三氧化矿物凝聚体、光固化玻璃离子水门汀及光固化氢氧化钙修复髓室底穿孔

Perforation of the pulp chamber floor: repair with mineral trioxide aggregate,light-cured glass ionomer cement and light-cured calcium hydroxide

背景:新型生物材料三氧化矿物凝聚体在密闭性、生物相容性、抑菌性等方面具有显著优势,可作为目前髓室底穿孔修复材料的首选,但其临床疗效未得到广泛验证。目的:比较光固化玻璃离子水门汀、光固化氢氧化钙及三氧化矿物凝聚体在修复髓室底穿孔中的治疗效果。方法:选择2013年5月至2015年5月滨州医学院附属医院牙科收治的153例髓室底穿孔患者,按照简单随机抽样方法将研究对象分为3组,各51例,分别采用光固化玻璃离子水门汀、光固化氢氧化钙、三氧化矿物凝聚体材料对患牙进行修补。比较3组患牙治疗1年后的治疗效果、牙周硬组织的修复时间、不良反应发生率及患者的满意度情况,同时比较三氧化矿物凝聚体组中不同特征(包括不同位置、穿孔直径及穿孔原因)患牙的临床疗效。结果与结论:与其他两组相比,三氧化矿物凝聚体组患牙的总有效率及总满意率均增高(P <0.05),不良反应发生率降低(P <0.05)。穿孔直径<2 mm时,三氧化矿物凝聚体组牙周硬组织的修复时间为3个月的比例明显高于其他两组,且光固化氢氧化钙高于光固化玻璃离子水门汀(P <0.05);三氧化矿物凝聚体组患牙中,穿孔直径<2 mm组的总有效率显著高于≥2 mm组,医源性组总有效率显著高于龋源性组(P <0.05)。Logistic回归结果显示:穿孔直径、穿孔原因均是三氧化矿物凝聚体疗效的显著影响因素(P <0.05)。结果证实,三氧化矿物凝聚体对髓室底穿孔患牙的修复效果显著,修复时间短,且不良反应少,可作为修复患牙的首选材料,其治疗效果与患牙的大小及原因有关。

BACKGROUND:Mineral trioxide aggregate(MTA),a new biomaterial,has significant advantages in sealing,biocompatibility,antibacterial activity,which can be used as the first choice for the repair of perforated pulp chamber floor.However,the clinical efficacy of MTA has not been widely verified.OBJECTIVE:To compare the therapeutic effects of light-cured glass ionomer cement(LGIC),light-cured calcium hydroxide(LCH)and MTA in the repair of perforation of the pulp chamber floor.METHODS:One hundred and fifty-three patients with perforation of the pulp chamber floor who were treated at the Department of Dentistry,Binzhou Medical University Hospital from May 2013 to May 2015 were selected as the research objects.According to the simple random sampling method,these patients were randomized into MTA group,LGIC group and LCH group,with 51 cases in each group.The MTA,LGIC and LCH were used to repair the affected teeth in corresponding groups.One-year post-treatment therapeutic effect,the repair time of periodontal hard tissue,the incidence of adverse reactions and the satisfaction of the patients were compared among the three groups.Meanwhile,the clinical efficacy on the affected teeth with different characteristics(including different position,perforation diameter and perforation reason)in the MTA group was compared.RESULTS AND CONCLUSION:The total effective rate and overall satisfaction rate of MTA group were significantly higher than those in the other two groups(P<0.05),while the incidence of adverse reactions was significantly lower in the MTA group than the other two groups(P<0.05).When the perforation diameter was<2 mm,the percentage of patients who underwent the repair of periodontal hard tissue within 3 months was significantly higher in the MTA group than the LGIC group and LCH group(P<0.05).Moreover,in the MTA group,the total effective rate with the perforation diameter<2 mm was significantly higher than with the perforation diameter≥2 mm(P<0.05),and the total effective rate of the iatrogenic group was significantly higher than that of the carious group(P<0.05).Logistic regression results showed that the diameter of perforation and the cause of perforation were both significant factors influencing the clinical efficacy of MTA(P<0.05).These results confirm that MTA has a significant effect on the repair of the perforation of the pulp chamber floor,characterized by relatively short repair time and few adverse reactions.Therefore,MTA can be used as the first choice for the restoration of the affected teeth,and its clinical efficacy is related to the size and the cause of the affected teeth.