收稿日期: 2023-10-10
网络出版日期: 2024-02-06
Efficacy and radiology evaluation of pulpotomy in mature permanent teeth
Received date: 2023-10-10
Online published: 2024-02-06
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。
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 . DOI: 10.19723/j.issn.1671-167X.2024.01.021
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
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