Private Endodontic Practice, Cetraro, Italy.
Postgraduate Program in Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Genetics Laboratory, Grande Rio University, and Human Genetics Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
J Endod. 2023 Jan;49(1):45-54. doi: 10.1016/j.joen.2022.11.005. Epub 2022 Nov 12.
This retrospective study evaluated the long-term outcome of direct pulp capping in mature teeth using specific case selection and treatment procedures.
Teeth with pulp exposure due to advanced caries and clinical diagnosis of reversible pulpitis were treated by direct pulp capping. Treatments were conducted over a period of 15 years by a single operator. Under magnification, caries was completely removed, the exposed pulp examined, and capped with either pure calcium hydroxide or a calcium hydroxide-based cement. The cavity was restored and the long-term outcome evaluated from 1 to >35 years. Teeth that were asymptomatic, responded to sensibility pulp tests within normal limits, and showed no radiographic periapical changes were categorized as success. Teeth with no response to pulp tests and/or showing radiographic evidence of apical periodontitis were classified as failures. The effects of independent variables (sex, age, symptoms, number and size of pulp exposures, bleeding time, capping material, bases used over the capping material, and final coronal restoration) on the outcome were evaluated.
In general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods. The success rate of the direct pulp capping procedure was 100%, 95%, 95%, 86%, and 89% at 1-, 5-, 10-, 20-, and 35-year follow-up examination, respectively. The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001). Other isolated variables associated with the outcome included the size and number of pulp exposures at the 20-year follow-up, and the exposure size, capping material, and restoration type at the 35-year follow-up. Multiple regression analysis confirmed the results for exposure size (P < .05), and disclosed a higher proportion of failures at 5 years when varnish was used as the base.
A very high success rate of the direct pulp capping with calcium hydroxide was observed, especially in the first 10 years following treatment. The main variable influencing the outcome was the quality of the coronal restoration.
本回顾性研究通过特定的病例选择和治疗程序，评估了用盖髓术治疗成熟恒牙牙髓暴露的长期疗效。
对于因深龋导致的牙髓暴露且临床诊断为可复性牙髓炎的患牙，采用直接盖髓术治疗。该治疗由一位医生在 15 年内完成。在放大条件下，彻底清除龋坏组织，检查暴露的牙髓，并用纯氢氧化钙或氢氧化钙基水泥盖髓。用玻璃离子水门汀垫底后修复窝洞，并在 1 年至>35 年内对长期疗效进行评估。无症状、牙髓测试反应正常、无根尖周放射影像改变的患牙为成功。无牙髓测试反应和/或有根尖周放射影像证据的患牙为失败。评估了性别、年龄、症状、牙髓暴露的数量和大小、出血时间、盖髓材料、盖髓材料上使用的基底、最终的冠部修复等独立变量对疗效的影响。
一般来说，在至少一个评估时间段内，148 名患者的 225 颗牙可进行随访检查。直接盖髓术的成功率分别为 100%、95%、95%、86%和 89%，在 1 年、5 年、10 年、20 年和 35 年的随访检查中。在所有随访期间，对治疗效果影响最大的主要变量是冠部修复的质量/存在（P<.001）。其他与疗效相关的孤立变量包括在 20 年随访时牙髓暴露的大小和数量，以及在 35 年随访时暴露的大小、盖髓材料和修复类型。多元回归分析证实了暴露大小的结果（P<.05），并显示在使用清漆作为基底时，5 年时失败的比例更高。
用氢氧化钙进行直接盖髓术的成功率非常高，尤其是在治疗后的头 10 年。影响疗效的主要变量是冠部修复的质量。
