恒牙牙髓炎的活髓保存治疗

活髓保存治疗是尽最大限度保留健康牙髓组织、提高患牙远期保存率的方法,但其被认为适应范围有限,疗效不确定。牙髓组织的病理学改变是决定临床治疗方案和评估疗效的组织学基础,而常用的检查方法无法全面反映牙髓的病理学改变。随着对牙髓生物学研究的深入、现代诊疗技术及盖髓材料的革新,活髓保存治疗越来越多地被应用在以往被认为需要摘除牙髓的患牙上。本文根据循证文献,就牙髓炎病理改变、恒牙牙髓炎活髓保存治疗的临床研究等方面进行分析讨论和总结。在活髓保存治疗的过程中综合运用包括激光多普勒血流仪、组织氧检测仪、核磁共振成像、牙科显微镜等技术与方法准确判断牙髓炎症状态,并依此决定牙髓的去留程度;结合严格的感染控制与高生物相容性盖髓材料的使用,活髓保存治疗可运用在部分龋源性露髓患牙与出现不可复性牙髓炎症状的恒牙上。未来的研究则需从牙髓修复再生机制、牙髓炎诊断精准化、盖髓材料的升级等方面提高恒牙牙髓炎活髓保存治疗的成功率。     

Vitapex用于活髓保存治疗的临床疗效

目的:观察Vitapex糊剂用于活髓保存治疗的效果.方法:选择因外伤、机械性意外露髓病人62例74个患牙,随机分为两组.实验组37牙采用Viapex加ZOE盖髓,对照组37牙采用氢氧化钙盖髓,追踪观察2年的治疗效果.结果:术后1年实验组成功率86.49%,对照组成功率78.38%,两组差异不显著(P＞0.05);但2年及以后观察,实验组成功率70.97%,对照组成功率53.57%,两组差异显著(P＜0.05).结论:Vitapex用于活髓保存治疗效果理想.     

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。     

用于活髓保存治疗的生物材料

用于活髓保存治疗的生物材料韩永战综述史俊南审阅第四军医大学口腔医学院（７１００３２）活髓保存治疗是牙髓病治疗方法之一，可保存全部或部分牙髓组织的活力从而避免了牙齿因失髓或死髓可能引起的变色、易折的缺陷。盖髓材料在活髓保存治疗中具有重要作用，是影响治疗...     

牙髓损伤的活髓保存治疗

建立损伤牙髓保髓治疗的专家共识,对提高我国牙髓病治疗水平具有重要的现实指导意义。牙髓疾病是影响人类口腔健康的主要疾病,盖髓术和牙髓切断术是损伤牙髓保髓治疗的主要方法。随着微创牙科理念的发展,如何合理应用各种治疗技术和材料,最大限度地保存健康牙髓组织,延长患牙保存期,实现保髓治疗效果的最大化已成为口腔临床迫切需要解决的问题。笔者现将部分牙体牙髓病治疗学专家的经验与认识共同汇总,以牙髓损伤性质与途径、牙髓损伤程度为基础,以宿主的牙髓防御与自身修复能力为导向,以损伤牙髓现代诊治技术为手段,探讨形成了关于牙髓损伤的活髓保存临床诊治路径的共识,供大家在临床工作中参考和改进。     

活髓保存材料的现状和展望

活髓保存是通过间接盖髓或直接盖髓保存牙髓的活力,刺激剩余牙髓形成牙本质-牙髓复合体的治疗方法.这种治疗方法需要有良好的盖髓材料隔绝感染组织,促进成牙本质细胞分化,形成修复性牙本质.本文对临床使用的活髓保存材料,具有应用前景的材料研究动向进行了综述.     

BMP在活髓保存治疗中的应用研究

ＢＭＰ在活髓保存治疗中的应用研究陆怀秀综述肖明振牛忠英审校在牙髓病治疗中，保存活髓一直被认为是符合生物学观点的方法，但虽经多年研究，临床效果却并不满意，盖髓材料在活髓保存治疗中具有重要作用，是影响治疗成败的一个重要因素。近年来生物材料在口腔医学领域受...     

