选择性与完全去龋技术治疗恒牙深龋近髓的临床疗效比较  

A clinical comparison of selective and complete caries removal techniques in the management of deep carious lesions proximal to the pulp in permanent teeth

作　　者：李午丽[1] 赵春晖[1] 孙成 郑桂婷[1] 孟丹婕 李颂[1] Li Wuli;Zhao Chunhui;Sun Cheng;Zheng Guiting;Meng Danjie;Li Song(Department of Endodontics,College&Hospital of Stomatology,Anhui Medical University,Key Lab.of Oral Diseases Research of Anhui Province,Hefei 230032,China;Department of General Dentistry,Hefei Stomatological Hospital,Hefei 230001,China)

机构地区：[1]安徽医科大学口腔医学院,安徽医科大学附属口腔医院牙体牙髓科,安徽省口腔疾病研究重点实验室,合肥230032 [2]合肥市口腔医院综合科,合肥230001

出　　处：《中华口腔医学研究杂志（电子版）》2024年第4期243-249,共7页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：安徽省卫生健康科研项目(AHWJ2023A20112);安徽医科大学口腔医学院学科建设项目(2022xkfyts05)。

摘　　要：目的比较选择性与完全去龋技术治疗恒牙深龋近髓的临床疗效。方法选取2021年10月至2023年10月于安徽医科大学附属口腔医院牙体牙髓科就诊的恒牙深龋患者52例(患牙52颗),采用随机数字表法将患者分为观察组(选择性去龋组)和对照组(完全去龋组)各26例(患牙26颗),分别在口腔手术显微镜下以对应方法去龋。根据去龋完成后是否露髓,采用iRoot BP Plus直接盖髓或TheraCal LC间接盖髓,流体树脂封闭牙本质层,3M复合树脂分层充填窝洞。采用卡方检验比较两组术中露髓率;采用独立样本t检验比较两组术后1周的疼痛程度;采用Fisher精确检验比较两组术后随访6个月的并发症;采用符合方案分析和意向治疗分析比较两组术后6个月的成功率。结果选择性去龋组的术中露髓率(0%)明显低于完全去龋组(30.77%),差异有统计学意义(P=0.004);选择性去龋组术后24 h的疼痛视觉模拟评分(VAS)值为(2.9±0.7)分,明显低于完全去龋组(3.3±0.6)分,差异有统计学意义(t=2.120,P=0.039);选择性去龋组的术后并发症(2例牙髓炎)与完全去龋组(1例根尖炎和2例牙髓炎)相比较,差异无统计学意义(P=0.369);符合方案分析结果显示,选择性去龋组术后半年的成功率(91.30%)和完全去龋组的成功率(87.50%)均较高,差异无统计学意义(RR失访不计入=0.696,95%CI失访不计入:0.128~3.790,P失访不计入=0.675)。意向治疗分析结果显示,选择性去龋组术后半年的成功率分别为80.77%和92.31%,完全去龋组的成功率分别为80.77%和88.46%,差异均无统计学意义(RR失访全部失败=1.000,95%CI失访全部失败:0.328~3.047,P失访全部失败=1.000;RR失访全部成功=0.667,95%CI失访全部成功:0.121~3.666,P失访全部成功=0.641)。结论与传统完全去腐技术相比较,选择性去龋技术牙髓暴露风险低、微创、术后并发症少、成功率高,建议在恒牙深龋近髓患者中推广应用。Objective This study aimed to assess the clinical efficacy of selective caries removal and complete caries removal for the management of deep carious lesions proximal to the pulp in permanent teeth.Methods Fifty⁃two patients presenting with deep caries in permanent teeth(affecting a total of 52 teeth)were recruited from the Department of Endodontics at the Affiliated Stomatological Hospital of Anhui Medical University between October 2021 and October 2023.A random number table method was utilised to divide each of the 26 cases(26 affected teeth)into an observation group(selective caries removal group)and a control group(complete caries removal group).Dental surgical microscopy was employed for precise tooth removal in both groups.Depending on pulp exposure following caries removal,either iRoot BP Plus or TheraCal LC was utilized for direct or indirect pulp capping.Flow resin was applied for dentin layer sealing,followed by cavity filling with 3M composite resin.A Chi⁃squared test was employed to ascertain whether there was a significant difference in the rate of intraoperative pulp exposure of the affected teeth between the two groups.An independent samples t⁃test was used to compare the pain levels of the patients in the two groups at one week postoperatively.A comparison of the postoperative complications of the patients in the two groups at the 6⁃month postoperative follow⁃up was conducted using Fisher′s exact test.Per⁃protocol and intention⁃to⁃treat analysis were conducted to evaluate the success rate of the affected teeth in both groups at the 6⁃month postoperative interval.Results The intraoperative pulp exposure rate in the selective caries removal group(0%)was significantly lower than that in the complete caries removal group(30.77%),and the difference was statistically significant(P=0.004).The visual analogue score(VAS)of pain in the selective caries removal group at 24 hours postoperatively was(2.9±0.7),which was significantly lower than that in the complete caries removal group(3.3

关 键 词：牙列 恒 龋齿 牙髓覆盖术 去龋技术 

分 类 号：R788.1[医药卫生—口腔医学]