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。     

Clinical and Radiographic Assessments of Potassium Nitrate in Polycarboxylate Versus Mineral Trioxide Aggregate as Pulpotomy Biomaterials in Immature Mandibular First Permanent Molars: A Randomized Clinical Trial

IntroductionThe purpose of this study was to compare clinically and radiographically the effects of potassium nitrate in polycarboxylate cement and mineral trioxide aggregate (MTA) as pulpotomy agents in vital immature mandibular first molars.MethodsThe trial design was a parallel randomized, 1:1 allocation ratio, with both the participants and the data assessor blinded. A total of 50 molars of 48 eligible children aged 6–9 years were studied. The children had mandibular immature first molars with extensive caries that revealed pulp exposure during caries excavation. Patients were randomly allocated equally into 2 groups in which potassium nitrate in polycarboxylate cement (the intervention group) and MTA (the control group) were used as pulpotomy biomaterials. The treated teeth were restored permanently. The primary outcome was clinical/radiographic assessment after 1 week, 6 months, and 12 months. The secondary outcomes were radiometric analysis at 6 and 12 months to determine dimensional changes during maturogenesis. The digital radiographs were imported to image processing software to perform radiometric measurements. Data were tabulated and statistically analyzed with significance set at P ≤ .05.ResultsOnly a single tooth failed at the 6-month recall, and another one was lost during recall in each group. Thus, the overall success rate for cases/group who finally attended the 12-month follow-up time point was 92% (23/25) with no statistically significant difference between the 2 groups. At the 12-month recall, successful cases showed root development with an increase in root length and a decrease in apical foramen width. Complete apical closure was observed in 65.2% of the roots in the intervention group and 52.1% in the control group.ConclusionsThe clinical and radiographic success reported in the present study reveals that potassium nitrate in polycarboxylate cement could be used as a biological and economic alternative to MTA as a pulpotomy agent in vital immature mandibular first molars. Further follow-up for longer periods is recommended.     

Comparison of Pulpal Responses to Pulpotomy and Pulp Capping with Biodentine and Mineral Trioxide Aggregate in Dogs

Introduction

This study evaluated the pulpal and periapical responses of dogs' teeth after pulpotomy and pulp capping with a new tricalcium silicate–based cement (Biodentine) when compared with mineral trioxide aggregate (MTA) by radiographic, histopathologic, and histomicrobiological analyses.

Methods

Sixty roots (30 teeth) of dogs were divided into 2 groups, Biodentine (n = 36 roots) and ProRoot MTA (control, n = 24 roots). Animals were killed after 120 days, and the teeth were subjected to histotechnical processing (hematoxylin-eosin and Brown and Brenn staining). Qualitative and quantitative histopathologic data were analyzed by Fisher exact and Mann-Whitney tests (α = 0.05).

Results

Radiographically, mineralized tissue bridge formation was observed in more specimens treated with Biodentine (96.8%) than with MTA (72.2%) (P = .02). Integrity of the lamina dura and absence of periapical bone rarefaction and root resorption (external and internal) were observed in all specimens. Histopathologic and histomicrobiological analyses revealed mineralized tissue bridge formation, pulpal vitality, odontoblast layer integrity, preserved periodontal ligament, and absence of bone or root resorption and microorganisms in both groups. Although the bridges formed at the amputation site had similar morphology, they were significantly thicker in the Biodentine group (P < .0001). Comparison between the radiographic and histopathologic results showed that radiographic visualization of more bridges in the Biodentine group was related to bridge thickness because radiographic diagnosis was flawed for bridges with thickness less than 0.5 mm. Fluorescence microscopy improved the visualization of bridge structure.

Conclusions

Biodentine presented tissue compatibility and allowed for mineralized tissue bridge formation after pulpotomy in all specimens with similar morphology and integrity to those formed with use of MTA. Periapical radiographs failed in detecting mineralized tissue bridges with thickness less than 0.5 mm.     

