Yi Jin-Kyu, Seo Ah-Rhim
Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea.
Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gang-dong, Seoul, Republic of Korea.
J Dent Sci. 2025 Jan;20(1):229-237. doi: 10.1016/j.jds.2024.08.002. Epub 2024 Aug 14.
BACKGROUND/PURPOSE: The occurrence of post-vital pulp therapy (VPT) symptoms is perplexing for dentists, and root canal treatment (RCT) is preferred for such conditions. Furthermore, managing post-VPT symptoms, rather than performing RCT, would preserve pulp vitality and enhance VPT outcomes. This study aimed to evaluate the efficacy of VPT retrials in preserving pulp vitality and substituting RCT in teeth with post-VPT symptoms.
VPT was performed on the exposed pulp during caries removal in symptomatic and asymptomatic teeth. VPTs were repeated in teeth with post-VPT symptoms. This study screened multi-time-practiced VPT cases from a VPT-performed data pool. The presence of vital pulp tissue after minimized pulp resection (MPR) was a prerequisite for substituting RCT with VPT retrials. A total of 22 cases from 19 patients were included in this study. MPR was introduced to maximize the preservation of the vital pulp.
After performing VPT, post-VPT symptoms occurred in pre-VPT asymptomatic teeth, or pre-VPT symptoms were modified in teeth with pre-VPT symptoms. The rate of pre-VPT irreversible pulpitis (IP), comprising symptomatic/asymptomatic IP, was 81.68%. The most prevalent post-VPT symptom was heightened sensitivity to thermal stimuli (68.2%), followed by spontaneous pain (45.5%). The post-VPT IP was 63.6%. VPT retrials resolved 90.9% of cases with post-VPT symptoms.
VPT retrials using MPR could enhance VPT outcomes and be a viable alternative to RCT for teeth with post-VPT symptoms.
背景/目的：牙体牙髓治疗（VPT）后症状的出现令牙医感到困惑，对于此类情况，根管治疗（RCT）是首选。此外，处理VPT后症状而非进行RCT，将保留牙髓活力并提高VPT的治疗效果。本研究旨在评估VPT再治疗在保留牙髓活力以及替代有VPT后症状牙齿的RCT方面的疗效。
在有症状和无症状牙齿的龋洞去除过程中，对暴露的牙髓进行VPT。对有VPT后症状的牙齿进行VPT再治疗。本研究从已进行VPT的数据池中筛选多次实施VPT的病例。在最小化牙髓切除（MPR）后存在活髓组织是用VPT再治疗替代RCT的前提条件。本研究共纳入了19例患者的22个病例。引入MPR以最大程度地保留活髓。
进行VPT后，VPT前无症状的牙齿出现了VPT后症状，或者VPT前有症状的牙齿其症状发生了改变。VPT前不可逆性牙髓炎（IP）（包括有症状/无症状IP）的发生率为81.68%。最常见的VPT后症状是对热刺激的敏感性增强（68.2%），其次是自发痛（45.5%）。VPT后IP为63.6%。VPT再治疗解决了90.9%有VPT后症状的病例。
使用MPR的VPT再治疗可以提高VPT的治疗效果，并且对于有VPT后症状的牙齿是RCT的一种可行替代方法。
