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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 341 -347. doi: 10.3877/cma.j.issn.1674-1366.2021.06.003

临床研究

三种方法治疗年轻恒牙根尖周病的效果分析
王涛1, 朱顶贵1, 郭世梁1, 张心宇1, 邢向辉1,†()   
  1. 1. 南京大学医学院附属口腔医院（南京市口腔医院）儿童口腔科　210008
  • 收稿日期:2021-09-07 出版日期:2021-12-01
  • 通信作者: 邢向辉

Assessment on the effect of three methods in the treatment of immature permanent teeth with apical periodontitis

Tao Wang1, Dinggui Zhu1, Shiliang Guo1, Xinyu Zhang1, Xianghui Xing1,†()   

  1. 1. Department of Pediatric Dentistry, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
  • Received:2021-09-07 Published:2021-12-01
  • Corresponding author: Xianghui Xing
  • Supported by:
    High-level Talents Selection and Training Project of Six Talent Peaks in Jiangsu Province(2019-WSW-128); Clinical Research Center for Oral Diseases Project of Nanjing(2019060009)
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引用本文：

王涛, 朱顶贵, 郭世梁, 张心宇, 邢向辉. 三种方法治疗年轻恒牙根尖周病的效果分析[J]. 中华口腔医学研究杂志(电子版), 2021, 15(06): 341-347.

Tao Wang, Dinggui Zhu, Shiliang Guo, Xinyu Zhang, Xianghui Xing. Assessment on the effect of three methods in the treatment of immature permanent teeth with apical periodontitis[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(06): 341-347.

目的

对比根尖诱导成形术、根尖屏障术及牙髓血运重建术3种治疗方法对年轻恒牙根尖周病的治疗效果。

方法

选取2019年4月至2020年8月就诊于南京市口腔医院儿童口腔科，因畸形中央尖导致的前磨牙根尖周炎病例共45例，临床表现为患牙有叩痛、松动、肿胀等，影像学检查（X线片）表现为根尖周暗影、根尖孔未闭合、牙根过短等。按随机数字表法平均分为牙髓血运重建组、根尖诱导成形术组和根尖屏障术组，每组15例分别进行治疗。治疗完成后每3~6个月复查1次，随访1~2年（至少1年）。采用SPSS 26.0统计学软件进行统计分析，3组患者临床疗效比较采用χ2检验，牙根长度及根尖孔宽度的比较采用t检验。

结果

根尖诱导成形术、根尖屏障术及牙髓血运重建术术后即刻的临床症状都消失。术后1年复查，牙髓血运重建组（80%）与根尖诱导成形术组（53.33%）治愈率均高于根尖屏障术组（0%），差异均具有统计学意义（P<0.001）；牙髓血运重建组治愈率高于根尖诱导成形术组，但差异不具统计学意义（P = 0.146）。根尖发育方面，术后牙髓血运重建组牙根长度为（10.80 ± 1.01）mm，根尖诱导成形术组牙根长度为（10.31 ± 1.08）mm，牙髓血运重建组牙根增长情况优于根尖诱导成形术组，差异有统计学意义（t = 2.402，P<0.05）；术后牙髓血运重建组根尖孔宽度为（0.21 ± 0.09）mm，根尖诱导成形术组根尖孔宽度为（0.45 ± 0.08）mm，牙髓血运重建组术根尖闭合情况也明显优于根尖诱导成形术组，差异有统计学意义（t = 11.201，P<0.001）。

结论

根尖诱导成形术、根尖屏障术与牙髓血运重建术均为治疗年轻恒牙根尖周炎的有效方法，但牙髓血运重建术在根尖孔闭合及牙根增长方面效果更加显著。

关键词: 根尖周炎, 根尖诱导成形术, 牙髓血运重建术, 根尖屏障术, 年轻恒牙
Objective

To compare the effect of apexification, apical barrier technique and pulp revascularization on the treatment of immature permanent teeth with periapical periodontitis.

