| ObjectiveThe treatment of immature permanent teeth which have pulp lesions or periapical lesions has always been a challenge due to the fact that those teeth have an open apex so that traditional root canal treatment such as apexification and MTA apical barriers technology cannot be carried out.Although the apexification has a certained effect,it needs a long period of treatment which leads to a high risk of root fracture because of long-term use of calcium hydroxide paste.MTA apical barriers technology can shorten the treatment process to a large extent because it does not require long-term intracanal medicament.Only one-time intracanal medicament is enough.However,MTA apical barriers technology cannot promote the subsequent physiological development of the root.Therefore,for the long term,it also has the complication such as root fracture.Recent years,with the aim to treat the immature permanent teeth which have pulp lesions or periapical lesions,a newly-rising treatment,dental pulp revascularization,has drawn considerable attention.Dental pulp revascularization can effectively promote the subsequent development of the root by inducing the formation of pulp-like tissue in root canals,which is similar to the natural development of the teeth.However,clinical research is still ongoing and the indication and the operating steps have not yet been standardized.Meanwhile,due to the lack of tracking a large amount of samples in a long term,there are many failed cases in clinical.In this research,the effect of dental pulp revascularization to different degree of pulp inflammation is analyzed by clinical research,which provides reference for the standard of indication.Meanwhile,experience is summarized to promote the wide use of dental pulp revascularization in clinical and to provide new methods and ideas for clinical treatment.MethodsThe subject of study were 48 teeth which were collected from 40 young patients who visited the the department of stomatology in Qingdao University Affiliated Hospital from Feb.2015 to Feb.2018.One group,26 subjects,were diagnosed with periodontitis in clinical with periapical lesion and the other group,22 subjects,were diagnosed withpulpitis in clinical without periapical lesion.All of the subjects were young permanent teeth with an open apex and all of them were with pulp lesion or periapical lesion.Under the consent of the young patient and his/her guardian,dental pulp revascularization were operated.As the routine,all of the root canals were opening up and cleaned by ultrasonic irrigation.And then,researchers made them dry and operated intracanal medicament with triple antibiotic or calcium hydroxide paste.After the effective control of the inflammation,apex hemorrhage was induced and then blood clot formed in the canals.In the end,close sealing were conducted at the coronal part.At the same time,regular visit of the young patients and his/her guardians were accomplished.The visit time was 3,6,12,18,24 months after the operation.In the return visit,radiological examination was operated in order to observe the root situation such as bone density in the periapical area,the length of the root,the thickness of the root wall and the apex.The effect of dental pulp revascularization of the two groups was under comparison by comparing the effective rate and recovery rate of the two groups and conducting statistical analysis.At the same time,influence factors of clinical effect are also analyzed.ResultsBy making follow-up visit,the shortest case has been tracked for 12 months,and the longest has been tracked for 30 months.From 48 subjects in total,24 subjects were cured,14 were improved and 10 were ineffective.The overall effective rate was 79.2%.For periodontitis group,9 subjects were cured,10 were improved and 7 subjects were ineffective.The overall effective rate is 73.1%.For pulpitis group,15 subjects were cured,4 were improved and 3 subjects were ineffective.The overall effective rate is 86.4%.The statistical analysis shows that the pulpitis group had better treatment effect than the periodontitis group.The difference was statistically significant(P<0.05).Moreover,when it comes to the recovery rate of revascularization,9 subjects were cured with an effective rate 34.6% for periodontitis group,and for pulpitis group,15 subjects were cured with an effective rate 68.2%.The pulpitis group had higher recovery rate than the periodontitis group(P=0.032).according to statistical analysis,the effects of triple antibiotic paste and calcium hydroxide paste on the therapeutic effect of the two groups were not statistically significant(P > 0 0.05).ConclusionDental pulp revascularization which can promote the development of the root is good for young permanent teeth with pulp lesions in clinical.There was no significant difference in the therapeutic effect of triple antibiotic or calcium hydroxide paste.Fromthe perspective of treatment effect and recovery rate,it had better performance on the pulpitis group than the periodontitis group,but the long-term effect is still under observation. |
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