活髓保存治疗中的微创理念

牙体牙髓病科最常见的疾病是龋病和牙髓根尖周病,其有效治疗手段是及时去除龋坏或感染坏死牙髓组织并进行严密无菌的充填,在阻断病变发展的基础上最大限度地保留健康牙体组织,尽可能提高患牙的远期保存率。随着现代诊疗设备的革新、新材料的应用,牙髓生物学基础和临床研究日益深入,其中牙髓炎症状态的判断、活髓牙的治疗策略、活髓保存治疗的预后分析这三方面更是提出了不同以往的一些新理念。基于此,我们通过此笔谈阐述牙体牙髓病中活髓保存微创治疗理念的重要意义,以进一步指导相关活髓保存技术在临床的应用。     

隐裂牙保存活髓治疗的时机选择

目的：探讨隐裂牙保存活髓治疗的时机。方法：176个隐裂牙分3组,A组：可复性牙髓炎期;B组：不可复性牙髓炎早期;C组：不可复性牙髓炎中晚期。均行保存活髓治疗后观察2周～6个月。结果：A组与B组成功率分别为89．66％和75．81％,且两组间无显著性差异（P〉0．05）;两组成功率均显著高于C组的3．57％．P〈0．05。结论：可复性牙髓炎和不可复性牙髓炎早期是隐裂牙保存活髓治疗的理想时机。     

活髓折裂牙的保存修复方法

牙齿折裂是口腔科常见病之一,治疗方法较多,而针对活髓牙折裂的治疗介绍较少。活髓牙折裂如波及牙髓,患者自觉症状较重,如果治疗方法不当,常导致患牙无法保留。本文介绍6例活髓折裂牙采用保存修复治疗的方法和体会。1方法门）局麻下制取患牙单侧颌印模,备用。保持印模湿润.使用藻酸盐印模材料即可。如条件许可,用硅橡胶印模材料效果更好。（2）拔除松动明显、不直保留的折裂牙片,常规全冠牙体预备。制作临时塑料全冠,将调好的处于拉丝晚期的目凝塑料置于取好备用的印模息牙处,将印模再放回日内原位置上,待自凝塑料发热,即可取出…     

Efficacy of laser Doppler flowmetry in determining pulp vitality of human teeth

Abstract – The aim of this study was to examine if laser Doppler flowmetry (LDF) could aid in distinguishing teeth with necrotic pulps from vital teeth and if so, which configuration of 5 experimental probes would give the best results. Each probe had 3 fibers arranged in a triangle. One fiber carried the laser light to the pulp tissue and 2 fibers carried the back-scattered light to the detector giving the output signal. The distance between the 3 fibers in the triangular arrangement in each probe was 250, 500, 800, 1000, and 1500 jam. A special rubber-base splint was used to hold the probe in place on the buccal surface of the tested teeth. Eleven anterior teeth with clinically diagnosed necrotic pulp were measured with the LDF method and the results compared to contralateral teeth with vital pulp. For the sake of comparison, 10 pairs of anterior teeth with vital pulps in 10 patients were tested as well. The LDF signals were fed into an analog printer and a lap-top computer where all calculations were done. With the LDF method, the output signals from the teeth with necrotic pulps were significantly lower with all 5 probes than the output signals from the contralateral vital teeth. On average, the signal was 42.7% lower from the teeth with necrotic pulps than from the vital teeth. Four of 11 teeth with necrotic pulp gave a positive response to an electrical pulp tester (EPT). The results suggested that the probe with the smallest separation of fibers was the most sensitive in distinguishing necrotic pulps from vital ones.     

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part I: vital pulp therapy

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium‐enriched mixture cement, Endo‐CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick‐Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term ‘bioactive endodontic cements (BECs)’, which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.     

The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review

Background/Aim

Pulp necrosis is a frequent complication following dental trauma. The diagnosis of the state of the dental pulp can be challenging as most commonly used diagnostic tools are subjective and rely on a response from the patient, potentially making their use unreliable, especially in the child population. The aim of the study was to systematically review the evidence on the use of laser Doppler flowmetry in the assessment of the pulp status of permanent teeth compared to other sensibility and/or vitality tests.

Methods

A systematic literature search, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov and www.controlled-trials.com , in addition to citation and manual reference list searches, was conducted up to 15^th January 2018. A risk of bias assessment was performed using the quality assessment for diagnostic accuracy studies tool (QUADAS‐2) with all steps performed independently by two reviewers.

Results

Four studies with a high risk of bias were included in the final analysis. Laser Doppler flowmetry was reported to be more accurate in differentiating between teeth with normal pulps and pulp necrosis with a sensitivity of (81.8%‐100%) and specificity of 100% in comparison to other vitality tests such as pulp oximetry (sensitivity = 81.3%, specificity = 94.9%) and sensibility tests such as electric pulp testing (sensitivity = 63.3%‐91.5%, specificity = 88%‐100%).

Conclusion

Despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut‐off ratios over which a tooth could be diagnosed as having a normal pulp.     

