再生性牙髓治疗在成熟恒牙中应用的临床研究进展

doi:10.7518/gjkq.2025037

摘要/Abstract

摘要：

目前对于成熟恒牙的牙髓根尖周病的治疗方法是以根管治疗术为主。根管治疗术技术敏感性高，要求患者有很好的依从性，且术后存在一定的牙体结构破坏、根折、再感染等风险。对于再生性牙髓治疗技术用于成熟恒牙牙髓根尖周病治疗的研究发现，该技术有望改善患牙临床症状、恢复牙体感觉反应、防御功能，使患牙在生理状态下得以长久保存。本文对近年来再生性牙髓治疗技术在成熟恒牙中临床应用研究进展进行综述。

关键词: 成熟恒牙, 再生性牙髓治疗, 根管治疗术, 自体移植

Abstract:

The prevailing approach for treating endodontic periapical diseases in mature permanent teeth is based on root canal therapy. This method is technically demanding and requires optimal patient compliance because it carries an inherent risk of postoperative structural damage, root fracture, and reinfection. A review of the literature on regenerative endodontic procedures for treating periapical diseases in mature permanent teeth indicates that the approach is expected to alleviate clinical symptoms, restore sensory responses, and the defensive functions of a tooth while allowing for the pre-servation of the tooth for an extended period in a physiological state. This article presents a review of the clinical applications of regenerative endodontic procedures for mature permanent teeth in recent years.

Key words: mature permanent teeth, regenerative endodontic procedures, root canal therapy, autotransplantation

中图分类号:

R781.05

蒋丽,何飞. 再生性牙髓治疗在成熟恒牙中应用的临床研究进展[J]. 国际口腔医学杂志, 2025, 52(4): 449-455.

Li Jiang,Fei He. Advances in research on the clinical application of regenerative endodontic procedures for mature permanent teeth[J]. Int J Stomatol, 2025, 52(4): 449-455.

图/表 1

表 1

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文献	年龄/岁	牙位	诊断	移植方法	随访时间	牙髓活力	影像学、组织学结果	成功率/%
[26]	12~14	33牙4例、43牙1例	异位埋伏牙	根尖切除后自体牙移植	26~80个月	阳性	X线片：5例移植4例愈合良好，1例移植后发生颈部外吸收	80
[30]	28	45牙	牙体缺失	48自体牙移植	18个月	阳性	CBCT：牙颈外部吸收；组织学：有纤维血管结缔组织，无成牙本质、成牙骨质样细胞	0
[35]	18~40	15、25、35牙	根尖周炎	自体牙髓移植（来自自体拔除阻生牙）	12个月	阳性	CBCT：根尖周病变完全消退，射线可透性几乎完全减弱；超声多普勒监测到接受自体牙髓移植牙根尖周血运重建	100
[36]	26	17牙	根尖周炎	自体上颌第三磨牙DPSC移植	48周	阳性	CBCT：根尖部有明显的矿化影像；MRI：再生牙髓高信号强度与正常牙髓相当	100
	29	16牙	牙髓炎				CBCT：腭部根管根尖1/3处牙本质壁沿着形成矿化组织
[37]	50	44牙	牙髓炎	自体DPSC+富白细胞-血小板纤维蛋白移植	3年	阳性	CBCT：根尖周骨结构完整，在牙根中1/3形成牙本质桥，根尖1/3出现根管钙化；激光多普勒示：对照牙35、44牙的平均灌注单位均较低，表明牙齿存在血液灌注	100
[38]	16~58	成熟切牙尖牙或下颌前磨牙18例	牙髓坏死或根尖周炎	同种异体人脐带间充质干细胞	12个月	阳性	CBCT：根尖骨病变相等，其中一些根尖病变缩小，或其中一个增加不超过0.1 mm	100
[39]	55	11牙	根尖周炎	同种异体间充质细胞移植	14个月	阳性	X线或CBCT示根尖周骨密度增加，根尖周病变完全愈合	100

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