Department of Pediatric Dentistry, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
Department of Orthodontics, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Centre for Evidence-Based Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
J Endod. 2022 Sep;48(9):1129-1136. doi: 10.1016/j.joen.2022.03.015. Epub 2022 Apr 8.
This retrospective study aimed to evaluate the clinical and radiographic outcomes of regenerative endodontic procedures (REPs) for traumatic immature permanent teeth. Meanwhile, predictors influencing treatment outcomes were also analyzed to provide evidence for the management of immature teeth after different traumatic scenarios.
Traumatized immature permanent teeth diagnosed with pulp necrosis treated by REPs using blood clot or concentrated growth factor scaffolds with at least 6 months of follow-up were included from 2012 to 2021. Treatment outcomes were categorized as a success or failure and survival. Further root development was assessed in terms of the percentage changes in the apical diameter, root length, and radiographic root area. Among different injury types, the clinical and radiographic outcomes of REPs were evaluated by the Fisher exact test and the Kruskal-Wallis test, respectively. Survival analysis and Cox regression analysis were performed to identify significant predictors affecting outcomes.
Sixty-two teeth with a mean of 22.3 months of follow-up satisfied the criteria, and 80.6% of the teeth had a successful outcome. A significant change was observed in a decrease of the apical diameter (69.3%) and an increase of the radiographic root area (22.6%) after REPs. Among different injury types, the success rates of REPs were as follows: fracture, 84.6%; luxation, 83.3%; combined injuries, 78.6%; and avulsion, 33.3% (P > .05). Fractured teeth had a significantly greater decrease of the apical diameter than combined injuries (P < .05). Avulsion was more prone to developing root resorption than fracture (P < .05). Scaffold was a significant predictor for success; a blood clot had a significantly reduced risk for failure than concentrated growth factor (hazard ratio = 16; 95% confidence interval, 2.1-125.2; P < .001).
REPs provided satisfactory outcomes in traumatized immature permanent necrotic teeth. However, severe injuries, especially avulsion, should be determined carefully to perform REPs when resorption is expected. Scaffold selection may be an important consideration.
本回顾性研究旨在评估再生性牙髓治疗（REP）用于外伤性未成熟恒牙的临床和放射学效果。同时，还分析了影响治疗效果的预测因素，为不同创伤情况下未成熟牙齿的处理提供依据。
纳入了 2012 年至 2021 年期间因牙髓坏死接受 REP 治疗的外伤性未成熟恒牙根尖未发育完成的患者，治疗方法为使用血凝块或浓缩生长因子支架。所有患者均至少随访 6 个月。将治疗结果分为成功或失败和存活。进一步根据根尖直径、根长和放射根面积的百分比变化评估根的进一步发育。在不同的损伤类型中，采用 Fisher 确切检验和 Kruskal-Wallis 检验分别评估 REP 的临床和放射学结果。进行生存分析和 Cox 回归分析，以确定影响结果的显著预测因素。
符合标准的牙齿共 62 颗，平均随访时间为 22.3 个月，其中 80.6%的牙齿治疗成功。REP 后，根尖直径明显减小（69.3%），放射根面积明显增大（22.6%）。在不同的损伤类型中，REP 的成功率分别为：骨折 84.6%，脱位 83.3%，联合损伤 78.6%，离体 33.3%（P>.05）。与联合损伤相比，骨折牙齿的根尖直径减小更为显著（P<.05）。与骨折相比，脱位更易发生根吸收（P<.05）。支架是成功的显著预测因素；与浓缩生长因子相比，血凝块发生失败的风险显著降低（危险比=16；95%置信区间，2.1-125.2；P<.001）。
REP 为外伤性未成熟坏死恒牙提供了满意的效果。然而，对于严重损伤，尤其是离体，应谨慎确定是否进行 REP，因为预计会发生吸收。支架的选择可能是一个重要的考虑因素。
