National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore.
Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.
Int Endod J. 2023 Dec;56(12):1459-1474. doi: 10.1111/iej.13978. Epub 2023 Oct 5.
This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine.
This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively.
In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period.
Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
本研究旨在比较活髓切断术和牙髓塑化术治疗至少 75%牙本质深度龋坏的疗效。
这是一项双臂、平行组、随机、优效性试验，纳入了有活力的成熟恒牙，其深龋原发或继发，影像学诊断至少 75%牙本质厚度，无临床不可逆性牙髓炎症状或影像学根尖病变证据。使用计算机生成的包含在不透明信封中的随机患者编码，将患龋牙盲法分配接受活髓切断术或牙髓塑化术治疗。所有牙齿均在治疗后 6 个月和 1 年时进行临床和影像学复查。采用 log rank 检验和 Cox 比例风险回归分析比较活髓切断术和牙髓塑化术的治疗效果，并分别确定潜在的预后因素。
在排除了 6 例因未完成分配治疗和 1 例因严重牙周病而剔除的牙齿后，活髓切断术组 58 颗牙和牙髓塑化术组 55 颗牙完成了治疗。1 年后，活髓切断术组 57/58（98.3%）颗牙和牙髓塑化术组 48/55（87.3%）颗牙可供分析。牙髓塑化术组 1 颗牙（2.1%）和活髓切断术组 8 颗牙（14.0%）需要进一步根管治疗（p<0.05）。无其他显著的生存预后因素。总的来说，活髓切断术或牙髓塑化术治疗的牙齿在 1 年内无需进一步干预而存活的比例为 91.4%。在审查期间未发生其他不良事件。
在本研究的限制范围内，牙髓塑化术在保留牙髓和根尖周健康方面优于活髓切断术。作为一种治疗方式，牙髓塑化术比活髓切断术对患者的成本更高，且治疗时间更长。需要进行长期随访以研究牙髓塑化术和活髓切断术的牙髓和修复效果。
