Rakhmanova M S, Korolenkova M V
National Medical Research Center of Dentistry and Maxillofacial Surgery, Moscow, Russia.
Stomatologiia (Mosk). 2020;99(6):55-63. doi: 10.17116/stomat20209906155.
Was to compare the efficacy of Ca(OH) apexification and regenerative endodontic procedure (REP) in immature teeth with pulp necrosis. The pilot study included 12 children aged 89 to 126 months having pulp necrosis in immature incisors. Dental trauma was the etiology for pulp necrosis in all cases and initial X-rays showed periapical translucency lesions (PTL). The patients were randomly divided in 2 groups with either Ca(OH) apexification (group 1, =6) or REP (group 2, =6). The root length and the growth of root wall thickness, as well as root to crown ratio and dentinal wall to root canal space ratio was assessed radiologically in 6, 12 and 24 months. The root length increase was detected in 83% of all cases, but the pattern of root dentine growth in the groups was different. Dentin thickness in REP group was more prominent in the apical third and was observed in 100% of cases while in group 1 dentin thickness increased mainly in the coronal and middle third of the root, dentin thickness increased only in 33% of all cases in the apexification group. PTL were successfully eliminated in both groups.
Results and complications of both methods allow limiting indications for their usage. Ca(OH) apexification is more reliable in cases of pulp necrosis in teeth with III and IV stages of root formation when an estimated time for apexification is 3 to 6 months, under condition of good patient cooperation and possibility for good marginal fit of the restoration. REP is indicated in cases with I, II and III stages of root formation, as well as initial root resorption signs regardless of root formation stage.
比较氢氧化钙根尖诱导成形术与牙髓再生治疗术（REP）对牙髓坏死的未成熟恒牙的疗效。该初步研究纳入了12名年龄在89至126个月之间、未成熟切牙髓坏死的儿童。所有病例中，牙髓坏死的病因均为牙外伤，最初的X线片显示根尖周透射性病变（PTL）。患者被随机分为两组，一组接受氢氧化钙根尖诱导成形术（第1组，n = 6），另一组接受牙髓再生治疗术（第2组，n = 6）。分别在6个月、12个月和24个月时通过影像学评估牙根长度、根壁厚度的生长情况，以及根冠比和牙本质壁与根管空间比。所有病例中83%检测到牙根长度增加，但两组牙根牙本质生长模式不同。牙髓再生治疗术组的牙本质厚度在根尖三分之一处更为显著，100%的病例均有此现象，而在第1组中，牙本质厚度主要在牙根的冠部和中部三分之一处增加，根尖诱导成形术组所有病例中仅有33%的病例牙本质厚度增加。两组的根尖周透射性病变均成功消除。
两种方法的结果和并发症决定了其适用范围。当估计根尖诱导成形时间为3至6个月时，在患者配合良好且修复体边缘密合性良好的情况下，氢氧化钙根尖诱导成形术对于处于牙根形成III期和IV期且牙髓坏死的牙齿更为可靠。牙髓再生治疗术适用于牙根形成I期、II期和III期的病例，以及无论牙根形成阶段如何均有初始牙根吸收迹象的病例。
