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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (1): 88-93. doi: 10.19723/j.issn.1671-167X.2023.01.013

• 论著 • 上一篇    下一篇

成年恒牙牙髓切断后牙髓钙化的X线片评价

雍颹*(),钱锟,朱文昊,赵晓一,刘畅,潘洁   

  1. 北京大学口腔医学院·口腔医院综合科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔生物材料重点实验室，北京 100081
  • 收稿日期:2022-09-19 出版日期:2023-02-18 发布日期:2023-01-31
  • 通讯作者: 雍颹 E-mail:yongwei1004@sina.com
  • 基金资助:
    北京大学口腔医院临床新技术新疗法项目(PKUSSNCT-17A14)

X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy

Wei YONG*(),Kun QIAN,Wen-hao ZHU,Xiao-yi ZHAO,Chang LIU,Jie PAN   

  1. Department of General Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2022-09-19 Online:2023-02-18 Published:2023-01-31
  • Contact: Wei YONG E-mail:yongwei1004@sina.com
  • Supported by:
    the New Clinical Technology Program of Peking University School and Hospital of Stomatology(PKUSSNCT-17A14)

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摘要：

目的: 比较使用两种硅酸钙类材料进行牙髓切断术的临床疗效，评价术后钙化桥形成和髓腔钙化情况。方法: 选择2017年11月至2019年9月在北京大学口腔医院综合科就诊对龋源性露髓的成年恒前磨牙、恒磨牙行牙髓切断术的患者，其纳入病例43例随机分为两组，分别使用生物陶瓷类膏状材料iRoot BP (iRoot组，n=22) 和三氧化矿物凝聚体(mineral trioxide aggregate，MTA) (MTA组，n=21) 作为盖髓剂。术后1年、2年复查，评价临床疗效，记录X线根尖片钙化桥形成指数(dentin bridge index, DBI)和牙髓钙化指数(pulp calcification index, PCI)。对患者、评价者均采用盲法。结果: 两组患者在性别、平均年龄、牙列及牙位分布上差异均无统计学意义(P＞0.05)。术后1年随访时失访7例(iRoot组4例，MTA组3例)，iRoot组有1例在1年复查时出现一过性敏感，两组患者2年随访时的治愈率均为100%。钙化桥形成比例术后1年为38.9%，术后2年为55.6%。根管影像部分甚至是完全消失的比例术前为5.6%，术后1年和2年则分别为38.9%和55.6%，经秩和检验，组间差异均有统计学意义(P < 0.05)。两组的钙化桥形成和牙髓钙化程度差异无统计学意义(P < 0.05)。术后的DBI和PCI评分呈现与术前持平(DBI占比44.4%、PCI占比25%)或逐渐增长(DBI占比55.6%，PCI占比75%)的趋势。经Spearman非参数相关性分析检验，发现年龄与术前牙髓钙化指数(PCI0)正相关(P < 0.05)，但与术后1年和2年的钙化桥指数(DBI1、DBI2)、牙髓钙化指数(PCI1，PCI2)极其变化程度(DBI2 vs. DBI1、PCI1 vs. PCI0、PCI2 vs. PCI0)无相关性(P>0.05)。结论: 用MTA和iRoot进行成年恒牙牙髓切断后，2年内均获得良好的临床疗效，部分病例根管系统有钙化加重的趋势，此趋势的发展程度两组间差异无统计学意义。

关键词: 牙髓切断术, 成年恒牙, 生物陶瓷材料, 钙化桥, 牙髓钙化

Abstract:

Objective: To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth. Methods: Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators. Results: There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05). Conclusion: According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Key words: Pulpotomy, Adult permanent teeth, Bioceramic material, Dentin bridge, Pulp calcification

中图分类号: 

  • R781.05

表1

两组入组病例基本资料"

Items Group iRoot
(n=22)		 Group MTA
(n=21)		 t/χ2 P
Gender, n 0.187 0.665
    Male 6 7
    Female 16 14
Average age/years, M (Min, Max) 30.7 (16, 59) 30.4 (21, 55) 0.093 0.926
Jaw, n 1.149 0.284
    Upper 16 12
    Lower 6 9
Tooth position, n 0.72 0.396
    Premolar 9 6
    Molar 13 15

表2

术前、术后1年、术后2年钙化桥指数(DBI)1~3级的分布"

Level of DBI Before operation (DBI0) 1-year follow-up (DBI1) 2-year follow-up (DBI2)
Cases Percentage Cases Percentage Cases Percentage
1 No dentin bridge 36 100 22 61.1* 16 44.4*
2 Thickness of dentin bridge < 1 mm 0 0 12 33.3* 13 36.1*
3 Thickness of dentinal bridge >1 mm 0 0 2 5.6* 7 19.4*

表3

术前、术后1年、术后2年牙髓钙化指数(PCI)1~4级的分布"

Level of PCI Before operation (PCI0) 1-year follow-up (PCI1) 2-year follow-up (PCI2)
Cases Percentage Cases Percentage Cases Percentage
1 No calcification 12 33.3 0 0% 0 0
2 The root canal images become thinner but all of them exist 22 61.1 22 61.1* 16 44.4*
3 Part of the root canal images disappear 2 5.6 13 36.1* 18 50.0*
4 All of the root canal images disappear 0 0 1 2.8* 2 5.6*

图1

25牙髓切断术后根管钙化表现"

图2

47牙髓切断术后根管钙化表现"

表4

钙化桥指数(DBI0、DBI1、DBI2)变化趋势类型及分布病例数"

Type Before operation
(DBI0)		 1-year follow-up
(DBI1)		 2-year follow-up
(DBI2)		 Cases
(n=36)
1 1 1 1 16
2 1 2 2 8
3 1 1 2 5
4 1 2 3 4
5 1 3 3 2
6 1 1 3 1

表5

牙髓钙化指数(PCI)变化趋势类型及分布病例数"

Type Before operation
(CPI0)		 1-year
(CPI1)		 2-year follow-up
(CPI2)		 Cases
(n=36)
1 1 2 2 10
2 2 3 3 9
3 2 2 3 7
4 2 2 2 4
5 3 3 3 2
6 2 4 4 1
7 2 3 4 1
8 1 2 3 1
9 1 3 3 1
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