国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (1): 102-109.doi: 10.7518/gjkq.2021017

• 综述 • 上一篇    下一篇

乳牙牙髓切断术在乳牙深龋治疗中的应用

赵梦珺1,李杨1,2,吴家媛2,3()   

  1. 1. 遵义医科大学口腔医学院 遵义 563000
    2. 遵义医科大学附属口腔医院 遵义 563000
    3. 贵州省高等学校口腔疾病研究特色重点实验室 遵义 563000
  • 收稿日期:2020-04-18 修回日期:2020-10-12 出版日期:2021-01-01 发布日期:2021-01-20
  • 通讯作者: 吴家媛
  • 作者简介:赵梦珺,住院医师,硕士,Email: 492187954@qq.com
  • 基金资助:
    国家自然科学基金(81460102);贵州省卫生健康委员会科学技术项目(gzwjkj2020-1-163);遵义市优秀青年科技创新人才培养项目(遵优青科号)([2018]8)

Application of pulpotomy in primary teeth with deep caries

Zhao Mengjun1,Li Yang1,2,Wu Jiayuan2,3()   

  1. 1. School of Stomatology, Zunyi Medical University, Zunyi 563000, China
    2. Hospital of Stomatology, Zunyi Medical University, Zunyi 563000, China
    3. Special Key Laboratory of Oral Diseases Research of Universities in Guizhou Province, Zunyi 563000, China
  • Received:2020-04-18 Revised:2020-10-12 Online:2021-01-01 Published:2021-01-20
  • Contact: Jiayuan Wu
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81460102);Science and Technology Project of Guizhou Provincial Health Commission(gzwjkj2020-1-163);Zunyi Outstanding Youth Science and Technology Innovation Talents Training Project No([2018]8)

摘要:

乳牙牙髓切断术是指在乳牙牙髓感染仅局限于冠髓时,将感染的冠髓去除后,用盖髓材料覆盖牙髓断面,保留健康的根部牙髓,进而保存患牙牙髓活力的治疗方式。随着微创治疗理念的普及以及新型生物材料的问世,乳牙牙髓切断术的疗效被重新认识。本文就乳牙牙髓切断术的疗效与应用现状、适应证、牙髓断面的处理方式、影响成功率的因素等方面作一综述。

关键词: 乳牙牙髓切断术, 盖髓材料, 激光

Abstract:

Pulpotomy in primary teeth refers to the treatment involving the removal of infected coronal pulp tissues when infected pulps in the primary teeth are limited, the covering of the surface of a healthy radicular pulpal tissue with a capping agent, and the retention of vital pulp teeth. Owing to the popularity of minimally invasive therapy and the invention of novel bioactive materials, the curative effect of pulpotomy in primary teeth has been reconsidered. This paper reviews latest research on applications, indications, the treatment of the surface of remaining healthy radicular pulpal tissue, factors affecting the success rate of surgery, and the associated factors of pulpotomy in primary teeth.

Key words: pulpotomy in primary teeth, pulp capping agent, laser

中图分类号: 

