目的:观察不同年龄段牙髓切除的临床疗效,探讨牙髓钙化的发生及特点。
方法:共有77例患者在普通牙科科接受了成熟的永久性前磨牙和磨牙的牙髓切除术,选择2019年10月至2022年8月的北京大学口腔医院。使用iRootBPPlus生物陶瓷材料作为牙髓覆盖剂进行一次牙髓切除术。按年龄分为3组:青少年组(11~20岁)25例,平均年龄(15.88±2.19)岁;中年组(21~50岁)27例,平均年龄(34.59±8.67)岁;老年组(51~83岁)25例,平均年龄(63.84±7.40)岁。术后1年复查,评价临床疗效,记录钙化桥的形成,钙化桥的厚度,和牙髓钙化指数(PCI)。
结果:三组在性别方面无统计学差异,牙列,和牙齿位置(P>0.05)。术后1年随访率为85.71%(66/77),包括青少年组的88.00%(22/25),中年组85.19%(23/27),老年组84.00%(21/25)。3组1年随访临床成功率为95.45%(21/22),91.30%(21/23),和95.24%(20/21),分别,差异无统计学意义(P>0.05)。在临床成功案例中,钙化桥12例(57.14%,12/21)在青少年组中,8例(38.10%,8/21)在中年组中,和3例(15.00%,3/20)在老年人组中,差异具有统计学意义(χ2=7.810,P=0.020<0.05)。3组钙化桥厚度比较,差异有统计学意义(F=4.434,P=0.020<0.05)。钙化桥厚度与年龄呈负相关(r=-0.516,P<0.05)。牙髓钙化指数变化ΔPCI分别为0.67±0.58,0.43±0.51,0.25±0.52,三组间差异有统计学意义(F=3.404,P=0.040<0.05)。
结论:牙髓切除术治疗老年患者龋齿来源的牙髓暴露也能获得较高的成功率。牙髓切除术后钙化的发生率和牙髓钙化的加速与年龄有关。青少年组更容易形成钙化桥,并且还显示出更明显的加速根管钙化。
OBJECTIVE: To observe the clinical efficacy of
pulpotomy in patients of different ages and to explore the occurrence and characteristics of pulpal calcification.
METHODS: A total of 77 patients who underwent
pulpotomy for mature permanent premolars and molars with caries-derived pulp exposure in the Department of General Dentistry, Peking University School and Hospital of Stomatology from October 2019 to August 2022 were selected. Pulpotomies were performed in a single visit using iRoot BP Plus bioceramic material as pulp capping agent. The patients were divided into three groups according to age: 25 cases in the adolescent group (11-20 years old) with a mean age of (15.88±2.19) years; 27 cases in the middle-aged group (21-50 years old) with a mean age of (34.59±8.67) years; and 25 cases in the elder-aged group (51-83 years old) with a mean age of (63.84±7.40) years. The patients were reviewed 1 year after the operation to evaluate the clinical efficacy and to record the formation of calcified bridge, thickness of calcified bridge, and pulp calcification index (PCI).
RESULTS: There was no statistically significant difference between the three groups in terms of gender, dentition, and tooth position (P > 0.05). The 1-year postoperative follow-up rate was 85.71% (66/77), including 88.00% (22/25) in the adolescent group, 85.19% (23/27) in the middle-aged group, and 84.00% (21/25) in the elder-aged group. The 1-year follow-up clinical success rates of the three groups were 95.45% (21/22), 91.30% (21/23), and 95.24% (20/21), respectively, with no statistically significant difference (P>0.05). Among the clinical success cases, calcified bridges appeared in 12 cases (57.14%, 12/21) in the adolescent group, 8 cases (38.10%, 8/21) in the middle-aged group, and 3 cases (15.00%, 3/20) in the elder-aged group, with statistically significant differences (χ2= 7.810, P = 0.020 < 0.05). The difference was statistically significant (F = 4.434, P = 0.020 < 0.05) when comparing the thickness of calcified bridges among the three groups. Calcified bridge thickness was negatively correlated with age (r = -0.516, P < 0.05). The changes in pulpal calcification index ΔPCI were 0.67 ± 0.58, 0.43 ± 0.51, and 0.25 ± 0.52, respectively, with statistically significant differences among the three groups (F = 3.404, P = 0.040 < 0.05).
CONCLUSIONS: Pulpotomy for caries-derived pulp exposure in elderly patients could also achieve a high success rate. The incidence of calcified bri-dges after
pulpotomy and the acceleration of pulpal calcification were age-related. The adolescent group was more likely to form calcified bridges and also showed more pronounced accelerated root canal calcification.