一项关于牙体预备后无症状性牙髓坏死发生率的前瞻性研究。

A prospective study of the incidence of asymptomatic pulp necrosis following crown preparation.

机构信息

Department of Endodontics, Dental School, University of Athens, Athens, Greece.

Private Practice Limited to Endodontics, Patra, Greece.

出版信息

Int Endod J. 2015 Jun;48(6):512-7. doi: 10.1111/iej.12340. Epub 2014 Jul 12.

DOI:10.1111/iej.12340

PMID:24964352

Abstract

AIM

To determine the incidence of asymptomatic pulp necrosis following crown preparation as well as the positive predictive value of the electric pulp testing.

METHODOLOGY

A total of 120 teeth with healthy pulps scheduled to receive fixed crowns (experimental teeth) were included. Teeth were divided into two groups according to the preoperative crown condition (intact teeth and teeth with preoperative caries, restorations or crowns) and into four groups according to tooth type (maxillary anterior teeth, maxillary posterior teeth, mandibular anterior teeth and mandibular posterior teeth). Experimental and control teeth were submitted to electric pulp testing on three different occasions before treatment commencement (stage 0), at the impression making session (stage 1) and just before the final cementation of the crown (stage 2). Teeth that were considered to contain necrotic pulps were submitted to root canal treatment. Upon access, absence of bleeding was considered as a confirmation of pulp necrosis. Data were analysed using bivariate (chi-square) and multivariate analysis (logistic regression). All reported probability values (P-values) were based on two-sided tests and compared to a significance level of 5%.

RESULTS

The overall incidence of pulp necrosis was 9%. Intact teeth had a significantly lower incidence of pulp necrosis (5%) compared with preoperatively structurally compromised teeth (13%) [(OR: 9.113, P = 0.035)]. No significant differences were found amongst the four groups with regard to tooth type (P = 0.923). The positive predictive value of the electric pulp testing was 1.00.

CONCLUSIONS

The incidence of asymptomatic pulp necrosis of teeth following crown preparation is noteworthy. The presence of preoperative caries, restorations or crowns of experimental teeth correlated with a significantly higher incidence of pulp necrosis. Electric pulp testing remains a useful diagnostic instrument for determining the pulp condition.

摘要

目的

确定牙体预备后无症状性牙髓坏死的发生率以及牙髓活力电测试的阳性预测值。

方法

共纳入 120 颗牙髓健康的拟行固定修复牙（实验组）。根据术前牙冠状态（完整牙和术前有龋坏、修复体或牙冠的牙）将牙分为两组，并根据牙位（上颌前牙、上颌后牙、下颌前牙和下颌后牙）分为四组。在治疗开始前（0 期）、取印模时（1 期）和最终牙冠粘固前（2 期），实验组和对照组牙分别进行三次牙髓活力电测试。认为有坏死牙髓的牙行根管治疗。开髓时无出血被认为是牙髓坏死的确认。数据采用双变量（卡方）和多变量分析（逻辑回归）进行分析。所有报告的概率值（P 值）均基于双侧检验，与 5%的显著性水平相比。