国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (6): 821-826.doi: 10.7518/gjkq.2026611

• 牙体牙髓专栏 • 上一篇    

再生性牙髓治疗失败的原因分析及防治策略

田晴(),宋光泰()   

  1. 口颌系统重建与再生全国重点实验室 口腔生物医学教育部重点实验室 口腔医学湖北省重点实验室 武汉大学口腔医(学)院 武汉大学口腔医院儿童口腔科 武汉 430079
  • 收稿日期:2025-06-16 修回日期:2025-08-29 出版日期:2026-11-01 发布日期:2026-10-29
  • 通讯作者: 宋光泰
  • 作者简介:田晴,硕士,Email:970276475@qq.com
  • 基金资助:
    湖北省自然科学基金(2015CF258)

Causes analysis and prevention and treatment strategies of failure in regenerative endodontic treatment

Qing Tian(),Guangtai Song()   

  1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Dept. of Pediatric Dentistry, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2025-06-16 Revised:2025-08-29 Online:2026-11-01 Published:2026-10-29
  • Contact: Guangtai Song
  • Supported by:
    Natural Science Foundation Project of Hubei Province(2015CF258)

摘要:

再生性牙髓治疗是一种以生物学为基础的治疗方法,因其能促进牙根继续发育且成功率较高,越来越多地应用于临床。目前研究主要关注再生性牙髓治疗的成功率及预后因素,而对治疗失败的原因和失败后治疗方案的选择关注较少。本文就再生性牙髓治疗失败的判定标准、失败原因、预防失败的策略及失败后治疗方案的选择进行综述。

关键词: 再生性牙髓治疗, 治疗失败, 防治策略

Abstract:

Regenerative endodontic treatment is a biology-based therapeutic method increasingly applied in clinical practice because it can promote continued root development and has demonstrated high success rates. The majority of current studies primarily focus on the success rates and prognostic factors of regenerative endodontic treatment; relatively less attention is paid to the causes of treatment failure and subsequent management strategies. Therefore, this study aims to review the criteria and causes of failure in regenerative endodontic treatment, the strategies to prevent failure, and the choice of treatment after failure.

Key words: regenerative endodontic treatment, treatment failure, prevention and treatment strategy

中图分类号: 

