国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (6): 686-695.doi: 10.7518/gjkq.2023095

• 综述 • 上一篇    下一篇

再生性牙髓治疗在成人根尖发育不全恒牙应用的研究进展

胡佳(),王秀清,卢国英,黄晓晶()   

  1. 福建医科大学口腔医学院/附属口腔医院牙体牙髓科 福建省口腔疾病研究重点实验室福建省口腔生物材料工程技术研究中心 福建省高校口腔医学重点实验室福建医科大学口腔医学研究院 福州 350002
  • 收稿日期:2023-03-13 修回日期:2023-07-29 出版日期:2023-11-01 发布日期:2023-10-24
  • 通讯作者: 黄晓晶
  • 作者简介:胡佳,主治医师,博士,Email: xiaofeixia_hu@163.com
  • 基金资助:
    福建省中青年教师教育科研基金(JAT200129)

Regenerative endodontic procedures for permanent tooth with immature apices in adult patients

Hu Jia(),Wang Xiuqing,Lu Guoying,Huang Xiaojing.()   

  1. Dept. of Cariology and Endodontics, School and Hospital of Stomatology, Fujian Medical University & Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterials & Stomatological Key Laboratory of Fujian College and University & Stomatology Institute of Fujian Medical University, Fuzhou 350002, China
  • Received:2023-03-13 Revised:2023-07-29 Online:2023-11-01 Published:2023-10-24
  • Contact: Xiaojing. Huang
  • Supported by:
    the Education and Scientific Research Project in Fujian Province(JAT200129)

摘要:

再生性牙髓治疗运用组织工程学原理,旨在实现牙根继续发育和牙髓牙本质复合体的功能性再生,已成为牙髓坏死年轻恒牙的首选治疗方案。成人根尖发育不全的感染恒牙的治疗难点在于形成根尖三维封闭和增强牙根抗折性。随着组织工程和生物材料的发展,再生性牙髓治疗在成人恒牙中的运用值得关注和探索。本文对再生性牙髓治疗应用于成人根尖发育不全恒牙的生物学基础、临床进展、治疗难点与策略进行了梳理、分析和阐述,并对其临床应用前景进行讨论。

关键词: 再生性牙髓治疗, 恒牙, 根尖发育不全, 根尖周病

Abstract:

Regenerative endodontic procedures have been used to treat infected immature permanent teeth in children and adolescents to achieve continued root development and dentin-pulp complex formation. Treating the infected teeth of adult patients with immature apices is challenging. Current treatments form physical barriers by apexification or apical barrier technique. Although teeth can be saved, they are devitalized and become susceptible to reinfections and fractures. With the development of tissue engineering and biomaterials, researchers have tried to save the immature permanent teeth of adults by regeneration. Here, the clinical efficacy of regenerative endodontic procedures is analyzed to explore whether they should be developed for dental pulp and/or dentin regeneration in adults with immature apices.

Key words: regenerative endodontic procedures, permanent teeth, immature apices, periapical periodontitis

中图分类号: 

  • R 781

表 1

成熟恒牙REPs治疗的研究汇总"

作者研究类型(病例数)年龄/岁牙位支架根管预备症状消失根尖暗影牙髓活力随访时间/月
冷测电活力
Machut等[16]病例报告 (2)45、4223PRF+GP机械预备缩小--6
Brizuela等[12]随机对照(18/36)*16~58前牙/前磨牙

BC+

UC-MSCs

机械预备愈合/缩小 (100%)+(56%)+(50%)12
El-Kateb等[21]随机对照(18)*20~34前牙BC#30/#50愈合/缩小 (100%)+(83%)+(77%)12
Arslan等[19]随机对照(26/46)*18~30单根牙BC#45~#80愈合/缩小 (92.3%)NM+(50%)12
Nageh等[23]临床研究 (15)18~4011/21BC+PRF#60~#80愈合+(60%)+(100%)12
Saoud等[24]病例报告 (7)8~21前牙/磨牙BC#25~#40愈合/缩小 (100%)--8~26
Saoud等[18]病例报告 (1)2312BC#35缩小--12
Paryani等[17]病例报告 (2)11、1411/21BC#60愈合NM+(50%)18、22
Shah等[15]临床研究 (18)15~76前牙/磨牙BC#25~#30愈合/缩小 (100%)--6~36

