乳磨牙根管治疗失败原因分析

目的探讨乳磨牙根管治疗失败的原因。方法收集2004年1月~2006年6月在广东省口腔医院儿童牙科就诊的乳磨牙根管治疗失败的病例128例,共136颗患牙,分析治疗失败的原因。结果失败患牙中因充填物脱落根管系统暴露再感染53颗(38.97%);遗漏根管52颗(38.24%);根管充填不密合、欠填21颗(15.44%);其它原因10颗(7.35%)。结论因充填物脱落造成髓腔暴露发生再感染和遗漏根管是造成乳磨牙根管治疗失败的主要原因。     

保守治疗20例婴幼儿上颌乳前牙复杂冠根折临床效果观察

目的 观察保守治疗婴幼儿上颌乳前牙复杂冠根折的效果。方法 收集在西安交通大学口腔医院儿童牙病科就诊的20例11～30个月婴幼儿上颌乳前牙复杂冠根折病例,根据牙根发育程度选择活髓切断术或根管治疗术及冠修复保存患牙。结果 患牙在术后1、3、6、12个月复查,无根尖周病变及牙龈炎症,继承恒牙胚继续发育。结论 对根折深度≤3 mm的患牙拔除断端后根据牙根发育程度选择活髓切断术或常规根管治疗术并冠修复术可以保存患牙并行使功能。     

氢氧化钙糊剂治疗乳磨牙髓底穿通

目的：探讨乳磨牙髓底根分叉穿通的病因病理，固化糊剂治疗的临床应用价值。方法：先常规清除窝洞龋坏组织，根髓低位切断术及完成根管充填，再刮除髓底穿通处病变组织，止血后，置1－2mm厚度固化糊剂，锌汀基，永久充填，结果：5－10岁患儿43例髓底穿通乳磨牙保存治疗后随访，最长4年，最短2年，良好20例，较好17例，2者为87％，失败6例，占13例，结论：乳磨牙髓室底较薄，髓底病变或制洞操作不慎易引起髓底根分叉穿通，采用固化糊剂治疗乳磨牙髓底根分叉穿通是有效的方法。     

Vitapex在乳牙牙髓炎、根尖周炎治疗中的应用

目的研究Vitapex在乳牙牙髓炎、根尖周炎治疗中的应用效果。方法96颗下颌乳磨牙,其中牙髓炎58颗,根尖周炎38颗。治疗前拍摄X线片,拔髓,根管预备,髓腔甲酚甲醛棉球暂封5 d,Vitapex根充,术后拍X线片,银汞充填。根充后3、6、12和24个月定期复查。结果2年成功率牙髓炎为91.38%,根尖周炎为78.95%。结论Vitapex是一种良好的乳牙根充材料。     

热牙胶旋转推入式根管充填的临床应用

为使根管充填术在临床操作上简便、易行 ,尝试用热牙胶旋转推入式根管充填。通过 1年来对376个牙根管充填的临床实践 ,认为热牙胶旋转推入式根充具有操作简便、根尖部充填密实、成本低、根管钉可立即置入等优点 ,可普遍用于前、后牙的根管治疗。1　材料和方法1.1　病例选择门诊需根管治疗的 2 70例患者 ,376个牙齿 (根尖孔未完全形成或根尖孔粗大牙齿除外 )。前牙 88个 ,前磨牙 6 5个 ,磨牙 2 2 3个。活髓牙 2 12牙 ,死髓牙 16 4牙。1.2　材料加热器 (Ｏｂｔｕｒａｔｉｏｎｈｅａｔｅｒｆｏｒａｄｖａｎｃｅｄｅｎｄｏｄｏｎｔｉｃ ,Ｔｏｋ…     

