成熟恒牙牙髓切断术的疗效及影像学评价

doi:10.19723/j.issn.1671-167X.2024.01.021

摘要/Abstract

摘要：

目的: 观察不同年龄患者牙髓切断术的临床疗效，探讨牙髓钙化发生的情况和特点。方法: 选择2019年10月到2022年8月就诊于北京大学口腔医院综合科龋源性露髓的成年恒前磨牙、恒磨牙行牙髓切断术的患者共77例，使用iRoot BP Plus生物陶瓷类材料作为盖髓剂，一次法完成牙髓切断术。将患者按年龄分为3组，青少年组(11 ~ 20岁)25例，平均年龄(15.88±2.19)岁；中年组(21 ~ 50岁)27例，平均年龄(34.59±8.67)岁；老年组(51 ~ 83岁)25例，平均年龄(63.84±7.40)岁。术后1年复查，评价临床疗效，记录钙化桥形成、钙化桥厚度，以及牙髓钙化指数(pulp calcification index，PCI)。结果: 3组患者在性别、牙列及牙位分布上差异均无统计学意义(P > 0.05)。术后1年随访率为85.71% (66/77)，其中青少年组随访率为88.00% (22/25)，中年组随访率为85.19% (23/27)，老年组随访率为84.00% (21/25)。3组病例1年复查临床成功率分别为95.45% (21/22)、91.30% (21/23)、95.24% (20/21)，差异无统计学意义(P>0.05)。临床成功病例中，钙化桥出现率青少年组12例(57.14%，12/21)，中年组8例(38.10%，8/21)，老年组3例(15.00%, 3/20)，差异有统计学意义(χ²= 7.810, P = 0.020 < 0.05)。3组间钙化桥厚度比较差异有统计学意义(F = 4.434, P = 0.020 < 0.05)。钙化桥厚度与年龄呈负相关(r = -0.516, P < 0.05)。3组间PCI变化(ΔPCI)分别为0.67±0.58、0.43±0.51、0.25±0.52，差异有统计学意义(F = 3.404, P = 0.040 < 0.05)。结论: 老年患者龋源性露髓牙髓切断术同样能够获得较高的成功率；牙髓切断术后钙化桥的发生率以及牙髓钙化的加速程度与年龄相关；青少年组更易形成钙化桥，同时也出现更明显的根管钙化加速现象。

关键词: 牙髓切断术, 年龄, 成熟恒牙, 影像学

Abstract:

Objective: To observe the clinical efficacy of pulpotomy in patients of different ages and to explore the occurrence and characteristics of pulpal calcification. Methods: A total of 77 patients who underwent pulpotomy for mature permanent premolars and molars with caries-derived pulp exposure in the Department of General Dentistry, Peking University School and Hospital of Stomatology from October 2019 to August 2022 were selected. Pulpotomies were performed in a single visit using iRoot BP Plus bioceramic material as pulp capping agent. The patients were divided into three groups according to age: 25 cases in the adolescent group (11-20 years old) with a mean age of (15.88±2.19) years; 27 cases in the middle-aged group (21-50 years old) with a mean age of (34.59±8.67) years; and 25 cases in the elder-aged group (51-83 years old) with a mean age of (63.84±7.40) years. The patients were reviewed 1 year after the operation to evaluate the clinical efficacy and to record the formation of calcified bridge, thickness of calcified bridge, and pulp calcification index (PCI). Results: There was no statistically significant difference between the three groups in terms of gender, dentition, and tooth position (P > 0.05). The 1-year postoperative follow-up rate was 85.71% (66/77), including 88.00% (22/25) in the adolescent group, 85.19% (23/27) in the middle-aged group, and 84.00% (21/25) in the elder-aged group. The 1-year follow-up clinical success rates of the three groups were 95.45% (21/22), 91.30% (21/23), and 95.24% (20/21), respectively, with no statistically significant difference (P>0.05). Among the clinical success cases, calcified bridges appeared in 12 cases (57.14%, 12/21) in the adolescent group, 8 cases (38.10%, 8/21) in the middle-aged group, and 3 cases (15.00%, 3/20) in the elder-aged group, with statistically significant differences (χ²= 7.810, P = 0.020 < 0.05). The difference was statistically significant (F = 4.434, P = 0.020 < 0.05) when comparing the thickness of calcified bridges among the three groups. Calcified bridge thickness was negatively correlated with age (r = -0.516, P < 0.05). The changes in pulpal calcification index ΔPCI were 0.67 ± 0.58, 0.43 ± 0.51, and 0.25 ± 0.52, respectively, with statistically significant differences among the three groups (F = 3.404, P = 0.040 < 0.05). Conclusion: Pulpotomy for caries-derived pulp exposure in elderly patients could also achieve a high success rate. The incidence of calcified bri-dges after pulpotomy and the acceleration of pulpal calcification were age-related. The adolescent group was more likely to form calcified bridges and also showed more pronounced accelerated root canal calcification.

Key words: Pulpotomy, Age, Mature permanent teeth, Radiology

中图分类号:

R781.3

赵晓一,刘畅,钱锟,潘洁. 成熟恒牙牙髓切断术的疗效及影像学评价[J]. 北京大学学报（医学版）, 2024, 56(1): 138-143.

Xiaoyi ZHAO,Chang LIU,Kun QIAN,Jie PAN. Efficacy and radiology evaluation of pulpotomy in mature permanent teeth[J]. Journal of Peking University (Health Sciences), 2024, 56(1): 138-143.

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Items	Adolescent group (n=25)	Middle-aged group (n=27)	Elder-aged group (n=25)	χ²	P
Gender, n				0.092	0.955
Male	10	10	9
Female	15	17	16
Jaw, n				3.121	0.210
Upper	16	15	10
Lower	9	11	15
Tooth position, n				1.217	0.544
Premolar	9	10	6
Molar	16	17	19

Items	PCI		ΔPCI
Items	Preoperative	Postoperative	ΔPCI
Adolescent group (n=21)	1.10±0.30	1.76±0.62	0.67±0.58
Middle-aged group (n=21)	1.67±0.58	2.10±0.70	0.43±0.51
Elder-aged group (n=20)	2.55±0.51	2.80±0.52	0.25±0.44
F	48.217	14.809	3.404
P	＜0.001	＜0.001	0.040

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