龋源性露髓成熟恒牙行活髓切断术的临床疗效观察

Observation of clinical effect of vital pulpotomy in carious pulp-exposed mature permanent teeth

目的:观察龋源性露髓成熟恒牙行活髓切断术的临床疗效,并对比部分冠髓切断术(partial pulpotomy,PP)、冠髓切断术(full pulpotomy,FP)与根管治疗(root canal treatment,RCT)的疼痛控制效果、临床成功率与牙体功能。方法:选择于本院就诊的90例患者(90颗龋源性露髓成熟恒牙),按不同治疗措施分为3组:术中去除部分冠髓,见牙髓断面新鲜,若能在5 min内止血,则行三氧化矿物凝聚体(mineral trioxide aggregate,MTA)部分冠髓切断术(PP组);否则继续去除全部冠髓至根管口,能在5 min内止血,则行MTA冠髓切断术(FP组);若还未能有效止血,则行根管治疗术(RCT组)。术后24 h、48 h、72 h采用视觉模拟评分(visual analogue scale,VAS)法评估患牙疼痛情况,对比3种治疗方式对疼痛控制的效果;术后1、3、6、12个月,通过患者症状、临床检查及根尖片进行疗效评价,对比3种治疗方式成功率;术后12个月对比3组患牙牙体功能。结果:PP组、FP组患者疼痛评分随时间逐渐降低(P均<0.01),与术前比较,3组患牙术后72 h VAS评分明显降低(P均<0.01);同一时间点比较,术前、术后24 h 3组疼痛评分比较差异均无统计学意义(P>0.05),术后48、72 h PP组、FP组两组间疼痛评分比较差异均无统计学意义(P均>0.05),但PP组、FP组疼痛评分低于RCT组,差异均有统计学意义(P均<0.01)。3组患牙1、3、6、12个月成功率差异无统计学意义(P>0.05);术后12个月,3组患牙舒适、咀嚼、稳固、语言功能差异无统计学意义(P>0.05)。结论:部分冠髓切断术及冠髓切断术治疗龋源性露髓成熟恒牙效果良好,与根管治疗相比,术后疼痛控制效果更好,更利于提高远期疗效,是适合龋源性露髓成熟恒牙的治疗方式。

Objective:To observe the clinical efficacy of pulpotomy in caries exposed pulps of mature permanent teeth,and to compare partial pulpotomy(PP)with full pulpotomy(FP)and root canal treatment(RCT)for pain control effect,clinical success rate and dental function.Methods:Ninety carious pulp exposed mature permanent teeth from 90 patients treated in the Stomatology department of the author's hospital were selected and divided into three groups according to different treatment measures.Partial coronal pulp was removed during the operation,and fresh pulp section was observed.If hemostasis could be achieved within 5 minutes,MTA partial pulpotomy(PP group)was performed.Otherwise,all coronal pulp could be removed to the root canal and hemostasis could be achieved within 5 minutes,MTA full pulpoctomy was performed(FP group).And root canal therapy(RCT group)was performed if hemostasis was not effective.Visual analogue scale(VAS)was used to evaluate the pain of the affected teeth 24,48 and 72 hours after surgery,and the effect of the three treatment methods was compared.Results:The pain score of PP group and FP group decreased gradually with time(P<0.01),and compared with preoperative conditions,the VAS of the three groups significantly decreased at 72 hours after surgery(P<0.01).Compared at the same time point,there were no statistically significant differences in pain scores among the three groups before surgery and 24 hours after surgery(P>0.05).There were no statistically significant differences in pain scores between the PP group and FP group at 48 and 72 hours after surgery(P>0.05),but the pain scores of the PP group and FP group were lower than those of the RCT group,and the differences were statistically significant(P<0.01).There was no significant difference in the success rate of patients with teeth at 1,3,6 and 12 months among three groups(P>0.05).At 12 months after surgery,there was no significant difference in dental comfort,chewing,stability and language function among three groups(P>0.05).Conclusion:Partial pulpotomy and full pulpotomy are effective in the treatment of mature teeth with caries derived pulp exposure.Compared with root canal therapy,it is more effective in postoperative pain control and can improve the long-term curative effect.It is a suitable treatment for mature teeth with caries derived pulp exposure.