不同生物材料在因龋露髓成熟恒牙活髓保存治疗中的效果研究

Efficacy study of vital pulp therapy using different biomaterials for management of carious pulp exposure in mature permanent teeth

目的评估不同生物材料[矿物三氧化物凝聚体(mineral trioxide aggragate,MTA)和iRoot BP Plus]在因龋露髓成熟恒牙活髓保存治疗中的临床效果。方法选取2020年10月至2023年5月于呼和浩特市口腔医院牙体牙髓科就诊的因龋露髓患者200例(200颗患牙),采用随机数字表法将患者分为MTA组(MTA为盖髓剂)和iRoot BP Plus组(iRoot BP Plus为盖髓剂),每组各100例(100颗患牙)。比较2组的临床疗效,牙本质桥、牙齿变色、髓腔钙化及牙根吸收发生情况,疼痛视觉模拟量表(visual analogue scale,VAS)评分及满意度差异。结果术后12个月,iRoot BP Plus组治疗成功率为87%(87/100),明显高于MTA组[72%(72/100)],差异有统计学意义(χ^(2)=6.903,P=0.014)。术后3、6、12个月,MTA组牙本质桥发生率分别为5%(5/100)、36%(36/100)、45%(45/100),iRoot BP Plus组分别为8%(8/100)、42%(42/100)、53%(53/100),差异均无统计学意义(均P>0.05);MTA组牙齿变色发生率分别为16%(16/100)、28%(28/100)、46%(46/100),而iRoot BP Plus组所有患牙均未变色(0%),差异均有统计学意义(均P<0.05)。2组患者术后24 h VAS评分及术后12个月满意度评价比较,差异均无统计学意义(均P>0.05)。结论活髓保存治疗因龋露髓成熟恒牙的临床效果良好。相较于MTA,iRoot BP Plus作为盖髓剂的治疗成功率更高,且不易导致牙齿变色,临床应用前景广阔。

Objective To evaluate the clinical efficacy of vital pulp therapy using different endodontic biomaterials Mineral Trioxide Aggregate(MTA)and iRoot BP Plus in mature permanent teeth with carious pulp exposure.Methods From October 2020 to May 2023,200 teeth with carious pulp exposure in mature permanent teeth were selected from the Department of Cariology and Endodontology,Hohhot Stomatological Hospital.The teeth were randomly divided into two groups,MTA group(n=100)and iRoot BP Plus group(n=100),different treatment methods of vital pulp preservation were selected according to the bleeding condition and capped with MTA or iRoot BP Plus according to the group.The clinical efficacy,occurrence of dentin bridge,tooth discoloration,pulp cavity calcification and root resorption,visual analogue scale(VAS)score and satisfaction were compared between the two groups.Results At 12 months after treatment,the success rate of treatment in the iRoot BP Plus group was 87%(87/100),which was significantly higher than that in the MTA group(72%),and the difference was statistically significant(χ^(2)=6.903,P=0.014).At 3,6 and 12 months after operation,the formation rates of dentin bridge were 5%(5/100),36%(36/100)and 45%(45/100)in MTA group and 8%(8/100),42%(42/100)and 53%(53/100)in iRoot BP Plus group,respectively,and the differences were not statistically significant(all P>0.05).At 3,6 and 12 months after operation,the incidence of teeth discoloration in the MTA group were 16%(16/100),28%(28/100),and 46%(46/100),respectively,while none of the teeth in the iRoot BP Plus group showed tooth discoloration(0%),and the differences were statistically significant(all P<0.05).At 24 h after operation,there was no significant difference in VAS score between the two groups(P>0.05).At 12 months after operation,there was no significant difference in patient satisfaction between the two groups(P>0.05).Conclusion The clinical efficacy of vital pulp therapy for management of carious pulp exposure in mature permanent teeth is good.Compared with MTA,iRoot BP Plus has a higher success rate of treatment as a pulp capping agent,and it is not easy to cause tooth discoloration,which has a broad clinical application prospect.