束CT影像定量评价

目的　探讨运用牙髓血运重建术治疗年轻恒牙牙髓坏死伴根尖周病变的临床疗效并进行影像学定量评价。方法    选择2018年1—11月于上海市口腔医院牙体牙髓病科就诊的18例年轻恒牙牙髓坏死伴根尖周病变患者的18颗患牙（均为单根管的下颌前磨牙）,行牙髓血运重建术。术后随访18个月,期间收集临床及影像学数据,分析临床疗效并对牙根影像面积、根尖孔直径以及牙根长度变化进行CBCT影像定量评估,分析可能影响术后牙根发育的因素。结果　所有18颗经过治疗的患牙临床症状均消失,无叩痛、松动及窦道,有效率为100%,其中成功15例（83.3%）、好转3例（16.7%）。以术前为基准,术后18个月牙根影像面积平均增加83.78%,根尖孔直径平均减少50.78%,牙根长度平均增加24.61%;年龄（是否大于17岁）与牙根是否继续发育相关,性别及根尖孔大小与牙根是否继续发育无明显相关性。结论    对于牙髓坏死伴根尖周病变的年轻恒牙,采用牙髓血运重建术可使牙根得到持续发育,年龄可影响术后牙根发育水平。     

牙髓血运重建术治疗年轻恒牙牙髓坏死的临床观察

目的:评价牙髓血运重建术用于年轻恒牙牙髓坏死的临床治疗效果。方法:选择8～16岁患者18例,因外伤或畸形中央尖折断致牙髓坏死伴不同程度的根尖周病变年轻恒牙20颗,牙根发育Nolla分期7～9期。20颗年轻恒牙均采用牙髓血运重建术,随访观察6～60个月,记录根尖周病变愈合及牙根发育情况。结果:20颗年轻恒牙经过牙髓血运重建治疗,通过6～60个月的随访观察,16颗治愈,2颗好转,2颗失败,总有效率90%。X线片示有效病例患牙根尖周阴影消失或缩小,牙根长度及根管壁厚度呈不同程度增加,部分长期随访的病例出现根尖钙化,管腔持续性窄缩。仅有2颗前磨牙复查时牙髓电活力测试结果呈阳性。结论:牙髓血运重建术治疗年轻恒牙牙髓坏死的病例,取得良好的治疗效果,术后临床症状消失,牙根继续发育,牙根延长,根管壁增厚,但远期疗效仍需长期观察随访。     

牙髓血运重建术和根尖诱导成形术疗效对比的Meta分析

目的 采用Meta分析探讨牙髓血运重建术和根尖诱导成形术治疗年轻恒牙牙髓不可逆性损伤的疗效。方法 从外文数据库（PubMed、Embase、Cochrane library）和中文数据库（中国知网、中国生物医学文献服务系统、万方和维普）中检索2001年1月—2021年10月公开发表的关于2种方法治疗年轻恒牙牙髓不可逆性损伤的随机对照试验研究（RCT）,并由2名成员严格按照纳入和排除标准独立进行筛选、数据提取和质量评价,采用RevMan 5.3和STATA 12.0软件进行Meta分析。结果 最终纳入19篇RCT研究,Meta分析结果显示牙髓血运重建术治疗年轻恒牙牙髓不可逆性损伤成功率显著高于根尖诱导成形术（P<0.05）,且在促进管壁厚度增加（P<0.05）、牙根延长（P<0.05）并发症的发生率（P<0.05）方面更有优势。结论 与根尖诱导成形术相比,牙髓血运重建术的成功率更高,且在促进牙根发育方面的疗效更佳。     

牙髓血运重建术在年轻恒牙牙髓坏死伴/不伴根尖周炎治疗中的临床疗效

目的:评价牙髓血运重建术在牙髓坏死伴/不伴根尖周炎的年轻恒牙牙髓治疗中的临床疗效。方法:回顾进行牙髓血运重建术治疗的10颗患牙,术后每3～6个月复查,随访10～27个月。通过问诊、临床检查和影像学检查评估治疗前后,患牙不适临床症状的转归以及牙根发育的情况。结果:牙髓血运重建术后,所有患牙不适临床症状消失,临床有效率和患牙临床生存率达100%,且影像学检查显示根尖周病变愈合,牙根继续发育,根尖孔直径减小,牙根长度增加(P<0.05),根管壁厚度增加不显著(P>0.05)。结论:牙髓血运重建术在牙髓坏死伴/不伴根尖周炎年轻恒牙的治疗中取得了较好的临床疗效。     

