Er∶YAG激光联合不同盖髓剂应用于乳牙直接盖髓术临床对照研究

摘要

Objective To compare clinical success rates of Er∶YAG laser combined with different capping agents for direct pulp capping in primary teeth and evaluate the pain during treatment.Methods A total of 60 teeth of 60 children between the age of 3 and 5 years were selected for this study.All the samples were randomly assigned to the following 4groups (n=1 5):Er∶YAG laser+ MTA,the exposed area was sealed with MTA after Er∶YAG laser for caries removal and cavity preparation;Er∶YAG laser+calcium hydroxide (CH),the treated area was sealed with CH paste after Er∶YAG laser for caries removal;dental handpiece+MTA,the exposed pulp was sealed with MTA after dental handpiece for caries removal;dental handpiece+CH,CH was applied after dental handpiece for caries removal.The depth of cavity preparation was recorded while the child felt painful.At the 3-,6-,12-and 24-month recall examiations,the effect was observed by X-ray.Results The proportion of the depth of cavity preparation (superficial dentin,middle dentin,deep dentin)by handpiece and Er∶YAG laser was 50％,40％,10％ and 0.67％,20％,79.33％,respectively.The two patterns of cavity preparation revealed significant difference (P ＜ 0.05),At the 3-,6-,12-month recall examiations,the success rates of the laser groups were higher than the handpiece groups,while they had no significant difference (P ＞ 0.05).At the 24 months,the success rates of the laser groups were 93.3％.They showed significantly higher success rates than the handpiece groups (P ＜ 0.05).The success rates of handpiece+MTA and handpiece+CH were 80％ (12/15)and 73％ (11/15),which did not reveal any significant difference.Conclusion Er∶YAG laser combined with pulp capping agents can be recommended for direct pulp therapy in primary teeth,and Er∶YAG laser will result in a slight pain,thus the children will be inclined to accept and complete the treatment.The clinical effect of MTA shows no statistical difference compared with CH.%目的 评价Er∶YAG激光联合盖髓剂应用于乳牙直接盖髓术的临床疗效及治疗过程疼痛程度.方法 选择2014年3-6月成都市妇女儿童中心医院口腔科门诊就诊的60例3～6岁因龋治疗低龄患儿,随机分为4组,每组15例,分别为Er∶YAG激光去龋+矿物三氧化物凝聚体(MTA)组、Er∶YAG激光去龋+氢氧化钙(CH)组、传统手机去龋+MTA组、传统手机去龋+CH组,记录患儿出现明显疼痛时的备洞深度.治疗后第3、6、12、24个月进行回访,通过拍摄X线片观察各组临床疗效.结果 使用传统手机和Er∶YAG激光患儿记录的备洞深度(牙本质浅层、牙本质中层、牙本质深层)数目比例分别为50.0％、40.0％、10.0％和0.67％、20.0％、79.33％,传统手机和Er∶YAG激光备洞疼痛差异有统计学意义(P＜0.05).第3、6、12个月回访时,Er∶YAG激光组成功率略高于传统手机,但4组成功率差异无统计学意义(P＞0.05).第24个月回访时,2个Er∶YAG激光组临床疗效成功率均为93.3％,与传统手机组比较差异有统计学意义(P＜0.05);传统手机+MTA及传统手机+CH组的成功率分别为80％(12/15)和73％(11/15),两组间差异无统计学意义(P＞0.05).结论 Er∶YAG激光备洞过程产生痛感小,低龄患儿易于接受和配合治疗.Er∶YAG激光联合使用盖髓材料的临床疗效成功率高于传统手机联合盖髓剂.MTA与CH用作直接盖髓术的临床疗效比较差异无统计学意义.