三氧化矿物凝聚体治疗年轻恒牙外伤的临床疗效

目的探讨三氧化矿物凝聚体（mineral trioxide aggregate,MTA）用于年轻恒牙牙外伤的治疗效果。方法收集年轻恒牙牙外伤患者30例,患牙30颗,手术显微镜下,4颗行MTA盖髓术,4颗行MTA活髓切断术,22颗行MTA根尖屏障修复术。随访观察1、3、6个月。结果 30颗患牙均得以保存,部分患牙根尖部牙骨质形成。结论 MTA用于年轻恒牙牙外伤的盖髓术、活髓切断术、根尖屏障修复术具有良好的治疗效果。     

Treatment Outcome after Repair of Root Perforations with Mineral Trioxide Aggregate: A Retrospective Evaluation of 90 Teeth

IntroductionIn this retrospective study, the success rate for the repair of root perforations using mineral trioxide aggregate was investigated.MethodsOne hundred forty consecutive cases of teeth with perforations were included in the sample; 128 finally met the inclusion criteria. All treatments were performed between 1999 and 2009 in a dental office limited to endodontics. Perforations were sealed with mineral trioxide aggregate using a dental operating microscope. Treatment success was assessed by analyzing clinical data and radiographs 1–10 years after treatment. The radiographs were evaluated by 2 independent calibrated examiners. The outcome measure was dichotomized as “healed” or “failure.” The relationship between preoperative data and treatment outcome was examined to determine potential prognostic factors.ResultsFrom 128 teeth, 90 were accessible for recall (70.3%). The mean follow-up interval was 3.4 years. Sixty-six teeth (73.3%) were classified as healed. A significant relationship between treatment success and the presence of a preoperative lesion at the perforation site was found. Those teeth in which a lesion at the perforation site was present before treatment showed a lower healing rate. Teeth with a preoperative communication between the perforation and the oral cavity showed the lowest success rate.ConclusionsTwo prognostic factors for healing of teeth with perforations were identified. The presence of a preoperative lesion at the perforation site and direct contact between the perforation and the oral cavity were related to lower treatment success rates.     

MTA和Vitapex糊剂治疗成人慢性根尖周炎伴根尖孔闭合不全的疗效比较

目的：比较三氧化物多聚体（mineral trioxide aggregate,MTA）和Vitapex糊剂应用于成人慢性根尖周炎伴根尖闭合不全恒牙的临床疗效。方法：选取成人慢性根尖周炎伴根尖孔闭合不全的恒牙共38颗,随机分为2组,实验组在根管显微镜下用MTA严密封闭根尖开放部位,硬固后根管行热牙胶充填;对照组用Vitapex糊剂行根尖诱导成形,在根尖部有硬组织形成后行根管充填。两组术后均定期复查,评价临床效果及X线片结果。结果：经过2年的复查,实验组所有病例在治疗后均无临床不适症状,X线片显示患牙11颗根尖阴影完全消失,8颗明显缩小,1颗无变化,有效率95%。对照组2颗磨牙因冠根折拔除,8颗根尖有硬组织形成,8颗根尖无硬组织形成,有效率为44.4%,两者差异有统计学意义。结论：MTA治疗成人根尖孔未闭合恒牙是一种较理想的根尖诱导成形材料,短期临床疗效好,长期效果有待于进一步观察。     

MTA复合纤维粘连蛋白盖髓的临床疗效评价

目的 :观察MTA复合纤维粘连蛋白作为活髓保存剂的临床疗效。方法 :选择 10 9名患者 ,分别用MTA、MTA复合纤维粘连蛋白和氢氧化钙盖髓 ,评价盖髓后 4周与 12周时的盖髓成功率。结果 :盖髓 4周时 ,MTA、MTA复合纤维粘连蛋白和氢氧化钙组的盖髓成功率的差别无统计意义 (P >0 .0 5 )。盖髓 12周时 ,3组材料的盖髓成功率的差别有统计意义 (P <0 .0 5 )。结论 :MTA复合纤维粘连蛋白的临床盖髓效果显著 ,优于氢氧化钙组     

Outcome of Endodontic Microsurgery Using Mineral Trioxide Aggregate or Root Repair Material as Root-end Filling Material: A Randomized Controlled Trial with Cone-beam Computed Tomographic Evaluation

IntroductionThe purpose of this randomized clinical trial was to evaluate healing after endodontic microsurgery (EMS) using mineral trioxide aggregate (MTA) versus EndoSequence root repair material (RRM; Brasseler, Savannah, GA) as root-end filling materials.MethodsTwo hundred forty-three teeth with persistent or recurrent apical periodontitis were randomly assigned to either the MTA or RRM group. EMS was performed, and follow-up visits with clinical and radiographic investigation were scheduled at 6, 12, and 24 months with follow-up cone-beam computed tomographic (CBCT) imaging after 12 months.ResultsOne hundred twenty teeth with an average follow-up of 15 months were evaluated. The overall success rate was 93.3% for periapical (PA) evaluation and 85% for CBCT evaluation. The RRM group exhibited 92% and 84% success rates as assessed on PA and CBCT imaging, respectively. The MTA group exhibited 94.7% and 86% success rates as assessed on PA and CBCT imaging, respectively. No significant difference was observed between the 2 groups. Microsurgical classification, root canal filling quality, root-end filling material depth, and root fracture were found to be significant outcome predictors.ConclusionsEMS is a predictable procedure with successful outcome both 2-dimensional and 3-dimensional radiographic evaluation when RRM or MTA was used as the root-end filling material.     