  • R783
[1] 王兴 . 第四次全国口腔健康流行病学调查报告[M]. 北京: 人民卫生出版社, 2018: 12.
Wang X. The fourth national oral health epidemio-logical survey report[M]. Beijing: People's Medical Publishing House, 2018: 12.
[2] 夏斌, 秦满, 韩烨 , 等. 儿童口腔科门诊治疗需求特征分析及对策[J]. 北京大学学报(医学版), 2013,45(1):92-96.
Xia B, Qin M, Han Y , et al. Children stomatology outpatient treatment requirements analysis and coun-termea-sures[J]. J Peking Univ (Heal Sci), 2013,45(1):92-96.
[3] Dhar V, Marghalani AA, Crystal YO , et al. Use of vital pulp therapies in primary teeth with deep ca-ries lesions[J]. Pediatr Dent, 2017,39(5):146-159.
[4] 张百泽 . 牙髓切断术与牙髓摘除术在深龋露髓乳磨牙临床治疗中的对比研究[D]. 西安: 第四军医大学, 2016.
Zhang BZ . Pulpotomy vs pulpectomy on the treatm-ent of pulp exposure carious primary molars[D]. Xi'an: The Fourth Military Medical University, 2016.
[5] Tang YX, Xu WT . Therapeutic effects of Pulpotomy and Pulpectomy on deciduous molars with deep ca-ries[J]. Pak J Med Sci, 2017,33(6):1468-1472.
doi: 10.12669/pjms.336.13488 pmid: 29492080
[6] 王小竞 . 微创美容技术在儿童口腔治疗中的应用[J]. 华西口腔医学杂志, 2018,36(4):349-354.
Wang XJ . Application of minimally invasive cosme-tic dentistry in the clinics of pediatric dentistry[J]. West China J Stomatol, 2018,36(4):349-354.
[7] 郑佳佳, 张笋, 葛立宏 . 我国乳牙牙髓切断术临床应用现况调查[J]. 现代口腔医学杂志, 2014,28(5):296-299.
Zheng JJ, Zhang S, Ge LH . A survey on the current status of pulpotomy in primary teeth among dentisits in China[J]. J Modern Stomatol, 2014,28(5):296-299.
[8] 郑佳佳, 陈小贤, 张笋 , 等. 中日两国部分口腔医师乳牙活髓保存诊疗操作现况调查[J]. 北京大学学报(医学版), 2015,47(6):1050-1052.
Zheng JJ, Chen XX, Zhang S , et al. Investigation on the diagnosis and treatment of vital pulp pre-servation of primary teeth by some dentists in China and Japan[J]. J Peking Univ (Heal Sci), 2015,47(6):1050-1052.
[9] American Academy of Pediatric Dentistry. Guideline on pulp therapy for primary and immature permanent teeth[J]. Pediatr Dent, 2018,40(6):343-351.
pmid: 32074905
[10] 秦满 . 儿童口腔科临床操作教程: 一步一步教你做临床[M]. 北京: 人民卫生出版社, 2017: 69-70.
Qin M. Pediatric dentistry clinical operation tuto-rial: teach you step by step[M]. Beijing: People,s Medical Publishing House, 2017: 69-70.
[11] Ansari G, Morovati SP, Asgary S . Evaluation of four pulpotomy techniques in primary molars: a randomized controlled trial[J]. Iran Endod J, 2018,13(1):7-12.
pmid: 29692828
[12] Çelik BN, Sarı Ş . Carious exposure versus mechanical exposure for MTA pulpotomy in primary teeth[J]. Biomed Res Int, 2016,2016:2753429.
doi: 10.1155/2016/2753429 pmid: 27995139
[13] Nematollahi H, Sarraf Shirazi A, Mehrabkhani M , et al. Clinical and radiographic outcomes of laser pulpotomy in vital primary teeth: a systematic review and meta-analysis[J]. Eur Arch Paediatr Dent, 2018,19(4):205-220.
