年轻恒牙牙髓再生治疗术后36个月的临床疗效评估

doi:10.19723/j.issn.1671-167X.2023.04.026

摘要/Abstract

摘要：

目的: 评价牙髓再生治疗术后36个月以上的临床疗效, 并分析患牙术后牙根继续发育的影响因素, 为长期预后的判断提供依据。方法: 回顾2013年1月至2017年6月在北京大学口腔医院儿童口腔科接受牙髓再生治疗术, 并复查36个月以上的年轻恒牙, 收集治疗前后的临床记录和影像学资料, 评价治疗结果, 总结不同的牙根发育形态。测量并比较治疗前后患牙牙根长度、根管壁厚度和根尖孔直径的变化, 对可能的影响因素进行分析。结果: 共纳入84颗患牙, 最长随访时间81个月, 平均(44.7±19.3)个月。其中68颗(81.0%)患牙临床症状消失, 根尖病变愈合; 55颗(80.9%)患牙的牙根继续发育; 40颗患牙在观察期内根尖孔闭合, 根尖孔闭合率为58.8%;24颗患牙牙根长度、根管壁厚度同时增长且根尖孔闭合, 形态接近生理状态。病因为畸形中央尖折断的患牙的牙根发育率92.5%, 病因为外伤的患牙的牙根发育率为58.3%, 差异有统计学意义(P < 0.05)。术中引血高度不同(根管口/根中部/根尖)的患牙牙根发育率不同(92.9%/81.0%/63.2%), 差异有统计学意义(P < 0.05)。结论: 牙髓再生治疗术后36个月大部分患牙的牙根继续发育, 但是最终牙根形态不同, 部分患牙形态可与正常发育状态相似; 病因和术中引血高度均与牙根能否继续发育显著相关。

关键词: 再生牙髓病学, 牙根, 牙钙化, 年轻恒牙

Abstract:

Objective: To evaluate the clinical outcomes of immature teeth treated with regenerative endodontic procedures with an over-36-month review, to identify potential contributing factors of root deve-lopment, and to provide new reference for long-time prognosis of regenerative endodontic procedures. Methods: We recruited teeth that had undergone regenerative endodontic procedures at the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from January 2013 to June 2017 and had a follow-up period of more than 36 months.Clinical and radiographic records were collected.We evaluated the treatment outcomes and summarized different patterns of root development.Changes in root length, root canal wall thickness were compared between preoperative and recall radiographs.A statistical analysis was performed using software SPSS 22.0 to identify potential contributing factors of root development. Results: In this study, 84 teeth were recruited and the mean follow-up period was (44.7±19.3) months.The longest follow-up period was 81 months.Sixty-eight teeth (81.0%) were clinical success with bony healing, and 55 teeth (80.9%) gained the continued root development.Forty teeth completed root development with apical closure.The rate of the apical closure reached 58.8%.Twenty-four teeth gained normal root morphology with the increasing of root length and canal wall thickness and apical closure.The rate of continued root development was 92.5% in teeth with broken central cusp and 58.3% in teeth with trauma, which was statistically significant (P < 0.05).There was a statistically significant difference (P < 0.05) between the root development rates of teeth with different induced bleeding heights (orifice/middle/tip of the root)(92.9%/81.0%/63.2%). Conclusion: Most of the teeth treated with regenerative endodontic procedures achieved continued root development with an over 36-month follow-up.However, the patterns of root development were different.The morphology of some teeth were close to the physiological state.Etiology and the height of induced bleeding are two factors significantly associated with the rate of the continued development root.

Key words: Regenerative endodontics, Tooth root, Tooth calcification, Immature teeth

中图分类号:

R788.2

代云飞,刘鹤,彭楚芳,姜玺军. 年轻恒牙牙髓再生治疗术后36个月的临床疗效评估[J]. 北京大学学报（医学版）, 2023, 55(4): 729-735.

Yun-fei DAI,He LIU,Chu-fang PENG,Xi-jun JIANG. Retrospective evaluation of treatment outcomes in immature teeth treated with regenerative endodontic procedures with an over-36-month review[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 729-735.

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参考文献 18

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Variables	Data
Age/years, $\bar x \pm s$	10.25±2.13
Gender, n(%)
Male	54 (64.3)
Female	30 (35.7)
Tooth type, n(%)
Anterior	37 (44.0)
Premolar	47 (55.9)
Etiology, n(%)
Broken central cusp	45 (53.6)
Trauma	35 (41.7)
Caries	4 (4.8)
Diagnosis, n(%)
Pulp necrosis	5 (6.0)
Acute apical abscess	15 (17.9)
Asymptomatic apical periodontitis	5 (6.0)
Chronic apical abscess	31 (36.9)
Symptomatic apical periodontitis	28 (33.3)
Follow-up period/months, $\bar x \pm s$	44.7±19.3

Variables	Data
Age/years, $\bar x \pm s$	9.69±2.41
Gender, n(%)
Male	10 (62.5)
Female	6 (37.5)
Tooth type, n(%)
Anterior	11 (68.8)
Premolar	5 (31.2)
Etiology, n(%)
Broken central cusp	5 (68.8)
Trauma	11 (31.2)
Diagnosis, n(%)
Acute apical abscess	1 (6.3)
Asymptomatic apical periodontitis	1 (6.3)
Chronic apical abscess	8 (50.0)
Symptomatic apical periodontitis	6 (37.5)

Dimensions of different morphology root	Types of root morphology				P
Dimensions of different morphology root	Ⅰ (n=24)	Ⅱ (n=16)	Ⅲ (n=11)	Ⅳ (n=13)	P
Increase of root length/%	32.51	5.35	16.78	5.94	＜0.01
Increase of root canal wall thickness/%	53.53	39.16	43.19	12.29	＜0.01

Variables	Failed group (n=13)	Success group (n=55)	P
Age/years, $\bar x \pm s$	9.69±2.56	10.56±1.90	0.170
Etiology, n			0.003
Broken central cusp	3	37
Trauma	10	14
Develop stage, $\bar x \pm s$	8.00±0.41	7.91±0.62	0.523
Induced bleeding, n			0.014
Orifice of the root	2	26
Middle of the root	4	17
Tip of the root	7	12
Canal sealing material, n			0.322
Bioceramic materials	11	51
Glass ionomer cement	2	4
Period of canal sealing/d, $\bar x \pm s$	42.00±30.37	36.83±23.26	0.501