血浆基质在牙髓根尖周病治疗中的应用

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases

血浆基质作为一种自体血液离心产物,具有再生修复的功能,已被广泛应用于口腔颌面部软硬组织再生修复、皮肤美容等领域,并取得了较好的效果。目前,牙髓再生治疗和根尖手术已成为保存牙髓以及保存患牙的主要方法,生物活性材料的应用至关重要,血浆基质作为一种自体生物活性材料,较易获取,可塑性强,具有天然优势。血浆基质可应用于以下情况:①无法刺激根尖出血的根尖孔未闭合年轻恒牙的牙髓血运重建术;②存在骨缺损的根尖屏障术及大面积穿孔髓室底或根侧壁修补术;③大面积根尖病变,伴或不伴随牙周疾病患牙的根尖手术。因血浆基质为自身血液来源制品,使用方面无明显禁忌。虽然已有系统综述表明,相比传统血凝块,血浆基质作为天然再生支架,可有效促进牙髓根尖周病的再生性修复。然而,由于血浆基质的特性受不同制备方式的影响,其适用范围有所差异。此外,目前尚缺乏血浆基质长期的临床研究结果,且组织学证据较难获取,仍然需要大量的体内外研究进一步探索。本文将对不同血浆基质在牙髓再生、根尖手术中的骨组织再生等方面的应用进行阐述,以期为临床医生在适应证选择及预后评估时提供参考。

The plasma matrix is a kind of autologous blood conduct.It has been widely used in maxillofacial tissue regeneration,skin cosmetology and some other fields.Recently,to preserve the dental pulp as well as the teeth,pulp re-generation therapy and apical surgery have become increasingly important as well as the applications of bioactive materi-als.As a kind of autologous bioactive material,the plasma matrix has some natural advantages as it is easy to obtain and malleable.The plasma matrix can be used in the following cases:①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding;②apical barrier surgery with bone defects and large ar-ea perforation repair with bone defects or root sidewall repair surgery;③apical surgeries of teeth with large area of api-cal lesions,with or without periodontal diseases.The plasma matrix is a product derived from our blood,and there are no obvious contraindications for its use.Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases.However,the applications of plasma matrix are different because its characteristics are affected by different preparation methods.In addition,there is still a lack of long-term clinical researches on the plasma matrix,and the histological evidences are difficult to obtain,so a large number of in vitro and in vivo experimental studies are still needed.This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.