  • R781.05
[1] American Association of Endodontists. AAE clinical considerations for a regenerative procedure revi-sed 5/18/2021[EB/OL]. (2021-05-18)[2025-04-20]. .
[2] Brignardello-Petersen R. There seems to be a high rate of success in immature teeth that undergo rege-nerative endodontic treatment, regardless of the cau-se of pulp necrosis[J]. J Am Dent Assoc, 2020, 151(11): e114.
[3] Lee C, Song MJ. Failure of regenerative endodontic procedures: case analysis and subsequent treatment options[J]. J Endod, 2022, 48(9): 1137-1145.
[4] Almutairi W, Yassen GH, Aminoshariae A, et al. Regenerative endodontics: a systematic analysis of the failed cases[J]. J Endod, 2019, 45(5): 567-577.
[5] Fouad AF. Contemporary microbial and antimicro-bial considerations in regenerative endodontic therapy[J]. J Endod, 2020, 46(9): S105-S114.
[6] de-Jesus-Soares A, Prado MC, Nardello LCL, et al. Clinical and molecular microbiological evaluation of regenerative endodontic procedures in immature permanent teeth[J]. J Endod, 2020, 46(10): 1448-1454.
[7] Vishwanat L, Duong R, Takimoto K, et al. Effect of bacterial biofilm on the osteogenic differentiation of stem cells of apical papilla[J]. J Endod, 2017, 43(6): 916-922.
[8] Lin LM, Shimizu E, Gibbs JL, et al. Histologic and histobacteriologic observations of failed revasculari-zation/revitalization therapy: a case report[J]. J Endod, 2014, 40(2): 291-295.
[9] Žižka R, Buchta T, Voborná I, et al. Root maturation in teeth treated by unsuccessful revitalization: 2 ca-se reports[J]. J Endod, 2016, 42(5): 724-729.
[10] 杨荣霖, 王华超, 薛明. 根管的机械预备与感染控制[J]. 中国实用口腔科杂志, 2024, 17(5): 513-517.
Yang RL, Wang HC, Xue M. Mechanical preparation and infection control of root canal[J]. Chin J Pract Stomatol, 2024, 17(5): 513-517.
[11] Ahrari F, Akhondian S, Shakiba R, et al. Laser applications in regenerative endodontics: a review[J]. J Lasers Med Sci, 2024, 15: e1.
[12] 戴丽, 宋玉梦, 卫峥, 等. 激光辅助冲洗在年轻恒牙牙髓血运重建中的临床效果分析[J]. 中国生物医学工程学报, 2024, 43(5): 636-640.
Dai L, Song YM, Wei Z, et al. Clinical effect analysis of laser-assisted irrigation in endodontic revascularization of young permanent teeth[J]. Chin J Bio-med Eng, 2024, 43(5): 636-640.
[13] 车舜, 郭威. 半导体激光对根管内粪肠球菌杀菌效果的体外实验研究[J]. 口腔医学, 2025, 45(2): 81-88.
Che S, Guo W. Antibacterial efficacy of diode laser on Enterococcus faecalis in root canal: an in vitro study[J]. Stomatology, 2025, 45(2): 81-88.
[14] Ribeiro L, Fischer BV, Vitali FC, et al. Advances in laser-assisted regenerative endodontic procedures: a scoping review[J]. J Dent, 2025, 158: 105783.
[15] 白玛曲珍, 甄雨琦, 徐智博, 等. 根管冲洗药物及冲洗方法的研究进展[J]. 现代口腔医学杂志, 2024, 38(4): 298-302.
Baima QZ, Zhen YQ, Xu ZB, et al. Research pro-gress on root canal irrigants and irrigation methods[J]. J Modern Stomatol, 2024, 38(4): 298-302.
[16] Ricucci D, Siqueira JF Jr. Endodontology: an integrated biological and clinical view[M]. London: Quintessence Publishing, 2013: 171-172.
[17] 郑佑祥, 范兵. 不同类别暂封材料封闭效果的研究进展[J]. 口腔医学研究, 2006, 22(6): 691-693.
Zheng YX, Fan B. Research progress on the sealing effect of different types of temporary restorative materials[J]. J Oral Sci Res, 2006, 22(6): 691-693.
[18] 梁宇红, 岳林. 根管治疗技术之根管充填和冠方封闭[J]. 中华口腔医学杂志, 2019, 54(12): 859-863.
Liang YH, Yue L. Root canal treatment: obturation of the root canal system[J]. Chin J Stomatol, 2019, 54(12): 859-863.
[19] Webber RT, del Rio CE, Brady JM, et al. Sealing quality of a temporary filling material[J]. Oral Surg Oral Med Oral Pathol, 1978, 46(1): 123-130.
[20] Weston CH, Barfield RD, Ruby JD, et al. Comparison of preparation design and material thickness on microbial leakage through Cavit using a tooth mo-del system[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 105(4): 530-535.
[21] 郭婷婷. 玻璃离子体联合Caviton暂封材料对防止根管消毒中冠方微渗漏作用的实验研究[D]. 乌鲁木齐: 新疆医科大学, 2023.
