乳牙直接盖髓术的研究进展

Research progress on direct pulp capping of primary teeth

乳牙龋病及牙髓病的及时治疗对于维护儿童口腔健康有重要意义。直接盖髓术是一种将生物活性材料直接覆盖于牙髓暴露处,促进牙本质桥形成的活髓保存治疗方法。直接盖髓术可用于治疗牙髓活力正常、露髓孔≤1 mm的机械性露髓乳牙,具有微创、舒适、操作简单和椅旁时间短等优点,适合在儿童口腔临床中开展。早期研究认为深龋露髓乳牙使用直接盖髓术疗效不佳,近年来随着材料和技术的进步,直接盖髓术在乳牙深龋治疗的临床研究中取得了良好的治疗效果。然而,因相关研究质量较低,龋源性露髓乳牙的直接盖髓治疗尚未被普遍推荐,其广泛应用仍需更多高质量循证医学证据的支持。牙髓状态、隔离去龋操作、盖髓剂、洞型及牙位、冠方封闭及牙科畏惧等均是乳牙直接盖髓术成功率的影响因素。临床操作中应正确判断牙髓状态,最大程度减少细菌污染。三氧化矿物凝聚体(mineral trioxide aggregate,MTA)是目前证据较为充分、治疗效果良好的直接盖髓剂,盖髓后应进行严密冠方封闭。iRoot BP Plus等新型生物活性材料应用于乳牙直接盖髓术的效果,以及止血方法等其他因素对患牙预后的影响仍待进一步深入探究。

The timely treatment of dental caries and pulp disease in primary teeth holds significant importance for maintaining children's oral health.Direct pulp capping(DPC)is a vital pulp treatment that involves covering the exposed pulp with bioactive materials to promote dentin bridge formation.DPC is commonly used in primary teeth with vital pulp and mechanical pulp exposure not exceeding 1 mm.DPC offers advantages such as minimal invasiveness,comfort,simplicity of operation and short chair-side time,making it suitable for pediatric dental clinical practice.Early studies suggested negative treatment outcomes for DPC in primary teeth with carious pulp exposure.Over the years,there have been advancements in materials and technology demonstrating positive outcomes in the clinical research of primary teeth with deep caries.However,due to the limited quality of related studies,DPC has not been widely recommended for the treatment of primary teeth with carious pulp exposure,and its widespread use needs further support by more high-quality evidence-based medical research.The success rate of DPC in primary teeth is influenced by factors including pulp status,clinical operations(such as isolation and caries removal),pulp capping material,cavity type,tooth position,coronal sealing,and dental fear.In clinical operation,dentists should accurately assess pulp status and minimize bacterial contamination.Mineral trioxide aggregate(MTA)is a DPC agent with relatively sufficient evidence and good therapeutic effects,and the crown should be tightly sealed after pulp capping.Additionally,the effects of novel biocompatible materials such as iRoot BP Plus used in DPC of primary teeth,and the influence of other factors like hemostatic methods on the prognosis of affected teeth,need further exploration.