MTA、iRoot BP Plus及氢氧化钙在年轻恒牙活髓切断术中临床疗效的比较分析

Comparative Analysis of Clinical Efficacy of MTA,iRoot BP Plus,and Calcium Hydroxide in Young Permanent Teeth Pulpotomy

目的:研究三氧化矿物凝聚体(MTA)、iRoot BP Plus(iRooT)以及氢氧化钙(Ca(OH)2)三种材料在年轻恒牙活髓切断术中的临床疗效。方法:将60例需要接受年轻恒牙活髓切断术的患者(60颗患牙)按照使用材料不同随机分为三组:MTA组、iRooT组和Ca(OH)2组,每组20例(20颗患牙),比较三组患者术后3个月和6个月手术成功率、牙本质桥形成和牙齿变色发生率、牙根管壁厚度、牙齿功能和美观度、以及血清基质金属蛋白酶-3(MMP-3)和白细胞介素-8(IL-8)水平。结果:(1)三组患者仅术后6个月临床治疗成功率存在显著差异(P<0.05);(2)Ca(OH)2组术后牙本质桥形成率显著低于其他两组(P<0.05),而牙齿变色发生率显著低于MTA组(P<0.05)和显著高于iRooT组(P<0.05)。(3)三组患者治疗后牙根管壁厚度均较治疗前显著增加,且治疗后Ca(OH)2组患牙根管壁厚度增加显著低于MTA组和iRooT组(P<0.05)。(4)Ca(OH)2组患者术后6个月牙齿舒适功能、固定功能和咀嚼功能评分均显著低于MTA组和iRooT组(P<0.05),而牙齿美观度评分显著低于iRooT组(P<0.05)和显著高于MTA组(P<0.05)。(5)三组患者术后6个月血清MMP-3和IL-8均显著低于术前(P<0.05),并且MTA组患者血清MMP-3和IL-8水平显著高于iRooT组(P<0.05)和显著低于CaOH组(P<0.05)。结论:iRoot BP Plus和MTA材料应用于年轻恒牙活髓切断术均具有较高的远期成功率,但MTA材料远期牙齿变色率较高因而影响牙齿美观度。

Objective:To investigate the clinical efficacy of three materials,mineral trioxide agglomerate(MTA),iRoot BP Plus(iRooT),and calcium hydroxide(Ca(OH)2),in the live pulpotomy of young permanent teeth.Methods:Sixty patients(60 affected teeth)requiring vivipectomy of young permanent teeth were randomly divided into three groups according to the materials used:the MTA group,the iRooT group and the Ca(OH)2 group,with 20 patients(20 affected teeth)in each group.The success rate of the procedure,the incidence of dentin bridge formation and tooth discoloration,root canal wall thickness,tooth function and aesthetics,and serum matrix metalloproteinase-3(MMP-3)and interleukin-8(IL-8)levels were compared between the three groups at 3 and 6 months after surgery.Results:(1)The clinical treatment success rate was different among the three groups at 6 months postoperatively only(P<0.05);(2)The postoperative dentin bridge formation rate was lower in the Ca(OH)2 group than in the other two groups(P<0.05),while the incidence of tooth discoloration was lower in the MTA group(P<0.05)and higher than in the iRooT group(P<0.05).(3)The root canal wall thickness increased in all three groups after treatment compared with that before treatment,and the increase in root canal wall thickness in the Ca(OH)2 group was lower than that in the MTA and iRooT groups after treatment(P<0.05).(4)The dental comfort function,fixed function and masticatory function scores were significantly lower in the Ca(OH)2 group than in the MTA and iRooT groups at 6 months postoperatively(P<0.05),while the dental esthetics scores were lower in the iRooT group(P<0.05)and higher than in the MTA group(P<0.05).(5)Serum MMP-3 and IL-8 were lower in all three groups 6 months after surgery than before surgery(P<0.05),and the serum MMP-3 and IL-8 levels were higher in the MTA group than in the iRooT group(P<0.05)and lower in the CaOH group(P<0.05).Conclusion:Both iRoot BP Plus and MTA materials have high long-term success rates for vivisection of young permanent teeth,but the MTA material has a high rate of long-term tooth discoloration and thus affects the aesthetics of the teeth.