【摘要】 目的 评估牙髓血运重建术联合富血小板纤维蛋白(platelet rich fibrin, PRF)治疗年轻恒牙牙髓坏死患儿的临床效果,并探讨牙周龈沟液细胞因子水平与疗效的相关性,为判断牙髓血运重建术预后提供新的思路。方法 选取2023年11月～2025年1月我院收治的90例年轻恒牙牙髓坏死患儿为对象,随机分为研究组(n=45)和对照组(n=45)。对照组采用牙髓血运重建术联合二联抗生素糊剂(double antibiotic past, DAP)治疗,研究组在对照组基础上联合PRF治疗,比较两组患儿的临床疗效、牙齿功能指标、病变愈合时间、牙根长度、根管壁厚度、疼痛视觉模拟评分(visual analog scale, VAS)、龈沟液细胞因子水平和并发症发生率。结果 研究组治疗总有效率为91.11%(41~/45),明显高于对照组的71.11%(32~/45)(P=0.015)。治疗后,两组咬合力、咀嚼效能较治疗前显著提高,且研究组咬合力、咀嚼效能高于对照组(P<0.05)。研究组病变愈合时间短于对照组(P<0.05)。术后3个月、术后6个月,两组根管壁厚度均较治疗前显著增厚,VAS均显著降低(P<0.05),且研究组根管壁更厚(P<0.05)。术后3个月,研究组VAS评分低于对照组(P<0.05)。两组术后牙根长度无统计学差异(P>0.05)。研究组龈沟液中白介素-6(interleukin-6, IL-6)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、基质金属蛋白酶-8(matrix metalloproteinase-8, MMP-8)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)水平均低于对照组,白介素-10(interleukin-10, IL-10)、基质金属蛋白酶组织抑制因子-1(tissue inhibitor of metalloproteinases-1, TIMP-1)、碱性成纤维细胞生长因子(basic fibroblast growth factor, b FGF)和血管内皮生长因子(vascular endothelial growth factor, VEGF)水平均高于对照组(P<0.05)。研究组并发症发生率低于对照组(P=0.026)。结论 牙髓血运重建术联合PRF治疗患儿的年轻恒牙牙髓坏死,可显著提高临床疗效,促进根管壁厚度的增加,减轻疼痛,缓解炎症,且安全性较高。更多还原

【Abstract】 Objective To evaluate the clinical efficacy of pulp revascularization combined with platelet rich fibrin(PRF) in the treatment of children with permanent tooth pulp necrosis, and explore the correlation between the levels of cytokines in periodontal crevicular fluid and the efficacy, in order to provide new ideas for the prognosis prediction of pulp revascularization. Methods Ninety children with permanent tooth pulp necrosis admitted to our hospital between November 2023 and January 2025 were enrolled as subjects and randomly divided into a study group(n=45) and a control group(n=45). The control group was treated with pulp revascularization combined with double antibiotic paste(DAP), while the study group received additional PRF therapy based on the control group’s regimen. The two groups were compared in terms of clinical efficacy, dental function indicators, lesion healing time, root length, root canal wall thickness, visual analog scale(VAS)for pain, cytokine levels in periodontal crevicular fluid, and incidence of complications. Results(1)The total effective rate of the study group was 91. 11%(41 ~/45), which was significantly higher than 71. 11%(32 ~/45) of the control group(P=0. 015). After treatment, both groups showed significant improvements in bite force and masticatory efficiency compared with their pre-treatment baseline values(P<0. 05), with the study group exhibiting higher bite force and masticatory efficiency than the control group. The study group also had a shorter lesion healing time than the control group(P<0. 05).(2)At 3 and 6 months post-surgery, both groups demonstrated a significant increase in root canal wall thickness and a significant decrease in VAS compared with pretreatment(P<0. 05). Specifically, the study group had a thicker root canal wall than the control group at both3 and 6 months post-surgery(P<0. 05). At 3 months post-surgery, the study group’s VAS was lower than that of the control group(P<0. 05); however, there was no significant difference in root length between the two groups at 3 or 6 months post-surgery(P>0. 05).(3)Regarding gingival crevicular fluid cytokines, the study group had lower levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), matrix metalloproteinase-8(MMP-8), and matrix metalloproteinase-9( MMP-9) than the control group. In contrast, the study group exhibited higher levels of interleukin-10( IL-10), tissue inhibitor of metalloproteinases-1(TIMP-1), basic fibroblast growth factor( bFGF), and vascular endothelial growth factor(VEGF) than the control group(all P<0.05). Additionally, the study group had a lower incidence of complications than the control group(P=0.026).Conclusion The combination of pulp revascularization and PRF for treating permanent tooth pulp necrosis in children can significantly enhance clinical efficacy, promote an increase in root canal wall thickness, alleviate pain, reduce inflammation, and exhibit high safety.更多还原