年轻恒前牙冠折损伤程度和露髓时间对活髓切断术疗效的影响

目的：对外伤引起的年轻恒前牙冠折露髓行活髓切断术，并于2年以上追踪观察其根管、根尖孔发育情况。方法：72例外伤冠折露髓牙，采用活髓切断术切断冠部牙髓，保留根髓活力，促进牙根发育。结果：72例患牙中，轻度损伤58例，治疗成功率为93．1％；重度损伤14例，成功率为64．2％，总成功率为87．5％。结论：活髓切断术是外伤冠折露髓的首选治疗方法。     

年轻恒前牙活髓切断术的临床疗效观察

目的 观察年轻恒前牙活髓切断术的临床疗效。方法 用活髓切断术治疗２０颗冠折露髓后３小时－１个月年轻恒前牙,术后追踪观察６个月－３年,结果 ２０颗年轻恒前牙有牙本质桥形成,牙根最终发育完成,其中仅１颗牙出现管腔钙化。结论 年轻恒牙活髓切断术适应证较宽,成功的关键在于掌握切髓的深度,使保留的牙髓正常,牙根发育程度及牙髓状况影响活髓切除术的疗效。     

儿童恒前牙切髓术后根髓组织学研究

目的：牙本质桥的形成是牙髓修复的特征，但至今人们对牙本质桥下方的牙髓组织是否健康仍有争议。本研究目的是观察儿童外伤冠折恒切牙切髓极后根髓的组织学特征，以证实牙髓修复后的牙髓组织变化状况。方法：对16例8－9岁儿童外伤冠折露髓的恒前牙行切髓术，氢氧化钙制剂覆盖牙髓断面，并在牙本质桥形成及根尖发育完成后不同时期行去髓术，将去除的根髓组织固定，常规组织学切片，显微镜观察。结果：术后12－24个月根尖发育完成，此时组织学观察可见牙本质桥下方的根髓组织无明显炎症。至36－48个月，牙髓组织逐渐出现退行性变，例如纤维性变和牙髓钙化等。结论：切髓术后2年内牙本质桥下方的根髓是正常的，而后牙髓逐渐出现退行性变，切髓术可作为儿童前牙冠折露髓的一种暂时治疗方法，当牙根发育完成时，则应采用去髓术。     

年轻恒前牙冠折露髓部分活髓切断术的疗效

目的研究年轻恒前牙冠折露髓部分活髓切断术的疗效。方法 120颗患牙中,有70颗采用部分活髓切断术,有50颗采用传统的活髓切断术,统计两组的成功率,并进行比较。结果部分活髓切断术和传统活髓切断术的成功率分别为91.7%和85.4%。结论部分活髓切断术是年轻恒牙冠折露髓一种理想的治疗方法,可以较长久的保存牙髓的活力,继续发挥其固有的功能,促进牙根的继续发育。     

冠折恒前牙活髓切断术的临床疗效观察

年轻恒牙牙髓有很好的愈合潜力,保存活髓牙齿,使牙根继续发育并形成正常尖周组织十分有意义.本文对27个冠折恒前牙行活髓切断术,依据临床症状、牙本质桥形成、牙髓活力测试、根内和尖周病变以及牙根继续发育等标准评价,观察6个月至3年,绝大多数患牙有牙本质桥形成和牙根继续发育.     

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目的观察儿童恒前牙外伤冠折露髓后采用活髓切断术的临床疗效。方法对2002—2007年黑龙江省口腔病防治院门诊收治的40例(55颗牙)因外伤引起的儿童恒前牙冠折露髓的病例,经碧兰麻局部浸润麻醉后,行常规活髓切断术,氧化锌丁香油水门汀暂时密封,术后1周,1、3、6个月定期观察,以后每6个月复查1次。复查时检测牙髓活力,摄X线片,分别记录X线片显示的牙髓断面愈合情况及牙根继续发育和根管及根尖周情况。结果切髓部位在牙颈部的成功率较高,占81.8%,术后3个月X线片显示牙本质桥影像趋于完整致密。在牙本质桥形成的同时,未发育成熟的牙根均能继续发育;而失败病例均是在根中部切髓者,术后3个月未见明显的牙本质桥,并出现尖周硬板破损的异常X线表现。结论为了充分利用生活牙髓的功能,使牙根继续发育,增强牙齿组织抗力,年轻恒牙冠折露髓后应尽量多地保存牙髓,切髓术时应以牙颈部或根管口为宜。     

