J Am Dent Assoc. 2023 Jun;154(6):486-494. doi: 10.1016/j.adaj.2023.02.018. Epub 2023 Apr 28.
The authors studied the treatment effect of full pulpotomy using a calcium silicate-based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis.
Eighty-one adult permanent teeth with symptoms indicative of irreversible pulpitis in 78 patients aged 18 through 72 years were evaluated for inclusion in the study. After caries excavation, the pulp was amputated to the level of the canal orifices. After hemostasis was achieved, calcium silicate-based bioactive ceramic was placed as the capping agent. The cavity was sealed temporarily with a glass ionomer cement and then restored with flowable resin and composite resin after 2 weeks if no positive symptoms were reported or detected. Postoperative evaluation was performed by means of clinical and radiographic examination at 2 weeks and 3, 6, and 12 months.
Overall success rates of the procedure were 96.3% (78 of 81), 93.8% (76 of 81), 92.6% (75 of 81), and 92.6% (75 of 81) at the 2-week, 3-month, 6-month, and 12-month recall visits, respectively. Six of the 81 teeth failed and required root canal therapy. In these 6 teeth, 3 exhibited severe cold stimuli pain and spontaneous pain at the 2-week follow-up, 2 had no response to electric pulp testing with apical percussion pain and periapical rarefaction at the 3-month follow-up, and 1 tooth exhibited periapical rarefaction and labial mucosal fistula at the 6-month follow-up.
Under the conditions of this study, full pulpotomy using a calcium silicate-based bioactive ceramic was a successful option for the treatment of adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis.
Vital pulp therapy is no longer impossible for adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis.
作者研究了使用基于硅酸钙的生物活性陶瓷对有不可逆性牙髓炎症状的成年恒牙进行全牙髓切断术的治疗效果。
对 78 名年龄在 18 至 72 岁的患者的 81 颗有不可逆性牙髓炎症状的恒牙进行评估，以纳入研究。在龋蚀清除后，将牙髓切除至根管口水平。止血后，将基于硅酸钙的生物活性陶瓷作为盖髓剂放置。如果没有阳性症状报告或检测到，用玻璃离子水门汀暂时封闭腔隙，然后在 2 周后用流动树脂和复合树脂进行修复。术后 2 周、3、6 和 12 个月进行临床和影像学检查。
2 周、3 个月、6 个月和 12 个月的复诊时，该手术的总体成功率分别为 96.3%（78/81）、93.8%（76/81）、92.6%（75/81）和 92.6%（75/81）。81 颗牙中有 6 颗失败，需要根管治疗。在这 6 颗牙中，有 3 颗在 2 周随访时出现严重冷刺激痛和自发性疼痛，有 2 颗在 3 个月随访时出现电活力测试无反应和根尖稀疏，有 1 颗在 6 个月随访时出现根尖稀疏和唇侧黏膜瘘。
在本研究条件下，使用基于硅酸钙的生物活性陶瓷的全牙髓切断术是治疗有龋源性不可逆性牙髓炎症状的成年恒牙的一种成功选择。
对于有龋源性不可逆性牙髓炎症状的恒牙，活髓治疗不再是不可能的。
