Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan.
Private Practice, Jackson, Michigan.
J Endod. 2017 Sep;43(9S):S75-S81. doi: 10.1016/j.joen.2017.07.009.
Clinicians face many challenges when treating immature permanent teeth in young patients. Immediate blood clot induction can be a successful option as described by some case reports. No experimental studies or clinical trials have addressed this question. We have designed a clinical trial in which we hypothesized that there is no difference in success between immediate or delayed induction protocols. After confirmation of pulpal necrosis, patients were randomized. In the delayed group, 15 teeth were treated following the American Association of Endodontists guidelines, and calcium hydroxide was used as the intracanal medication. In the immediate group, 13 teeth had a blood clot inducted at the first appointment. The teeth were evaluated after 1, 3, and 12 months. Three independent evaluators assessed the periapical healing. The Pearson chi-square test or the Fisher exact test was used to compare the success rates between the 2 groups. Currently, of the 25 recruited patients (28 teeth), 19 have completed their 12-month follow-up. The group with delayed induction had a 71% success rate, and the group with immediate induction had a 33% success rate. In most cases (79%), trauma was the etiology. All successful cases started at stage 9 of root development (Nolla), and the majority showed healing type 2. Determination of the stage of root formation and etiology are possible critical factors for any therapeutic decision. In summary, it is early to conclude or suggest any of the protocols. Clearly, much more data are needed before sample size requirements can be met.
临床医生在治疗年轻患者的未成熟恒牙时面临许多挑战。一些病例报告描述了即刻诱导血凝块是一种成功的选择。目前还没有实验研究或临床试验来解决这个问题。我们设计了一项临床试验，假设即刻或延迟诱导方案之间的成功率没有差异。在确认牙髓坏死后，患者被随机分组。在延迟组中，根据美国牙髓病学会指南治疗了 15 颗牙齿，并使用氢氧化钙作为根管内用药。在即刻组中，13 颗牙齿在第一次就诊时诱导了血凝块。在 1、3 和 12 个月后对牙齿进行评估。三名独立评估者评估根尖愈合情况。采用 Pearson 卡方检验或 Fisher 确切概率检验比较两组的成功率。目前，在 25 名入组患者（28 颗牙）中，有 19 名完成了 12 个月的随访。延迟诱导组的成功率为 71%，即刻诱导组的成功率为 33%。在大多数情况下（79%），创伤是病因。所有成功的病例均从根尖发育阶段 9 开始（Nolla），大多数显示愈合类型 2。确定根尖形成的阶段和病因是任何治疗决策的关键因素。总之，现在下结论或建议任何方案都为时过早。显然，在满足样本量要求之前，还需要更多的数据。