带环应用于根管治疗后乳磨牙充填修复的临床效果

目的探讨带环应用于根管治疗后牙合龈距离较小的乳磨牙修复的临床疗效。方法完成根管治疗的106颗牙合龈距离小于4 mm的乳磨牙随机分为2组,带环组53颗牙光固化树脂充填修复后用带环粘接固定,对照组53颗患牙用光固化树脂充填修复。治疗后3、6、12个月进行疗效评价。结果带环组12个月成功率为90.57%,对照组12个月成功率为56.60%,两组比较差异有统计学意义（χ2=15.73,P〈0.05）。结论带环应用于根管治疗后牙合龈距离较小的乳磨牙充填修复治疗,可显著提高充填修复体的固位力,提高治疗成功率,简便易行,值得临床推广应用。     

上颌第一磨牙腭根双根管1例

目的：探讨上颌第一磨牙变异根管的诊断及治疗对策。方法：l例右上颌第一磨牙根管治疗病例,通过根尖片和清理髓腔及根管系统,探测出腭侧双根管,即刻对其进行冠向下法根管预备,超声荡洗后氢氧化钙封药,冷牙胶侧方加压充填根管。结果：术后6个月复查,患者无主观症状,咀嚼功能良好,x线片示根尖无病变,达到临床治疗成功标准。结论：临床上要减少遗漏根管,需要注意上颌第一磨牙根管治疗前的根管数日、位置的判断,以及治疗过程中髓腔入口的改良、根符定位及扩通,提高根管治疗的成功率。     

根管充填与塑化联合应用治疗磨牙牙髓病和根尖周病

目的　探讨根管充填和塑化联合应用治疗磨牙牙髓病和根尖周病的临床效果。方法　将30 6颗牙髓病和根尖周病患牙随机分为两组。一组根据根管形态、根管预备中遇到的情况,粗大平直根管和引起窦道的根管行根管充填,弯曲、狭窄、闭锁、断针残留的根管行根管塑化。另一组不能完善进行根管治疗采取变异干髓术。术后1年、2年复查并摄X线根尖片观察治疗效果,比较两组疗效。结果　通过2年以上的临床观察,根管充填和塑化治疗联合应用,总成功率为85 .71% ,与变异干髓治疗成功率(73.39% )有显著性差异。结论　根管充填和塑化联合应用能利用两种治疗各自的优势,实现根管系统良好的封闭,对磨牙牙髓病、根尖周病疗效满意。     

应用牙科全麻技术治疗30例儿童牙病患者的疗效分析

目的:分析应用牙科全麻技术(DGA)治疗的30例儿童牙病患者的年龄、性别等分布特征以及处置项目情况与随访结果.方法:中国医科大学口腔医学院儿童牙科2006-2007年应用DGA治疗的病例30例,一次性治疗口内所有患牙,处置项目包括龋齿充填术、间接盖髓术、活髓切断术、根管治疗术、拔牙术以及对所有牙的龈上洁治术、光滑面涂布氟保护漆、余留健康前磨牙和乳、恒磨牙窝沟封闭.对患者的自然情况、处置项目以及随访结果进行整理分析,应用SPSS10.0软件包进行χ2检验,比较不同年龄组DGA治疗病例的男女性别比例分布以及各种处置项目所占的比例在乳、恒牙之间的差别.结果:患者年龄19个月～14岁,均为不合作儿童,其中智力发育障碍者占10%,智力健康者占90%;在各年龄组中,男性患者均多于女性;在各处置项目中,龋齿充填术占18.67%,间接盖髓术占23.26%,活髓切断术占0.77%,根管治疗术占29.16%,拔牙术占2.05%,窝沟封闭术占26.09%;乳牙根管治疗术的比例高于窝沟封闭术,而恒牙则相反,统计学上有高度显著性差异(χ2=11.630,P=0.001).复查时,除2例智力发育障碍儿童外,均可配合检查治疗:经过6～12个月的复查,无一例有新龋发生,3例患儿出现充填物脱落,其中前牙3颗,根管治疗后的后牙2颗.结论:龋齿充填术和根管治疗术是儿童DGA治疗的主要项目,采取龋病的综合防治策略,能有效降低儿童的新发龋坏;DGA是对不合作儿童进行治疗的安全有效的行为管理技术.     

