Stomatological Hospital, School of Stomatology, Southern Medical University, S366 Jiangnan Boulevard, Haizhu District, Guangzhou city, Guangdong Province, China.
BMC Oral Health. 2024 Oct 9;24(1):1202. doi: 10.1186/s12903-024-04967-3.
Currently, the indications for pulpectomy of primary molars performed under dental general anesthesia vary across countries. Therefore, we retrospectively investigated the five-year survival rate of primary molars following pulpectomy performed under dental general anesthesia and the impact of this treatment on permanent successors, assessed the risk factors related to overall survival and clarified the indications for pulpectomy.
The medical records of children receiving pulpectomy of primary molars under dental general anesthesia from August 1, 2013, to November 30, 2023, were reviewed. Potential risk factors, including gender, age, general health, tooth type, tooth location, endodontic diagnosis and quality of root filling, were assessed via univariate and multivariate Cox proportional hazards regression models, and the survival rate was examined via the Kaplan‒Meier technique. Moreover, the rate of resorption of the root canal filling materials, degree of resorption of the overfilled/over-extended root canal filling materials and development of permanent successors were assessed by clinical and radiographic examination.
The study included 320 teeth from 161 children (86 boys and 75 girls). The overall five-year survival rate was 38.2%, and the mean overall survival time was 54.2 months. Endodontic diagnosis was considered a significant risk factor (P < 0.05). In the first, second and third years, 57.4%, 81.8%, and 94.8%, respectively, of obturation materials in the root canals were resorbed at a faster rate than the roots. There was an altered eruption direction in 7 permanent teeth, and 4 permanent teeth were diagnosed with enamel hypoplasia.
In this study, the 60-month survival rate of primary molars treated by pulpectomy under dental general anesthesia was 38.32%. Operators should have an accurate assessment of the status of the pulp, have a strict grasp of the preoperative indications and select the appropriate treatment method according to the guidelines. Individual cases suggest overfilling, overextension and periapical periodontitis in primary molars have an impact on enamel hypoplasia and altered eruption direction in permanent teeth.
目前，各国在全麻下进行乳磨牙牙髓切除术的适应证存在差异。因此，我们回顾性调查了全麻下进行乳磨牙牙髓切除术的 5 年生存率，以及该治疗方法对恒牙继承的影响，评估了与总生存率相关的风险因素，并阐明了牙髓切除术的适应证。
回顾性分析 2013 年 8 月 1 日至 2023 年 11 月 30 日期间接受全麻下乳磨牙牙髓切除术的儿童的病历。通过单变量和多变量 Cox 比例风险回归模型评估性别、年龄、一般健康状况、牙齿类型、牙齿位置、牙髓诊断和根管充填质量等潜在风险因素，并通过 Kaplan-Meier 技术检查生存率。此外，通过临床和影像学检查评估根管充填材料的吸收率、超填/超扩根管充填材料的吸收程度以及恒牙的发育情况。
本研究纳入了 161 名儿童（86 名男孩和 75 名女孩）的 320 颗牙齿。总的 5 年生存率为 38.2%，平均总生存时间为 54.2 个月。牙髓诊断被认为是一个显著的风险因素（P<0.05）。在第 1、2 和 3 年，分别有 57.4%、81.8%和 94.8%的根管内充填材料的吸收速度快于牙根。有 7 颗恒牙的萌出方向发生改变，4 颗恒牙被诊断为釉质发育不全。
本研究中，全麻下进行乳磨牙牙髓切除术的 60 个月生存率为 38.32%。术者应准确评估牙髓状况，严格掌握术前适应证，并根据指南选择合适的治疗方法。个别病例提示乳磨牙的过度充填、过度延伸和根尖周炎会影响恒牙的釉质发育不全和萌出方向改变。