242颗牙本质折断恒牙牙髓预后及影响因素的回顾性分析

目的 分析牙本质折断恒牙的牙髓预后及其影响因素。方法 对行间接盖髓治疗且复诊时间大于2年的牙本质折断病例进行回顾分析,记录牙髓预后情况,回归分析影响牙髓预后的危险因素。结果 收集到牙本质折断病例205例,涉及患牙242颗。242颗患牙中,78颗（32.2%）发生了牙髓坏死,3颗（1.2%）发生了牙髓钙化。牙本质折断后行间接盖髓术的成功率为67.8%。复诊期间177颗年轻恒牙中141颗根尖孔闭合。冠折近髓程度与牙髓坏死率有相关性（P=0.001）。结论 牙本质折断恒牙行间接盖髓术的预后较好,冠折近髓程度是判断牙髓预后的重要指征。     

氢氧化钙制剂诱导根尖形成的探讨

临床上儿童前牙因外伤冠折、双尖牙畸形中央尖 ,引起一系列病变 ,影响了牙根发育。近二年来 ,我们采用控制感染及药物诱导的方法进行治疗 ,获得了满意效果。　　作者单位 :330 0 0 6南昌 ,江西医学院第二附属医院口腔科　　一、材料和方法患儿共 18例 ,年龄 8～ 14岁 ;男性 10例 ,女性 8例。上中切牙 11颗 ,侧切牙 3颗 ,下双尖牙 4颗 ,上中切牙、侧切牙为外伤性冠折牙。牙本质折断未露髓患牙 9颗。露髓患牙5颗 ,双尖牙均为畸形中央尖折断后牙髓感染。牙髓急性炎症者 6例 ,牙髓慢性炎症者 12例 ,这些患牙均无根尖病变。彻底清理根管 ,去尽感…     

恒前牙牙根中部以下根折复位后的临床治疗

目的：提高牙根中部以下根折恒前牙复位后牙髓的存活率和死髓后根管治疗术的质量。方法：正畸方丝弓技术复位固定92位患者176个牙根中部以下根折恒前牙后2年内观察牙髓活力情况，配合应用氢氧化钙对部分死髓牙进行了根管治疗术。结果：就诊时间1h内根中部以下根折恒前牙复位固定6个月后有平均53．52％的患牙电牙髓活力测试为阳性反应，X线片显示平均60．56％患牙牙根根折处和根尖周有较完整硬组织屏障形成；配合应用氢氧化钙治疗9个月后的死髓患牙X线片显示平均73．91％其根折处和根尖周有较完整硬组织屏障形成，6．52％患牙因根折处和根尖周出现明显炎症和根吸收而拔除。结论：牙根中部以下根折恒前牙应及时正确复位，定期复查，死髓患牙应尽早充分地应用氢氧化钙，促进根折处和根尖周形成硬组织屏障，绝大部分患牙都能恢复其咀嚼功能。     

年轻恒前牙冠折露髓后活髓切断术的疗效分析

牙髓是保证牙根继续发育的主要组织 ,故年轻恒前牙冠折露髓后 ,应尽量保存牙髓活力。我科自 1998年至今 ,对年轻恒前牙因冠折露髓采用活髓切断术进行治疗后 ,定期复查 ,本文就影响疗效因素进行分析。1　材料和方法1.1　对象患者 3 3例 ,45个牙。外伤时间从 1ｄ～ 1周 ,折断部位不超过冠颈 1/ 3 ,Ｘ片显示无根折 ,根尖尚未完全闭合、根尖无明显病变者 ,男 2 0例 ,女 13例 ,年龄 :6.5～ 11.5岁 ,平均年龄 9岁 ;10岁以前有 2 4例 ,占 72 .1% ,10岁以后 9例占 2 7.9%。单个牙 2 3例占 69.7% ,两牙同时露髓 10例占 3 0 .3 %。外伤牙位 :上中切牙 …     

Treatment of crown fractures with exposed pulps

Traumatic injuries are a common cause of pulpal damage in anterior teeth. Crown fractures with exposed pulps represent 18 percent to 20 percent of the traumatic injuries that involve the teeth. This clinical study comprised 36 patients, who were referred for 40 crown fractures with pulp exposures. There were 39 maxillary incisors and one mandibular incisor. The partial pulpotomy (Cvek's technique) consists of amputating exposed pulp tissue to a depth of 1 to 2 mm below the point of pulp exposure. After partial pulpotomy, the pulpal wound is covered with calcium hydroxide; and the cavity is sealed with glass ionomer cement or a composite crown. Clinical and radiographic assessment of the hard-tissue barrier was done after three months. Patients were monitored for periods ranging from one to 12 years. The purpose of this clinical report was to evaluate Cvek's technique in the management of coronal fractures with pulp exposures and the long-term outcome of the partial pulpotomy in immature and mature teeth. In virtually all of the cases, this treatment was successful. Careful partial pulpotomy remains a prudent treatment choice with proper case selection.     

