国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (6): 827-832.doi: 10.7518/gjkq.2026613

• 牙体牙髓专栏 • 上一篇    

乳牙牙髓状态评估及活髓保存治疗新进展

杨盼盼1(),赵玉鸣2()   

  1. 1.郑州大学附属儿童医院 河南省儿童医院郑州儿童医院口腔科 郑州 450018
    2.北京大学口腔医学院·口腔医院儿童口腔科 北京 100081
  • 收稿日期:2025-05-19 修回日期:2026-02-26 出版日期:2026-11-01 发布日期:2026-10-29
  • 通讯作者: 赵玉鸣
  • 作者简介:杨盼盼，主治医师，硕士，Email：yangpanpan1987@126.com
  • 基金资助:
    国家临床重点专科建设项目(PKUSSNKP-202112)

Advanced research on pulp status assessment and vital pulp therapies for primary teeth

Panpan Yang1(),Yuming Zhao2()   

  1. 1.Dept. of Stomatology, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou 450018, China
    2.Dept. of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing 100081, China
  • Received:2025-05-19 Revised:2026-02-26 Online:2026-11-01 Published:2026-10-29
  • Contact: Yuming Zhao
  • Supported by:
    National Clinical Key Discipline Construction Project(PKUSSNKP-202112)

RichHTML

20

PDF (PC)

86

摘要：

目前，乳牙深龋及牙髓炎的治疗理念更倾向于微创，在不影响疗效的前提下，尽量保存活髓。乳牙活髓保存治疗的术式包括间接牙髓治疗、直接盖髓术、部分牙髓切断术、冠髓切断术。准确判断牙髓状态对活髓保存治疗的成功至关重要。由于儿童的理解和合作问题，以及乳牙的牙髓生理学特殊性，牙髓状态判断是一项具有挑战性的任务。临床医生必须基于病史、临床及影像学检查、牙髓测试等进行综合判断。牙科显微镜的临床应用和人工智能技术的发展，使得乳牙牙髓状态的评估取得令人鼓舞的成果。本文就深龋乳牙的牙髓状态评估及活髓保存治疗新进展进行综述。

关键词: 乳牙, 深龋, 牙髓炎, 牙髓状态, 活髓保存治疗

Abstract:

Currently, the treatment philosophy for deep caries and pulpitis in primary teeth favors minimally invasive approaches, prioritizing the preservation of critical pulp tissue as possible without compromising therapeutic outcomes. Current vital pulp therapy procedures include indirect pulp therapy, direct pulp capping, partial pulpotomy, and full pulpo-tomy. Accurate assessment of pulp status is essential for the success of vital pulp therapy. However, assessing pulp status in primary teeth often poses significant challenges. This is due to children's limited comprehension and cooperation, coupled with the unique physiological characteristics of primary tooth pulp. Clinicians must rely on a solid foundation of empirical knowledge gained from medical history, clinical examination, and radiographic findings and incorporate pulp tes-ting results whenever feasible to formulate a comprehensive assessment. Moreover, the clinical application of dental ope-rating microscopes and advancements in artificial intelligence technology are yielding promising results in improving pulp status assessment for primary teeth. This article reviews the latest advancements in pulp status assessment and vital pulp therapy for primary teeth with deep caries.

Key words: primary teeth, deep caries, pulpitis, pulp status, vital pulp therapy

中图分类号: 

