The Department of Stomatology, Jieyang Affiliated Hospital, SunYat-sen University, Jieyang, Guangdong, PR China.
The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, PR China.
Eur J Paediatr Dent. 2021 Sep;22(3):207-214. doi: 10.23804/ejpd.2021.22.03.6.
Immature necrotic teeth are frequent findings in adolescents that may lead to thin root walls and open apexes. The absence of an apical stop becomes a challenge for endodontic treatment because it is difficult or impossible to seal the immature root canal with conventional endodontic techniques. Revascularisation therapy (RET) may be more suitable for the treatment of immature necrotic teeth. However, clinicians are still more inclined to choose apexification (AP) when considering the predictability of treatment results.
The literature was searched via PubMed/MEDLINE and the Cochrane Library, Web of Science data from June, 2001 to September, 2020 and randomised clinical trials were selected that compared RET with AP for the treatment of immature necrotic teeth assessing clinical and radiographic results.
A total of 556 articles were retrieved, though only five studies were included. There were no differences in the periapical healing rate, overall effective rate/invalid rate, or apical closure rate between RET and AP. The root length was significantly increased in the RET group compared with the AP group quantitatively (pooled difference in means=1.28, 95% CI: [1.08, 1.48], Z=12.69, P<0.00001) and qualitatively (pooled RR=4.12, 95% CI: [2.44, 6.97]), Z=5.28, P<0.00001). The effective rate of root thickness was significantly increased in the RET group compared with the AP group (pooled RR=22.63, 95% CI: [6.08, 84.26]), Z=4.65, P<0.00001).
Both RET and AP were effective options regarding the healing of periapical periodontitis or the closure of open apices. Pulp revascularisation is more effective for root elongation and thickening without higher risk of overall invalid treatment.
未成熟坏死牙在青少年中很常见，这可能导致牙根壁变薄和根尖敞开。由于用传统根管治疗技术难以或不可能封闭未成熟的根管，根尖停止发育成为根管治疗的挑战。血管再生活性治疗（REV）可能更适合治疗未成熟坏死牙。然而，在考虑治疗结果的可预测性时，临床医生仍然更倾向于选择根尖诱导成形术（AP）。
通过 PubMed/MEDLINE 和 Cochrane 图书馆、Web of Science 数据库（2001 年 6 月至 2020 年 9 月）检索文献，并选择比较 REV 和 AP 治疗未成熟坏死牙的随机临床试验，评估临床和影像学结果。
共检索到 556 篇文章，但仅纳入了 5 项研究。REV 和 AP 治疗未成熟坏死牙的根尖周愈合率、总有效率/无效率或根尖闭合率无差异。REV 组的根长较 AP 组明显增加（定量：均数差值=1.28，95%可信区间：[1.08，1.48]，Z=12.69，P<0.00001；定性：RR=4.12，95%可信区间：[2.44，6.97]，Z=5.28，P<0.00001）。REV 组的根厚有效率明显高于 AP 组（RR=22.63，95%可信区间：[6.08，84.26]，Z=4.65，P<0.00001）。
REV 和 AP 在治疗根尖周炎愈合或根尖敞开方面均为有效选择。牙髓血管再生活性治疗更有利于牙根伸长和增粗，且整体无效治疗的风险没有增加。
