背景:由于生物材料和组织工程领域的发展,旨在保存和再生牙本质-牙髓复合物的牙髓切除术最近呈指数增长。尽管在这一领域的研究数量有所增加,目前的文献中仍然缺乏证据。
目的:(1)报告乳牙和恒牙牙髓切除术临床试验的结果评估方法;(2)确定乳牙和恒牙牙髓切除术临床试验中使用的各种生物活性剂和生物可降解支架。
方法:对文献进行了范围审查,包括对PubMed的初步研究的搜索,Scopus,WebofScience,ProQuestandClinicaltrials.gov.搜索2012年至2023年之间发表的对照试验或随机对照试验,涉及使用生物活性/再生封盖材料接受部分或全部牙髓切除术的原发性或恒牙。
结果:在1038篇文章中,有127项研究符合所有纳入标准,并被纳入当前的范围审查。超过90%的研究评估了临床和影像学结果。组织学,微生物,在所有纳入的研究中,仅9.4%的患者对炎症结局进行了测量.大多数研究(67.7%)涉及乳牙。119项研究使用了不可降解的生物活性水泥,虽然32项研究使用了可生物降解的支架,天然衍生物和植物提取物研究仅在7项研究中使用。在2012年(4项研究)和2023年(11项研究)之间,发表的文章数量普遍增加。印度,埃及,土耳其,和伊朗被发现发表的文章总数最高(分别为28、28、16和10)。
结论:乳牙和恒牙的牙髓切除术研究主要依赖于主观的临床和影像学结果评估方法,很少客观地分析牙髓炎症状态。用于牙髓切除术治疗的可生物降解支架的使用一直在增加,其中大多数研究在中低收入国家的全球分布明显。然而,仍需要开发一套可预测的结果指标,并从良好进行的新型牙髓切除术敷料的临床试验中获得长期证据.
BACKGROUND: Pulpotomy procedures aiming to preserve and regenerate the dentin-pulp complex have recently increased exponentially due to developments in the field of biomaterials and tissue engineering in primary and permanent teeth. Although the number of studies in this domain has increased, there is still scarcity of evidence in the current literature.
OBJECTIVE: (1) Report the methods of outcome assessment of pulpotomy clinical trials in both primary and permanent teeth; (2) Identify the various bioactive agents and biodegradable scaffolds used in pulpotomy clinical trials in both primary and permanent teeth.
METHODS: A scoping
review of the literature was performed, including a search of primary studies on PubMed, Scopus, Web of Science, ProQuest and Clinicaltrials.gov. A search for controlled trials or randomized controlled trials published between 2012 and 2023 involving primary or permanent teeth receiving partial or full pulpotomy procedures using bioactive/regenerative capping materials was performed.
RESULTS: 127 studies out of 1038 articles fulfilled all the inclusion criteria and were included in the current scoping
review. More than 90% of the studies assessed clinical and radiographic outcomes. Histological, microbiological, or inflammatory outcomes were measured in only 9.4% of all included studies. Majority of the studies (67.7%) involved primary teeth. 119 studies used non-degradable bioactive cements, while biodegradable scaffolds were used by 32 studies, natural derivates and plant extracts studies were used in only 7 studies. Between 2012 (4 studies) and 2023 (11 studies), there was a general increase in the number of articles published. India, Egypt, Turkey, and Iran were found to have the highest total number of articles published (28, 28,16 and 10 respectively).
CONCLUSIONS: Pulpotomy studies in both primary and permanent teeth relied mainly on subjective clinical and radiographic outcome assessment methods and seldom analyzed pulpal inflammatory status objectively. The use of biodegradable scaffolds for pulpotomy treatments has been increasing with an apparent global distribution of most of these studies in low- to middle-income countries. However, the development of a set of predictable outcome measures as well as long-term evidence from well conducted clinical trials for novel pulpotomy dressing materials are still required.