不同盖髓材料在年轻恒牙冠折露髓后活髓切断术中的应用效果比较

Comparison of Application Effect of Different Pulp Cap Materials in Pulpotomy of Young Permanent Teeth with Crown Fracture and Exposed Pulp

目的比较不同盖髓材料在年轻恒牙冠折露髓后活髓切断术中的应用效果。方法回顾性分析2019年8月至2021年1月南京大学医学院附属口腔医院收治的102例年轻恒牙冠折露髓患者的临床资料,患者均接受活髓切断术治疗,根据盖髓材料不同将研究对象分为三组,各34例,氢氧化钙组术中盖髓材料采用氢氧化钙,三氧化矿物凝聚体(MTA)组术中盖髓材料采用MTA,生物陶瓷组术中盖髓材料选用新型生物陶瓷材料iRoot BP Plus。观察三组患者治疗1、3、6、12个月后的成功率、牙本质桥形成率,并分析患者治疗后牙功能、牙美观度及不良反应发生情况。结果三组患者治疗1、3个月后成功率比较差异无统计学意义(P>0.05),治疗6个月后氢氧化钙组、MTA组、生物陶瓷组成功率分别为79.41%(27/34)、94.12%(32/34)、97.06%(33/34),治疗12个月后成功率分别为73.53%(25/34)、88.24%(30/34)、94.12%(32/34),三组患者治疗6、12个月后成功率比较差异有统计学意义(P<0.05)。三组患者治疗1、3个月后牙本质桥形成率比较差异无统计学意义(P>0.05),治疗6个月后氢氧化钙组、MTA组、生物陶瓷组牙本质桥形成率分别为73.53%(25/34)、97.06%(33/34)、94.12%(32/34),治疗12个月后牙本质桥形成率分别为82.35%(28/34)、97.06%(33/34)、97.06%(33/34),三组患者治疗6、12个月后牙本质桥形成率比较差异有统计学意义(P<0.05)。治疗12个月后生物陶瓷组咀嚼功能、牙舒适度、牙稳定性、美观度评分均高于氢氧化钙组和MTA组(P<0.05),MTA组美观度评分高于氢氧化钙组(P<0.05)。氢氧化钙组、MTA组、生物陶瓷组治疗期间总不良反应发生率分别为26.47%(9/34)、29.41%(10/34)、5.88%(2/34),三组比较差异有统计学意义(P<0.05),且生物陶瓷组低于氢氧化钙组和MTA组(P<0.05)。结论年轻恒牙冠折露髓患者选取新型生物陶瓷材料iRoot BP Plus实施活髓切断术远期成功率、牙本质桥形成率高于氢氧化钙,且新型生物陶瓷材料iRoot BP Plus牙功能、牙美观度更高,不良反应发生率较低,安全性更佳。

Objective To compare the effect of different pulp capping materials in the pulpotomy of young permanent teeth with crown fracture and exposed pulp.Methods The clinical data of 102 young patients with permanent teeth crown fracture and pulp exposure admitted to the Affiliated Stomatological Hospital of Nanjing University Medical College from Aug.2019 to Jan.2021 were retrospectively analyzed.The patients were all treated with pulpotomy.According to the different pulp capping materials,the subjects were divided into three groups,34 cases each.Calcium hydroxide was used as pulp capping material in calcium hydroxide group;mineral trioxide aggregate(MTA)was used as pulp capping material in MTA group;the new bioceramic material iRoot BP Plus was selected as the pulp capping material in bioceramic group.The success rate and dentin bridge formation rate at 1,3,6,and 12 months after treatment in the three groups were observed,and the dental function,dental aesthetics and adverse reactions were analyzed after treatment.Results There was no significant difference in the success rate between the three groups at 1 and 3 months after treatment(P>0.05).At 6 months after treatment,the success rates of the calcium hydroxide group,MTA group and bioceramic group were 79.41%(27/34),94.12%(32/34)and 97.06%(33/34),respectively.At 12 months after treatment,the success rates were 73.53%(25/34),88.24%(30/34)and 94.12%(32/34),respectively,and there was statistically significant difference in the success rates between the three groups at 6 and 12 months after treatment(P<0.05).There was no significant difference in the dentin bridge formation rate between the three groups at 1 and three months after treatment(P>0.05).At 6 months after treatment,the dentin bridge formation rates in the calcium hydroxide group,MTA group and bioceramic group were 73.53%(25/34),97.06%(33/34)and 94.12%(32/34),respectively.At 12 months after treatment,the dentin bridge formation rates were 82.35%(28/34),97.06%(33/34)and 97.06%(33/34),respectively,and there was statistically significant difference in the dentin bridge formation rates between the three groups at 6 and 12 months after treatment(P<0.05).At 12 months after treatment,the masticatory function,dental comfort,dental stability and aesthetic scores of the bioceramic group were higher than those of the calcium hydroxide group and MTA group(P<0.05),and aesthetic score of the MTA group was higher than that of the calcium hydroxide group(P<0.05).The total incidence of adverse reactions in the calcium hydroxide group,MTA group and bioceramic group during treatment was 26.47%(9/34),29.41%(10/34)and 5.88%(2/34),respectively,and the difference among the three groups was statistically significant(P<0.05),and the bioceramic group was lower than the calcium hydroxide group and MTA group(P<0.05).Conclusion The long-term success rate and dentin bridge formation rate of pulpotomy of young permanent teeth with crown fracture and exposed pulp using the novel bioceramics material iRoot BP Plus are higher than using calcium hydroxide,and the novel bioceramics material iRoot BP Plus has higher dental function and aesthetic degree,lower incidence of adverse reactions and better safety.