年轻恒牙冠折临床处置技巧及疗效评估

目的：探讨年轻恒牙冠折的临床处理技巧及疗效。方法：对26例8～15岁患者32个年轻恒牙外伤冠折病例根据不同症状采取间接盖髓术、活髓切断术、根尖诱导术、根管治疗术等进行治疗,对治疗结果进行随访,观察术后1周、3周、6周、6个月的疗效。结果：术后1周观察,间接盖髓术组有1例,活髓切断术组有2例患牙发生自发性疼痛。术后6个月复查,间接盖髓术组成功7例,失败1例;活髓切断术组成功10例,失败2例;根尖诱导术组成功5例,失败2例;根管治疗术组成功5例,无失败病例。结论：对冠折未露髓的年轻恒牙应及时处理,防止细菌侵入造成牙髓感染;冠折露髓的年轻恒牙应根据患牙根尖发育情况采取活髓切断术、根尖诱导成形术、根管治疗术等不同的治疗方案,治疗完成后还应定期随访,如发现牙髓情况变化,要及时调整治疗方案,以利于牙齿的继续发育和后期修复。     

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目的比较部分活髓切断术和间接盖髓术两种方法治疗年轻恒前牙外伤冠折近髓的临床疗效,为临床寻求更佳治疗方法。方法对2005—2008年来济宁口腔医院儿童牙病科就诊的24例前牙外伤患者的31颗冠折近髓的患牙,按患者的就诊顺序随机分成部分活髓切断组(16颗)和间接盖髓组(15颗),分别采用部分活髓切断术和间接盖髓术对患牙进行治疗,随诊观察2年。结果部分活髓切断组的成功率为93.7%,间接盖髓组的成功率为80.0%,两组成功率比较差异无统计学意义(P>0.05)。结论采用部分活髓切断术治疗冠折近髓的年轻恒前牙可能较间接盖髓术更有优势。     

MTA用于龋源性露髓年轻恒牙部分活髓切断治疗的初步研究

目的：应用三氧化矿化聚合物（MTA）对龋源性露髓的年轻恒牙进行部分活髓切断术治疗并评价临床效果。方法：采用MTA作活髓保存剂,对26例29颗因龋露髓的年轻恒磨牙采用部分活髓切断术治疗,随访18个月,评价其疗效。结果：MTA部分活髓切断术治疗龋源性露髓年轻恒磨牙成功率为96.55%,67.85%治疗成功患牙有牙本质桥形成。结论：部分活髓切断术是治疗龋源性露髓年轻恒牙的有效方法,MTA是可供选用的较为理想的活髓保存剂。     

光固化氢氧化钙在年轻恒牙直接盖髓术中的疗效观察

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。多用于龋病治疗时意外穿髓和外伤导致意外露髓。由于年轻恒牙的牙根尚未完全发育,根尖孔尚未形成,如果此时进行根管治疗效果不佳。如能通过直接盖髓术促进牙髓组织修复,牙根继续发育,根尖形成,将有利于保留患牙。笔者用光固化氢氧化钙作为盖髓剂对年轻牙外伤性露髓、意外穿髓、临床无明显症状的龋源性露髓牙进行了直接盖术,获得满意的效果。     

MTA用于冠折露髓年轻恒牙活髓切断术1例

对1例10岁儿童恒牙冠折用MTA作为盖髓剂行活髓切断术,随访26个月,治疗牙无临床症状,牙髓有活力,根尖孔形成。     

MTA用于年轻恒牙活髓切断的临床观察

目的观察MTA在年轻恒牙活髓切断术中的临床疗效。方法随机选择7-13岁患儿79颗牙根未发育完全而露髓的患牙,随机分为2组,分别用MTA和氢氧化钙作为活髓切断后的盖髓药物,随访观察两组疗效的差异,并采用χ2、U检验作统计学分析。结果MTA组成功率96%,氢氧化钙组成功率71%,两组有显著性差异(P<0.05)。结论MTA是良好的活髓保存药物,用于活髓切断时疗效优于氢氧化钙。     

