自凝羟基磷灰石/去甲万古霉素盖髓剂的应用特点

背景：羟基磷灰石具有良好的生物相容性，可保护牙髓组织，促进骨样牙本质的形成和牙髓组织的愈合，但无抗感染能力。越来越多的学者认为活髓保存治疗时应配伍其他抗菌药物来提高疗效。目的：实验拟观察自凝羟基磷灰石，去甲万古霉素复合物作为盖髓材料的疗效，并与临床应用最广泛的盖髓剂氢氧化钙相比较。设计、时间及地点：随机对照观察实验，于2004—01／2005～06在上海交通大学医学院附属第九人民医院口腔综合科完成。对象及材料：选择能按时复诊且签署知情同意书的深龋或牙髓穿髓患者60例（60颗牙），男28例，女32例，年龄9～40岁。诊断标准：患牙有食物嵌塞痛或冷热刺激痛，去除刺激后疼痛缓解，无自发痛，放射痛及夜间痛。材料：自凝羟基磷灰石／25％去甲万古霉素复合物（上海二医口腔材料研究室制）；可硬化氢氧化钙（Dycal，美国登士柏公司）。方法：将60例患者随机分为实验组和对照组，每组30例（30颗牙）。实验组用自凝羟基磷灰石／2．5％去甲万古霉索复合物作为盖髓剂，对照组用可硬化氢氧化钙作为盖髓剂。复查后如无任何不适，则行永久性充填。若盖髓后，患者出现任何不适症状，立刻复诊，改做根管治疗。主要观察指标：观整患者牙髓反应情况。结果：实验组1例患者在盖髓1周后出现隐痛，改做根管治疗，成功率为97％。对照组2例分别存盖髓3d和1周后出现隐痛，改做根管治疗，成功率为93％。结论：自凝羟基磷灰石复合物盖髓成功率高，效果与氢氧化钙相似，是一种良好的活髓保存盖髓剂。

Self-solidifying hydroxyapatite/norvancomycin composite for pulp capping

BACKGROUND: Hydroxyapatite has favorable biocompatibility, can protect pulp tissue and promote the formation of osteoid dentin and the concrescence of pulp tissue. However, hydroxyapatite has no capability of anti-infection. Increasing scholars deem that antibacterials should be added with the hydroxyapatite during the treatment of vital pulp conservation to elevate curative effects.OBJECTIVE: To observe the curative effects of self-solidifying hydroxyapatite/norvancomycin composite as pulp capping material and to make a comparison with calcium hydroxide.DESIGN, TIME AND SETTING: The present randomized controlled observation experiment was performed at the General Dental Clinic, the Ninth People's Hospital, Shanghai Jiao Tong University Medical College between January 2004 and June 2005.PARTICIPANTS AND MATERIALS: A total of 60 patients (60 teeth) that suffered from deep caries or pulp exposure, could return visit on time, and agreed to sign informed consents were selected for this study. These patients comprised of 28 males and 32 females, aged 9-40 years. Diagnosis criteria: Teeth with food impaction pain and/or caloric stimulation pain which can relieve after stimulation removal; in addition, with no spontaneous pain, radiating pain, and hypnalgia. Self-solidifying hydroxyapatite/2.5% norvancomycin composite were prepared in the Department of Dental Material, Shanghai Second Hospital. Self-hardening calcium hydroxide was provided by Dentsply Company, USA.METHODS: All 60 patients were randomly divided into an experimental group and a control group, with 30 patients (30 teeth) per group. Self-solidifying hydroxyapatite/2.5% norvancomycin composite and self-hardening calcium hydroxide were applied as pulp capping agents in the experimental and control groups, respectively. Pulpal tissue reactions were assessed after 8 weeks. Teeth with normal response were restored permanently, and the others were given root canal treatment.MAIN OUTCOME MEASURES: Pulpal tissue reaction of patients.RESULTS: In the experimental group, one case showed vague pain after 1-week pulp capping and received root canal therapy, with success rate of 97%. In the control group, two cases presented with vague pain after 3-day and 1-week pulp capping, respectively, and also received root canal therapy, with success rate of 93%.CONCLUSION: Self-solidifying hydroxyapatite/norvancomycin composite acquires a high success rate of pulp capping, with curative effects similar to calcium hydroxide, it is a good pulp capping agent for vital pulp preservation.