国际口腔医学杂志

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)

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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机械预备是缩小--6
Brizuela等[12]随机对照（18/36）*16~58前牙/前磨牙

BC+

UC-MSCs

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

数

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11821是9BC+PRF少量是愈合根尖闭合-12
Neelamurthy等[26]临床研究918~35单根牙否8~9BC无是愈合/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少量是愈合根尖闭合（1）/根长少量增加（1）NM50
Zhujiang等[28]病例报告12037否8BC+rh-PDGF-BB少量是愈合根尖闭合+15
Nevins等[29]病例报告428~48前牙/前磨牙是9BC少量是缩小根尖闭合（1）NM12
Saoud等[30]病例报告12621是9BC#60是缩小

根尖闭合，管壁

增厚

-13
Saoud等[18]病例报告12311否9BC#100是缩小

根尖闭合，管壁

增厚

-12
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