MTA应用于穿孔修补和根尖屏障的临床效果观察

目的:临床观察MTA(mineraltrioxideaggregate)用于根尖屏障术和根管或髓室穿孔修补的治疗效果。方法:收集临床上使用MTA治疗的病例11例,其中无髓恒牙根尖孔敞开病例7例( 7个患牙)行MTA根尖屏障术,在手术显微镜下完成MTA根尖屏障的制备,垂直加压充填根管。治疗过程仅需1 ~2次复诊。使用MTA进行根管或髓室穿孔修补病例4例共5个患牙。11例观察期0. 5 ~4年多不等。结果:经追踪观察, 11例患牙在临床症状的控制和获得骨愈合方面都有良好的效果。结论:本研究结果提示,MTA对穿孔修补和根尖屏障术方面是一种满意的材料。     

年轻恒牙的外伤治疗

在许多国家,牙外伤已经严重影响着青少年的口腔健康,外伤所累及的年轻恒牙在形态和结构上尚未完全发育成熟,根尖孔开放,髓腔宽大,根管壁薄。当年轻恒牙发生冠折和脱位性损伤时,治疗方法的选择对其预后显得尤为重要。年轻恒牙的牙本质小管比成熟恒牙的粗大,外伤冠折累及牙本质时,细菌容易进入牙本质小管感染牙髓;牙本质长期暴露,可造成牙髓坏死和牙冠变色。年轻恒牙外伤后应尽量保存暴露的活髓,选择氢氧化钙行盖髓术或活髓切断术;年轻恒牙即便发生牙髓坏死,也应选择根尖诱导形成术,促进牙根继续发育完成。     

无机三氧化物聚合体用于年轻恒牙根尖封闭的短期疗效观察

目的 观察无机三氧化物聚合体(MTA)一次性封闭根尖开放年轻恒牙的疗效.方法 13颗年轻恒牙采用MTA一次性封闭根尖开放部位,形成硬组织屏障后行流动牙胶充填根管,冠部永久性充填,术后定期复诊.结果 所有患牙在治疗后的复诊期间均无不适症状,同时原根尖周透射区局限、缩小或消失.结论 MTA用于年轻恒牙根尖封闭的短期疗效确切.     

MTA应用于间接盖髓术的疗效研究

我科自2005 年以来,将MTA(mineral trioxide aggregate)用于间接盖髓术治疗患深龋或牙髓充血的乳磨牙或年轻恒磨牙共76 例,现将3 年的随访结果报告如下. 1 资料和方法 1.1 一般资料 我院门诊选择76 例患深龋或牙髓充血的乳磨牙或年轻恒磨牙,随机分为MTA组43 个牙(其中乳牙29 颗,年轻恒牙14 颗),氢氧化钙组33 个牙(其中乳牙21 颗,恒牙12 颗),分别使用MTA和氢氧化钙行间接盖髓术,其他常规处理相同.     

Repair of furcal perforation treated with mineral trioxide aggregate in a primary molar tooth: 20-month follow-up

Furcal perforations may occur during access opening of the pulp chamber or cavity preparation. The perforation can cause an inflammatory reaction in the periodontal ligament. Management of these iatrogenic accidents can pose a significant clinical challenge, mainly when they occur in primary teeth. Current developments in the techniques and materials utilized for root perforation repair have enhanced this procedure's prognosis. Recently, mineral trioxide aggregate (MTA) has been used for several dental purposes. This biocompatible material promotes bone healing and elimination of clinical symptoms. The purpose of this case report was to describe the treatment of a furcal perforation using mineral trioxide aggregate (MTA) in a primary molar tooth. After 20 months, the tooth was asymptomatic. The radiolucent image had disappeared and bone formation at the furcation area had been observed, suggesting healing of the underlying periodontal tissues. Therefore, MTA may be considered an alternative option for the repair of furcal perforation in primary teeth, prolonging the longevity of these dental elements.     

