中华口腔医学研究杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 312 -318. doi: 10.3877/cma.j.issn.1674-1366.2024.05.005 × 扫一扫
论著
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Xiaoxu Huang1, Lixia Huang1, Chen Xu1, Lisha Di1,†()
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黄晓旭, 黄丽霞, 徐晨, 狄丽莎. 牙髓切断术治疗年轻恒前牙复杂冠折的临床疗效分析[J]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 312-318.
Xiaoxu Huang, Lixia Huang, Chen Xu, Lisha Di. Clinical efficacy analysis of pulpotomy for immature permanent anterior teeth with complicated crown fracture[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(05): 312-318.
回顾性分析牙髓切断术在儿童年轻恒前牙复杂冠折中应用的临床疗效及其影响因素。
筛查2014年1月至2022年12月就诊于中山市口腔医院儿童口腔科，因年轻恒前牙复杂冠折行牙髓切断术的儿童。选择术前影像学检查和初诊病历均显示为年轻恒牙，并且有复诊记录的296颗牙齿作为研究对象。采集患儿治疗过程中的临床资料及影像学检查，记录盖髓剂的种类、橡皮障的使用情况和外伤后就诊时间，并分析相关结果。
共纳入164例患儿175颗患牙，其中男性92例（56.10%）、女性72例（43.90%），平均年龄9.20岁，复查随访时间平均为19.41个月。完成牙髓切断术后6个月成功率为97.14%、1年后成功率为94.86%。术后复查2年以上的患牙共计76颗，累计失败16颗。使用iRoot BP Plus®作为盖髓剂成功率为93.04%，高于使用氢氧化钙作为盖髓剂的成功率（86.67%），差异无统计学意义（χ2 = 1.93，P = 0.17）。术中使用橡皮障成功率（94.12%）高于未使用橡皮障（88.49%），差异无统计学意义（χ2 = 1.42，P = 0.23）。超过24 h就诊患牙的成功率为86.67%，低于24 h内就诊患牙成功率（92.31%），Fisher′s精确概率检验提示组间差异无统计学意义（χ2 = 1.28，P = 0.37）。患牙初诊时，牙根发育在Nolla 8期前患牙成功率为94.74%，高于Nolla 9期的83.61%，差异有统计学意义（χ2 = 5.92，P = 0.03）。
采用牙髓切断术治疗年轻恒前牙复杂冠折可以取得较高的成功率；即使外伤后就诊时间超过7 d，仍可以尝试行牙髓切断术；牙根发育程度越接近成熟，其成功率降低。对于没有条件使用iRoot BP Plus®和橡皮障的医疗机构，在严格把握适应证的情况下，年轻恒前牙复杂冠折行牙髓切断术使用氢氧化钙作为盖髓剂仍可以获得良好疗效。
The clinical effects and influencing factors of pulpotomy in the treatment of immature permanent anterior teeth with complicated crown fracture in children were analyzed retrospectively.
Children who had undergone pulpotomy for immature permanent anterior teeth with complicated crown fracture from January 2014 to December 2022, in the Department of Pediatric Dentistry, Hospital of Stomatology, Zhongshan, were recruited. According to the preoperative apical X-ray images and the initial medical record, 296 immature permanent teeth with follow-up records were included in the study. The types of pulp capping agents, the use of rubber barrier and the visit time after trauma were recorded.
A total of 175 teeth from 164 patients were included in the study, in which 92 were male (56.10%), and 72 were female (43.90%). The mean follow-up time was 19.41 months. The success rate of pulpotomy treatment was 97.14% after 6 months and 94.86% after 1 year. A total of 76 cases were followed up for more than 2 years, and 16 cases were failed. There was no statistically significant difference in the success rate between the groups using calcium hydroxide (86.67%) and iRoot BP Plus® (93.04%) (χ2 = 1.93, P = 0.17). The success rate of using rubber barrier during operation (94.12%) was higher than that without rubber barrier (88.49%). The difference was not statistically significant (χ2 = 1.42, P = 0.23). The success rate of dental treatment over 24 hours was 86.67%, lower than that within 24 hours (92.31%), and Fisher′s exact probability test suggested no statistically significant difference between these two groups (χ2 = 1.28, P = 0.37). The success rate of ≤Nolla 8 patients (94.74%) was higher than that of Nolla 9 patients (83.61%), which was statistically significant (χ2 = 5.92, P = 0.03) .
The pulpotomy can be used to treat complicated crown fracture of immature permanent anterior teeth with high success rate. Pulpotomy can be attempted even if the visit was more than 7 days after trauma. The more mature the root development was, the lower the success rate would be. When the indications are strictly followed, using calcium hydroxide as a pulp capping agent could obtain good results for complicated crown fracture of immature permanent anterior teeth when iRoot BP Plus® or rubber barrier are not available.