[14] Farhad A, Mohammadi Z . Calcium hydroxide: a review[J]. Int Dent J, 2005,55(5):293-301.
pmid: 16245464
[15] Caruso S, Dinoi T, Marzo G , et al. Clinical and radiographic evaluation of biodentine versus calcium hydroxide in primary teeth pulpotomies: a retrospective study[J]. BMC Oral Health, 2018,18(1):54.
[16] 张笋, 秦满, 葛立宏 , 等. 碘仿氢氧化钙复合盖髓剂在乳牙活髓切断术中的应用观察[J]. 现代口腔医学杂志, 2000,14(2):119-120.
Zhang S, Qin M, Ge LH , et al. The application of iodoform calcium hydroxide compound pulp capping agent in pulpotomy of deciduous teeth[J]. J Modern Stomatol, 2000,14(2):119-120.
[17] Farsi DJ, El-Khodary HM, Farsi NM , et al. Sodium hypochlorite versus formocresol and ferric sulfate pulpotomies in primary molars: 18-month follow-up[J]. Pediatr Dent, 2015,37(7):535-540.
pmid: 26883612
[18] Akcay M, Sari S, Duruturk L , et al. Effects of so-dium hypoclorite as disinfectant material previous to pulpotomies in primary teeth[J]. Clin Oral Investig, 2015,19(4):803-811.
doi: 10.1007/s00784-014-1296-0 pmid: 25115995
[19] Hemavathi , Nagarathna J, Srinath SK, et al. Clinical and radiographic evaluation of the efficacy of so-dium hypochlorite as a haemostatic agent compared with physiologic saline on the success of calcium hydroxide pulpotomies in primary molars: an in vivo study[J]. Eur Arch Paediatr Dent, 2018,19(6):423-430.
pmid: 30317420
[20] Kuo HY, Lin JR, Huang WH , et al. Clinical outcomes for primary molars treated by different types of pulpotomy: a retrospective cohort study[J]. J Formos Med Assoc, 2018,117(1):24-33.
doi: 10.1016/j.jfma.2017.02.010 pmid: 28325624
[21] Medina-Fernandez I, Celiz AD . Acellular biomate-rial strategies for endodontic regeneration[J]. Biomater Sci, 2019,7(2):506-519.
[22] 窦桂丽, 吴南, 赵双云 , 等. 乳磨牙牙髓切断术两年疗效观察及其影响因素回顾性分析[J]. 北京大学学报(医学版), 2018,50(1):170-175.
Dou GL, Wu N, Zhao SY , et al. Two-year outcomes of pulpotomy in primary molars using mineral tri-oxide aggregate: a retrospective study[J]. J Peking Univ (Heal Sci), 2018,50(1):170-175.
[23] 黄晶洁, 张荣德, 赵媛 , 等. 无机三氧化复合物在乳磨牙牙髓切断术中应用价值的系统评价[J]. 牙体牙髓牙周病学杂志, 2011,21(7):400-404, 419.
Huang JJ, Zhang RD, Zhao Y , et al. Mineral trioxide aggregate as a pulp capping agent in primary molar pulpotomy: a systematic review[J]. Chin J Conserv Dent, 2011,21(7):400-404, 419.
[24] Biedma Perea M, Solano Mendoza B, Garcia-Godoy F , et al. Clinical and radiographic evaluation of white MTA versus formocresol pulpotomy: a 48-month follow-up study[J]. Am J Dent, 2017,30(3):131-136.
pmid: 29178757
[25] 王子瑞, 陈宇江, 惠泽明 , 等. 新型生物陶瓷材料在儿童牙髓治疗中的临床研究进展[J]. 中华口腔医学研究杂志(电子版), 2019,13(4):247-251.
Wang ZR, Chen YJ, Hui ZM , et al. Clinical research progress of novel bioceramics in pediatric pulp the-rapy[J]. Chin J Stomatol Res (Electron Ed), 2019,13(4):247-251.