Evaluation of accuracy, reliability, and repeatability of five dental pulp tests

Introduction

The aim of this study was to compare the clinical accuracy, reliability, and repeatability of laser Doppler flowmetry (LDF), an electric pulp test (EPT), and various thermal pulp sensibility tests.

Methods

Pulp tests were done on 121 teeth in 20 subjects by using LDF, EPT, and thermal pulp testing (CO₂, Endo Frost [EF], Ice) during 2 or 3 test sessions with at least 1-week intervals. The order of testing was reversed on the second visit. A laser Doppler flowmeter was used to measure mean pulp blood flow (Flux) calibrated against a brownian motion medium and zeroed against a static reflector. The laser source was 780 nm, with 0.5-mm fiber separation in the probe, 3.1 kHz as the primary bandwidth for filter set to 0.1-second time output constant. Customized polyvinylsiloxane splints were fabricated for each participant, and a minimum of 90-second recording time was used for each tooth. Raw data were analyzed by using repeated measure analysis of variance, pairwise comparisons, and interclass correlations (ICC).

Results

The accuracy of EPT, CO₂, and LDF tests was 97.7%, 97.0%, and 96.3%, respectively, without significant differences (P > .3). Accuracy of EF and Ice was 90.7% and 84.8%, respectively. EPT (P = .015) and CO₂ (P = .022) were significantly more accurate than EF. LDF was more accurate than EF, but this was not statistically significant (P = .063). Ice was significantly less accurate than EPT (P = .004), CO₂ (P = .005), LDF (P = .006), and EF (P = .019). With the exception of Ice (effect of visit: F_2,38 = 5.67, mean squared error = 0.01, P = .007, η²_p = 0.23), all tests were reliable. Ice (ICC = 0.677) and LDF (ICC = 0.654) were the most repeatable of the tests, whereas EPT (ICC = 0.434) and CO₂ (ICC = 0.432) were less repeatable.

Conclusions

CO₂, EPT, and LDF were reliable and the most accurate tests, but CO₂ and EPT were less repeatable yet less time-consuming than LDF. EF was reliable but not as accurate as EPT and CO₂ and less repeatable than Ice and LDF. Ice was the most repeatable but the least accurate and least reliable test.     

Blood flow changes in the dental pulp during limited exercise measured by laser Doppler flowmetry

The effect of limited exercise on pulpal blood flow was assessed by laser Doppler flowmetry (LDF). The primary aim of the investigation was to determine whether clinically significant changes could be induced by mild exercise when LDF was used to monitor pulpal blood flow. Blood flow readings were obtained from the coronal pulps of 17 upper central incisor teeth of 10 human volunteers before, during and after limited exercise. Readings were also obtained from the adjacent attached gingivae. Pulse rate was recorded concurrently. Pulpal blood flow was found to vary during exercise, with a mean percentage change of 38% from the level at rest; the range was from a 100% decrease to a 200% increase. The mean percentage increase in gingival blood flow was 65%, with a range of 6-300%. The main indication that blood flow was being assessed was the pulsatile nature of the output. Results were compared only within individual teeth. The pulse rate increased during exercise (mean percentage increase 54%, range 11-98%). There was no direct relationship between increased pulse rate and pulpal blood flow. It was evident that the mechanisms controlling pulpal and gingival blood flows differed. Laser Doppler flowmetry readings were only reproducible in individual teeth provided that the patient was at rest, and this should be taken into account in clinical or research measurements.     

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。     

Comparison of the reliability of laser Doppler flowmetry,pulse oximetry and electric pulp tester in assessing the pulp vitality of human teeth

Summary This study was designed to evaluate and compare the reliability of laser Doppler flowmetry (LDF), pulse oximetry (PO) and electric pulp tester (EPT) for assessing the pulpal status as a vitality test method by calculating their sensitivity, specificity and predictive values. Data were collected from 59 pairs of maxillary anterior teeth (38 pairs of central, 21 pairs of lateral incisors) in 51 patients (range 12–18 years, mean age 14·6 ± 1·73 years, 28 women, 23 men). The teeth with complete endodontic fillings constituted the study group, and the healthy, contralateral teeth of the same patients were constituted the control group. The calculated sensitivity was 0·915 for the EPT and 0·813 for the PO. And the specificity of EPT was 0·881 and PO was 0·949. The difference between the LDF values obtained from the study, and control group was statistically significant (P = 0·0001). The findings of this study indicated that LDF can reliably discriminate the vitality of the teeth with a sensitivity and specificity of 1·0 for this sample. Laser Doppler flowmetry was found to be a more reliable and effective method than PO and EPT of assessing the pulpal status of human teeth.