螺旋加压法充填乳牙根管

为了使根管充填更理想 ,对 12 5个需要做根管治疗的乳牙采用了螺旋加压充填法 ,临床效果满意。1　病例选择80例患儿 ,年龄 3～ 8岁 ,男 45例 ,女 35例。急性牙髓炎 2 0牙 (其中乳前牙 8个 ,乳磨牙 12个 ) ,慢性牙髓炎 10 5牙 (其中乳前牙 2 9个 ,乳磨牙 76个 ) ,共 12 5个患牙 ,术前拍Ｘ线片确诊。2　方法常规拔髓 ,清理根管 ,药物消毒 ,以氧化锌丁香油碘仿糊剂作根充材料 ,用螺旋形输送器进行根充。　　根据根管的粗细 ,选择相应型号的螺旋形输送器 ,安装于慢速机头上 ,使其工作端螺纹呈逆时针方向 ,蘸糊剂插入根管的 1/ 2～ 2 / 3处 ,然后…     

Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth

PURPOSE: This study was performed to retrospectively evaluate treatment of deep caries in primary molars with formocresol pulpotomy (FP) and indirect pulp therapy (IPT). METHODS: 133 primary molars with deep caries approaching the pulp were treated with FP (N = 78) or IPT (N = 55) and followed 2-7 years. All IPTs received immediate stainless steel crowns (SSCs); 61 FPs got an immediate SSC, 13 an intermediate restorative material (IRM), and 4 amalgam. Thirteen IPTs and 25 FPs had pre-operative pain compatible with a diagnosis of reversible pulpitis. Treatment notes and radiographs were independently assessed. RESULTS: Overall IPT success was 93% (51/55) versus 74% (58/78) for FP. Molars with pain compatible with a diagnosis of reversible pulpitis were successfully treated by IPT 85% (11/13) versus 76% (19/25) for FP. FP-treated molars exhibited earlier exfoliation 38% (30/78), while all IPT molars exhibited normal exfoliation. FPs receiving immediate SSCs had 50/61 (82%) succeed; FPs restored with an IRM temporary succeeded 5/13 (39%), amalgam 3/4 (75%). CONCLUSIONS: IPT success was significantly higher than FP (P = 0.01) in the treatment of deep caries. Both IPT and FP were successful in treating teeth with pain compatible with the diagnosis of reversible pulpitis. FP significantly hastened the exfoliation of pulpotomized primary molars (P = 0.001). IPT in primary teeth can be successfully used in a one step procedure. SSCs placed immediately after FP significantly increased FP success vs. FP followed by IRM temporary (P = 0.01).     

部分活髓切断术在年轻恒磨牙龋源性露髓治疗中的应用

目的：应用部分活髓切断术治疗年轻恒磨牙龋源性露髓并评价其临床效果。方法：对35例41颗因龋病引起的年轻恒磨牙露髓的病例采用部分活髓切断术治疗并定期观察。结果：采用部分活髓切断术治疗年轻恒磨牙龋源性露髓成功率为92.68%。结论：对于龋源性露髓的年轻恒磨牙,部分活髓切断术是成功而有效的治疗方法。     

Evaluation of Complete Pulpotomy With Biodentine on Mature Permanent Molars With Signs and Symptoms of Symptomatic Irreversible Pulpitis: 12-months Follow-up

IntroductionComplete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-months success rate of complete pulpotomy with Biodentine on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis.Materials and methodsA total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 minutes of hemostasis) on at least 1 canal. A complete pulpotomy with Biodentine was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. A 12-months postoperative follow-up was conducted to evaluate clinical and radiologic success.ResultsA total of 66 patients received complete pulpotomy; 52 could be examined 12 months postoperatively. Clinical and radiologic analysis at 12 months postoperatively revealed a success rate of 87% (45 of 52 molars) and a failure rate of 13% (7 of 52 molars). There was a relationship between age, tooth type, and preoperative periapical condition and treatment success with P < .05.ConclusionCompliance with the indications and protocol for complete pulpotomy with Biodentine on mature permanent molars with symptomatic irreversible pulpitis gives positive results at the 12-month follow-up.     

Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date?

Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. IPT has a significantly higher success in treating all primary first molars, but especially those with reversible pulpitis compared with FP. The purpose of this article was to review the dental literature and new research in vital pulp therapy to determine the following: (1) Is a pulpotomy indicated for a true carious pulp exposure? (2) Is there a diagnostic method to reliably identify teeth that are candidates for vital pulp therapy? (3) Is primary tooth pulpotomy out of date, and should indirect pulp therapy replace pulpotomy? )     

Success rate of three capping materials used in pulpotomy of primary molars: A randomized clinical trial

BackgroundCarious primary molars, symptomless, or with reversible pulpitis are most frequently treated with pulpotomy to maintain arch integrity, otherwise they would be extracted. The present study was conducted to assess clinically and radiographically the success rate of three capping materials: Nanohydroxyapatite (NHA), Mineral Trioxide Aggregate (MTA), and Formocresol (FC) in pulpotomy of primary molars.MethodsA clinical trial was carried out on healthy, four to eight years old children, with 72- second primary molars indicated for pulpotomy. Molars were divided into 3 equal groups (24 teeth each) designated to NHA (group 1), MTA (group 2), and FC (group 3) as pulp medicaments. Treated teeth were finally restored with stainless steel crowns. Subjects were monitored clinically and radiographically after three, six, and twelve months. Statistical analysis was presented as intended to treat analysis. Categorical data were analyzed using Fisher’s exact test. The significance level was set at p ≤ 0.05. Statistical analysis was performed using SPSS, version 26.ResultsBy the end of the twelve months, the number and percentages of successfully treated molars for Group (1), Group (2) and Group (3) were 10 (41.7%), 19 (79.2%) and 18 (75.0%) respectively; with (NHA) group showing a significantly lower rate of success, (p = 0.019).ConclusionsMTA is still the material of choice for pulpotomy in primary molars.Trial RegistrationThis trial was registered on Clincal.Trial.gov (https://clinicaltrials.gov), on February 8, 2019 (Retrospectively registered). The protocol ID is 181053. The Identifier is NCT03833557.     

A one-year follow-up of partial pulpotomy and calcium hydroxide capping in primary molars

Abstract Partial pulpotomy and capping with calcium hydroxide was performed in 93 lower primary molars. The pulpal diagnosis was chronic coronal pulpitis. The amputation was done with a gentle technique, using high speed and diamond burs. Calcium hydroxide was applied to the wound surface without any intermediate layer of blood clot. The cavity was sealed with slow-setting zinc oxide-eugenol cement, phosphate cement and silver amalgam. The teeth were followed clinically and roentgenologically. After one year 67 successful endodontic treatments and 14 failures were registered. The remaining 12 teeth were lost for reasons unconnected with the endodontic treatment. The frequency of successful treatments, estimated with the aid of a modified life table method, was 83%. Partial pulpotomy thus proved favorable compared to traditional coronal pulpotomy and should therefore be considered the treatment of choice in primary molars with chronic coronal pulpitis provided a gentle surgical technique is used and no blood clot is left between wound surface and calcium hydroxide.     

MTA pulpotomy of human permanent molars with irreversible pulpitis

The histological success of mineral trioxide aggregate (MTA) pulpotomy for treatment of irreversible pulpitis in human teeth as an alternative treatment was investigated in this study. Fourteen molars which had to be extracted were selected from patients 16–28 years old. The selection criteria include carious pulp exposure with a history of lingering pain. After isolation, caries removal and pulp exposure, MTA was used in pulpotomy treatment. Patients were evaluated for pain after 24 h. Two patients were lost from this study. Twelve teeth were extracted after 2 months and were assessed histologically. Recall examinations confirmed that none of the patients experienced pain after pulpotomy. Histological observation revealed that all samples had dentin bridge formation completely and that the pulps were vital and free of inflammation. Although the results favour the use of MTA as a pulpotomy material, more studies with larger samples and a longer recall period are suggested to justify the use of MTA for treatment of irreversible pulpitis in human permanent teeth.     