表 2

REPs治疗成人根尖发育不全恒牙的研究汇总"

作者研究类型

病例

年龄/岁牙位再治疗牙根发育*支架机械预备症状消失根尖暗影牙根变化牙髓活力随访时间/月
Nosrat等[25]病例报告118219BC+PRF少量愈合根尖闭合-12
Neelamurthy等[26]临床研究918~35单根牙8~9BC愈合/缩小 (100%)

根尖闭合/牙根

发育(66.7%)

+(1)10
Gavi?o Ordu?a等[27]病例报告321~35前牙是(1)8~9BC+PRP少量愈合根尖闭合(1)/根长少量增加(1)NM50
Zhujiang[28]病例报告120378BC+rh-PDGF-BB少量愈合根尖闭合+15
Nevins等[29]病例报告428~48前牙/前磨牙9BC少量缩小根尖闭合(1)NM12
Saoud等[30]病例报告126219BC#60缩小

根尖闭合,管壁

增厚

-13
Saoud等[18]病例报告123119BC#100缩小

根尖闭合,管壁

增厚

-12
1 林晓明, 苏江凌, 卜翠萍. 显微镜下血运重建术与根尖诱导成形术治疗恒牙牙髓坏死的疗效比较[J]. 上海口腔医学, 2022, 31(3): 318-321.
Lin XM, Su JL, Pu CP. Comparative study on the effect of microscopic revascularization and apexi-fication in the treatment of pulp necrosis of per-manent teeth[J]. Shanghai J Stomatol, 2022, 31(3): 318-321.
2 邹杰林, 毛靖, 石鑫. 牙髓-牙本质复合体再生的影响因素及其生物学策略[J]. 浙江大学学报(医学版), 2022, 51(3): 350-361.
Zou JL, Mao J, Shi X. Influencing factors of pulp-dentin complex regeneration and related biological strategies[J]. J Zhejiang Univ (Med Sci), 2022, 51(3): 350-361.
3 Chrepa V, Henry MA, Daniel BJ, et al. Delivery of apical mesenchymal stem cells into root canals of mature teeth[J]. J Dent Res, 2015, 94(12): 1653-1659.
4 He L, Kim SG, Gong QM, et al. Regenerative en-dodontics for adult patients[J]. J Endod, 2017, 43(9S): S57-S64.
5 Arslan H, Şahin Y, Topçuoğlu HS, et al. Histologic evaluation of regenerated tissues in the pulp spaces of teeth with mature roots at the time of the regenera-tive endodontic procedures[J]. J Endod, 2019, 45(11): 1384-1389.
6 Ivica A, Deari S, Patcas R, et al. Transforming growth factor beta 1 distribution and content in the root dentin of young mature and immature human premolars[J]. J Endod, 2020, 46(5): 641-647.
7 He L, Zhou J, Chen M, et al. Parenchymal and stromal tissue regeneration of tooth organ by pivotal signals reinstated in decellularized matrix[J]. Nat Mater, 2019, 18(6): 627-637.
8 Kim JY, Xin XJ, Moioli EK, et al. Regeneration of dental-pulp-like tissue by chemotaxis-induced cell homing[J]. Tissue Eng Part A, 2010, 16(10): 3023-3031.
9 Meza G, Urrejola D, Saint Jean N, et al. Persona-lized cell therapy for pulpitis using autologous dental pulp stem cells and leukocyte platelet-rich fibrin: a case report[J]. J Endod, 2019, 45(2): 144-149.
10 Zayed M, Iohara K, Watanabe H, et al. Characterization of stable hypoxia-preconditioned dental pulp stem cells compared with mobilized dental pulp stem cells for application for pulp regenerative the-rapy[J]. Stem Cell Res Ther, 2021, 12(1): 302.
11 Chen YW, Yu YC, Chen L, et al. Human umbilical cord mesenchymal stem cells: a new therapeutic option for tooth regeneration[J]. Stem Cells Int, 2015, 2015: 549432.
12 Brizuela C, Meza G, Urrejola D, et al. Cell-based regenerative endodontics for treatment of periapical lesions: a randomized, controlled phase Ⅰ/Ⅱ clinical trial[J]. J Dent Res, 2020, 99(5): 523-529.
