中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (4): 499-503.doi: 10.3969/j.issn.2095-4344.2359

• 组织工程口腔材料 tissue-engineered oral materials • 上一篇    下一篇

不同生物活性支架治疗年轻恒牙再生牙髓活力的比较

李文静，李浩渤，刘从娜，程东梅，陈惠珍，张志勇   

  1. 河北医科大学第二医院口腔内科，河北省石家庄市   050000
  • 收稿日期:2019-11-16 修回日期:2019-11-20 接受日期:2020-02-14 出版日期:2021-02-08 发布日期:2020-11-21
  • 通讯作者: 张志勇，主任医师，河北医科大学第二医院口腔内科，河北省石家庄市 050000
  • 作者简介:李文静，女，1978年生，河北省石家庄市人，汉族，2008年河北医科大学毕业，硕士，副主任医师，主要从事牙体牙髓病研究。
  • 基金资助:
    河北省科技计划项目(17277795D)

Comparison of different bioactive scaffolds in the treatment of regenerative pulp of young permanent teeth

Li Wenjing, Li Haobo, Liu Congna, Cheng Dongmei, Chen Huizhen, Zhang Zhiyong   

  1. Department of Oral Medicine, Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
  • Received:2019-11-16 Revised:2019-11-20 Accepted:2020-02-14 Online:2021-02-08 Published:2020-11-21
  • Contact: Zhang Zhiyong, Chief physician, Department of Oral Medicine, Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
  • About author:Li Wenjing, Master, Associate chief physician, Department of Oral Medicine, Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
  • Supported by:
    the Science and Technology Plan Project of Hebei Province, No. 17277795D

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摘要：

文题释义：
再生性牙髓治疗：年轻恒压由于受外力损伤或牙髓炎可导致牙髓坏死，导致牙齿发育中断，根尖不能闭合，若直接填充或根管治疗可导致牙齿损坏脱离。再生性牙髓治疗可以对新鲜的损伤牙髓进行一定程度的暂时功能替代、诱导，进而促进根管继续发育，实现根尖孔闭合，其中关键的操作是选择合适的支架覆盖牙髓。
根尖孔封闭：正常情况下发育完成的牙根尖孔是封闭的，但年轻恒压受损后处理不当会导致发育中断，根尖孔无法封闭，导致牙齿不完整、不稳定，容易破碎脱离。通过再生性牙髓治疗可促进根尖继续发育，实现封闭。

背景：再生性牙髓治疗具有生物相容性好、牙根发育完善、牙髓活力保存率高等优点，其血管再生过程中需要借助支架以维持干细胞的生存和血管再生。
目的：分析不同生物活性支架应用于年轻恒牙再生性牙髓治疗的效果。
方法：选择2016年6月至2018年6月河北医科大学第二医院收治的急性牙髓炎患者160例(患牙168颗)，年龄8-16岁，按病因分为外伤组(n=92)和龋齿组(n=76)，每组内分别使用4种支架进行再生性牙髓治疗，4种支架分别为三氧化矿物聚合物(MTA组)、iRoot BP Plus、自体富血小板纤维蛋白联合三氧化矿物聚合物(PRF+MTA组)、脱细胞真皮基质联合三氧化矿物聚合物(ADM+MTA组)。记录1，3，6，12，24个月患牙的牙体色泽、牙髓活力、萌出高度，采用X射线摄像比较根管长度、根管壁厚度、根尖周暗影及根尖孔封闭情况，统计成功率。研究获得河北医科大学第二医院伦理委员会批准。
结果与结论：①外伤组末次随访时，4种支架组间的牙体色泽、牙髓活力、萌出高度比较差异无显著性意义(P > 0.05)，4种支架组间的根管长度、根管壁厚度、根尖周暗影、根尖孔封闭情况比较差异有显著性意义(P < 0.05)，其中PRF+MTA组效果最好；②龋齿组末次随访时，4种支架组间的牙体色泽、牙髓活力、萌出高度比较差异无显著性意义(P > 0.05)，4种支架组间的根管长度、根管壁厚度、根尖周暗影、根尖孔封闭情况比较差异有显著性意义(P < 0.05)，其中PRF+MTA组效果最好；③无论是外伤组还是龋齿组，4种支架组间的治疗成功率比较差异有显著性意义(P < 0.05)，其中以PRF+MTA组最高；④结果表明，自体富血小板纤维蛋白联合三氧化矿物聚合物在年轻恒牙再生性牙髓治疗中有优秀的生物诱导性，较其他支架能更好地保存牙髓活力，诱导年轻恒牙牙根形成，提高治疗成功率。

https://orcid.org/0000-0002-6997-1927 (李文静)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程


关键词: 材料, 支架, 生物活性支架, 牙髓, 牙髓炎, 恒牙, 牙髓活力, 生物诱导

Abstract: BACKGROUND: Regenerative endodontic therapy has the advantages of good biocompatibility, complete root development and high pulp vitality preservation rate. During vascular regeneration, scaffold is needed to maintain the survival of stem cells and vascular regeneration.   
OBJECTIVE: To analyze the effect of different bioactive scaffolds on regenerative pulp of young permanent teeth.
METHODS: Totally 160 patients (168 teeth) with acute pulpitis at the age of 8 to 16 years, who were treated in the Second Hospital of Hebei Medical University from June 2016 to June 2018, were enrolled in this study. The patients were divided into traumatic group (n=92) and dental caries group (n=76) according to a cause of a disease. Each group was subdivided into mineral trioxide aggregate (MTA), iRoot BP Plus, autologous platelet-rich fibrin (PRF)+MTA and acellular dermal matrix (ADM)+MTA subgroups. The corresponding stents were used to treat regenerative pulp. At 1, 3, 6, 12 and 24 months, the tooth color, pulp vitality, and eruption height were recorded. Root canal length, root canal wall thickness, periapical shadow and apical foramen closure were compared using X-ray photography; and the success rate was calculated. This study was approved by the Ethics Committee of Second Hospital of Hebei Medical University. 
RESULTS AND CONCLUSION:  (1) At the final follow-up in the traumatic group, tooth color, pulp vitality and eruption height were not significantly different among the four scaffold subgroups (P > 0.05). Root canal length, root canal wall thickness, periapical shadow and apical foramen occlusion were significantly different among the four scaffold subgroups (P < 0.05). Among them, the effect was best in the PRF+MTA subgroup. (2) At the final follow-up in the dental caries group, tooth color, pulp vitality and eruption height were not significantly different among the four scaffold subgroups (P > 0.05). Root canal length, root canal wall thickness, periapical shadow and apical foramen occlusion were significantly different among the four scaffold subgroups (P < 0.05). Among them, the effect was best in the PRF+MTA subgroup. (3) No matter traumatic group or dental caries group, the success rate was significantly different among the four scaffold subgroups (P < 0.05); and the success rate was highest in the PRF+MTA subgroup. (4) Results verified that PRF combined with MTA has excellent biological induction in the treatment of young permanent teeth with regenerative pulp. Compared with other scaffolds, it can better preserve pulp vitality, induce the formation of young permanent teeth roots and improve the success rate of treatment.

Key words: materials, scaffolds, bioactive scaffolds, pulp, pulpitis, permanent teeth, pulp vitality, biological induction

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