  • R781.1
[1] Coll JA, Dhar V, Chen CY, et al. Primary tooth vital pulp treatment interventions: systematic review and Meta-analyses[J]. Pediatr Dent, 2023, 45(6): 474-546.
[2] Igna A, Mircioagă D, Boariu M, et al. A diagnostic insight of dental pulp testing methods in pediatric dentistry[J]. Medicina (Kaunas), 2022, 58(5): 665.
[3] Adam M. ‘Cold is gold’? The diagnostic accuracy of sensibility and vitality testing techniques[J]. Evid Based Dent, 2022, 23(4): 137.
[4] Versloot J, Veerkamp JS, Hoogstraten J. Dental Discomfort Questionnaire: assessment of dental discomfort and/or pain in very young children[J]. Community Dent Oral Epidemiol, 2006, 34(1): 47-52.
[5] Dhillon IK, Hong CH, Hu S, et al. Accuracy of the American Association of Endodontists diagnostic criteria for assessing pulp health in primary teeth[J]. Clin Oral Invest, 2023, 27(10): 6043-6053.
[6] Aillón IEV, Tello G, Corrêa-Faria P, et al. Dental pain in preschool children using the Brazilian Dental Discomfort Questionnaire and its association wi-th dental caries and socioeconomic factors[J]. Pe-diatr Dent, 2020, 42(1): 22-27.
[7] Chen E, Abbott PV. Dental pulp testing: a review[J]. Int J Dent, 2009, 2009: 365785.
[8] Day PF, Flores MT, O’Connell AC, et al. Internatio-nal Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition[J]. Dent Traumatol, 2020, 36(4): 343-359.
[9] 中华口腔医学会儿童口腔医学专业委员会. 乳牙牙髓病诊疗指南[J]. 中华口腔医学杂志, 2021, 56(9): 840-848.
Society of Pediatric Dentistry, Chinese Stomatological Association. Clinical guidelines for pulp therapies of primary teeth[J]. Chin J Stomatol, 2021, 56(9): 840-848.
[10] Boutsiouki C, Frankenberger R, Krämer N. Relative effectiveness of direct and indirect pulp capping in the primary dentition[J]. Eur Arch Paediatr Dent, 2018, 19(5): 297-309.
[11] AAE position statement on vital pulp therapy[J]. J Endod, 2021, 47(9): 1340-1344.
[12] Ricucci D, Loghin S, Siqueira JF Jr. Correlation between clinical and histologic pulp diagnoses[J]. J Endod, 2014, 40(12): 1932-1939.
[13] Nagarathna C, Shakuntala BS, Jaiganesh I. Efficiency and reliability of thermal and electrical tests to evaluate pulp status in primary teeth with assessment of anxiety levels in children[J]. J Clin Pediatr Dent, 2015, 39(5): 447-451.
[14] Hori A, Poureslami HR, Parirokh M, et al. The ability of pulp sensibility tests to evaluate the pulp status in primary teeth[J]. Int J Paediatr Dent, 2011, 21(6): 441-445.
[15] Bulut M, Ulusoy AT. The variability of electric pulp response thresholds in primary molars: a clinical study[J]. Eur Arch Paediatr Dent, 2021, 22(4): 693-697.
[16] Alghaithy RA, Qualtrough AJ. Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review[J]. Int Endod J, 2017, 50(2): 135-142.
[17] Karayilmaz H, Kirzioğlu Z. Comparison of the re-liability of Laser Doppler flowmetry, pulse oximetry and electric pulp tester in assessing the pulp vitality of human teeth[J]. J Oral Rehabil, 2011, 38(5): 340-347.
[18] Khademi M, Shekaari MA, Parizi MT, et al. Comparison of nerve fibers in the deciduous first and second molar teeth: an in vitro study[J]. Eur Arch Paediatr Dent, 2021, 22(1): 43-48.
[19] Bargrizan M, Ashari MA, Ahmadi M, et al. The use of pulse oximetry in evaluation of pulp vitality in immature permanent teeth[J]. Dent Traumatol, 2016, 32(1): 43-47.