[26] Awawdeh L, Al-Qudah A, Hamouri H , et al. Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentine: a prospective randomized clinical trial[J]. J Endod, 2018,44(11):1603-1609.
[27] Stringhini Junior E, Dos Santos MGC, Oliveira LB , et al. MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials[J]. Clin Oral Investig, 2019,23(4):1967-1976.
doi: 10.1007/s00784-018-2616-6 pmid: 30238414
[28] Collado-González M, García-Bernal D, Oñate-Sánc-hez RE, et al. Cytotoxicity and bioactivity of various pulpotomy materials on stem cells from human exfoliated primary teeth[J]. Int Endod J, 2017,50(Suppl 2):e19-e30.
[29] El Meligy OA, Allazzam S, Alamoudi NM . Compari-son between biodentine and formocresol for pulpo-tomy of primary teeth: a randomized clinical trial[J]. Quintessence Int, 2016,47(7):571-580.
doi: 10.3290/j.qi.a36095 pmid: 27175451
[30] Liu SY, Wang SN, Dong YM . Evaluation of a bio-ceramic as a pulp capping agent in vitro and in vivo[J]. J Endod, 2015,41(5):652-657.
doi: 10.1016/j.joen.2014.12.009 pmid: 25637192
[31] 雷玥, 杨颖婷, 战园 . 生物陶瓷材料在乳牙牙髓切断术中的应用[J]. 北京大学学报(医学版), 2019,51(1):70-74.
Lei Y, Yang YT, Zhan Y . Evaluation of bioceramic putty repairment in primary molars pulpotomy[J]. J Peking Univ (Heal Sci), 2019,51(1):70-74.
[32] Shi S, Bao ZF, Liu Y , et al. Comparison of in vivo dental pulp responses to capping with iRoot BP Plus and mineral trioxide aggregate[J]. Int Endod J, 2016,49(2):154-160.
doi: 10.1111/iej.12439 pmid: 25661049
[33] Zhang S, Yang X, Fan M . BioAggregate and iRoot BP Plus optimize the proliferation and mineralization ability of human dental pulp cells[J]. Int Endod J, 2013,46(10):923-929.
[34] Naghavi N, Ghoddusi J, Sadeghnia HR , et al. Genotoxicity and cytotoxicity of mineral trioxide aggregate and calcium enriched mixture cements on L929 mouse fibroblast cells[J]. Dent Mater J, 2014,33(1):64-69.
doi: 10.4012/dmj.2013-123 pmid: 24492114
[35] Ayatollahi F, Hazeri Baqdad Abad M, Razavi SH, et al. Evaluating the accuracy of two microleakage assessment methods for mineral trioxide aggregate and calcium-enriched mixture cement[J]. Iran Endod J, 2017,12(4):497-501.
pmid: 29225648
[36] 王丹, 魏习, 周鹏 , 等. 新型材料CEM的研究现状[J]. 现代口腔医学杂志, 2018,32(1):56-59.
Wang D, Wei X, Zhou P , et al. Research status of new material CEM[J]. J Modern Stomatol, 2018,32(1):56-59.
[37] Madani Z, Alvandifar S, Bizhani A . Evaluation of tooth discoloration after treatment with mineral trio-xide aggregate, calcium-enriched mixture, and Biodentine ® in the presence and absence of blood [J]. Dent Res J (Isfahan), 2019,16(6):377-383.