13 邹晓英, 岳林. 再生性牙髓治疗的生物学基础及临床探索[J]. 中华口腔医学杂志, 2022, 57(1): 3-9.
Zou XY, Yue L. Biological basis and clinical exploration of regenerative endodontic therapy[J]. Chin J Stomatol, 2022, 57(1): 3-9.
14 Torabinejad M, Nosrat A, Verma P, et al. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis[J]. J Endod, 2017, 43(11): 1806-1820.
15 Shah N, Logani A. SealBio: a novel, non-obturation endodontic treatment based on concept of regeneration[J]. J Conserv Dent, 2012, 15(4): 328-332.
16 Machut K, Żółtowska A. Plasma rich in growth factors in the treatment of endodontic periapical lesions in adult patients: 3-dimensional analysis using cone-beam computed tomography on the outcomes of non-surgical endodontic treatment using A-PRF+ and calcium hydroxide: a retrospective cohort study[J]. J Clin Med, 2022, 11(20): 6092.
17 Paryani K, Kim SG. Regenerative endodontic treatment of permanent teeth after completion of root development: a report of 2 cases[J]. J Endod, 2013, 39(7): 929-934.
18 Saoud TM, Sigurdsson A, Rosenberg PA, et al. Treatment of a large cystlike inflammatory periapical lesion associated with mature necrotic teeth using regenerative endodontic therapy[J]. J Endod, 2014, 40(12): 2081-2086.
19 Arslan H, Ahmed HMA, Şahin Y, et al. Regenerative endodontic procedures in necrotic mature teeth with periapical radiolucencies: a preliminary randomized clinical study[J]. J Endod, 2019, 45(7): 863-872.
20 Li L, Pan YH, Mei LQ, et al. Clinical and radiographic outcomes in immature permanent necrotic evaginated teeth treated with regenerative endodontic procedures[J]. J Endod, 2017, 43(2): 246-251.
21 El-Kateb NM, El-Backly RN, Amin WM, et al. Quantitative assessment of intracanal regenerated tissues after regenerative endodontic procedures in mature teeth using magnetic resonance imaging: a randomized controlled clinical trial[J]. J Endod, 2020, 46(5): 563-574.
22 Glynis A, Foschi F, Kefalou I, et al. Regenerative endodontic procedures for the treatment of necrotic mature teeth with apical periodontitis: a systematic review and meta-analysis of randomized controlled trials[J]. J Endod, 2021, 47(6): 873-882.
23 Nageh M, Ahmed GM, El-Baz AA. Assessment of regaining pulp sensibility in mature necrotic teeth using a modified revascularization technique with platelet-rich fibrin: a clinical study[J]. J Endod, 2018, 44(10): 1526-1533.
24 Saoud TM, Martin G, Chen YH, et al. Treatment of mature permanent teeth with necrotic pulps and apical periodontitis using regenerative endodontic procedures: a case series[J]. J Endod, 2016, 42(1): 57-65.
25 Nosrat A, Bolhari B, Saber Tahan S, et al. Revitali-zing previously treated teeth with open apices: a case report and a literature review[J]. Int Endod J, 2021, 54(10): 1782-1793.
