年轻恒牙活髓保存治疗

年轻恒牙活髓保存的目的是为了保护冠部或根部剩余牙髓组织的活性和功能,促进牙根生理性发育。传统观点认为,活髓保存只适用于牙髓正常或可逆性牙髓炎、无根尖病变的患牙,以保留患牙剩余未被感染的健康牙髓组织。但迄今为止,并没有可靠的手段能准确判断牙髓状态。此外,多个研究显示龋源性露髓、伴有不可逆性牙髓炎及根尖周感染的患牙活髓保存治疗成功。临床上应充分利用年轻恒牙牙髓组织再生修复能力强的组织学特点,对年轻恒牙牙髓治疗采取更为保守的方法,以期获得更好的预后。     

氢氧化钙樟脑酚糊剂盖髓的疗效分析

目的 研究用樟脑酚液调拌氢氧化钙成糊剂保护暴露牙髓。方法 对未受污染或新鲜露髓的恒牙,用樟脑酚液调拌氢氧化钙成糊剂直接盖髓、双层垫底、永久充填,观察1～2年的疗效。结果 160颗患牙除12颗失败外,其余148颗牙充填后咀嚼功能恢复,牙髓活力正常。结论 樟脑酚液调拌氢氧化钙的糊剂盖髓是一种保存活髓治疗的有效方法。     

恒牙牙髓切断术的新进展

作为一种微创活髓保存技术,牙髓切断术一直是牙髓治疗的热点研究项目。该技术旨在通过切除部分牙髓组织后盖髓以达到去除牙髓炎症,保持牙髓活力以促进牙根继续发育并长期保存患牙的目的。随着材料更新、技术提高以及相关试验的证实,目前,在恒牙活髓保存治疗中,牙髓切断术的适应证有所扩展。本文基于过往研究归纳了恒牙牙髓切断术的适应证及术式的进展,并简要介绍了其预后影响因素及疗效评估方式,以期为临床开展相关治疗及未来研究方向提供参考。     

成熟恒牙牙髓炎活髓保存治疗的研究与应用

保存活髓对于成熟恒牙的长期保存具有重要意义。近年来,随着牙髓生物学的深入研究,开展牙髓微创治疗,保存剩余健康牙髓组织,成为成熟恒牙牙髓炎治疗的新目标。本文将从成熟恒牙牙髓炎的分类、治疗方法、预后影响及激光应用等方面,对成熟恒牙活髓保存的研究及临床应用进行总结概括。     

异体陶瓷化骨粉复合盖髓剂用于活髓保存的临床研究

目的　观察异体陶瓷化骨粉复合盖髓剂直接盖髓保存活髓的临床疗效及探讨影响疗效的因素。方法　在陶瓷化骨粉中加入克林霉素 ,经材料学及动物实验研究证实性能良好后 ,临床用于 12 6例露髓患牙直接盖髓 ,追踪观察临床症状、牙髓活力状态、X线片表现 ,按疗效标准记录分析。结果　 12 6例中成功 117例 ,成功率达92 .85 %。认为盖髓剂性状、适应症选择 (牙髓状况 )、规范操作及充填材料的微渗漏预防诸因素与疗效关系密切。结论　异体陶瓷化骨粉复合盖髓剂是一种新型理想的活髓保存材料 ,有很好的临床应用价值     

牙髓炎的活髓保存及再生治疗新进展:从基础到临床

近年关于牙髓炎治疗的研究取得了较大进展,这主要得益于牙髓炎治疗的基础和临床研究的飞速进展,一些基础研究已转化为临床实践。牙髓炎检测方法的研究进展可以帮助临床医师更准确地诊断牙髓炎的状态,并采取相应的治疗手段,包括间接或直接盖髓术、牙髓切断术、牙髓再生术和根管治疗术等。针对牙髓炎的诊断理念、牙髓免疫防御和修复功能研究以及新型盖髓剂材料研究均有了较大进展,牙髓炎的活髓保存治疗成功率显著提高。对于难以实现活髓保存治疗的弥漫性冠髓炎或根髓炎,除根管治疗术外,牙髓血运重建、细胞归巢和牙髓干细胞移植牙髓再生等牙髓再生术也可作为一种治疗选择。本文重点阐述牙髓炎治疗研究进展和相关的临床转化实践,旨在为牙髓炎的活髓保存和牙髓再生治疗提供参考。     