Guo TT. Experimental study on the effect of glass ionomer combined with Caviton temporary sealing material on crown microleakage during root canal disinfection[D]. Urumqi: Xinjiang Medical University, 2023.
[22] 高燕, 杨金玲, 吕陶红, 等. 暂时封固对根管治疗牙冠方微渗漏影响的体外研究[J]. 中华口腔医学研究杂志(电子版), 2010, 4(3): 268-274.
Gao Y, Yang JL, Lü TH, et al. In vitro study of in-fluence of temporary fillings on coronal microleaka-ge of endodontically treated teeth[J]. Chin J Stomatol Res (Electr Ed), 2010, 4(3): 268-274.
[23] Gunal E, Bezgin T, Ocak M, et al. Effects of various thicknesses and levels of mineral trioxide aggregate coronal plugs on nanoleakage and fracture resistan-ce in revascularization: an in vitro study[J]. Aust Endod J, 2021, 47(3): 608-615.
[24] 郭慧慧, 吴笛, 张正, 等. 牙髓再生治疗中屏障及厚度变化对冠方封闭性能的影响[J]. 医药卫生, 2024(9): 97-104.
Guo HH, Wu D, Zhang Z, et al. Influence of barrier and thickness variation on coronal seal ability in regenerative endodontic treatment[J]. Med Health, 2024(9): 97-104.
[25] Abbott PV. Prevention and management of external inflammatory resorption following trauma to teeth[J]. Aust Dent J, 2016, 61(): 82-94.
[26] Lin S, Moreinos D, Wisblech D, et al. Regenerative endodontic therapy for external inflammatory lateral resorption following traumatic dental injuries: evidence assessment of best practices[J]. Int Endod J, 2022, 55(11): 1165-1176.
[27] Dadpe AM, Shah DY, Natanasabapathy V, et al. Regenerative endodontic procedures in teeth with root resorption: a systematic review[J]. Eur Endod J, 2023, 8(3): 170-186.
[28] Erdogan O, Casey SM, Bahammam A, et al. Radiographic evaluation of regenerative endodontic procedures and apexification treatments with the assessment of external root resorption[J]. J Endod, 2024, 50(10): 1420-1428.e1.
[29] Yoshpe M, Ruparel N, Einy S, et al. Treatment of necrotic anterior and posterior teeth with regenerative endodontic procedures using PRF as a scaffold: a retrospective study[J]. Appl Sci, 2022, 12(13): 6774.
[30] Lu J, Lu YG, Lu ZJ, et al. Clinical and radiographic outcomes of regenerative endodontic procedures for traumatized permanent necrotic teeth with apical pe-riodontitis and external root resorption[J]. Int Endod J, 2023, 56(7): 802-818.
[31] Nageh M, Ibrahim LA, AbuNaeem FM, et al. Ma-nagement of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam compu-ted tomography evaluation[J]. Clin Oral Invest, 2022, 26(2): 1505-1516.
[32] Yoshpe M, Einy S, Ruparel N, et al. Regenerative endodontics: a potential solution for external root resorption (case series)[J]. J Endod, 2020, 46(2): 192-199.
[33] Ashraf A, Pérez Alfayate R. Regenerative endodontic treatment in teeth with internal root resorption: an insight over the available literature[J]. Int J Sci Res Dent Med Sci, 2020, 2(4): 131-134.
[34] Kaufman AY, Kahler B. Arrest and repair of inflammatory root resorption after an endodontic regeneration procedure—a hypothesis and case report[J]. J Endod, 2024, 50(12): 1743-1751.
[35] Lu J, Liu H, Lu ZJ, et al. Regenerative endodontic procedures for traumatized immature permanent tee-th with severe external root resorption and root perforation[J]. J Endod, 2020, 46(11): 1610-1615.
[36] Chen MY, Chen KL, Chen CA, et al. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures[J]. Int Endod J, 2012, 45(3): 294-305.
[37] Chaniotis A. Treatment options for failing regenerative endodontic procedures: report of 3 cases[J]. J Endod, 2017, 43(9): 1472-1478.
[38] Bautista A, Ghilotti J, Sanz JL, et al. Decoronation as a therapeutic alternative for ankylosis in children and adolescents for vertical bone preservation and growth: a systematic review[J]. J Clin Med, 2025, 14(6): 1945.
[39] Jiang X, Liu H. An uncommon type of segmental root development after revitalization[J]. Int Endod J, 2020, 53(12): 1728-1741.
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