乳磨牙MTA直接盖髓术后即刻充填的临床观察

目的 评价乳磨牙MTA直接盖髓术后即刻充填临床疗效.方法 用MTA对4～8岁儿童的36颗深龋洞去腐露髓或意外穿髓的乳磨牙进行直接盖髓术后即刻充填治疗,治疗后6个月和2年后随访,观察盖髓后患牙症状、牙髓活力、X线片等疗效指标.结果 MTA治疗36颗乳磨牙,经6个月和2年后随访,其中34颗成功,牙髓活力正常,可见X线片修复性牙本质形成;2颗失败.结论 MTA应用于儿童乳磨牙直接盖髓术是有效的盖髓剂.     

三氧化矿物凝聚体用于修补髓腔穿孔的临床效果观察

目的 研究三氧化矿物凝聚体(mineral trioxide aggregate,MTA)修补髓腔穿孔的临床效果.方法 收集临床髓室底或髓室、根管侧壁穿孔的恒牙8颗,用MTA对穿孔处填塞、修补.完成根管充填及永久充填后定期复查.追踪观察0.5～5.0年.结果 经复查8颗患牙无临床不适症状,咀嚼功能正常,X线片显示穿孔处未见新的牙槽骨病变,或原有牙槽骨病变缩小.结论 MTA是一种较理想的髓腔穿孔修补材料.     

A prospective clinical study of periradicular surgery using mineral trioxide aggregate as a root-end filling

A prospective outcome study of periradicular surgery using microsurgical techniques and root-end filling with mineral trioxide aggregate (MTA) was performed. Nonhealing endodontically treated teeth (n = 321) were included in the study. Surgery was completed under local anesthesia using a standardized clinical protocol. Patients were recalled periodically and examined for signs and symptoms of failure. Thirty-nine teeth were lost from recall. Of the 276 teeth examined, 163 showed complete healing radiographically with no other signs and symptoms; 82 teeth had no symptoms but incomplete or uncertain healing, and 31 teeth showed nonhealing (three had persistent pain despite evidence of complete radiologic healing and eight teeth did not heal for reasons unrelated to the surgical treatment). The overall success rate was 88.8%, including all teeth with no clinical symptoms. In this study, the use of MTA as a root-end filling, following microsurgical techniques, showed a high success rate.     

富血小板血浆复合MTA盖髓的组织学观察

目的:从组织学方面探讨富血小板血浆(PRP)作为自身复合生长因子用于盖髓修复治疗的可行性。方法:选取2条健康成年杂种犬50颗牙齿,对每颗实验牙进行人工穿髓,制造牙髓损伤模型,单独应用PRP或将PRP与Dycal或MTA复合进行盖髓治疗,并设Dycal盖髓组和MTA盖髓组作为对照组进行比较,观察12周后各实验组修复性牙本质桥形成情况。结果:术后12周,MTA盖髓组中6例有完整的修复性牙本质桥形成;PRP组所有标本均未见有完整的修复性牙本质桥形成;PRP复合MTA盖髓组10例标本均可形成完整修复性牙本质桥;Dycal组有3例完整修复性牙本质桥形成;Dycal与PRP组1例有完整的修复性牙本质桥。结论:PRP与MTA复合盖髓具有良好的牙髓修复效果。     

根管显微镜下三氧化物多聚体封闭根端的疗效观察

目的：评价根管显微镜下三氧化物聚合体（mineral trioxide aggregate,MTA）封闭恒牙根尖孔开放形成根尖屏障的疗效。方法：选择恒牙根尖孔开放合并根尖周炎的患牙63颗,在根管显微镜下用三氧化物多聚体（MTA）严密封闭根端,形成根尖屏障后以热牙胶充填,定期复诊观察。结果：63颗患牙中,1颗（23）因牙根长及舌向倾斜,在显微镜下视野不清导致欠填,其余62颗患牙均充填严密。术后X线片显示43颗适充,17颗少量超充。3个月后复查,2例因瘘管反复不闭合行手术倒充填,2例失访,其余患牙均达到成功要求,无叩痛,复查X线片示根尖周病变明显缩小或消失,骨小梁再现。少量超填不影响疗效,总成功率为95%。结论：牙科手术显微镜下MTA封闭治疗根尖孔开放的恒牙疗效确切,准确方便。     

