活髓切断术应用于龋源性露髓恒牙的初步研究

发布时间：2018-03-21 10:23

本文选题：深龋　切入点：活髓切断术　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：随着生活水平的提高,人们对口腔健康越发重视,口腔健康明显影响着人们的生活质量。在临床上,我们发现越来越多的患者具有强烈的保存活髓、保留患牙的意识,尤其对很常见的龋源性露髓患牙。但是对于这种龋源性露髓的牙根发育完成恒牙,根管治疗被认为是治疗的金标准。根据文献报道我们知道牙髓组织具有形成、营养、感觉、防御的能力,活髓患牙的保存率明显高于无髓患牙。因此,活髓切断术用于成熟恒牙的研究,便成为我们本次研究的主要内容。目的观察活髓切断术应用于牙根发育已完成、龋源性露髓的恒牙临床效果,为其在临床应用,提供一定的理论基础和临床指导。方法收集龋源性露髓且牙根发育完成的患牙(62例),行活髓切断术的患牙为实验组A(32例),行根管治疗的患牙为对照组B(30例)。A组患牙利用阿替卡因肾上腺素注射液(必兰)进行局麻,上橡皮障,利用无菌球钻去龋坏组织、去龋未净,探及穿髓孔,更换使用活切包器械,揭净髓室顶,充分暴露髓腔,利用锐利的挖匙或球钻切断冠部炎症牙髓组织,断面整齐,无菌生理盐水冲洗牙髓断面,去除组织碎屑,无菌湿棉球压迫止血。将按照说明书调置的MTA糊剂覆盖于断面上约2mm厚,勿向根方施力,之后将无菌生理盐水湿棉球轻轻置于MTA上,暂封24小时后,去暂封物,观察MTA凝固情况,3M树脂充填,调牙合,抛光,拍摄术后X线片。B组患牙局麻,上橡皮障,无菌球钻去净龋坏组织、揭净髓室顶,拔髓,根尖定位仪测定工作长度,根向技术进行根管预备,5.25%次氯酸钠溶液及大量生理盐水冲洗根管,吸潮纸尖干燥根管、试主尖、最后进行根管充填,流动树脂封根管口,3M树脂充填、调牙合,抛光,拍摄术后X线片。分别1、3、6、12个月进行复诊,通过临床评估及影像学评估来评价治疗效果,并进行比较,采SPSS18.0软件包进行统计分析。结果观察一年活髓切断术的成功率为93.75%,根管治疗的成功率为93.10%,两组成功率无显著差异(χ2=0.010,P=0.665)。结论活髓切断术应用于龋源性露髓的牙根发育完成恒牙,既保留了部分牙髓组织,也避免了牙体组织预备,适合临床推广,具有一定可行性。
[Abstract]:With the improvement of living standard, people pay more and more attention to oral health. Oral health obviously affects people's quality of life. Clinically, we find that more and more patients have a strong sense of preserving the living pulp and keeping the affected teeth. Especially for very common cariogenic exposed teeth. But root canal therapy is considered to be the gold standard for permanent teeth. According to the literature, we know that dental pulp tissue is formed, nutritious, and felt. The defense ability of living pulp teeth is significantly higher than that of unmyelinated teeth. Therefore, the study of active pulp incision for mature permanent teeth has become the main content of our study. Objective to observe that the application of living pulp incision in root development has been completed. The clinical effect of cariogenic pulp exposed permanent teeth, for its clinical application, Methods A total of 62 patients with caries exposed pulp and complete root development were collected, 32 cases of experimental group were treated with active pulp incision, and 30 cases of group A were treated with root canals as control group (n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30, n = 30). The teeth were treated by local anesthesia with Atevacaine epinephrine injection (Beilan). On rubber barrier, use sterility ball drill to remove decayed tissue, remove caries not clean, probe through pulp hole, replace and use alive wrapping apparatus, clean pulp chamber top, fully expose pulp cavity, use sharp scoop or ball drill to cut off inflammatory pulp tissue of the crown, section is neat, Wash dental pulp section with sterile saline, remove tissue debris, and dry wet cotton ball to stop bleeding. Cover the MTA paste adjusted according to the instructions to the section about 2 mm thick, do not apply force to the root, Then the sterile saline wet cotton ball was placed on the MTA gently, and after 24 hours of temporary sealing, the temporary sealing material was removed, the solidification of MTA was observed by 3M resin filling, the occlusion was adjusted and polished, the local anaesthesia of teeth in group B was photographed after operation, and the rubber barrier was added to the teeth. The sterility ball drilled the clean decayed tissue, removed the top of the pulp chamber, pulled out the pulp, measured the working length of the root tip, prepared the root canal with 5.25% sodium hypochlorite solution and a large amount of normal saline for root canal preparation, and dried the root canal at the top of the hygroscopic paper. Finally, root canal filling, flowing resin sealing root canal orifice and 3M resin filling, adjusting occlusion, polishing, taking X-ray film after operation were carried out respectively. The treatment effect was evaluated by clinical evaluation and imaging evaluation after 12 months, respectively, and compared with each other. Results the success rate of one year active pulp incision was 93.755.The success rate of root canal therapy was 93.100.There was no significant difference between the two groups (蠂 ~ 2 0.010 ~ (10)). Conclusion\\\; It not only preserves some pulp tissues, but also avoids tooth tissue preparation, which is suitable for clinical application and has certain feasibility.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

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