Mineral trioxide aggregate as pulp dressing agent in pulpotomy treatment of primary molars: 42-month clinical study

PURPOSE: To evaluate the long-term clinical and radiographical results of using gray mineral trioxide aggregate (MTA) in pulpotomy treatments in primary molars. METHODS: A total of 69 primary molars were treated with pulpotomy procedures using MTA and follow-up every 6 months up to 42 months. RESULTS: Clinical success was 100% as none of the molars showed clinical pathologic signs; radiographical success was 98.5% as one case of internal resorption was recorded. Reparative dentin deposition was found as stenosis of the pulp canals in 84% of the cases 42 months after treatment and as dentin bridge formation in 83% of the cases 42 months after treatment. Moreover, 11 permanent successors erupted at their normal exfoliation time without pathology after pulpotomy treatment with gray MTA of the primary molars.     

Comparative investigation of clinical/radiographical signs of mineral trioxide aggregate and formocresol on pulpotomized primary molars

The objectives of this study were (1) to evaluate clinically and radiographically the effects of mineral trioxide aggregate (MTA) as a pulp dressing after coronal pulp amputation (pulpotomy) in primary molars, (2) to compare the effects of MTA and formocresol in pulpotomized primary teeth. Sixty primary mandibular molars of thirty healthy children aged between 5-8 years were treated by conventional pulpotomy technique. The teeth on the right side are assigned to MTA (Group A) and the left side for the Formocresol (Group B). The children were examined clinically and radiographically every 6 months over a period of 36 months. Results of present study revealed that both MTA and Formocresol has the same effect on the first as well as second primary molars, with chi-square value being 1.1483 (P ≥ 0.05). None of the teeth in either group showed any clinical pathology, showing 100% success rate but radiographically formocresol group showed one case of internal resorption that was regarded as failure in the present study. MTA seems to be more promising predictable with positive response in vital pulp therapy in future than formocresol pulpotomy except for the cost factor.     

Caries control and other variables associated with success of primary molar vital pulp therapy

PURPOSE: This research evaluated initial treatment of deep dental caries with caries control (CC) procedure and the effect of other factors on the success of indirect pulp therapy (IPT) and formocresol pulpotomy (FP). METHODS: Retrospective chart audits were performed on 226 primary molars with deep caries approaching the pulp that were treated using IPT and FP. Mean follow-up was 3.4 years. CC with glass ionomer cement (GIC) was performed on 50 of the 226 teeth 1 to 3 months before pulp therapy. RESULTS: IPT therapy was successful 94% of the time, whereas FP was successful 70% of the time. The initial use of CC increased the IPT/FP success rate to 92% vs a 79% success rate in teeth without CC. Primary molar FP success on primary first molars was 61% vs 83% in second molars. IPT therapy was successful 92% of the time for first molars vs 98% of the time for second molars. Thirty-six percent of the FP-treated teeth exfoliated early vs 2% of the IPT-treated teeth. Primary first molars with reversible pulpitis had a higher success with IPT (85%) vs FP (53%). The type of final restoration did not affect IPT or FP success, except that FPs restored with an immediate IRM (Dentsply/Caulk, Milford, Del) restoration decreased success to 39%. CONCLUSIONS: IPT for the treatment of deep dental caries lesions produced greater long-term success than FP. FP success in primary first molars was lower compared to IPT success, especially in teeth with reversible pulpitis. Also FP-treated teeth showed significantly earlier exfoliation patterns. The prior treatment of deep dental caries lesions with CC procedures improved the subsequent IPT or FP success.