生物材料在活髓保存中的应用

Application of biological materials in vital pulp therapy

背景:研究显示,牙髓治疗后牙齿尤其是磨牙牙齿的存留率明显低于活髓牙,失牙危险比为7.4∶1。随着组织再生观念的进步与生物医用材料的发展,人们开始寻求提高牙齿存留率的新型牙髓治疗方式。目的:文章就各种生物材料的临床效果、应用现状及研究前景做一综述,以帮助临床医师在活髓保存中选择合适的生物材料。方法:以中文检索词“活髓保存,氢氧化钙,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”检索CNKI、万方数据库;以英文检索词“vital pulp therapy,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”检索PubMed数据库,检索时间范围重点为2011年1月至2021年11月。通过阅读文献题目、摘要及全文筛选,最后纳入56篇文献进行综述。结果与结论:①在微创治疗中,为改善预后并且提高牙齿的保存期,除了追求剩余牙体硬组织的完整性外,应尽量保留健康的牙髓组织,活髓保存不仅对根尖未发育完善的年轻恒牙具有重要意义,对于根尖发育完善的恒牙也意义重大;②氢氧化钙是临床上应用时间最长的盖髓剂,其效果稳定、价格低廉,但无法严密封闭牙髓,所诱导形成的牙本质桥存在隧道样缺损,预后不佳;③三氧化矿物凝聚体的生物相容性优于氢氧化钙,封闭性好,能有效控制炎症,同时也存在着价格高、凝固时间长、可能导致牙冠变色等问题;④近年来,iRoot BP Plus、Biodentine、TheraCal LC、BioAggregate等新型生物材料也逐渐走入临床视野,展现出了光明的前景,仍有待于进一步的临床研究。然而无论使用何种盖髓材料,适应证的准确选择是成功保留健康牙髓组织的关键。

BACKGROUND:Studies have shown that the retention rate of endodontically treated teeth(especially molars)is significantly lower than that of vital teeth.The hazard ratios for loss were 7.4:1.With the progress of the concept of tissue regeneration and the development of biological materials,people are searching for new endodontic treatments to increase the retention rates.OBJECTIVE:To review the clinical effect,application status and research prospect of various biological materials in order to help clinicians choose a better method in vital pulp therapy.METHODS:Based on Chinese search terms“vital pulp therapy,calcium hydroxide,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”,the authors searched and matched relevant documents in CNKI and Wanfang database.With the English search terms“vital pulp therapy,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”,the authors searched for relevant literature in PubMed database.The retrieval time was from January 2011 to November 2021.After reading title,abstract and full-text selection of literature,56 articles were finally included for review.RESULTS AND CONCLUSION:(1)In minimally invasive endodontics,in addition to pursuing the integrity of residual dental hard tissues,healthy dental pulp should be retained as far as possible.Preservation of vital pulp is important to both immature permanent teeth and mature permanent teeth.It can help to improve prognosis and increase the retention rates.(2)Calcium hydroxide is the longest-used pulp capping agent in clinic.Its effect is stable and the price is low,but it cannot seal the pulp tightly.There are tunnel-like defects in the dentin bridge of the patients,and the prognosis is poor.(3)The biocompatibility of mineral trioxide aggregates is better than that of calcium hydroxide,with good sealing properties,which can effectively control inflammation.There are problems such as high price,long coagulation time,and possible discoloration of the crown.(4)In recent years,new biomaterials such as iRoot BP Plus,Biodentine,TheraCal LC,and BioAggregate have gradually entered the clinic,showing bright prospects.Further clinical research is still needed.However,no matter what pulp capping material is used,accurate selection of indications is the key to successful preservation of healthy pulp tissue.