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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 179-184. doi: 10.19723/j.issn.1671-167X.2024.01.028

• 技术方法 • 上一篇    下一篇

生物活性陶瓷iRoot BP Plus®在儿童年轻恒前牙复杂冠折牙髓切断术中的应用

郑佳佳1,杨雪2,温泉1,付元2,邵校2,*(),丁美丽1,*()   

  1. 1. 北京大学口腔医学院·口腔医院门诊部, 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, 北京 100034
    2. 北京大学口腔医学院·口腔医院急诊科, 北京 100081
  • 收稿日期:2023-10-10 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 邵校,丁美丽 E-mail:bluesky408210@163.com;majoriesxx@163.com
  • 基金资助:
    北京大学口腔医院临床新技术新疗法项目(PKUSSNCT-23B09);北京大学口腔医院门诊部新技术新疗法项目(YMZXJ-1605)

Application of bioactive ceramics iRoot BP Plus® in pulpotomy for complicated crown fracture of immature permanent anterior teeth in children

Jiajia ZHENG1,Xue YANG2,Quan WEN1,Yuan FU2,Xiao SHAO2,*(),Meili DING1,*()   

  1. 1. First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100034, China
    2. Department of Oral Emergency, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2023-10-10 Online:2024-02-18 Published:2024-02-06
  • Contact: Xiao SHAO,Meili DING E-mail:bluesky408210@163.com;majoriesxx@163.com
  • Supported by:
    the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-23B09);the Program for New Clinical Techniques and Therapies of First Clinical Division, Peking University School and Hospital of Stomatology(YMZXJ-1605)

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摘要：

目的: 观察生物活性陶瓷材料iRoot BP Plus®(Innovative BioCeramix Inc, Vancouver, BC, Canada)在儿童年轻恒前牙复杂冠折牙髓切断术中的应用，并对其预后进行分析，为该术式的更广泛应用提供临床参考。方法: 收集2017年3月至2022年9月因恒前牙复杂冠折就诊于北京大学口腔医院急诊科，行以生物活性陶瓷iRoot BP Plus®为盖髓剂的牙髓切断术患者。根据患者术前根尖片和初诊病历显示为年轻恒牙者，纳入97颗年轻恒牙进行研究。收集患者初诊及复查时的临床及影像学检查资料，临床检查包括根尖孔形成情况、松动度、牙冠颜色、牙髓活力测试(冷测)、有无脓肿和瘘管，影像学检查包括根周膜连续性、根尖周低密度影像、复诊时盖髓剂下方牙本质桥形成情况、髓腔及根管钙化情况，并对上述结果进行分析。结果: 最终纳入有复诊记录的64例患者共75颗患牙，其中男性37例(57.8%)，女性27例(42.2%)，就诊时平均年龄为9.1岁，平均随访时长19.3个月。采用iRoot BP Plus®盖髓的牙髓切断术后6个月成功率为96.0%，术后1年成功率为94.7%。术后复查2年以上者共23例，累计失败6例。成功率在患牙就诊时距外伤的时间是否超过24 h组中(P=0.61)以及是否松动组中(P=0.28)的差异无统计学意义。结论: 对无移位性损伤的年轻恒牙复杂冠折患牙，采用iRoot BP Plus®盖髓的牙髓切断术1年成功率很高，该术式具备广泛推广价值。

关键词: 牙髓切断术, 复杂冠折, 年轻恒牙, 生物活性陶瓷

Abstract:

