Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Faculty of Dentistry, Chiang Mai, Thailand.
Division of Operative Dentistry, Department of Restorative Dentistry and Periodontology, Chiang Mai University, Faculty of Dentistry, Chiang Mai, Thailand.
Eur Endod J. 2023 Jan;8(1):37-46. doi: 10.14744/eej.2022.18894.
This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients.
The dental records of patients aged 6 to 18 years with VPT-treated permanent molars restored with resin composites were retrospectively evaluated for the presence of fractures on these teeth. Kaplan-Meier methods were used to estimate the survival probabilities. The potential risk factors were assessed using the multivariable Cox proportional hazard model.
A total of 234 treated molars from 189 patients were included. An overall average follow-up time was 33.34+-20.54 months (ranging from 6 to 83 months). At the end of the study, 21.8% of molars had fractures with the majority of them (92.2%) were restorable. Radiographically, only 3.9% of the fractured molars had periapical lesions and considered VPT failures. The percentages of the fracture types are as follows: 54.9% natural tooth structure fracture, 27.5% restoration fracture, and 17.6% combination fracture. The most common fracture location among the 37 molars with natural tooth fracture (either alone or in combination with restoration fracture) was at the marginal ridge (59.5%), followed by the marginal ridge extending to cusp (21.6%), and the cusp itself (18.9%). The cumulative survival probabilities of these teeth decreased over time, reaching 66.02% (95% CI: 55.89-74.36) after 5 years. VPT-treated molars in the mandible had a 2.1 times higher risk of fracture than those in the maxilla. Furthermore, the molars treated with partial and coronal pulpotomy had 2.4 times and 4.6 times higher risks of fracture when compared to those with indirect pulp capping, respectively.
In VPT-treated permanent molars in young patients, more fractures were seen in mandibular teeth and in teeth with pulp roof removal (partial and coronal pulpotomy). Clinicians should plan for proper restoration on these teeth. (EEJ-2022-08-097).
本研究旨在评估微创牙髓切断术（VPT）治疗的年轻患者恒磨牙用直接树脂复合材料修复后的生存情况和风险因素。
对微创牙髓切断术治疗并用树脂复合材料修复的 6 至 18 岁患者的恒磨牙的牙体折裂情况进行回顾性评估。采用 Kaplan-Meier 方法估计生存率。采用多变量 Cox 比例风险模型评估潜在的风险因素。
共纳入 189 名患者的 234 颗治疗磨牙。平均随访时间为 33.34+-20.54 个月（6 至 83 个月）。研究结束时，21.8%的磨牙发生折裂，其中大部分（92.2%）可修复。影像学上，仅有 3.9%的折裂磨牙有根尖病变，被认为是 VPT 失败。折裂类型的比例如下：54.9%为天然牙结构折裂，27.5%为修复体折裂，17.6%为联合折裂。37 颗发生天然牙折裂（单独或与修复体折裂联合）的磨牙中最常见的折裂部位是边缘嵴（59.5%），其次是边缘嵴延伸到牙尖（21.6%），以及牙尖本身（18.9%）。这些牙齿的累积生存率随时间下降，5 年后为 66.02%（95%CI：55.89-74.36）。下颌磨牙发生折裂的风险比上颌磨牙高 2.1 倍。此外，与间接盖髓相比，行部分牙髓切断术和冠髓切断术的磨牙发生折裂的风险分别高 2.4 倍和 4.6 倍。
在年轻患者的微创牙髓切断术治疗的恒磨牙中，下颌磨牙和牙髓顶去除（部分牙髓切断术和冠髓切断术）的磨牙更容易发生折裂。临床医生应针对这些牙齿进行适当的修复。（EEJ-2022-08-097）。
