成熟恒牙因龋露髓行生物陶瓷材料直接盖髓术的临床疗效观察  

Clinical efficacy observation of direct pulp capping using iRoot BP Plus therapy in mature permanent teeth with carious pulp exposure

作　　者：刘思毅[1] 宫玮玉[1] 刘木清[2] 龙赟子 董艳梅[1] Liu Siyi;Gong Weiyu;Liu Muqing;Long Yunzi;Dong Yanmei(Department of Cariology and Endodontology,Peking University School and Hospital of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Laboratory for Digital and Material Technology of Stomatology&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Department of Radiology,Peking University School and Hospital of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Laboratory for Digital and Material Technology of Stomatology&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Department of General Dentistry II Peking University School and Hospital of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Laboratory for Digital and Material Technology of Stomatology&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院牙体牙髓科,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,100081 [2]北京大学口腔医学院·口腔医院医学影像科,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,100081 [3]北京大学口腔医学院·口腔医院综合治疗二科,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,100081

出　　处：《中华口腔医学杂志》2020年第12期945-951,共7页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81870753);北京大学口腔医院临床新技术新疗法项目(PKUSSNCT-19A11)。

摘　　要：目的观察用生物陶瓷盖髓剂对因龋露髓成熟恒牙行直接盖髓术的临床疗效和影响因素,探讨对此类患牙行活髓治疗的可行性及适应证选择。方法选择2016年1月至2017年9月于北京大学口腔医学院·口腔医院牙体牙髓科就诊的57例龋源性露髓患者(57颗患牙),所有病例的术前诊断均为深龋或可复性牙髓炎,且上橡皮障去腐露髓后出血鲜红,经2.5%次氯酸钠棉球轻压3 min内可止血;显微镜下以生物陶瓷盖髓剂(iRoot BP Plus)行直接盖髓术后即刻或2周复诊时行复合树脂粘接修复。术后12~50个月(平均30个月)复查,通过患者症状、临床检查及根尖X线片进行疗效评价。采用Kaplan-Meier生存分析统计治疗成功率,Log-Rank检验分析各种因素对疗效的影响。结果50例患者[年龄(32±13)岁(13~68岁),男性12例,女性38例]接受了1年以上的复查,总体成功率为90%(45/50);Kaplan-Meier生存分析显示术后1、2年及≥3年的成功率分别为98%、89%和81%。分析发现年龄、性别、是否有牙髓刺激症状、牙位和洞形、露髓孔大小以及冠方修复材料等因素对疗效均无显著影响(P>0.05)。结论对诊断为深龋或可复性牙髓炎的露髓成熟恒牙以生物陶瓷作为盖髓剂行直接盖髓术可获得良好疗效,年龄、性别、是否有牙髓刺激症状、患牙牙位与洞形、露髓孔大小等因素不影响疗效。Objective To evaluate the clinical efficacy and influence factors of direct pulp capping using a bioactive ceramic in mature permanent teeth with carious pulp exposure,in order to explore the feasibility and indications of vital pulp therapy for such teeth.Methods From January 2016 to September 2017,57 patients(57 teeth)with carious pulp exposure in mature permanent teeth were selected from the Department of Cariology and Endodontology,Peking University School and Hospital of Stomatology.All the teeth were preoperatively diagnosed as deep caries with normal pulp or reversible pulpitis.After rubber dam isolation,all the carious dentin was removed and the exposed pulp tissue was observed under microscope.Hemostasis should be achieved within 3 min by using 2.5%sodium hypochlorite cotton pellets with a gently press.A resin composite restoration was performed immediately or 2 weeks later after direct pulp capping by using a bioceramic material(iRoot BP Plus).The patients were re-examined 12 to 50 months after operation(average 30 months)and the outcomes were evaluated by symptoms,clinical examination and X-ray.Kaplan-Meier survival analysis was used to calculate the success rate and influence factors were analyzed by Log-Rank test.Results Totally 50 patients[age(32±13)years old(13-68 years old),12 males and 38 females]received the follow-up examination more than one year.The overall success rate was 90%(45/50)and the success rates at 1 year,2 years,3 years and more were 98%,89%and 81%,respectively.Age,gender,symptom,tooth and cavity type,pulpal exposure size and coronal restoration material had no significant correlations with the treatment outcome(P>0.05).Conclusions Direct pulp capping of mature permanent teeth with carious pulp exposure by using iRoot BP Plus might have high success rate.There′s no significant correlations between the major clinical factors and the treatment outcome.

关 键 词：牙髓暴露 成熟恒牙 直接盖髓 生物陶瓷盖髓剂 

分 类 号：R782.22[医药卫生—口腔医学]