26 Neelamurthy PS, Kumar RA, Balakrishnan V, et al. Revascularization in immature and mature teeth with necrotic pulp: a clinical study[J]. J Contemp Dent Pract, 2018, 19(11): 1393-1399.
27 Gaviño Orduña JF, Caviedes-Bucheli J, Manzanares Céspedes MC, et al. Use of platelet-rich plasma in endodontic procedures in adults: regeneration or repair? A report of 3 cases with 5 years of follow-up[J]. J Endod, 2017, 43(8): 1294-1301.
28 Zhujiang A, Kim SG. Regenerative endodontic treatment of an immature necrotic molar with arrested root development by using recombinant human platelet-derived growth factor: a case report[J]. J Endod, 2016, 42(1): 72-75.
29 Nevins AJ, Cymerman JJ. Revitalization of open apex teeth with apical periodontitis using a collagen-hydroxyapatite scaffold[J]. J Endod, 2015, 41(6): 966-973.
30 Saoud TM, Huang GT, Gibbs JL, et al. Management of teeth with persistent apical periodontitis after root canal treatment using regenerative endodontic the-rapy[J]. J Endod, 2015, 41(10): 1743-1748.
31 Nangia D, Saini A, Sharma S, et al. Treatment outcome of regenerative endodontic procedures in mature permanent teeth compared to nonsurgical en-dodontic treatment: a systematic review and meta-analysis[J]. J Conserv Dent, 2021, 24(6): 530-538.
32 Wu W, Zhou J, Xu CT, et al. Derivation and growth characteristics of dental pulp stem cells from patients of different ages[J]. Mol Med Rep, 2015, 12(4): 5127-5134.
33 Murakami M, Hayashi Y, Iohara K, et al. Trophic effects and regenerative potential of mobilized mesenchymal stem cells from bone marrow and adipose tissue as alternative cell sources for pulp/dentin regeneration[J]. Cell Transplant, 2015, 24(9): 1753-1765.
34 Estefan BS, El Batouty KM, Nagy MM, et al. Influence of age and apical diameter on the success of endodontic regeneration procedures[J]. J Endod, 2016, 42(11): 1620-1625.
35 Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case[J]. J Endod, 2012, 38(10): 1428-1434.
36 Lin LM, Kim SG, Martin G, et al. Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy[J]. Aust Endod J, 2018, 44(3): 292-299.
37 Lin LM, Shimizu E, Gibbs JL, et al. Histologic and histobacteriologic observations of failed revascula-rization/revitalization therapy: a case report[J]. J Endod, 2014, 40(2): 291-295.
38 Abada HM, Hashem AAR, Abu-Seida AM, et al. The effect of changing apical foramen diameter on regenerative potential of mature teeth with necrotic pulp and apical periodontitis[J]. Clin Oral Investig, 2022, 26(2): 1843-1853.
39 Laureys WGM, Cuvelier CA, Dermaut LR, et al. The critical apical diameter to obtain regeneration of the pulp tissue after tooth transplantation, replantation, or regenerative endodontic treatment[J]. J Endod, 2013, 39(6): 759-763.