Evaluation of Blood Clot,Platelet-rich Plasma,Platelet-rich Fibrin,and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial

Introduction

Regenerative endodontic procedures (REPs) using autologous platelet concentrates as scaffolds can improve the biologic outcome of treatment. This prospective, randomized trial compared the clinical and radiographic performance of REPs using platelet-rich plasma (PRP), platelet-rich fibrin (PRF), a platelet pellet (PP), and an induced blot clot (BC).

Treatment Outcome of Mineral Trioxide Aggregate: Repair of Root Perforations—Long-term Results

Introduction

This historical cohort study follows on a previously reported trial, with the aim of assessing the outcome for teeth with root perforations managed by the orthograde placement of mineral trioxide aggregate (MTA) and identifying potential outcome factors for such treatment with a larger sample size and longer follow-up periods than in the first phase of the project.

Methods

The treatment outcomes of 64 root perforations repaired between 2000 and 2012 with MTA were investigated. The root perforations were located in different areas of the root. Calibrated examiners assessed clinical and radiographic outcomes by using standardized follow-up protocols 12–107 months after treatment (median, 27.5 months). Preoperative, intraoperative, and postoperative information was evaluated. The outcomes were dichotomized as healed or diseased.

Results

Of the 64 teeth examined (85% recall rate), 86% were healed. The univariate analyses (χ² tests) identified 2 potential prognostic factors, experience of the treatment providers (odds ratio, 2.14; 95% confidence interval, 0.39–11.74; P < .01) and placement of a post after treatment (odds ratio, 0.06; 95% confidence interval, 0.01–0.27; P < .01). In the multivariate stepwise logistic Cox regression, none of the potential prognostic factors displayed a significant effect on the outcome at the 5% level.

Conclusions

MTA appears to have good long-term sealing ability for root perforations regardless of the location. The results of this historical cohort study confirm the results of the first phase of this project.     

Efficacy of Biodentine and Mineral Trioxide Aggregate in Primary Molar Pulpotomies—A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Clinical Trials

Objectives

Pulpotomy is the favored treatment for pulp exposure in carious primary teeth. This review aimed to compare the success rates of biodentine (BD) and mineral trioxide aggregate (MTA) pulpotomies in primary molars using meta-analysis (MA) and trial sequential analysis (TSA) and also to assess the quality of the results by Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Evaluation of the Efficacy of Erbium,Chromium-doped Yttrium,Scandium, Gallium,and Garnet Laser in Partial Pulpotomy in Permanent Immature Molars: A Randomized Controlled Trial

IntroductionThe use of the erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser in vital pulp therapy contributes to the formation of dentin bridges and a sterile zone as well as the maintenance of the vitality of the pulp. However, no prior studies have used the Er,Cr:YSGG laser in partial pulpotomy of immature permanent teeth. The aim of this study was to compare the efficacy of partial pulpotomy treatment using mineral trioxide aggregate (MTA) alone and MTA with the Er,Cr:YSGG laser in permanent immature molars.MethodsA total of 90 caries-exposed permanent immature molar teeth were included and randomly divided into 2 groups: the MTA group (n = 45) and the laser + MTA group (n = 45). In the MTA group, MTA was applied to the exposed area on the pulp after bleeding control. In the same session, the tooth was restored with a composite resin. In the laser + MTA group, before MTA condensation, the Er,Cr:YSGG laser was applied to the exposure area. Patients were recalled at 1, 3, 6, and 12 months after treatment. The Mann-Whitney U and chi-Square tests were used for statistical analysis.ResultsThe success rate (95.5%) of the laser + MTA group was similar to that of the MTA group (88.8%). There was no significant difference between groups in terms of the frequency of at least 1 pathologic clinical or radiographic failure at 12 months (P > .05).ConclusionsPartial pulpotomy treatment showed a high success rate in immature permanent molars; however, the use of the laser did not contribute to the success rate compared with MTA alone.     