牙髓炎的活髓保存及再生治疗新进展：从基础到临床

近年关于牙髓炎治疗的研究取得了较大进展, 这主要得益于牙髓炎治疗的基础和临床研究的飞速进展, 一些基础研究已转化为临床实践。牙髓炎检测方法的研究进展可以帮助临床医师更准确地诊断牙髓炎的状态, 并采取相应的治疗手段, 包括间接或直接盖髓术、牙髓切断术、牙髓再生术和根管治疗术等。针对牙髓炎的诊断理念、牙髓免疫防御和修复功能研究以及新型盖髓剂材料研究均有了较大进展, 牙髓炎的活髓保存治疗成功率显著提高。对于难以实现活髓保存治疗的弥漫性冠髓炎或根髓炎, 除根管治疗术外, 牙髓血运重建、细胞归巢和牙髓干细胞移植牙髓再生等牙髓再生术也可作为一种治疗选择。本文重点阐述牙髓炎治疗研究进展和相关的临床转化实践, 旨在为牙髓炎的活髓保存和牙髓再生治疗提供参考。     

年轻恒牙直接盖髓术的临床和病理学研究

直接盖髓术是用药物覆盖暴露的牙髓,以促进牙髓愈合和修复的治疗.通常仅适应于健康牙髓的新鲜暴露病例,对于因龋病露髓的患牙则不宜应用.近年,不少学者报道对去龋露髓的患牙采用直接盖髓术也取得了较好效果,其疗效不低于健康露髓牙.本研究是对临床无明显症状或症状轻微的深龋露髓年轻恒磨牙,进行直接盖髓术,试图探讨保留全部活髓的临床疗效,并对观察中的失败病例在改变治疗时进行牙髓的临床病理学研究.     

部分活髓切断术在年轻恒牙保髓治疗中的应用

年轻恒牙急性牙髓炎是一类常见的急性牙髓感染病症,是否保留生活牙髓是尚存争议的问题。作者在严格掌握适应证的基础上,选择由龋齿和外伤所引起的急性牙髓炎年轻恒牙46例,通过开随引流、控制感染后,在局麻下行部分活髓切断加直接盖髓的方法以保存大部分活髓组织。经2年随访,成功38颗,占82.6%,失败8颗,占17.4%。     

龋源性露髓成熟恒牙活髓保存治疗的研究进展

保存牙髓活力、维持牙髓功能、尽可能保留患牙的微创治疗理念是当代成熟恒牙牙髓治疗的重要发展趋势。本文基于最新研究,归纳龋源性露髓的成熟恒牙活髓保存治疗的临床疗效及其影响因素,简要介绍相关研究的新进展,以期为临床开展活髓保存治疗及今后该领域的发展提供参考。     

活髓保存治疗之惑及解决之道

牙髓组织具有形成牙本质、提供营养、传导痛觉和对外界刺激产生保护性反应的功能。牙髓组织病理学改变性质是决定牙齿治疗方案的选择和治疗效果评估的组织学基础。当牙髓病变可逆或局限时,应消除感染,保存活髓,维护牙髓的功能。长久以来,活髓保存治疗的临床诊治,特别是其适应证和预后因素,一直是临床医生争论的热点话题,且常常给很多医生造成困惑。本文从适应证、牙髓状态评估、感染消除、盖髓材料选择等方面对活髓保存治疗中存在的困惑以及解决方法进行介绍,同时提出了活髓保存治疗的临床路径和操作规范,以便临床上更好地开展活髓保存治疗。     

Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: a case report

Abstract –  Successful direct pulp capping of cariously exposed permanent teeth with reversible pulpitis and incomplete apex formation can prevent the need for root canal treatment. A case report is presented which demonstrates the use of mineral trioxide aggregate (MTA) as a direct pulp capping material for the purpose of continued maturogenesis of the root. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. MTA can be considered as an effective material for vital pulp therapy, with the goal of maturogenesis.     

Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology

The American Association of Endodontists (AAE) Consensus Conference Recommended Diagnostic Terminology states that mature permanent teeth clinically diagnosed with irreversible pulpitis are treated with pulpectomy and root canal filling because inflamed vital pulp is not capable of healing. Histological studies have demonstrated that clinically diagnosed irreversible pulpitis does not involve the entire pulp. A recent International Endodontic Journal Editorial suggested clinical diagnosis of pulp disease should be reassessed because of the poor correlation between clinical symptoms and pulp sensibility testing and the actual histological status of the pulp. This review identified studies in a PubMed search that provide evidence for vital pulp therapy (VPT) of mature permanent teeth with irreversible pulpitis is predictable if correctly diagnosed and properly treated. A narrative review was undertaken to outline the correlation between the clinical symptoms/signs and pulp sensibility testing and the histological findings of the pulp. Treatment procedures for permanent teeth are outlined.     