Comparison of iRoot BP Plus and Calcium Hydroxide as Pulpotomy Materials in Permanent Incisors with Complicated Crown Fractures: A Retrospective Study

IntroductionCalcium hydroxide has been used as a traditional pulpotomy agent for a long time but has some disadvantages. iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, Canada) is a newly developed, ready-to-use calcium silicate–based bioactive ceramic with excellent bioactivity and sealing ability. However, whether iRoot BP Plus shows superiority over calcium hydroxide as a pulpotomy material on permanent incisors with complicated crown fractures remains unknown.MethodsThis research included 205 permanent incisors with complicated crown fractures. These teeth were treated with pulpotomy and divided into 2 groups according to the pulpotomy material (105 treated with iRoot BP Plus and 100 with calcium hydroxide). Clinical and radiographic information was collected during the 12- to 24-month follow-up period. The formation of reparative dentin bridges and pulp canal obliteration were analyzed using radiographs in both groups.ResultsThe success rates for recall in the average follow-up period of 17.5 ± 4.4 months (12–24 months) after pulpotomy treatment were significantly different between the 2 groups, with 99% for the iRoot BP Plus group and 93% for the calcium hydroxide group. Reparative dentin bridges were observed in 92.4% of the iRoot BP Plus group and 90% of the calcium hydroxide group, but the difference was not significant. Pulp canal obliteration was observed in 2 teeth (2%) in each group.ConclusionsThe success rates obtained in our study indicate that iRoot BP Plus as a pulpotomy agent can be a suitable alternative to calcium hydroxide to manage complicated crown fractures.     

Treatment of crown fractures with pulp exposure in primary incisors

The treatment options of enamel dentin crown fractures with pulpal exposure in the primary dentition traditionally consist of direct pulp capping, pulpotomy, pulpectomy, or extraction. Many clinicians disagree on the most appropriate treatment, and individual preferences exist within dentistry. Partial pulpotomy, also known as the Cvek pulpotomy, is a mode of treatment which is widely used in the permanent dentition but less so in primary teeth. This conservative technique is described and its advantages over the others are presented. In addition, a report of a case with a 2-year follow-up is also included. The purposes of this article are: (1) to present the indications and contraindications of the various treatment modalities for primary incisors with complicated crown fractures; and (2) to suggest partial pulpotomy as a conservative and more appropriate approach for primary incisors with complicated crown fracture.     

Partial pulpotomy as a treatment alternative for exposed pulps in crown-fractured permanent incisors

Abstract Sixty-three vital permanent incisors with complicated crown fractures were treated by partial pulpotomy and assessed clinically and radiographically for healing. Healing of the pulp was considered to have taken place when the following criteria were fulfilled: absence of clinical symptoms, radiographic evidence of dentin bridge formation, no intrapulpal or periapical pathosis, continued root development in immature teeth, and a positive response to electrical pulp testing. The treatment was successful in 59 teeth (94%). In the remaining 4 teeth, necrosis of the pulp was diagnosed clinically and radiographically 3 weeks to 6 months after treatment. The high frequency of healing in both the present and previous studies seems to justify recommending partial pulpotomy as the treatment of choice in crown-fractured teeth with pulp exposure.     

Equivalency study of histological responses to complete or partial pulpotomies in inflamed baboon immature first permanent molars.

Partial pulpotomy is an accepted treatment for traumatised incisor teeth with exposed pulps. Clinical studies in humans suggest that this may also be an acceptable technique for carious exposed pulps in molar teeth, but objective histological evidence to support this perception is lacking. OBJECTIVE: To compare histological responses to complete or partial pulpotomies of inflamed pulps in immature baboon first permanent molar teeth. METHODS: An experimental study in the baboon (Papio ursinus). Pulpitis was induced with fresh Streptococcus mutans placed into occlusal cavities with a small pulpal exposure in 34 first permanent molars of 9 juvenile baboons. After 14 days a pulpotomy, either complete or partial, was performed on the same molars in contra-lateral quadrants using calcium hydroxide covered with IRM and amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. RESULTS: Reaction frequencies in the complete and partial pulpotomy teeth were: dentine bridges 9/16 and 10/16, viable pulp in root canals 10/16 and 13/18, peri-apical abscesses 3/13 and 4/13. Fisher's exact probability test showed no statistically significant rates between the groups. CONCLUSIONS: Complete or partial pulpotomy of inflamed pulps in immature baboon first permanent molars produced comparable reactions.     

