年轻恒牙外伤性冠折露髓时间与初诊叩痛对预后的影响

Study on the effect of traumatic coronary pulp exposure time and initial percussion pain on prognosis in young permanent teeth

目的探讨外伤引起的年轻恒牙冠折露髓患者经活髓切断术或直接盖髓术后预后不良的独立危险因素,并评价露髓时间、初诊叩痛对牙髓预后的影响。方法回顾性分析2018年3月至2020年9月河北省承德医学院附属医院收治的219例外伤引起的年轻恒牙冠折露髓患者的临床资料。患者初诊治疗为活髓切断术或直接盖髓术且于术后1年进行随访。采用单因素和多因素logistic回归分析影响牙髓预后不良的独立危险因素,并通过受试者操作特征(ROC)曲线分析上述独立危险因素对牙髓预后不良的预测价值。结果经术后1年随访,治疗失败20例,成功199例,活髓切断术总成功率为90.87%。单因素分析结果显示,根尖发育情况、露髓时间、初诊叩痛与牙髓预后不良有关(P<0.05),而年龄、性别、受伤原因、受伤牙位、温度试验结果、牙髓电活力差值、露髓孔直径、患牙松动度、治疗方案与牙髓不良预后无关(P>0.05)。多因素logistic回归分析结果显示,初诊叩痛(+++)是影响牙髓预后不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,初诊叩痛(+++)预测牙髓预后不良的曲线下面积为0.860,敏感度为0.832,特异度为0.865。结论初诊叩痛(+++)是外伤引起的年轻恒牙冠折露髓患者预后不良的独立危险因素,且对预后不良的预测价值较高,而露髓时间与牙髓预后无明显相关性。

Objective To investigate the independent risk factors of poor prognosis in young patients with coronal exposure due to trauma after live pulp amputation or direct pulp capping,and to evaluate the influence of pulp exposure time and initial percussion pain on pulp prognosis.Method The clinical data of 219 cases of young permanent tooth crown exposure caused by trauma admitted to the Affiliated Hospital of Chengde Medical University from March 2018 to September 2020 were retrospectively analyzed.Patients were initially treated with either live pulpotomy or direct pulpotomy and were followed up 1 year after surgery.Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors for poor dental pulp prognosis,and the predictive value of these independent risk factors for poor dental pulp prognosis was analyzed by the receiver operating characteristics(ROC)curve.Result After 1 year follow-up,there were 20 cases of treatment failure and 199 cases of successful treatment.The total success rate of living pulp amputation was 90.87%.Single factor results showed that apical development,pulp exposure time and initial knock pain were associated with poor pulp prognosis(P<0.05),while age,sex,injury cause,injured tooth location,temperature test results,difference of pulp electrical activity,diameter of pulp exposure hole,flexibility of affected tooth and treatment plan were not associated with poor pulp prognosis(P>0.05).Multivariate logistic regression analysis showed that percussion pain at first diagnosis(+++)was an independent risk factor for poor pulp prognosis(P<0.05).ROC curve analysis results showed that the area under the curve of initial percussion pain(+++)predicting poor pulp prognosis was 0.860,sensitivity was 0.832,specificity was 0.865.Conclusion Initial percussion pain(+++)is an independent risk factor for poor prognosis in young permanent teeth with traumatic crown fracture and exposed pulp,and has a high predictive value.Pulp exposure time was not significantly related to pulp prognosis.