40 Fang YJ, Wang XH, Zhu JJ, et al. Influence of apical diameter on the outcome of regenerative endo-dontic treatment in teeth with pulp necrosis: a review[J]. J Endod, 2018, 44(3): 414-431.
41 Fouad AF. Contemporary microbial and antimicro-bial considerations in regenerative endodontic therapy[J]. J Endod, 2020, 46(9S): S105-S114.
42 Verma P, Nosrat A, Kim JR, et al. Effect of residual bacteria on the outcome of pulp regeneration in vivo [J]. J Dent Res, 2017, 96(1): 100-106.
43 Borlina SC, de Souza V, Holland R, et al. Influence of apical foramen widening and sealer on the hea-ling of chronic periapical lesions induced in dogs’ teeth[J]. Oral Surg Oral Med Oral Pathol Oral Ra-diol Endod, 2010, 109(6): 932-940.
44 Dissanayaka WL, Zhang CF. The role of vasculature engineering in dental pulp regeneration[J]. J Endod, 2017, 43(9S): S102-S106.
45 Saghiri MA, Asatourian A, Sorenson CM, et al. Role of angiogenesis in endodontics: contributions of stem cells and proangiogenic and antiangiogenic factors to dental pulp regeneration[J]. J Endod, 2015, 41(6): 797-803.
46 陈霞, 汪成林, 叶玲. 再生性牙髓治疗的临床和组织学结果的描述性系统评价[J]. 口腔医学, 2020, 40(9): 807-813.
Chen X, Wang CL, Ye L. Clinical and histological assessment of regenerative endodontic procedures: a discriptive systmatic review[J]. Stomatology, 2020, 40(9): 807-813.
47 Yan HJ, De Deus G, Kristoffersen IM, et al. Rege-nerative endodontics by cell homing: a review of recent clinical trials[J]. J Endod, 2023, 49(1): 4-17.
48 Fouad AF, Diogenes AR, Torabinejad M, et al. Microbiome changes during regenerative endodontic treatment using different methods of disinfection[J]. J Endod, 2022, 48(10): 1273-1284.
49 Ruiz-Linares M, Monroy-Rojas JF, Solana C, et al. Antimicrobial potential of new diclofenac hydrogels for disinfection in regenerative endodontics: an in vitro and ex vivo study[J]. Int Endod J, 2023, 56(1): 103-117.
50 Abdel Hafiz Abdel Rahim AS, Abdelgawad F, Abd Alsamed AM, et al. Case report: single visit photo-activated disinfection in regenerative endodontics[J]. F1000Res, 2019, 8: 1519.
51 Chen ZL, Miao D, Zhang L, et al. Efficacy of concentrated growth factor with low-level laser for the regeneration of interdental papilla defects[J]. Odontology, 2022, 110(4): 795-804.
52 Hong S, Li L, Cai W, et al. The potential application of concentrated growth factor in regenerative endo-dontics[J]. Int Endod J, 2019, 52(5): 646-655.
53 王文茹, 马蓉, 袁国华, 等. 浓缩生长因子介导的年轻恒牙再生性牙髓治疗一例[J]. 中华口腔医学杂志, 2021, 56(9): 896-900.
Wang WR, Ma R, Yuan GH, et al. Regenerative en-dodontic procedures using concentrated growth factor for an immature tooth: a case report[J]. Chin J Stomatol, 2021, 56(9): 896-900.
54 Yu HY, Zhang XY, Song WJ, et al. Effects of 3-dimensional bioprinting alginate/gelatin hydrogel scaffold extract on proliferation and differentiation of human dental pulp stem cells[J]. J Endod, 2019, 45(6): 706-715.