Clinical long-term evaluation of MTA as a direct pulp capping material in primary teeth

Aim To evaluate the effectiveness of mineral trioxide aggregate (MTA) when used as a pulp capping material in primary teeth. Methodology Clinical follow‐up was performed on 25 symmetrical pairs of primary molars with deep occlusal caries, in 25 patients between the ages of 5 and 8 years. Pulps exposed during cavity preparation were treated by direct pulp capping with MTA or calcium hydroxide, based with resin‐bonded zinc oxide eugenol cement and restored with amalgam. Clinical and radiographic examinations were carried out at 1, 3, 6, 9, 12, 18 and 24 months. Results Twenty‐four‐month clinical and radiographic follow‐ups were carried out on 22 patients. One patient failed to return for evaluation after 1 month, one after 9 months and another after 12 months. During follow‐up, none of the MTA and calcium hydroxide groups exhibited clinical or radiographic failure. Conclusions Mineral trioxide aggregate was found to be as successful as calcium hydroxide when used for direct pulp capping in primary teeth. Further histological investigations are needed to support these findings.     

Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report

PURPOSE: The aim of this study was to compare the effect of mineral trioxide aggregate (MTA) to that of formocresol (FC) as pulp dressing agents in pulpotomized primary molars with carious pulp exposure. METHODS: Forty-five primary molars of 26 children were treated by a conventional pulpotomy technique. The teeth were randomly assigned to the MTA (experimental) or FC (control) group by a toss of a coin. Following removal of the coronal pulp and hemostasis the pulp stumps were covered with an MTA paste in the experimental group. In the control group, FC was placed with a cotton pellet over the pulp stumps for 5 minutes and removed; the pulp stumps were then covered by zinc oxide-eugenol (ZOE) paste. The teeth of both groups were restored with stainless steel crowns. Eighteen children with 32 teeth arrived for clinical and radiographic follow-up evaluation ranging from 6 to 30 months. RESULTS: The follow-up evaluations revealed only one failure (internal resorption detected at a 17 months postoperative evaluation) in a molar treated with formocresol. None of the MTA-treated teeth showed any clinical or radiographic pathology. Pulp canal obliteration was observed in 9 of 32 (28%) evaluated molars. This finding was detected in 2 out of the 15 teeth treated with FC (13%) and in 7 out of the 17 treated with MTA (41%). CONCLUSION: MTA showed clinical and radiographic success as a dressing material following pulpotomy in primary teeth and seems to be a suitable replacement for formocresol in primary teeth.     

Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review

Mineral trioxide aggregate (MTA) has over the last two decades begun to take the place of calcium hydroxide (CH) in the treatment of a variety of pulpal and periodontal healing complications following dental trauma. These conditions include teeth with: (i) exposed pulps, (ii) immature roots and pulp necrosis, (iii) root fractures and pulp necrosis located in the coronal part of the pulps, and (iv) external infection-related (inflammatory) root resorption. The main reasons for replacing CH with MTA in these situations have generally been the delayed effect when using CH to induce hard tissues, the quality of such induced hard tissues, and finally the dentin weakening effect of CH, which in some instances lead to cervical root fractures in immature teeth. MTA appears, from a relatively few clinical studies, to overcome these shortcomings of CH. The lack of long-term clinical studies, however, may warrant a certain reservation in an unrestricted replacement of CH with MTA. A definite need for randomized clinical studies comparing CH and MTA in trauma healing situations is urgently needed.