[38] Chen Y, Chen XL, Zhang YL , et al. Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis[J]. BMC Oral Health, 2019,19(1):227.
doi: 10.1186/s12903-019-0917-z pmid: 31647004
[39] 郭怡丹, 张笋 . Er: YAG激光用于比格犬牙髓切断术[J]. 北京大学学报(医学版), 2016,48(4):714-719.
Guo YD, Zhang S . Preliminary research of Er: YAG laser used for pulpotomy of Beagle dogs[J]. J Peking Univ (Heal Sci), 2016,48(4):714-719.
[40] Ansari G, Safi Aghdam H, Taheri P , et al. Laser pulpotomy‒an effective alternative to conventional techniques‒a systematic review of literature and meta-analysis[J]. Lasers Med Sci, 2018,33(8):1621-1629.
pmid: 30014215
[41] 罗薇, 陈柯 . 激光在乳牙牙髓切断术中的应用进展[J]. 国际口腔医学杂志, 2017,44(6):717-720.
Luo W, Chen K . Research progress on application of laser pulpotomy in primary teeth[J]. Int J Stoma-tol, 2017,44(6):717-720.
[42] Doğanay Yıldız E, Arslan H . Effect of low-level laser therapy on postoperative pain in molars with symptomatic apical periodontitis: a randomized placebo-controlled clinical trial[J]. J Endod, 2018,44(11):1610-1615.
pmid: 30144985
[43] Marques NC, Neto NL, Rodini Cde O , et al. Low-level laser therapy as an alternative for pulpotomy in human primary teeth[J]. Lasers Med Sci, 2015,30(7):1815-1822.
doi: 10.1007/s10103-014-1656-7 pmid: 25240388
[44] Uloopi KS, Vinay C, Ratnaditya A , et al. Clinical evaluation of low level diode laser application for primary teeth pulpotomy[J]. J Clin Diagn Res, 2016, 10(1): ZC67-ZC70.
pmid: 26894180
[45] 黄定明, 傅裕杰, 谭学莲 . 牙髓活力状态的临床判断之惑及解决之道[J]. 牙体牙髓牙周病学杂志, 2017,27(8):431-436, 458.
Huang DM, Fu YJ, Tan XL . Confusion and solution for pulp vitality testing[J]. Chin J Conserv Dent, 2017,27(8):431-436, 458.
[46] 钱悦鸣, 尹悦, 陈晨 , 等. 激光多普勒血流仪在年轻恒牙牙髓活力检测方面的应用研究综述[J]. 世界复合医学, 2016,2(1):77-79.
Qian YM, Yin Y, Chen C , et al. Application of laser Doppler flowmetry in young permanent teeth pulp vitality testing[J]. World J Complex Med, 2016,2(1):77-79.
[47] 马宁虎, 肖刚, 张媛媛 , 等. 激光多普勒血流仪检测年轻上颌切牙牙髓血流的探索[J]. 华西口腔医学杂志, 2017,35(5):494-497.
Ma NH, Xiao G, Zhang YY , et al. Study on using laser doppler flowmetry to determine the pulpal blood flow of immature maxillary incisors[J]. West China J Stomatol, 2017,35(5):494-497.
[48] 葛立宏 . 儿童口腔医学[M]. 4版. 北京: 人民卫生出版社, 2016: 141.
Ge LH. Pediatric dentistry[M]. 4th ed. Beijing: Peo-ple's Medical Publishing House, 2016: 141.
[49] Mente J, Petrovic J, Gehrig H , et al. A prospective clinical pilot study on the level of matrix metalloproteinase-9 in dental pulpal blood as a marker for the state of inflammation in the pulp tissue[J]. J Endod, 2016,42(2):190-197.
doi: 10.1016/j.joen.2015.10.020 pmid: 26725178
[50] Zanini M, Meyer E, Simon S . Pulp inflammation dia-gnosis from clinical to inflammatory mediators: a systematic review[J]. J Endod, 2017,43(7):1033-1051.
