Krug Ralf, Schwarz Fabian, Hahn Britta, Reymus Marcel, Eggmann Florin, Krastl Gabriel, Soliman Sebastian
Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
Clin Oral Investig. 2025 Jun 5;29(6):332. doi: 10.1007/s00784-025-06407-0.
To investigate the long-term tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), depending on blood contamination and placement method in-vitro.
Eighty bovine teeth, sliced to a length of 18 mm (crown 8 mm, root 10 mm), were randomly assigned to 10 groups (n = 8), receiving ortho- or retrograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (BiO) with and without bovine blood. Orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were root-filled with gutta-percha and sealer, adhesively restored, and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment, after 24 h, and up to 72 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by ANOVA with post-hoc-tests, Shapiro-Wilk-test, Friedman-test, Mann-Whitney-U-test, t-test, and post-hoc-tests with Bonferroni correction (α = 0.05).
The increase of tooth discoloration occurred in all groups with no significant differences between HCSCs (p >.05). After six years, color changes were strongly marked on roots but insignificant on crowns. The color differences on the measuring surface of the apical plug were statistically significant between 24 and 72 months (p <.001). Blood had a more relevant impact on tooth color than BiO. There were no substantial long-term effects of retrograde placement (p >.05) or preoperative dentin sealing (p >.05).
Apical plugs of the tested HCSCs cause ongoing discoloration of bovine roots, but no discoloration of bovine tooth crowns within a six-year period.
Apical plugs should be carefully placed. If direct contact with the coronal dentin is avoided, long-term aesthetic impairments are unlikely to occur.
在体外研究不同的水硬性硅酸钙基水门汀（HCSCs）导致的牙齿长期变色情况，该变色取决于血液污染情况和充填方法。
80颗牛牙，切成18毫米长（牙冠8毫米，牙根10毫米），随机分为10组（每组n = 8），接受正向或逆向根尖充填治疗（APT）。根尖充填物长度为4毫米，由ProRoot MTA（登士柏）、Medcem MTA（Medcem）、TotalFill BC RRM快速凝固糊剂（Brasseler）或Medcem医用波特兰水泥（Medcem）加氧化铋（BiO）制成，有或无牛血污染。比较正向（有或无术前粘结性牙冠牙本质封闭）和逆向APT。牙齿用牙胶尖和封闭剂进行根管充填，粘结修复后，保存在蒸馏水中。在治疗前、24小时后以及治疗后长达72个月，通过分光光度法测量根尖充填物、牙胶尖/封闭剂和牙冠表面的牙齿颜色。计算颜色差异（ΔE）值，并通过方差分析及事后检验、夏皮罗-威尔克检验、弗里德曼检验、曼-惠特尼-U检验、t检验以及采用邦费罗尼校正的事后检验（α = 0.05）进行分析。
所有组均出现牙齿变色增加，不同HCSCs之间无显著差异（p > 0.05）。6年后，牙根上的颜色变化明显，但牙冠上不明显。根尖充填物测量表面在24个月至72个月之间的颜色差异具有统计学意义（p < 0.001）。血液对牙齿颜色的影响比BiO更显著。逆向充填（p > 0.05）或术前牙本质封闭（p > 0.05）没有实质性的长期影响。
受试HCSCs的根尖充填物会导致牛牙根持续变色，但在6年内不会导致牛牙冠变色。
应谨慎放置根尖充填物。如果避免与牙冠牙本质直接接触，则不太可能出现长期美学损害。
