牙髓存活和可逆性牙髓炎成熟恒牙选择性去腐和全去腐治疗后术后处理需求：一项随机临床试验。

Pulp survival and postoperative treatment needs following selective vs. total caries removal in mature permanent teeth with reversible pulpitis: A randomized clinical trial.

机构信息

Department of Conservative Dentistry Jordan University of Science and Technology, Irbid, Jordan.

出版信息

J Dent. 2024 Dec;151:105408. doi: 10.1016/j.jdent.2024.105408. Epub 2024 Oct 22.

DOI:10.1016/j.jdent.2024.105408

PMID:39442480

Abstract

OBJECTIVES

To compare pulpal survival and treatment needs following selective and total caries removal in mature permanent teeth.

METHODS

The design was a parallel double blind, randomized clinical trial. Mature teeth with caries radiographically extending ≥ 2/3 of dentine and without spontaneous pulpitis were included. Teeth were allocated to either selective (SCR) or total caries removal (TCR) using block randomization technique. In the SCR group, caries removal to firm dentine was followed by placement of Biodentine and composite restoration. In TCR group caries removal was to hard dentine; with immediate management by vital pulp therapy (VPT) using Biodentine in case of pulp exposure. Preoperative pain levels were recorded. Teeth were followed up after 6 and 12 months. Data were analyzed using Chi square test and regression analysis.

RESULTS

124 teeth with a diagnosis of reversible pulpitis were treated (63 in SCR, 61 in TCR). 17/ 61 teeth (28%) in the TCR had pulp exposure, managed by VPT and were successful at recall. Pulp survival was significantly higher in TCR compared to SCR at 6 months (100 % vs 93.65%, p =0.04 respectively) and at 12 months (98.4% vs 82.5, P= 0.003 respectively). Multivariate analysis revealed the type of procedure (SCR vs TCR) and the preoperative pain levels (above or below 5/10) as significant prognostic factors. The odds of failure increased significantly for teeth treated with SCR (OR 27.6, 3.6-212.4, p=0.001) and if preoperative pain levels were ≥5/10 (OR 0.2, 0.04-0.8, P=0.024).

CONCLUSION

Selective caries removal for deep carious lesions in mature teeth failed to reveal overt pulp exposures in more than one quarter of cases and led to significantly lower pulp survival over one year, when compared with complete caries removal and immediate VPT.

CLINICAL SIGNIFICANCE

In deep carious lesions of mature permeant teeth with revrsible pulpitis, total caries removal to hard dentine is recommended for a predictable pulp survival.

CLINICAL TRIAL REGISTRATION

This trial was registered at CliniclTrials.gov (NCT05144711).

摘要

目的

比较选择性去龋和全去龋在成熟恒牙牙髓存活和治疗需求方面的差异。

方法

设计为平行双盲、随机临床试验。纳入有影像学显示龋坏延伸至牙本质 2/3 以上且无自发性牙髓炎的成熟恒牙。采用区组随机化方法将牙齿分配至选择性去龋（SCR）或全去龋（TCR）组。SCR 组中，在到达质地坚硬的牙本质后，使用 Biodentine 进行垫底并复合树脂修复。TCR 组中，将龋坏去除至硬牙本质，若牙髓暴露，立即采用 Biodentine 进行活髓治疗（VPT）。记录术前疼痛水平。治疗后 6 个月和 12 个月进行随访。使用卡方检验和回归分析进行数据分析。

结果

共纳入 124 颗诊断为可逆性牙髓炎的牙齿（SCR 组 63 颗，TCR 组 61 颗）。TCR 组中有 17/61 颗（28%）牙齿发生牙髓暴露，通过 VPT 治疗成功。TCR 组的牙髓存活率在 6 个月（100%比 93.65%，p=0.04）和 12 个月（98.4%比 82.5%，P=0.003）时均显著高于 SCR 组。多变量分析显示，治疗方法（SCR 与 TCR）和术前疼痛水平（大于或小于 5/10）是显著的预后因素。SCR 治疗的牙齿失败风险显著增加（OR 27.6，3.6-212.4，p=0.001），且术前疼痛水平≥5/10（OR 0.2，0.04-0.8，p=0.024）。