Methods

Immature permanent teeth with periapical periodontitis in 45 patients (caused by abnormal central cusp) at Nanjing Stomatological Hospital from April 2019 to August 2020 were collected. Clinical symptoms include percussive pain, odontoseisis, swelling, etc. X-ray showed periapical shadow, root tip which is not closed as well as not enough root length, etc. All of the 45 patients were divided into 3 groups (n = 15 each) according to the method of random number table, apexification group, apical barrier technique group, and pulp revascularization group. Reviewed every 3-6 mouths after treatment, and followed up for 1-2 years (at lease 1 year) . The data were analyzed with SPSS 26.0, the clinical efficacy of patients in 3 groups was compared by χ2 test, and the comparison of root length and root tip width was applied by t test.

Results

Clinical symptoms of three groups disappeared immediately after surgery. The cure rate of the apexification group (53.33%) and pulp revascularization group (80%) were higher than the apical barrier technique group (0%) one year after surgery, and the difference was statistically significant (P<0.001) . The cure rate of the pulp revascularization group was higher than the apexification group, but the difference was not statistically significant (P = 0.146) . In terms of root tip development, the root length of pulp revascularization group was (10.80 ± 1.01) mm, which in apexification group was (10.31 ± 1.08) mm. The root development of pulp revascularization group was more noteworthy than apexification group (t = 2.402, P<0.05) . The root tip width was (0.21 ± 0.09) mm in pulp revascularization group and (0.45 ± 0.08) mm in apexification group, and the root tip closure in pulp revascularization group was highly effective against apexification group (t = 11.201, P<0.001) .

Conclusions

Apexification, apical barrier technique, and pulp revascularization are all effective methods in the treatment of immature permanent teeth with periapical periodontitis, but the pulp revascularization is more effective in the closure of root tip and root development.

Key words: Periapical periodontitis, Apexification, Pulp revascularization, Apical barrier technique, Immature permanent teeth
图1 牙根长度和根尖孔宽度测量示意图　A：牙根长度测量示意图，j为近远中釉牙骨质界j1、j2中点，a为根尖顶点，j与a点之间的垂直距离即为牙根长度；B：根尖孔宽度测量示意图，近远中根尖孔点a1、a2之间的距离为根尖孔宽度。
表1 年轻恒牙根尖周炎患儿不同治疗方法的临床疗效情况[例（%）]
组别 患者数 治愈 未治愈
根尖屏障术组 15 0（0） 15（100）
根尖诱导成形术组 15 8（53.33） 7（46.67）
牙髓血运重建术组 15 12（80） 3（20）
表2 根尖诱导成形术组与牙髓血运重建术组年轻恒牙根尖周炎患儿治疗前后牙根长度、根尖孔宽度比较（mm，±s）
组别 患者数 牙根长度 根尖孔宽度
术前 术后 术前 术后
根尖诱导成形术组 15 10.15 ± 1.03 10.31 ± 1.08 1.15 ± 0.07 0.45 ± 0.08
牙髓血运重建术组 15 10.17 ± 1.05 10.80 ± 1.01 1.16 ± 0.04 0.21 ± 0.09
t值   0.105 2.402 0.813 11.201
P值   0.917 0.023 0.423 0.000
图2 年轻恒牙根尖周炎患儿根尖屏障术治疗前后X线片情况　A：术前（外院治疗史）；B：术中（测量长度）；C：术中（放置根尖屏障）；D：术后即刻；E：术后半年，牙根无明显继续发育；F：术后1年，牙根无明显继续发育；G：术后2年，牙根无明显继续发育；箭头所示为患牙根尖情况。
图3 年轻恒牙根尖周炎患儿根尖诱导成形术治疗前后X线片情况　A：术前（外院治疗史）：B：术中；C：术后即刻；D：术后6个月，根尖封闭形成，牙根略有增长，根尖孔宽度略有缩小；E：术后1年，较术后6个月无明显变化；F：永久重填；箭头所示为患牙根尖情况。
图4 年轻恒牙根尖周炎患儿牙髓血运重建术治疗前后X线片情况　A：术前；B：术后即刻；C：术后1个月，见根尖阴影缩小；D：术后6个月，管腔逐渐狭窄，根尖略有闭合，牙根长度略有伸长；E：术后1年，根尖孔闭合，牙根长度增长明显；箭头所示为患牙根尖情况。
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