Evaluation of Stress Distributions in Mandibular Molar Teeth with Different Iatrogenic Root Perforations Repaired with Biodentine or Mineral Trioxide Aggregate: A Finite Element Analysis Study

IntroductionIn this study, finite element analysis was used to evaluate the stress distributions in simulated mandibular molar teeth with various iatrogenic root perforation types after reparation with Biodentine (Septodont, Saint-Maur-des-Fossés, France) or mineral trioxide aggregate (MTA).MethodsAn extracted human mandibular molar tooth was scanned using a micro–computed tomographic device, and a 3-dimensional solid model was created. Then, 3 different iatrogenic perforation types (furcation perforation [FP], strip perforation [SP], and post drill perforation [PDP]) and 2 different repair materials (MTA and Biodentine [BD]) were simulated on the model. In addition, a sound tooth (ST) model (control) and a model left unrepaired for each type of perforation were created; then, access cavities were restored using resin composite, except for the sound tooth model. Consequently, a total of 10 experimental models were designed. An oblique force of 300 N angled at 45° to the occlusal plane was simulated. Evaluations of von Mises stress were performed in the perforated regions.ResultsMaximum von Mises stress values were 7.76 MPa for ST/corresponding to the FP region, 8.48 MPa for ST/corresponding to the SP region, 14.20 MPa for ST/corresponding to the PDP region, 10.89 MPa for FP /MTA, 7.65 MPa for FP/BD, 14.67 MPa for FP/unrepaired, 15.92 MPa for SP/MTA, 15.82 MPa for SP/BD, 21.95 MPa for SP/unrepaired, 10.20 MPa for PDP/MTA, 9.17 MPa for PDP/BD, and 17.86 MPa for PDP/unrepaired.ConclusionsThe results of this finite element analysis indicated that BD models showed lower maximum von Mises stress values than the MTA models, and SPs exposed higher stress concentrations in root perforation regions than FPs and PDPs. The use of MTA and BD may reduce the risk of potentially harmful stress in root perforation regions.     

MTA治疗成年患者根尖孔未闭合患牙的疗效评价

目的 评价无机三氧化聚合物（MTA）治疗成年患者根尖孔未闭合患牙的临床疗效。方法 选取成年患者根尖孔未闭合的前牙及前磨牙共41颗,随机分为2组,试验组21颗牙,在完成根管预备和消毒后,在手术显微镜下将MTA充填于根尖孔及根管下段,厚约3-5 mm,硬固后采用热牙胶完成根管中上段的充填;对照组20颗牙,采用氢氧化钙类根管糊剂Vitapex行根尖诱导成形术,定期复查,在根尖部有硬组织形成后完成根管治疗。记录患者就诊次数、治疗周期及治疗效果。结果 试验组术后X线片显示15颗患牙适充,6颗牙超充约0.5-2 mm,根管内充填物致密;平均就诊次数3.5次,平均治疗周期11.8 d,复查时多数患牙窦道闭合,根尖周病变明显缩小或消失,无新的暗影出现;对照组11颗患牙诱导成功,根尖有硬组织形成,9颗牙无明显根尖屏障形成,平均就诊次数6次,平均治疗周期306.8 d。结论 与根尖诱导成形术比较,MTA治疗成年患者根尖孔未闭合患牙的周期短,疗效好。     

Outcomes of Vital Pulp Therapy Using Mineral Trioxide Aggregate or Biodentine: A Prospective Randomized Clinical Trial

Introduction

Mineral trioxide aggregate (MTA) has been used in pulp capping of cariously exposed mature permanent teeth with promising results. The search for alternative materials that seal better and set faster than MTA and do not stain is ongoing. Biodentine (Septodont, St Maur-des-Fossés, France) exhibits these advantages but has not been tested yet for a prolonged duration in mature teeth. This study aimed to evaluate the clinical performance of Biodentine and white MTA (Angelus, Londrina, Brazil) in cariously exposed mature permanent teeth.

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.     

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.     

Response to Pulp Sensibility Tests after Full Pulpotomy in Permanent Mandibular Teeth with Symptomatic Irreversible Pulpitis: A Retrospective Data Analysis

IntroductionThis retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis.MethodsThe records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P < .05.ResultsA higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P < .05). Sex-based responses to the electric pulp test (P > .05) and the cold test were similar (P > .05). The age-based response was similar for the electric pulp test (P > .05) but was significant for the cold test (P < .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P > .05) or the cold test (P > .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00).ConclusionsThe majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.