Conservative endodontic treatment of teeth fractured in the middle or apical part of the root

Abstract –  According to treatment type, root-fractured teeth with pulp necrosis or exposed pulps were divided into five groups, group 1: 17 teeth in which the root canal of the coronal fragment only was filled with gutta-percha (GP); group 2: seven teeth in which the root canals of the coronal and apical fragments were both filled with GP; group 3: 19 teeth in which the coronal fragment was filled with GP and the apical fragment was surgically removed; group 4: 68 teeth where the root canal of the coronal fragment was treated with calcium hydroxide and subsequently filled with GP; and group 5: five vital teeth with root and concomitant crown fractures in which the exposed pulps were treated by partial pulpotomy. The frequency of periodontal healing was 76% in group 1, zero in group 2, 68% in group 3 and 86% in group 4. Compared with groups 1 and 2 combined, healing in group 4 was significantly more frequent. In groups 1, 2 and 4, failures occurred significantly more often in teeth showing overfilling, i.e. protrusion of GP into the space between the fragments, compared with teeth without overfilling. All five teeth in group 5 showed healing. It was concluded that root canal filling with GP of the coronal fragment only, with or without surgical removal of the apical fragment, can be successful in selected cases. Treatment of the root canal with calcium hydroxide followed by GP filling appears to be the treatment of choice in root-fractured non-vital teeth. Partial pulpotomy of exposed pulps in five teeth showed results similar to root-unfractured teeth with pulp exposure treated with this technique.     

Metapex糊剂用于年轻恒牙活髓切断术的临床研究

观察Metapex糊剂用于活髓切断术的临床疗效。方法：对因各种原因引起冠折露髓的年轻恒牙患者28例3l颗患牙行活髓切断术治疗,用Metapex糊剂作为活髓保存剂。术后对患牙进行定期随访观察。结果：26例患者29颗患牙均于1～3个月在x线片上观察到牙本质钙化桥的形成并持续增厚,牙根继续发育直至根尖孔闭合,整个过程约1．5～3．0年,无根内外吸收和根管钙化出现,成功率93．55％。结论：Metapex糊剂用于活髓切断术可取得较满意的疗效。     

Mineral trioxide aggregate pulpotomies: a case series outcomes assessment

BACKGROUND: The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. METHODS: Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. RESULTS: Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. CONCLUSIONS: MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. CLINICAL IMPLICATIONS: MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.     

三氧化物多聚体应用于活髓切断术的临床疗效研究

目的评价三氧化物多聚体(MTA)用于活髓切断术的临床效果。方法选取外伤冠折露髓的年轻恒前牙48颗,随机分为2组,每组24颗。氢氧化钙组用氢氧化钙盖髓,MTA组用MTA盖髓,追踪观察3年并进行临床评价。结果MTA组成功22颗,失败2颗,氢氧化钙组成功20颗,失败4颗,2组差异无统计学意义。结论MTA是一种较理想的直接盖髓剂。     

Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury

Objectives. The aim of the present study was to investigate pulp healing responses following crown fracture with and without pulp exposure as well as with and without associated luxation injury and in relation to stage of root development. Patient material and methods. The long‐term prognosis was examined for 455 permanent teeth with crown fractures, 352 (246 with associated luxation injury) without pulpal involvement and 103 (69 with associated luxation injury) with pulp exposures. Initial treatment for all patients was provided by on‐call oral surgeons at the emergency service, University Hospital (Rigshospitalet), Copenhagen. In fractures without pulpal involvement, dentin was covered by a hard‐setting calcium hydroxide cement (Dycal®), marginal enamel acid‐etched (phosphoric acid gel), then covered with a temporary crown and bridge material. In the case of pulp exposure, pulp capping or partial pulpotomy was performed. Thereafter treatment was identical to the first group. Patients were then referred to their own dentist for resin composite restoration. Results. Patients were monitored for normal pulp healing or healing complications for up to 17 years after injury (x = 2·3 years, range 0·2–17·0 years, SD + 2·7). Pulp healing was registered and classified into pulp survival with no radiographic change (PS), pulp canal obliteration (PCO) and pulp necrosis (PN). Healing was related to the following clinical factors: stage of root development at the time of injury, associated damage to the periodontium at time of injury (luxation) and time interval from injury until initial treatment. Crown fractures with or without pulp exposure and no concomitant luxation injury showed PS in 99%, PCO in 1% and PN in 0%. Crown fractures with concomitant luxation showed PS in 70%, PCO in 5% and PN in 25%. An associated damage to the periodontal ligament significantly increased the likelihood of pulp necrosis from 0% to 28% (P < 0·001) in teeth with only enamel and dentin exposure and from 0% to 14% (P < 0·001) in teeth with pulp exposure. Conclusions. In the case of concomitant luxation injuries, the stage of root development played an important role in the risk of pulp necrosis after crown fracture. However, the primary factor related to pulp healing events after crown fracture appears to be compromised pulp circulation due to concomitant luxation injuries.