基质金属蛋白酶3在活髓保存治疗中的研究进展

牙髓组织是疏松的结缔组织,当遇到外界刺激时能够产生一系列级联反应进行自身修复。活髓的保存治疗成为牙髓生物学研究的热点,主要以氢氧化钙、MTA及复合盖髓材料盖髓剂为代表。基质金属蛋白酶3 （MMP3）不仅可以降解细胞外基质成分,还与组织形态发生,损伤修复,炎症反应等过程有着密切的联系。随着对MMP3研究的不断深入,揭示出其在损伤牙髓组织中高表达,同时也促进了成牙本质细胞的增殖和分化。将MMP3制成生物活性盖髓材料覆盖于牙髓断面后发现MMP3促进了新生血管和硬组织的形成,提示MMP3可能参与了牙髓损伤后的修复过程,这就为开发新型生物活性盖髓材料提供了新思路。该文就近几年活髓保存治疗的现状及MMP3在活髓保存治疗中的研究进展做一综述。     

Management of deep caries and the exposed pulp

Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one‐visit as indirect pulp treatment or two‐visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re‐emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp–dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence‐based management strategies and education in management of the exposed pulp are critical in the future.     

Direct pulp capping with mineral trioxide aggregate: an observational study

BACKGROUND: Pulp capping in carious teeth has been considered unpredictable and therefore contraindicated. A recently developed material, mineral trioxide aggregate (MTA), resists bacterial leakage and may provide protection for the pulp, allowing repair and continued pulp vitality in teeth when used in combination with a sealed restoration. METHODS: Forty patients aged 7 to 45 years accepted pulp-capping treatment when they received a diagnosis no more severe than reversible pulpitis after undergoing cold testing and radiographic examination. The primary author removed caries using a caries detector dye and sodium hypochlorite solution for hemostasis and placed MTA over the exposures and all surrounding dentin. The operator then restored the teeth provisionally with unbonded Clearfil Photocore (Kuraray Medical, Okayama, Japan). During a second visit, the operator restored the teeth with bonded composite after sensibility testing and confirmed MTA curing. At recall appointments, patients were evaluated for reparative dentin formation, pulpal calcification, continued normal root development and evidence of pathosis. RESULTS: Over an observation period of nine years, the authors followed 49 of 53 teeth and found that 97.96 percent had favorable outcomes on the basis of radiographic appearance, subjective symptoms and cold testing. All teeth in younger patients (15/15) that initially had open apexes showed completed root formation (apexogenesis). CONCLUSIONS: MTA can be a reliable pulp-capping material on direct carious exposures in permanent teeth when a two-visit treatment protocol is observed. PRACTICE IMPLICATIONS: Vital pulp therapy using MTA is a treatment option for teeth diagnosed with a condition no more severe than reversible pulpitis.     

不同盖髓材料用于盖髓术的临床研究

目的 比较可乐丽菲露SE3 BOND和Dycal氢氧化钙盖髓的临床效果。方法 将79例患者的84颗患牙分成2组,乐丽菲露SE3 BOND 组62颗患牙,Dycal氢氧化钙组22颗患牙。2组病例分别用Dycal氢氧化钙以及可乐丽菲露SE3 BOND盖髓,光固化玻璃离子垫底,光固化复合树脂充填。结果 盖髓治疗8个月后追踪观察,深龋近髓的患牙用Dycal氢氧化钙盖髓的成功率93.5%,与用可乐丽菲露SE3 BOND盖髓（87.1%）比较,差异无统计学意义(P>0.05）;深龋穿髓的患牙用Dycal氢氧化钙盖髓的成功率（75%）明显高于可乐丽菲露SE3 BOND（50% ）,差异有统计学意义（P<0.05）。结论 在深龋近髓患牙盖髓术治疗中,可乐丽菲露SE3 BOND和Dycal氢氧化钙的疗效均佳,但在深龋穿髓患牙盖髓术治疗的病例中,Dycal氢氧化钙对深龋穿髓疗效明显优于可乐丽菲露SE3 BOND。     

Direct pulp capping: a review

Abstract The healthy pulp has good healing potential when it is exposed, although the exact repair mechanism is still undetermined, and it is not material-specific. Calcium hydroxide appears to promote the healing process and is the most widely accepted capping material. Paste-type calcium hydroxide formulations are more consistent in promoting healing of pulp exposures than cement forms where bacterial microleakage is eliminated. The prognosis for pulp capping with calcium hydroxide is good if the pulp has no pre-existing symptoms of pain, and the environment provided for it is suitable. This requires the absence of blood clots and bacterial contamination. Where there are some symptoms of pain in a vital tooth, pretreatments with suitable materials improve the prognosis.     

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提要：保存活髓是治疗龋病、齿科手术操作及外伤所致牙髓暴露的理想方法。理想的盖髓材料应具有诱导牙髓细胞分化、修复性牙本质形成和保存活髓的特性。目前,临床常用的盖髓材料均不理想。因此,国内外许多学者都在致力于寻找一种更好、更完美的盖髓材料。本文就近年来盖髓材料的研究进展做一介绍。     

Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth

Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries.

Material and methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices.

Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment.

Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.