牙髓血运重建术治疗年轻恒牙根尖周病变的临床及影像学评估

Clinical and Radiological Evaluation of Pulp Revascularization for Immature Permanent Teeth with Apical Periodontitis

目的:评价牙髓血运重建术治疗根尖发育不成熟年轻恒牙的疗效。方法:选择诊断为根尖周炎或牙髓坏死的患牙28颗,术前拍摄X线片,记录根尖周病变和牙根发育状况,进行牙髓血运重建术。术后对每颗患牙进行临床和X线评价,对数据进行统计学分析,总结疗效及与牙根发育相关因素。结果:28颗患牙(29例根管)平均复查时间15.44(12~30)个月;牙根继续发育21例,根管壁厚度增加20例,根管钙化4例;牙根发育类型分为4类:A:牙根增长,根尖聚拢(变小或闭合),B:牙根未增长,根尖封闭,C:根管腔钙化封闭,D:根冠内出现钙化屏障,E:治疗前后牙根无变化;牙髓血运重建术成功16例,好转13例,失败0例,有效率为100%;年龄及引血程度与牙根是否继续发育相关,根尖孔大小、根尖周病变面积、牙根发育分期与牙根是否继续发育无明显相关性。结论:牙髓血运重建术治疗根尖发育不成熟的患牙具有可行性,但其远期疗效仍需要继续追踪随访。

Objective:To evaluate the treatment effectiveness of revascularization in necrotic immature teeth.Methods:Twenty-eight immature teeth which were diagnosed as periodontitis or pulp necrosis were recruited.X-ray was taken before revascularization.Clinical and radiographic data were collected.Statistical analysis was conducted to summarize the clinical factors which were related to root development.Results:The average follow-up time was 15.44(12-30)months,among which 21 root canals achieved increase of root length,20 root canals showed increase of dental wall thickness,and 4 root canals had calcification.Five types of responses were observed:type A,continued root maturation(apical foramen closure/narrow);type B,no significant continuation of root development with the root apex becoming closed;type C,severe calcification(obliteration);type D,a hard tissue barrier formed in the canal between the coronal MTA plug and the root apex;type E,there was no change compared before.The increase of root length was significantly different between the age and degree of bleeding,however,no significant different in the size of the root apical,the lesion area around the root apical,and the stage of root development.Conclusion:Pulp revascularizafion could be an effective treatment for immature permanent teeth,but its long-term effect still needs to be followed up.