牙髓血运重建术治疗年轻恒牙牙髓炎及根尖周炎的回顾性研究

目的:评价牙髓血运重建术治疗年轻恒牙牙髓炎及根尖周炎的疗效及影像学改变。方法:回顾分析95例因牙髓炎或根尖周炎行牙髓血运重建术的年轻恒牙病例。根据临床症状及影像学特点分为实验组、对照组。比较两组术后疗效,利用Image J软件测量并比较牙根发育情况。结果:术后(11.86±7.89)个月,实验组有效率(83.67%)低于对照组(97.83%);根尖孔闭合程度(0.39±0.40)明显低于对照组(0.60±0.32);两组牙根增长、放射性牙根面积变化及髓腔弥漫性钙化比例无明显差异。结论:年轻恒牙根尖破坏情况是影响牙髓血运重建术疗效和牙根发育情况的因素之一。     

牙髓血运重建术治疗年轻恒牙根尖周病的研究进展

根管内血运重建术是1waya在2001年首次提出的一种牙髓再生方法,主要通过彻底有效的根管消毒。为牙髓干细胞、牙乳头间充质干细胞等增殖和分化提供良好的环境,从而促使牙根继续发育,多用于治疗年轻恒牙根尖周炎。至今,已有多位学者报道采用该方法取得了令人满意的结果．即患牙的根尖周损害影像消失、牙根继续发育。本文将从根管内血运重建术的发生原理、组织学来源、抗菌剂的应用及组织支架等方面的研究进展做一述评。     

牙髓血管再生治疗年轻恒牙根尖周炎的应用

目的:观察牙髓血管再生治疗年轻恒牙根尖周炎的效果。方法:10名患者12颗牙,平均年龄10.8岁,根尖周有暗影,牙根未发育完成。术后每1~2月复查1次,连续观察6~18个月。结果:8颗牙牙根继续发育;从放置MTA至根尖发育完成的平均时间为4.6个月;牙根长度与对侧同名牙无明显差异。结论:牙髓血管再生是治疗年轻恒牙根尖周炎的有效方法。     

年轻恒牙根尖诱导成形术后根尖发育的影响因素

目的观察年轻恒牙根尖诱导成形术后根尖发育情况和根尖封闭愈合类型,分析影响根尖发育的临床因素。方法收集行根尖诱导成形术的患牙35颗,详细观察患牙术前、术中、术后的X线片,记录根尖发育情况和根尖封闭愈合类型,分析根尖诱导成形术后根尖发育的影响因素。结果 35颗患牙有21颗患牙根尖发育完成,其中Ⅰ类愈合7颗,Ⅱ类愈合14颗;有14颗患牙未显示牙根发育,其中Ⅲ类愈合13颗,Ⅳ类愈合1颗。由于根尖段残留有生活的牙髓使诱导剂显示欠填是根尖发育的保护因素（OR=0.047,P=0.009）,而根尖周低密度影成为根尖发育的危险因素（OR=12.113,P=0.004）。结论根尖段残留的生活牙髓和牙乳头可促进牙根继续发育,根尖周病变影响根尖发育。     

根尖孔大小对牙髓组织再生及牙齿抗压强度的影响

目的:探讨根尖孔大小对牙髓组织再生及牙齿抗压强度的影响。方法:收集因正畸拔除的牙根发育完成、 无牙根折裂的单根下前磨牙,离体牙截冠后,保留12 mm牙根,随机分为5组,每组25颗牙,根管预备至不同主锉号数,分别为30#、40#、60#、80#及100#主锉组,其中30#主锉组为对照组。体外培养人牙髓干细胞并接种于0.25%水凝胶支架中,将其分别注入不同主锉预备过的根管内,每组均取5颗牙,其牙根于Transwell小室分别培养14、21、28 d,提取水凝胶中细胞的总RNA,进行实时定量聚合酶链反应(real-time polymerase chain reaction,Real-time PCR)检测;每组余下的10颗牙,其牙根冠部封闭后植入裸鼠皮下,28 d后取出,5颗进行组织学观察,5颗进行静态载荷实验。结果:Real-time PCR检测牙本质涎磷蛋白(dentin sialophosphoprotein, dspp)、牙本质基质蛋白-1(dentin matrix protein-1, dmp-1)的表达,第28天时,各实验组均高于对照组(P<0.05),且40#主锉组高于其它实验组(P<0.05)。组织学分析表明,30#、40#、60#主锉组均未见连续的牙髓样组织形成,80#、100#主锉组可见组织形成,但未表现出典型牙髓样组织结构。静态载荷实验结果表明,40#主锉组的平均抗压载荷与对照组比较差异无统计学意义,其它实验组均低于对照组(P<0.05)。结论:根尖孔预备至100#(1 mm)以内时,根尖孔大小对牙髓组织再生没有明显影响,但根尖孔预备大于40#时,抗压强度明显下降。     

Revascularization with and without Platelet-rich Plasma in Nonvital,Immature, Anterior Teeth: A Pilot Clinical Study

Introduction

This study was conducted to evaluate and compare maturogenesis induced by revascularization with and without platelet-rich plasma (PRP).

