根据新的和传统的牙髓炎分类，全牙髓切断术和根管治疗后成熟磨牙的术后疼痛：一项前瞻性、随机对照试验。
Postoperative pain after total pulpotomy and root canal treatment in mature molars according to the new and traditional classifications of pulpitis: a prospective, randomized controlled trial.
机构信息
Department of Endodontics, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey.
Department of Endodontics, Faculty of Dentistry, Çukurova University, Adana, Turkey.
出版信息
BMC Oral Health. 2024 Sep 12;24(1):1075. doi: 10.1186/s12903-024-04836-z.
BACKGROUND
The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain.
METHODS
Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman's correlation test. The significance level was set at 0.05.
RESULTS
Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05).
CONCLUSIONS
In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h.
CLINICAL TRIAL REGISTRATION
The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23.
背景
本研究旨在比较完全活髓切断术（TP）和根管治疗术（RCT）治疗不可复性牙髓炎成熟磨牙的术后疼痛。比较传统的牙髓炎症分类系统和 Wolters 系统在评估术后疼痛方面的差异。
方法
纳入 80 颗下颌磨牙，分为 Wolters（中度/重度牙髓炎症）。牙齿随机分为两组（RCT 或 TP）。RCT 按照标准化方案进行。TP 进行到根管口水平，用 2.5%次氯酸钠止血。放置 3mm 厚的 MTA 作为活髓切断材料。用玻璃离子水门汀和复合树脂修复牙齿。在术前和干预后 6、12、24、48 和 72 小时以及 7 天记录疼痛评分。采用 Mann-Whitney U 检验、Friedman 检验、Wilcoxon 符号秩检验和 Spearman 相关检验对数据进行统计学分析。显著性水平设为 0.05。
结果
64 例患者在一周随访时进行了分析，所有患者均根据 AAE 诊断为不可复性牙髓炎；根据 Wolters 分类，22 颗牙为中度，42 颗牙为重度。中度牙髓炎患者 TP 和 RCT 之间的疼痛评分无显著差异（p>0.05）。重度牙髓炎患者在 24 和 72 小时时，TP 和 RCT 之间存在显著差异；RCT 组疼痛评分较高（p<0.05）。
结论
在中度牙髓炎患者中，TP 手术比 RCT 更快地缓解症状。在重度牙髓炎患者中，TP 在 24 和 72 小时时与 RCT 相比，疼痛评分明显较低。
临床试验注册
本研究在 ClinicalTrials.gov 进行了回顾性注册（NCT05923619）。注册日期：2023 年 6 月 16 日。
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