Objective: To analyze the clinical and radiographic effectiveness of a calcium silicate-based bioactive ceramic iRoot BP Plus® pulpotomy of immature permanent teeth with complicated crown fracture and to evaluate the factors influencing its long-term success rate. Methods: The digital medical records of patients under 13 years old who had undergone iRoot BP Plus® pulpotomy in the Department of Oral Emergency or the First Clinical Division, Peking University School and Hospital of Stomatology from March 2017 to September 2022 due to complicated crown fracture of anterior teeth, and had taken at least one post-operation apical radiograph were reviewed. The clinical and radiographic information at the initial examination and follow-up period were obtained, including crown color, mobility, percussion, cold test (partial pulpotomy teeth), dental restoration, fistula, swelling or inflammation of the gingival tissue, the formation of apical foramen, pathologic radiolucency and calcification of pulp chamber or root canal obliteration. Data were tested by Fisher exact test and a multiple comparison. Results: In the study, 64 patients including 37 males (57.8%) and 27 females (42.2%) with a mean age of 9.1 years : ere finally enrolled. The total number of permanent teeth that received pulpotomy was 75, and the average follow-up time was 19.3 months. The success rate was 93.1% with the time interval between dental injury and treatment in 24 h, while the success rate dropped to 88.2% with the time intervals beyond 24 h. The time intervals did not significantly affect the pulp survival rate (P=0.61) after pulpotomy (partial or coronal). The success rate 6 months after pulpotomy was 96. 0%, and one-year success rate was 94. 7%. A total of 23 cases were reviewed for more than 2 years after pulpotomy, and 6 cases failed. The mobility had no significant effect on the success rate (P=0.28). Pulp chamber calcification and pulp canal obli-teration were not observed in all the post-operative radiographs. Conclusion: The one year clinical and radiographic success rates obtained in this study indicate that iRoot BP Plus® is an appropriate pulp capping material option for pulpotomy treatment of complicated crown fracture in immature permanent teeth without displacement injuries. This technique has broad promotional value.

Key words: Pulpotomy, Complicated crown fracture, Immature permanent teeth, Bioactive ceramics

中图分类号: 

  • R788.4

表1

患牙牙位分布情况"

Items Position Total
11 21 31
Number 41 33 1 75
Percentage 54.7% 44.0% 1.3% 100.0%

表2

不同随访时间点患牙的检查结果比较"

Post-operative factors T1 (n=42) T2 (n=42) T3 (n=39) T4 (n=33) ≥2 years (n=23)
Clinical and radiographic
    Success 41 42 38 31 22
    Fail 1 0 1 2 1
Mobility
    0 39 42 38 31 22
    1 1 0 0 1 0
    2 1 0 1 1 1
Percussion test
    - or ± 39 40 38 31 22
    + to +++ 2 2 1 2 1
Coronal restoration
    Presence 40 42 39 31 23
    Fall off 1 0 0 2 1

表3

不同随访时间点部分牙髓切断术牙髓活力冷测结果的比较"

Cold test T1(n=6) T2(n=6) T3(n=7) T4(n=4) ≥2 years follow-up
Normal response 6 3 3 4 7
Heightened but not lengthened 0 0 1 0 0
Positive 0 1 0 0
Prolonged reaction 0 2 2 0 0
No response 0 1 0 0 0

表4

6例牙髓切断术失败病例的临床资料"

Case no. Age/years Gender Tooth number Procedure Fail time/months
1 12 Male 11 Complete pulpotomy 26.2
2 10 Female 11 Complete pulpotomy 0.5
3 8 Female 21 Complete pulpotomy 20.2
4 9 Female 11 Partial pulpotomy 10.4
5 9 Female 21 Complete pulpotomy 5.4
6 8 Male 21 Complete pulpotomy 1.4

图1

11、21牙位复杂冠折采用iRoot BP Plus®为盖髓剂行部分牙髓切断术后18个月随访根尖片表现未见异常"

图2

21牙位年轻恒牙复杂冠折采用iRoot BP Plus®为盖髓剂行牙髓切断术后5.4个月出现根尖周炎表现"

表5

不同就诊时间患牙的治疗情况"

Items Duration time Total
≤ 24 h > 24 h
Failure 4 2 6
Success 54 15 69
Total 58 17 75

表6

初诊时不同松动度患牙的治疗情况"

Mobility Success Failure Total
0 58 4 62
Ⅰ 11 1 12
Ⅱ 0 1 1
Total 69 6 75
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