Methods

Twenty patients with nonvital, immature anterior teeth were randomly categorized into 2 groups. Subsequent to chemomechanical preparation, revascularization with and without PRP carried on a collagen sponge was induced in groups 1 and 2, respectively. The cases were followed up clinically and radiographically at 6- and 12-month intervals.

Results

Clinically, all cases were asymptomatic with complete resolution of signs and symptoms. Radiographically, there was a marked difference in periapical healing, apical closure, and dentinal wall thickening in group 2 in comparison with group 1. However, root lengthening was comparable for both of the procedures.

Conclusions

Revascularization is a conservative and an effective method for inducing maturogenesis in nonvital, immature teeth. Supplementations with PRP can potentially improve the desired biological outcome of this regenerative technique.     

Traumatized Immature Teeth Treated with 2 Protocols of Pulp Revascularization

Introduction

Pulp revascularization may be considered a promising alternative for traumatized necrotic immature teeth. The aim of this study was to evaluate traumatized immature teeth treated with 2 protocols of pulp revascularization.

Methods

Twenty-three teeth of young patients (7–17 years old) with necrotic upper incisors caused by dental trauma were divided into 2 groups; one group was treated with triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) (TAP) (n = 12), and the other was medicated with combination of calcium hydroxide and 2% chlorhexidine gel (CHP) (n = 11). Patients were treated and followed up for a period from 9–19 months in 2 dental institutions for evaluation of clinical and radiographic data.

Results

Most of the teeth were affected by lateral luxation (47.8%). Clinical evaluation in group TAP showed significant reduction in spontaneous pain (P = .01), pain on horizontal percussion (P = .007), and pain on palpation (P = .03), whereas group CHP showed significant reduction in pain on vertical percussion (P = .03). Crown discoloration was observed significantly more in teeth of group TAP (83.3%) (P < .002). On radiographic exam, periapical repair was found in all TAP-treated teeth (P = .03). Similarly, the same findings were found for all teeth treated with CHP with exception of 1 tooth (P = .21). Apical closure was significantly observed in both groups (P < .05). Increase in root length was demonstrated in 5 teeth (41.7%) and 3 teeth (27.3%) of groups TAP and CHP, respectively. Thickening of lateral dentinal walls was observed in 5 teeth of each group.

Conclusions

Revascularization outcomes for traumatized patients treated with the tested protocols presented similar clinical and radiographic data. However, TAP caused esthetic problem leading to tooth discoloration, which can be considered a disadvantage when compared with CHP.     

Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review

Introduction

The aim of this review was to evaluate whether the apical diameter of teeth with necrotic pulp affects the outcomes of regenerative endodontic treatment and to determine the minimal apical size needed to obtain proper pulp revascularization.

Pulp Revascularization of Immature Teeth With Apical Periodontitis: A Clinical Study

IntroductionThe purpose of this study was to examine the effect of a pulpal revascularization procedure for immature necrotic teeth with apical periodontitis.MethodsTwelve patients, each with an immature permanent tooth with chronic or acute apical periodontitis, were recruited. A triantibiotic mix (ciprofloxacin, metronidazole, and minocycline) was used to disinfect the pulp for 1 week. Then a blood clot was created in the canal, over which grey mineral trioxide aggregate was placed. Patients were recalled periodically.ResultsSix patients dropped from the study (as a result of pain or failure to induce bleeding after canal disinfection) and instead received a standard apexification procedure. Another 3 patients did not attend any recall appointments. The remaining teeth (n = 3) were found to exhibit complete root development, with a positive response to pulp testing.ConclusionsRevascularization could be effective for managing immature permanent teeth with apical periodontitis with appropriate case selection.     

Mineral Trioxide Aggregate as Apical Plug in Teeth with Necrotic Pulp and Immature Apices: A 10-year Case Series

Introduction

This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique.

Methods

Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores.

Results

Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant.

Conclusions

The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.     

Reinforcement of Simulated Immature Permanent Teeth after Mineral Trioxide Aggregate Apexification

Objectives

The objectives of this study were to compare the fracture resistance of simulated human immature teeth that have undergone mineral trioxide aggregate (MTA) apexification and have been root-filled with fiber post, composite resin, MTA, or gutta-percha.