[20] Sharma DS, Mishra S, Banda NR, et al. In vivo eva-luation of customized pulse oximeter and sensitivity pulp tests for assessment of pulp vitality[J]. J Clin Pediatr Dent, 2019, 43(1): 11-15.
[21] Kaur H, Yeluri R, Garg N, et al. Evaluation of oxygen saturation levels using a custom-modified finger pulse oximeter for assessment of pulp vitality in various clinical situations in pediatric dental practi-ce: an in vivo study[J]. Int J Clin Pediatr Dent, 2024, 17(S1): S30-S36.
[22] Igna A, Rusu D, Ogodescu E, et al. Age-related va-riation of pulpal oxygen saturation in healthy primary and permanent teeth in children: a clinical study[J]. J Clin Med, 2022, 12(1): 170.
[23] Kanumuru KR, Solomon N, Ramkumar H, et al. Assessment of pulpal oxygen saturation in caries-free and carious maxillary primary central incisors using a customized dental pulse oximeter[J]. Int J Clin Pediatr Dent, 2023, 16(4): 560-564.
[24] Saikiran KV, Gurunathan D, Elicherla SR, et al. Pulp oxygen saturation measurement as a diagnostic tool for assessing pulp status in primary teeth[J]. J Indian Soc Pedod Prev Dent, 2022, 40(4): 349-355.
[25] Kahler B, Taha NA, Lu J, et al. Vital pulp therapy for permanent teeth with diagnosis of irreversible pulpitis: biological basis and outcome[J]. Aust Dent J, 2023, 68(): S110-S122.
[26] Aaminabadi NA, Parto M, Emamverdizadeh P, et al. Pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth[J]. Clin Oral Invest, 2017, 21(5): 1831-1841.
[27] Mutluay M, Arıkan V, Sarı S, et al. Does achievement of hemostasis after pulp exposure provide an accurate assessment of pulp inflammation[J]. Pe-diatr Dent, 2018, 40(1): 37-42.
[28] Canoğlu E, Güngör HC, Uysal S. Direct pulp capping of primary molars with calcium hydroxide or MTA following hemorrhage control with different medicaments: randomized clinical trial[J]. Pediatr Dent, 2022, 44(3): 167-173.
[29] Zheng LW, Wang HL, Mei L, et al. Artificial intelligence in digital cariology: a new tool for the diagnosis of deep caries and pulpitis using convolutional neural networks[J]. Ann Transl Med, 2021, 9(9): 763.
[30] Ma T, Zhu JX, Wang DD, et al. Deep learning-based detection of irreversible pulpitis in primary molars[J]. Int J Paediatr Dent, 2025, 35(1): 57-67.
[31] Sahin N, Saygili S, Akcay M. Clinical, radiogra-phic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial[J]. Clin Oral Investig, 2021, 25(6): 3945-3955.
[32] ElSebaai A, Wahba AH, Grawish ME, et al. Ca-lcium hydroxide paste, mineral trioxide aggregate, and formocresol as direct pulp capping agents in primary molars: a randomized controlled clinical trial[J]. Pediatr Dent, 2022, 44(6): 411-417.
[33] Tungjitphianpong P, Trairatvorakul C, Thunyakitpi-sal P, et al. Partial pulpotomy success in primary molars followed up for 24 months: a randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan[J]. Int J Paediatr Dent, 2024, 34(5): 630-638.
[34] Nematollahi H, Noorollahian H, Bagherian A, et al. Mineral trioxide aggregate partial pulpotomy versus formocresol pulpotomy: a randomized, split-mouth, controlled clinical trial with 24 months follow-up[J]. Pediatr Dent, 2018, 40(3): 184-189.
[35] Zhao YM, Tao YY, Wang Y, et al. Comparison of iRoot BP Plus and mineral trioxide aggregate for pulpotomy in primary molars under general anesthesia: a 3-year retrospective study[J]. PeerJ, 2024, 12: e18453.
