Bjørndal Lars, Demant Sune, Dabelsteen Sally
Department of Cariology and Endodontics, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Cariology and Endodontics, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Oral Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Endod. 2014 Apr;40(4 Suppl):S76-81. doi: 10.1016/j.joen.2014.01.016.
Studies on dental regeneration involving interventions for pulp therapy such as regeneration and revascularization procedures are promising for the injured tooth; however, a complete replication of the original pulp tissue does not seem to take place. In cases in which we wish to preserve or maintain parts of the pulp during treatment, it is apparent that the effectiveness of healing or biological regeneration is dependent on the degree of inflammation of the pulp tissue. Thus, the control or prevention of a pulp infection is still a major issue for the clinicians. Data indicate that the typical reason for performing endodontic treatment is deep caries. The biological concept of vital pulp therapy associated with deep caries takes the treatment and evaluation of the unexposed as well as the exposed pulp into account. Interestingly, the clinical diagnosis is typically the same. Deep caries with reversible pulpitis may receive differing treatments such as excavation procedures aiming to avoid pulp exposure or more pulp invasive treatments such as pulp capping or pulpotomy. This should not be the case. Consequently, huge treatment variation is noted among clinicians based on the same caries diagnosis. Which treatment should be selected? High-quality trials are needed, and it is important to obtain information on the actual lesion depth and an estimate of the lesion activity before treatment. These may be basic indicators for the regenerative potential of dental pulp. Recent clinical trials dealing with the treatment of deep caries lesion are discussed, including pulp invasive and noninvasive concepts, to attempt to solve the task of getting the best clinical outcome for adult patients.
涉及牙髓治疗干预措施（如再生和血管化程序）的牙齿再生研究对于受损牙齿而言前景广阔；然而，原始牙髓组织似乎无法完全复制。在治疗过程中我们希望保留或维持部分牙髓的情况下，显然愈合或生物再生的有效性取决于牙髓组织的炎症程度。因此，控制或预防牙髓感染仍是临床医生面临的主要问题。数据表明，进行牙髓治疗的典型原因是深龋。与深龋相关的活髓治疗的生物学概念考虑了未暴露牙髓以及暴露牙髓的治疗和评估。有趣的是，临床诊断通常是相同的。患有可复性牙髓炎的深龋可能会接受不同的治疗，如旨在避免牙髓暴露的去龋程序，或更具侵入性的牙髓治疗，如盖髓术或牙髓切断术。情况不应如此。因此，基于相同的龋病诊断，临床医生之间存在巨大的治疗差异。应选择哪种治疗方法呢？需要高质量的试验，并且在治疗前获取有关实际病变深度和病变活动估计的信息很重要。这些可能是牙髓再生潜力的基本指标。本文讨论了近期处理深龋病变治疗的临床试验，包括牙髓侵入性和非侵入性概念，试图解决为成年患者获得最佳临床结果的任务。