pmid: 28527838
[51] Aminabadi NA, Parto M, Emamverdizadeh P , et al. Pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth[J]. Clin Oral Investig, 2017, 21(5): 1831-1841. Erratum in: Clin Oral Investig, 2017,21(5):1843.
doi: 10.1007/s00784-017-2098-y pmid: 28332168
[52] 郑黎薇, 邹静, 夏斌 , 等. 儿童乳磨牙金属预成冠的修复治疗[J]. 国际口腔医学杂志, 2017,44(2):125-129.
Zheng LW, Zou J, Xia B , et al. Restoration of prefor-med metal crown on dental caries of primary molars[J]. Int J Stomatol, 2017,44(2):125-129.
[53] Gadallah L, Hamdy M, El Bardissy A , et al. Pulpo-tomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis[J]. F1000Res, 2018,7:1560.
doi: 10.12688/f1000research.16142.3 pmid: 31249668
[1] 孙旭,邓振南,文才,赵颖. Er: YAG激光照射种植体表面微形貌变化的扫描电子显微镜观察[J]. 国际口腔医学杂志, 2023, 50(6): 669-673.
[2] 杨静,柳登高. 内镜下激光碎石术治疗唾液腺结石病的研究进展[J]. 国际口腔医学杂志, 2023, 50(6): 704-710.
[3] 赵雅丽,王植,高阳,辛鹏飞,张宽收,刘青梅. 磷酸钛氧钾激光在牙齿漂白治疗中的研究进展[J]. 国际口腔医学杂志, 2023, 50(2): 195-202.
[4] 郭子源,常笑,韩开放,张锡忠. 低能量激光促进正畸牙移动有效性研究的系统评价与Meta分析[J]. 国际口腔医学杂志, 2022, 49(2): 163-172.
[5] 章善,沈树平,张舫,杨卫东. Er: YAG激光光子激活光声流技术对根管壁牙本质失水状况及牙根抗压强度的影响[J]. 国际口腔医学杂志, 2022, 49(1): 55-59.
[6] 何蓉,刘学军,周宇琨. 光子引导的光声流效应在根管荡洗中应用的系统评价[J]. 国际口腔医学杂志, 2021, 48(6): 644-655.
[7] 王悦,文冰,邓梦婷,李建平. 低能量激光治疗对种植体周围组织愈合的研究进展[J]. 国际口腔医学杂志, 2021, 48(6): 725-730.
[8] 刘敏,张宽收,刘青梅. 激光蚀刻牙体组织在直接粘接技术中的研究进展[J]. 国际口腔医学杂志, 2021, 48(3): 292-296.
[9] 张敏,万浩元. 种植体周围炎药物治疗与激光治疗的研究进展[J]. 国际口腔医学杂志, 2020, 47(4): 463-470.
[10] 于林彤,宋光泰. 铒激光在儿童口腔医学中的应用[J]. 国际口腔医学杂志, 2020, 47(3): 351-355.
[11] 姜雪,黄淡远,廖文. 磷酸钛氧钾激光应用于口腔疾病治疗的研究进展[J]. 国际口腔医学杂志, 2019, 46(4): 456-462.
[12] 秦娇娇,焦珊,王成坤. Er:YAG和Nd:YAG激光对牙本质与瓷修复体粘接面粘接强度影响的研究进展[J]. 国际口腔医学杂志, 2019, 46(3): 361-366.
[13] 侯晔坡,高杰. Er:YAG激光照射对牙科陶瓷材料粘接影响的研究进展[J]. 国际口腔医学杂志, 2019, 46(1): 68-72.
[14] 罗薇, 陈柯. 激光在乳牙牙髓切断术中的应用进展[J]. 国际口腔医学杂志, 2017, 44(6): 717-720.
[15] 陈静, 黄晓峰. 激光在口腔正畸临床应用中的进展[J]. 国际口腔医学杂志, 2017, 44(6): 712-716.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张新春. 桩冠修复与无髓牙的保护[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 王昆润. 长期单侧鼻呼吸对头颅发育有不利影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[3] 彭国光. 颈淋巴清扫术中颈交感神经干的解剖变异[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 杨凯. 淋巴化疗的药物运载系统及其应用现状[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 康非吾. 种植义齿下部结构生物力学研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 柴枫. 可摘局部义齿用Co-Cr合金的激光焊接[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 孟姝,吴亚菲,杨禾. 伴放线放线杆菌产生的细胞致死膨胀毒素及其与牙周病的关系[J]. 国际口腔医学杂志, 2005, 32(06): 458 -460 .
[8] 费晓露,丁一,徐屹. 牙周可疑致病菌对口腔黏膜上皮的粘附和侵入[J]. 国际口腔医学杂志, 2005, 32(06): 452 -454 .
[9] 赵兴福,黄晓晶. 变形链球菌蛋白组学研究进展[J]. 国际口腔医学杂志, 2008, 35(S1): .
[10] 庞莉苹,姚江武. 抛光和上釉对陶瓷表面粗糙度、挠曲强度及磨损性能的影响[J]. 国际口腔医学杂志, 2008, 35(S1): .