[36] Coll JA, Dhar V, Chen CY, et al. Use of vital pulp therapies in primary teeth 2024[J]. Pediatr Dent, 2024, 46(1): 13-26.
[37] Dimitraki D, Papageorgiou SN, Kotsanos N. Direct pulp capping versus pulpotomy with MTA for ca-rious primary molars: a randomised clinical trial[J]. Eur Arch Paediatr Dent, 2019, 20(5): 431-440.
[38] Wassel M, Hamdy D, Elghazawy R. Evaluation of four vital pulp therapies for primary molars using a dual-cured tricalcium silicate (TheraCal PT): one-year results of a non-randomized clinical trial[J]. J Clin Pediatr Dent, 2023, 47(2): 10-22.
[39] Rodd HD, Boissonade FM. Vascular status in human primary and permanent teeth in health and di-sease[J]. Eur J Oral Sci, 2005, 113(2): 128-134.
[40] Rodd HD, Boissonade FM. Immunocytochemical investigation of immune cells within human primary and permanent tooth pulp[J]. Int J Paediatr Dent, 2006, 16(1): 2-9.
[41] Hu XY, Liang ZJ, Wang Q, et al. A retrospective study of iRoot BP Plus pulpotomy compared with Vitapex pulpectomy for irreversible pulpitis of primary molars with the presence of coronal pulp tissue[J]. Int J Paediatr Dent, 2023, 33(2): 216-226.
[42] Lin GSS, Chin YJ, Choong RS, et al. Treatment outcomes of pulpotomy in primary teeth with irrever-sible pulpitis: a systematic review and Meta-analysis[J]. Children, 2024, 11(5): 574.
[1] 班红艳,连小丽,代晓华,邹慧儒. 3~6岁儿童乳牙龋病严重程度影响因素分析[J]. 国际口腔医学杂志, 2026, 53(5): 703-710.
[2] 周灿,曾倩,韦曦. 浓缩生长因子在活髓保存治疗中的应用前景[J]. 国际口腔医学杂志, 2022, 49(6): 684-689.
[3] 陈荟宇,白明茹,叶玲. 信号素3A与口腔常见病关系的研究进展[J]. 国际口腔医学杂志, 2022, 49(5): 593-599.
[4] 李佩,林凌,赵玮. 乳牙牙髓干细胞在口腔组织再生修复中的研究进展[J]. 国际口腔医学杂志, 2022, 49(4): 483-488.
[5] 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.
[6] 赵梦珺,李杨,吴家媛. 乳牙牙髓切断术在乳牙深龋治疗中的应用[J]. 国际口腔医学杂志, 2021, 48(1): 102-109.
[7] 杨鑫, 李思洁, 赵玮. Wnt信号通路在调控牙髓干细胞多向分化及炎症损伤修复中的作用[J]. 国际口腔医学杂志, 2018, 45(3): 286-290.
[8] 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.
[9] 郑黎薇, 邹静, 夏斌, 刘英群, 黄洋, 赵今. 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.
[10] 黄桂月,刘波,陈梅红,许艳华. 昆明市乳牙列错畸形发病率的调查研究[J]. 国际口腔医学杂志, 2017, 44(2): 141-143.
[11] 李小兵，郭维华，黄诗言，徐舒豪，饶南荃，张扬根. 低位乳磨牙伴下颌第一前磨牙水平阻生1例[J]. 国际口腔医学杂志, 2016, 43(4): 377-379.
[12] 张玲,蒋薇,李灏来. 运用音乐疗法对深龋患者治疗时进行疼痛干预的护理研究[J]. 国际口腔医学杂志, 2016, 43(2): 137-139.
[13] 谷楠 孙鑫 刘富萍 张宇娜 张雪 李海鹰. 脱落乳牙牙髓干细胞的生物学特性[J]. 国际口腔医学杂志, 2015, 42(6): 715-719.
[14] 朱玉婷 刘江峰 李晓星 杨会肖 黄江勇 于淼 陈秉勋 李艳利. 脂多糖上调人牙髓细胞B细胞淋巴瘤-2蛋白及其相关X蛋白的表达[J]. 国际口腔医学杂志, 2015, 42(4): 391-394.
[15] 姚森1 冯红杰2. 改良牙合垫式活动矫治器矫治33例儿童乳牙反牙合的疗效观察[J]. 国际口腔医学杂志, 2013, 40(5): 586-587.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 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): .
[2] 轩东英. 不同赋形剂对氢氧化钙抗菌效果的影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[3] 房兵. 唇腭裂新生儿前颌骨矫正方法及对上颌骨生长发育的影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 康健,华成舸. 术前诱导化疗在头颈部肿瘤预后评价中的意义[J]. 国际口腔医学杂志, 2008, 35(S1): .
[5] 唐翀,宣鸣. 软骨组织工程支架材料的研究进展[J]. 国际口腔医学杂志, 2008, 35(S1): .
[6] 孙兰英1 王其宝1 包崇云2 葛文章1 杜毅1. 碱性磷酸酶mRNA 在体内组织工程骨中的表达[J]. 国际口腔医学杂志, 2011, 38(4): 388 -391 .
[7] 杨凯. 烧伤瘢痕肉瘤[J]. 国际口腔医学杂志, 2000, 27(03): .
[8] 陈意 陶人川 林雪芳 刘贞敏 雍翔智 李润英. 人中性粒细胞防御素1~3的日节律性分泌[J]. 国际口腔医学杂志, 2013, 40(4): 429 -431 .
[9] 孙营营综述 林崇韬审校. 低碱性磷酸酯酶症及其在口腔中的表现[J]. 国际口腔医学杂志, 2011, 38(5): 581 -583 .
[10] 吴幸晨综述 束陈斌审校. 窝沟封闭术在儿童口腔临床中的应用和防龋效能[J]. 国际口腔医学杂志, 2013, 40(4): 467 -470 .