CBCT在年轻恒牙显微牙髓再生术中的应用研究

Application study of CBCT in the regeneration of dental pulp in young permanent teeth

目的探讨CBCT用于评价显微牙髓再生术治疗年轻恒牙牙髓根尖周病的效果。方法随机选择2011年6月~2014年9月接受治疗的年轻恒牙牙髓根尖周病患者100例进行研究,所有患者均接受牙髓再生术治疗,并随机分为甲、乙两组,每组50例,其中对甲组患者采用X线片进行术中和术后治疗效果的评估,对乙组患者采用CBCT进行治疗效果评估,比较两组患者的治疗成功率。结果术后36个月,两组患者牙龈指数,牙周袋深度及附着丧失均显著改善(P<0.05),但是两组牙龈指数,牙周袋深度及附着丧失比较差异无统计学意义(P>0.05)。乙组术后3、6、12、18、24、36个月治疗总有效率均显著优于甲组,两组数据差异显著(P<0.05)。甲组根尖闭合主要发生于术后12个月,而乙组主要在术后6个月,且乙组平均闭合时间显著低于甲组(P<0.05)。甲组术后24个月牙髓活力反应恢复率为78.0%(39/50),乙组为94.0%(47/50),两组数据差异显著(χ~2=5.316,P=0.021<0.05)。甲组10例患者术后6个月出现疼痛和肿胀,有牙龈瘘管形成,牙根发育停止,乙组1例患者出现上述症状,两组数据差异显著(χ~2=8.274,P=0.004<0.05)。结论锥形束CT在显微牙髓再生术用于治疗年轻恒牙牙髓根尖周病的过程中能够在各个观察角度和层面清晰地显示出手术前和手术中根管的数目、走形及其在根尖处是否有融合等情况,指导临床治疗的进行,从而有效提高的成功率,减少遗漏根管现象的发生,具有临床推广价值。

Objective To investigate the efficacy of CBCT for evaluation of endodontic regeneration in treatment of periapical periodontitis in young permanent teeth. Methods 100 cases of patients with periapical periodontitis in young permanent teeth treated from June 2011 to September 2014 were randomly selected to study. All patients were given the treatment of dental pulp regeneration, and were randomly divided into group A and group B with 50 cases in each group. The therapeutic effect of intraoperative and postoperative treatment in the patients in group A was evaluated by X-ray while the therapeutic effect of intraoperative and postoperative treatment in the patients in group B was evaluated by CBCT. The successful rate of treatment between the two groups was compared. Results 36 months after surgery, gingival index, periodontal pocket depth and attachment loss were significantly improved in the two groups （P 〈 0.05）. However, there was no significant difference in gingival index, depth of periodontal pocket and attachment loss between the two groups （P 〉 0.05）. After 3, 6, 12, 18, 24 and 36 months of treatment in group B, the total effective rate was significantly higher than that of group A and the difference between the two groups was significant （P 〈 0.05）. The apical closure occurred mainly in 12 months after the surgery in group A but in 6 months after operation in group B, and the average closing time in group B was significantly lower than that in group A （P 〈 0.05）. The recovery rate of dental pulp vitality response 24 months after the surgery was 78% （39/50） in group A while 94% （47/50） in group B, and the data difference between two group was significant （X2=5.316, P=0.021 〈 0.05）. Six months after the operation, pain and swelling appeared in 10 patients in group A and their gingival fistula formed and the root development stopped while the symptoms above occurred in one patient in group B. The data difference between two group was significant （Z2=8.274, P=0.004 〈 0.05）. Conclusion The cone beam CT can clearly show the number of root canals and their shape and whether they are fused at the tip of the root before and after the operation in the process of dental pulp regeneration in the treatment of periapieal periodontitis in young permanent teeth, which can guide the clinical treatment so as to improve the success rate and reduce the occurrence of missing root canal phenomenon. This therapeutic method has the value of clinical promotion.