恒牙牙髓炎的活髓保存治疗

doi:10.12016/j.issn.2096-1456.2021.07.001

口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (7): 433-441.DOI: 10.12016/j.issn.2096-1456.2021.07.001

恒牙牙髓炎的活髓保存治疗

吴补领^1,²(),罗奕菲^2,³,徐稳安¹,童忠春⁴

1.南方医科大学深圳口腔医院（坪山）牙体牙髓科,广东深圳（518118）
2.南方医科大学口腔医学院,广东广州（510515）
3.南方医科大学南方医院口腔科,广东广州（510515）
4.中山大学附属口腔医院牙体牙髓科,广东广州（510055）

收稿日期:2020-09-05 修回日期:2020-11-12 出版日期:2021-07-20 发布日期:2021-04-19
通讯作者: 吴补领
作者简介:吴补领,南方医科大学口腔医学院院长、南方医科大学深圳口腔医院（坪山）院长,医学博士、主任医师、二级教授、博士生导师。毕业于第四军医大学口腔医学院,先后赴日本东京齿科大学、大阪大学、明海大学,德国国际牙科培训中心、香港大学研修、学习、访问;兼任日本明海大学齿学部、大阪齿科大学客座教授,国际牙医师学院院士。现任中华口腔医学会常务理事;中华老年口腔医学专业委员会前任主任委员、牙体牙髓病学专业委员会常委、国家教育部高等学校教学指导委员会委员;广东省口腔医学会副会长、老年口腔医学专业委员会主任委员、牙体牙髓病学专业委员会副主任委员等学术职务,《中华口腔医学杂志》、《国际口腔医学杂志》、《口腔疾病防治》等6种专业杂志的特邀编审或编委。负责国家级、军队重点课题15项,获得国家级、省部级科技奖9项;发表学术论文200余篇,其中SCI收录30余篇;主编、参编专著18部。荣获军队、国家高等学校优秀教师、骨干教师等奖励,荣立三等功1次。
基金资助:
国家自然科学基金项目(81870755);国家自然科学基金项目(81970930)

Vital pulp therapy of pulp inflammation of permanent teeth

WU Buling^1,²(),LUO Yifei^2,³,XU Wenan¹,TONG Zhongchun⁴

1. Department of Cariology and Endodontics, Shenzhen Stomatology Hospital (Pingshan), Southern Medical University, Shenzhen 518118, China
2. College of Stomatology, Southern Medical University, Guangzhou 510515, China
3. Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
4. Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China

Received:2020-09-05 Revised:2020-11-12 Online:2021-07-20 Published:2021-04-19
Contact: Buling WU
Supported by:
National Natural Science Foundation of China(81870755);National Natural Science Foundation of China(81970930)

摘要/Abstract

摘要：

活髓保存治疗是尽最大限度保留健康牙髓组织、提高患牙远期保存率的方法,但其被认为适应范围有限,疗效不确定。牙髓组织的病理学改变是决定临床治疗方案和评估疗效的组织学基础,而常用的检查方法无法全面反映牙髓的病理学改变。随着对牙髓生物学研究的深入、现代诊疗技术及盖髓材料的革新,活髓保存治疗越来越多地被应用在以往被认为需要摘除牙髓的患牙上。本文根据循证文献,就牙髓炎病理改变、恒牙牙髓炎活髓保存治疗的临床研究等方面进行分析讨论和总结。在活髓保存治疗的过程中综合运用包括激光多普勒血流仪、组织氧检测仪、核磁共振成像、牙科显微镜等技术与方法准确判断牙髓炎症状态,并依此决定牙髓的去留程度;结合严格的感染控制与高生物相容性盖髓材料的使用,活髓保存治疗可运用在部分龋源性露髓患牙与出现不可复性牙髓炎症状的恒牙上。未来的研究则需从牙髓修复再生机制、牙髓炎诊断精准化、盖髓材料的升级等方面提高恒牙牙髓炎活髓保存治疗的成功率。

关键词: 牙髓炎, 恒牙, 活髓保存治疗, 直接盖髓术, 牙髓切断术, 适应证, 预后, 防御反应, 修复反应, 激光多普勒血流仪, 组织氧检测仪, 核磁共振成像, 盖髓材料

Abstract:

Vital pulp therapy aims to maintain healthy pulp tissue as much as possible to improve the long-term survival of teeth. It has limited indications and uncertain curative effects. The pathological changes in inflamed pulp are the histological basis for the determination of treatment strategies and the treatment outcome; however, pulp sensitivity testing cannot reflect the actual histological status of the pulp. With the development of basic and clinical research on vital pulp therapy, the innovation of modern diagnostic and therapeutic technology and capping material, vital pulp therapy can be used as a treatment of teeth on which it was previously thought pulpectomy was necessary. Based on the evidence-based literature, this paper analyzes and summarizes the pathological changes of pulpitis and clinical research on the treatment of pulpitis. Vital pulp therapy can be a treatment for mature teeth with carious exposure and symptoms of irreversible pulpitis if comprehensive applications, including laser Doppler flowmetry, tissue oxygen monitoring, magnetic resonance imaging and microscopy, are used to determine the degree of pulp retention and if infection control and the use of biocompatible capping material are emphasized. In the future, it will be necessary to improve the success rate of vital pulp therapy for the treatment of pulpitis through research on the mechanism of pulp repair and regeneration, the precise diagnosis of pulpitis, and the development of pulp capping materials.

Key words: pulpitis, permanent teeth, vital pulp therapy, direct pulp capping, pulpotomy, indication, prognosis, defease reaction, repair reaction, laser doppler flowmetry, tissue oxygen monitor, magnetic resonance imaging, pulp capping material

中图分类号:

吴补领,罗奕菲,徐稳安,童忠春. 恒牙牙髓炎的活髓保存治疗[J]. 口腔疾病防治, 2021, 29(7): 433-441.

WU Buling,LUO Yifei,XU Wenan,TONG Zhongchun. Vital pulp therapy of pulp inflammation of permanent teeth[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(7): 433-441.

图/表 1

图1 16牙龋源性露髓后行局部活髓切断术

Figure 1 Partial pulpotomy in the 16 tooth with carious exposure a: a radiograph showed that the deep caries lesion of tooth 16 was close to the pulp horn; b: after caries excavation, exposure of the pulp horn was identified; c: after anesthesia, rubber dam isolation and thorough caries excavation; d: pulp wound after removal of infected tissue and hemostasis with sodium hypochlorite; e: the wound was capped with iRoot BP, flowable resin was used as cavity liner and the cavity was restored with resin composite; f: a radiograph taken 3 months after treatment showed the cavity restored with resin composite and normal periapical conditions

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恒牙牙髓炎的活髓保存治疗

Vital pulp therapy of pulp inflammation of permanent teeth

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