55 曹春玲, 韩冰, 王晓燕. 水凝胶用于牙髓再生的研究进展[J]. 国际口腔医学杂志, 2021, 48(2): 192-197.
Cao CL, Hang B, Wang XY. Research progress on hydrogels for pulp regeneration[J]. Int J Stomatol, 2021, 48(2): 192-197.
56 颜燕宏, 祁胜财, 彭前, 等. 介孔二氧化硅载甲硝唑复合水凝胶体外抗菌性及牙髓细胞黏附研究[J]. 临床口腔医学杂志, 2021, 37(4): 200-204.
Yang YH, Qi SC, Peng Q, et al. Antibacterial and pulp cell adhesion of mesoporous silica-loaded me-tronidazole composite hydrogel in vitro [J]. J Clin Stomatol, 2021, 37(4): 200-204.
57 Huang CC, Narayanan R, Alapati S, et al. Exosomes as biomimetic tools for stem cell differentiation: applications in dental pulp tissue regeneration[J]. Biomaterials, 2016, 111: 103-115.
58 Ivica A, Ghayor C, Zehnder M, et al. Pulp-derived exosomes in a fibrin-based regenerative root filling material[J]. J Clin Med, 2020, 9(2): E491.
59 陈彦, 杨雪婷, 马悦, 等. 基于外泌体的牙髓再生策略[J]. 中华口腔医学杂志, 2021, 56(7): 709-714.
Chen Y, Yang XT, Ma Y, et al. Exosomes-based strategies for dental pulp regeneration[J]. Chin J Stomatol, 2021, 56(7): 709-714.
[1] 李转转,格根塔娜. 牙髓血运重建术和根尖诱导成形术疗效对比的Meta分析[J]. 国际口腔医学杂志, 2023, 50(2): 177-185.
[2] 李转转,格根塔娜. 牙髓血运重建术根管冲洗消毒药物的研究进展[J]. 国际口腔医学杂志, 2022, 49(5): 569-577.
[3] 周易,赵玉鸣. 牙髓再生支架材料的研究进展[J]. 国际口腔医学杂志, 2022, 49(1): 19-26.
[4] 郜慧慧,邓淑丽,何新敏,胡济安. 外伤年轻恒牙的牙髓状态判断及治疗选择[J]. 国际口腔医学杂志, 2021, 48(6): 675-682.
[5] 周懿婕,宋光泰. 年轻恒牙挫入性损伤的处理策略[J]. 国际口腔医学杂志, 2021, 48(2): 135-140.
[6] 李梅,文宁宁,赵媛. 年轻恒牙牙髓坏死后治疗方案的选择[J]. 国际口腔医学杂志, 2020, 47(4): 445-451.
[7] 江义笛,汪成林,叶玲. 再生性牙髓治疗的并发症[J]. 国际口腔医学杂志, 2019, 46(1): 73-77.
[8] 陈之怡, 陈振琦. 唇腭裂患者前牙区恒牙的发育异常[J]. 国际口腔医学杂志, 2017, 44(4): 393-397.
[9] 雷期音, 陈柯. 年轻恒牙牙髓再生的临床应用进展[J]. 国际口腔医学杂志, 2017, 44(3): 267-272.
[10] 鞠迎新,刘鲁川. 铒激光在根尖周病治疗中的应用[J]. 国际口腔医学杂志, 2016, 43(4): 473-476.
[11] 黄晓,汪俊. 前牙冠折断端再接粘接效果的影响因素[J]. 国际口腔医学杂志, 2015, 42(5): 568-571.
[12] 关蕊 侯本祥. 感染根管内微生物检测方法的研究进展[J]. 国际口腔医学杂志, 2013, 40(1): 125-128.
[13] 何怡1 邹静2 杨燃1. 年轻恒牙外伤固定方法的研究进展[J]. 国际口腔医学杂志, 2013, 40(1): 129-131.
[14] 刘佳佳1综述 秦满2审校. 根管内血运重建用于年轻恒牙牙髓坏死的治疗[J]. 国际口腔医学杂志, 2012, 39(3): 349-352.
[15] 马兰综述 宋光泰审校. 继承恒牙胚与乳牙生理性根吸收的关系[J]. 国际口腔医学杂志, 2010, 37(3): 284-284~286.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张京剧. 青年期至中年期颅面复合体变化的头影测量研究[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 刘玲. 镍铬合金中铍对可铸造性和陶瓷金属结合力的影响[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 王昆润. 在种植体上制作固定义齿以后下颌骨密度的动态变化[J]. 国际口腔医学杂志, 1999, 26(06): .
[4] 王昆润. 修补颌骨缺损的新型生物学相容材料[J]. 国际口腔医学杂志, 1999, 26(06): .
[5] 陆加梅. 不可复性关节盘移位患者术前张口度与关节镜术后疗效的相关性[J]. 国际口腔医学杂志, 1999, 26(06): .
[6] 王昆润. 重型颌面部炎症死亡和康复病例的实验室检查指标比较[J]. 国际口腔医学杂志, 1999, 26(06): .
[7] 王昆润. 二甲亚砜和双氯芬酸并用治疗根尖周炎[J]. 国际口腔医学杂志, 1999, 26(06): .
[8] 汤庆奋,王学侠. 17β-雌二醇对人类阴道和口腔颊粘膜的渗透性[J]. 国际口腔医学杂志, 1999, 26(06): .
[9] 王昆润. 咀嚼口香糖对牙周组织微循环的影响[J]. 国际口腔医学杂志, 1999, 26(06): .
[10] 宋红. 青少年牙周炎外周血分叶核粒细胞的趋化功能[J]. 国际口腔医学杂志, 1999, 26(06): .