国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (4): 445-451.doi: 10.7518/gjkq.2020078

• 综述 • 上一篇    下一篇

年轻恒牙牙髓坏死后治疗方案的选择

李梅,文宁宁,赵媛()   

  1. 兰州大学口腔医院牙体牙髓科 兰州 730000
  • 收稿日期:2019-11-30 修回日期:2020-03-21 出版日期:2020-07-01 发布日期:2020-07-10
  • 通讯作者: 赵媛 E-mail:zhaoy@lzu.edu.cn
  • 作者简介:李梅,主治医师,硕士,Email:15229523086@163.com
  • 基金资助:
    中华口腔医学会口腔健康促进与口腔医学发展西部临床科研基金(CSA-W2015-09);甘肃省陇原创新人才项目. 纵20180033

Treatment options for young permanent teeth with pulp necrosis

Mei Li,Ningning Wen,Yuan Zhao()   

  1. Dept. of Cariology and Endodontics, Hospital of Stomatology, Lanzhou University, Lanzhou 730000, China
  • Received:2019-11-30 Revised:2020-03-21 Online:2020-07-01 Published:2020-07-10
  • Contact: Yuan Zhao E-mail:zhaoy@lzu.edu.cn
  • Supported by:
    This study was supported by Western China Clinical Research Foundation for Oral Health Promotion and Development of Chinese Stomatological Association(CSA-W2015-09);Gansu Province Longyuan Innovative Talents Project. 20180033

摘要:

年轻恒牙牙髓坏死后,由于牙根未发育完全,严重影响该牙的存留状况。目前,年轻恒牙牙髓坏死的诊疗方式主要有根尖诱导成形术、根尖屏障术及牙髓血运重建术,每种治疗方法均有各自的优缺点。本文针对年轻恒牙牙髓坏死后常用治疗方法的原理、优缺点及选择要素进行综述,以期为口腔临床医生提供选择治疗方法的依据。

关键词: 年轻恒牙, 牙髓坏死, 根尖诱导成形术, 根尖屏障术, 牙髓血运重建术

Abstract:

The retention of young permanent teeth with pulp necrosis is seriously affected because the root is not fully developed. At present, three main treatments used for young permanent teeth with pulp necrosis are apexification, apical barrier techniques, and revascularization. This article reviews the principles, advantages, disadvantages, and selection factors of each treatment to help dentists in choosing possible treatment options.

Key words: young permanent teeth, pulp necrosis, apexification, apical barrier techniques, revascularization

中图分类号: 

  • R781.05

表 1

年轻恒牙牙髓坏死后常用治疗方法及其优缺点"

评价项目 根尖诱导成形术 根尖屏障术 牙髓血运重建术
根尖周病变愈合率/%[4,25-26,42-43] 77~100 68~94 76~100
牙根进一步发育[43] 长度增加比/% 0.4 6.1 14.9
宽度增加比/% 1.5 0 28.2
牙髓组织再生[41] 部分组织再生
并发症概率/% [33] 14 0 42
就诊次数/次[7,23] 3~8 2~3 2~3
随访时间[3] 每3个月1次,直至钙化屏障形成 术后0~2年,每6个月1次;术后2~4年,每年1次 术后0~2年,每6个月1次;术后2~7年,每年1次
技术敏感性[44] 较高
失败后可选择的治疗方式[28,29] 二次根尖诱导成形术或根尖屏障术 根尖手术 二次血运重建术或根尖诱导成形术或根尖屏障术

表 2

年轻恒牙牙髓坏死后选择治疗方案时的考量要素"

评价项目 根尖诱导成形术 根尖屏障术 牙髓血运重建术
牙根发育情况[47,49] 牙根长度 >根长2/3 >根长2/3 <根长2/3
根尖孔直径/mm <1 <1 >1
病变范围[52,53] 无影响 伴有根尖周病变则成功率降低 尚不明确
病变时间[51,56] 无影响 无影响 超过6个月成功率降低
牙髓坏死的病因[26] 无影响 无影响 龋病、发育畸形患牙较外伤患牙效果更佳
患者年龄[9,49] 6~18岁 6~18岁 7~18岁均可,13岁以下效果更佳
患者全身情况[64,65] 良好 良好 良好且无影响组织愈合的系统性疾病
患者依从性[64,65]
距患牙永久修复的时间[64,65] 较长 较长
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