Vreven J, Jones P, van Nieuwenhuysen J P, Lasfargues J J
Ecole de Médecine Dentaire et Stomatologie UCL, Bruxelles, Belgique.
Real Clin. 1990 Apr;1(2):135-53.
There are many circumstances under which the condition of the pulp calls for root canal work, due to the real or potential risk of pain, infection, inflammation or functional difficulties (acute, irreversible pulpitis, chronic pulpitic conditions, necrosis and its consequences, etc.). Other circumstances exist in which injury to the pulp is not necessarily irreversible: initial pulpitis, iatrogenic fracture of the pulp, traumatisms, dystrophic deteriorations. The high success rate for endodontic therapy could argue for elimination of impaired or necrose-prone pulp. In fact, however, unsuccessful pulpectomies often lead to loss of the dental organ and successful endodontic treatment severely weakens the whole tooth structure and often implies prosthetic restoration, with the consequent increase in tissular loss. In order to preserve pulp and crown tissues, pulpal vitality should be protected in all cases where such conservative efforts do not worsen the prognosis for maintaining the tooth on its arch or jeopardize a planned restoration. Solutions are presented for various types of situations, according to the risks encountered.
由于存在疼痛、感染、炎症或功能障碍的实际或潜在风险（急性、不可逆性牙髓炎、慢性牙髓炎情况、坏死及其后果等），牙髓状况需要进行根管治疗的情况有很多。还存在其他一些情况，牙髓损伤不一定是不可逆的：初期牙髓炎、医源性牙髓骨折、创伤、营养不良性恶化。牙髓治疗的高成功率可能支持消除受损或易坏死的牙髓。然而，事实上，不成功的牙髓切除术常常导致牙齿缺失，而成功的牙髓治疗会严重削弱整个牙齿结构，并且常常意味着需要进行修复治疗，从而导致组织损失增加。为了保留牙髓和牙冠组织，在所有保守治疗不会使牙齿在牙弓上保留的预后变差或危及计划中的修复的情况下，都应保护牙髓活力。根据所遇到的风险，针对各种情况提出了解决方案。
