Angle Orthod. 2020 Sep 1;90(5):695-701. doi: 10.2319/022520-129.1.
To assess changes in pulp blood flow (PBF) and pulp sensibility (PS) in teeth of patients with a history of dental trauma undergoing maxillary expansion.
Twenty-five patients requiring rapid maxillary expansion (RME) had the pulp status of their maxillary anterior teeth assessed using laser Doppler flowmetry, electric pulp testing, and thermal testing (CO2 snow). Each patient was tested at T1 (prior to expansion), T2 (2 weeks after rapid expansion), and T3 (3 months after expansion). Relationships between PBF, time interval, and history of trauma were evaluated using linear mixed modelling.
Within the Trauma group, PBF was significantly lower (P ≤ .05) at T2 and T3 in comparison to T1 and significantly lower (P ≤ .05) at T2 in comparison to T3. In the Non-trauma group, PBF at T2 was significantly lower (P ≤ .05) than PBF at T1 and T3; however, no significant difference (P > .05) in PBF was observed when comparing PBF at T1 and T3. In both groups, PS was maintained in almost all teeth (>90%).
RME in healthy teeth causes reduction of PBF before reestablishment of pretreatment values. RME in traumatized teeth causes reduction of PBF without PBF being reestablished to pretreatment levels. Teeth with a history of compromise may have reduced adaptive capacity under insults such as RME, which should be appreciated during the informed consent process.
评估有牙外伤史的患者行上颌扩弓后牙髓血流(PBF)和牙髓感觉(PS)的变化。
25 例需行快速上颌扩弓(RME)的患者使用激光多普勒血流仪、电活力测试和热测试(CO2 雪)评估其上颌前牙的牙髓状态。每位患者分别在 T1(扩弓前)、T2(扩弓后 2 周)和 T3(扩弓后 3 个月)时进行测试。使用线性混合模型评估 PBF、时间间隔和外伤史之间的关系。
在创伤组中,T2 和 T3 时 PBF 明显低于 T1(P ≤.05),T2 时明显低于 T3(P ≤.05)。在非创伤组中,T2 时 PBF 明显低于 T1 和 T3(P ≤.05);然而,T1 和 T3 时 PBF 之间无显著差异(P >.05)。两组中,PS 在几乎所有牙齿中(>90%)均得以维持。
健康牙齿的 RME 会导致 PBF 降低,直至恢复到治疗前水平。外伤牙的 RME 会导致 PBF 降低,且 PBF 无法恢复到治疗前水平。有过损伤史的牙齿在受到 RME 等刺激时可能会降低适应能力,在知情同意过程中应注意这一点。