Iaculli Flavia, Rodríguez-Lozano Francisco Javier, Briseño-Marroquín Benjamín, Wolf Thomas Gerhard, Spagnuolo Gianrico, Rengo Sandro
Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", 80131 Naples, Italy.
Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain.
J Clin Med. 2022 Jul 11;11(14):4016. doi: 10.3390/jcm11144016.
Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries' lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory mediators and of post-operative pain. Pain plays a central role in the chance to perform VPT in mature permanent teeth, since it may be considered as a pre-operative diagnostic criterion as well as a treatment success parameter. In addition, proper assessment of pulp inflammation and choice of appropriate materials are key factors in enhancing VPT success.
近期，即使对于患有深龋病变的有症状成熟恒牙，也有人提出将活髓治疗（VPT）作为一种替代方法，旨在长期维持牙髓活力和/或避免非手术根管治疗（NSRCT）。然而，迄今为止，可逆性或不可逆性牙髓炎的诊断仅基于临床疼痛的程度和性质，并未准确反映牙髓炎症状态。因此，本研究的目的是基于当前科学文献提供综述，以证明VPT对成熟恒牙的临床有效性，验证水硬性硅酸钙基水门汀的应用及其在疼痛管理中的作用。VPT不仅可以成功应用于诊断为可逆性牙髓炎的成熟恒牙，也可应用于有不可逆性牙髓炎体征和症状的恒牙。水硬性水门汀在降低促炎介质和术后疼痛方面显示出良好效果。疼痛在成熟恒牙进行VPT的可能性中起着核心作用，因为它既可以被视为术前诊断标准，也可以作为治疗成功的参数。此外，正确评估牙髓炎症和选择合适的材料是提高VPT成功率的关键因素。
