年轻恒牙牙髓血管再生治疗的疗效观察与分析

Effect of revascularization treatment of immature permanent teeth with endodontic infection

目的观察年轻恒牙牙髓血管再生治疗的临床疗效,以评价氢氧化钙糊剂介导牙髓感染的年轻恒牙血管再生治疗的可行性。方法 201 1年1月～2012年12月于广州市妇女儿童医疗中心口腔科就诊的34例均为外伤、龋病或非龋病等因素导致的牙髓感染、坏死、根尖周炎或根尖脓肿的年轻恒牙,分为试验组和对照组,各17例。试验组局麻下将患牙进行常规开髓引流,冲洗消毒,并内封氢氧化钙糊剂以行血管再生治疗,对照组行传统的根尖诱导成形术。术后随访并观察两组疗效。结果试验组4例分别于术后6～18个月复诊发现,根尖周病变愈合,根管腔变小,牙根形成,根尖孔闭合,10例术后12～18个月,根尖周病变愈合,牙根有延长,根管壁有增厚,根尖孔缩小,1例术后2个月出现疼痛和肿胀,2例分别于术后7个月和8个月出现疼痛,有牙龈瘘管形成,牙根发育停止。对照组1例根尖诱导12个月后根尖区病变消失,根端闭合,11例术后6～18个月后根尖孔有硬组织形成,根尖区病变区域缩小,但均未见牙根长度有明显改变;5例在诱导12～18个月后仍无明显的根尖屏障形成。两组治疗有效率的差异无统计学意义(P>0.05)。结论通过内封氢氧化钙糊剂的血管再生治疗能够有效促进患有牙髓炎或根尖周炎的年轻恒牙的继续发育,具有广阔的临床应用前景。

Objective To observe the effect of revascularization for treatment of immature teeth with endodontic infection mediated by calcium hydroxide. Methods Seventeen pediatric patients with endodontic infections of the permanent teeth were treated with routine root canal and pulp cavity irrigation and disinfection followed by application of calcium hydroxide paste to the root canal orifice to induce revascularization. Another 17 patients received conventional apexification procedures to serve as the control group. The patients were followed up to observe the therapeutic effect of the treatments. Results In the revascularization treatment group, 4 cases showed healed periapical lesions 6 to 18 months after the surgery with thickened root canal walls and closure of the apical foramen; in 10 cases, the periapical lesions healed 12 to 18 months postoperatively with lengthened root, thickened root canal wall, and narrowed apical foramen. One patient reported pain and swelling at 2 months, and 2 patients showed the formation of gum fistula and ceased development of the roots at 7 and 8 months. In the control group, the periapical lesions healed in 1 cases at 12 months postoperatively with apical foramen closure; in 11 cases, hard tissues formed in the root apex without obviously lengthened roots 6 to 8 months after the surgery; in 5 cases, no apical barrier formed even 12 to 18 months after the surgery. The overall effective rates were similar between the two groups （P〉0.05）. Conclusions Revasoalarization by calcium hydroxide sealing can promote root development of immature permanent teeth with pulpitis or periradicular periodontitis.