Mass Eliyahu, Zilberman Uri
The Barzilai Medical Center, Hahistadrut 2, Ashkelon 78278, Israel.
Quintessence Int. 2011 Jul-Aug;42(7):547-54.
Radiographic appearance of pulp reactions to partial pulpotomy in young permanent molars with deep caries may determine the efficiency of the procedure. The objective of this study was to determine the value of this procedure by analyzing the pulpal and periapical appearance of permanent molars after long-term follow-up periods.
Based on predetermined radiologic criteria, periapical radiographs of 49 young permanent molars of 31 females and 13 males, aged 6.9 to 17.7 years (mean, 11.4 years) treated with partial pulpotomy were evaluated and compared to their antimeres. Follow-up time ranged from 7 to 154 months (mean, 49 months).
Based on clinical and radiographic findings, the success rate was considered 93.9% (46 of 49 teeth). Three teeth had chronic pulpitis with periapical exacerbation. In 14 (30.4%) of the 46 teeth, normal radiographic pulp appearance was found, and in 2 (4.3%), pulpal calcifications were similar to their antimere tooth. Dentinal bridges were observed underneath the partial pulpotomy site in 27 molars (58.7%), while radiopacities in the pulpotomized pulp horns of 5 teeth (10.9%) suggested development of obstructive calcifications. Increased calcifications of the pulp were seen in 13 (28.3%) molars, in comparison with their antimeres. Six of the 46 molars with immature root development completed full apexogenesis. No periapical pathoses, total pulp obliteration, or resorption were observed.
The long-term radiologic interpretation of the pulp after partial pulpotomy in young permanent molars supports the clinical impression that it is a warranted treatment in well-chosen cases.
深龋年轻恒牙行部分活髓切断术后牙髓反应的影像学表现可决定该治疗方法的有效性。本研究的目的是通过分析长期随访后恒牙的牙髓和根尖周表现来确定该治疗方法的价值。
根据预先确定的放射学标准，对31名女性和13名男性的49颗年龄在6.9至17.7岁（平均11.4岁）的年轻恒牙进行部分活髓切断术治疗后的根尖片进行评估，并与对侧同名牙进行比较。随访时间为7至154个月（平均49个月）。
根据临床和影像学检查结果，成功率为93.9%（49颗牙中的46颗）。3颗牙患有慢性牙髓炎伴根尖周病变加重。在46颗牙中的14颗（30.4%），发现牙髓影像学表现正常，2颗（4.3%）牙髓钙化与其对侧同名牙相似。在27颗磨牙（58.7%）的部分活髓切断术部位下方观察到牙本质桥，而5颗牙（10.9%）的活髓切断术牙髓角出现不透光区提示有阻塞性钙化形成。与对侧同名牙相比，13颗磨牙（28.3%）牙髓钙化增加。46颗牙根发育未成熟的磨牙中有6颗完成了根尖形成。未观察到根尖周病变、牙髓完全闭锁或吸收。
年轻恒牙部分活髓切断术后牙髓的长期影像学解读支持了临床印象，即在精心选择的病例中，该治疗方法是合理的。
