直接盖髓应用材料的研究进展

doi:10.7518/hxkq.2018.06.018

摘要/Abstract

摘要：

直接盖髓术和活髓切断术的远期效果与盖髓材料的种类关系密切。直接盖髓材料的种类繁多,除临床上常用的氢氧化钙和三氧化矿物凝聚体（MTA）外,各种新的盖髓材料不断涌现。以硅酸钙类材料为代表的盖髓剂性能优良,受到学者们的广泛关注。此外,具有促再生和矿化作用的釉基质蛋白衍生物Emdogain以及其他具有修复功能的材料,也有望应用于盖髓。

关键词: 盖髓, 修复性牙本质, 牙本质桥, 氢氧化钙, 三氧化矿物凝聚体, 硅酸钙, 釉基质衍生物

Abstract:

The long-term effect of direct pulp capping and pulpotomy is closely related to the type of pulp capping materials. Various kinds of direct pulp capping materials are available, such as calcium hydroxide and mineral trioxide aggregates. Diverse new pulp capping materials have been reported recently. The excellent performance of calcium silicates has attracted much attention in previous studies. Moreover, enamel matrix derivative (Emdogain), which is capable of regeneration and reminera-lization, and other materials with similar capabilities have shown potential for use in pulp capping.

Key words: pulp capping, reparative dentin, dentin bridge, calcium hydroxide, mineral trioxide aggregate, cal-cium silicates, enamel matrix derivative

中图分类号:

R783.1

范梦琳,何利邦,李继遥. 直接盖髓应用材料的研究进展[J]. 华西口腔医学杂志, 2018, 36(6): 675-680.

Menglin Fan,Libang He,Jiyao Li. Recent advances in direct pulp capping materials[J]. West China Journal of Stomatology, 2018, 36(6): 675-680.

图/表 1

参考文献 57

[1]	Parisay I, Ghoddusi J, Forghani M . A review on vital pulp therapy in primary teeth[J]. Iranian Endod J, 2015,10(1):6-15. URL pmid: 4293574
[2]	Petrou MA, Alhamoui FA, Welk A , et al. A randomized clinical trial on the use of medical Portland cement, MTA and calcium hydroxide in indirect pulp treatment[J]. Clin Oral Investig, 2014,18(5):1383-1389. doi: 10.1007/s00784-013-1107-z URL pmid: 24043482
[3]	Akhlaghi N, Khademi A . Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature[J]. Dent Res J (Isfahan), 2015,12(5):406-417. doi: 10.4103/1735-3327.166187 URL pmid: 4630703
[4]	Poggio C, Beltrami R, Colombo M , et al. In vitro antibact-erial activity of different pulp capping materials[J]. J Clin Exp Dent, 2015,7(5):e584-e588.
[5]	Dundar A, Yalcin M, Arslan U . Evaluation of antibacterial effects of pulp capping agents with direct contact test me-thod[J]. Eur J Dent, 2014,8(1):95-99. doi: 10.4103/1305-7456.126256 URL pmid: 24966754
[6]	Poggio C, Ceci M, Dagna A , et al. In vitro cytotoxicity eva-luation of different pulp capping materials: a comparative study[J]. Arch Ind Hyg Toxicol, 2015,66(3):181-188.
[7]	Qureshi A, Nandakumar E, Nandakumar R , et al. Recent advances in pulp capping materials: an overview[J]. J Clin Diagn Res, 2014,8(1):316-321. doi: 10.7860/JCDR/2014/7719.3980 URL pmid: 24596805
[8]	Grewal N, Salhan R, Kaur N , et al. Comparative evaluation of calcium silicate-based dentin substitute (Biodentine ^®): and calcium hydroxide (pulpdent): in the formation of reac-tive dentin bridge in regenerative pulpotomy of vital primary teeth: triple blind, randomized clinical trial [J]. Contemp Clin Dent, 2016,7(4):457-463. doi: 10.4103/0976-237X.194116 URL
[9]	Bidar M, Naghavi N, Mohtasham N , et al. Mineral trioxide aggregate and portland cement for direct pulp capping in dog: a histopathological evaluation[J]. J Dent Res Dent Clin Dent Prospects, 2014,8(3):134-140. doi: 10.5681/joddd.2014.025 URL pmid: 4206754
[10]	Bal C, Oztas N, Cincik M , et al. Immunolocalization of fibro-nectin during reparative dentinogenesis in rat molor teeth after pulp capping with mineral trioxide aggregate or calcium hydroxide[J]. N Y State Dent J, 2011,77(6):36-42.
[11]	Tawil PZ, Duggan DJ, Galicia JC. Mineral trioxide aggregate(MTA) : its history,composition, clinical applications [J]. Compend Contin Educ Dent, 2015, 36(4): 247-252; quiz 254, 264. doi: 10.1136/jmedgenet-2013-101642 URL pmid: 25821936
[12]	Kim RJ, Kim MO, Lee KS , et al. An in vitro evaluation of the antibacterial properties of three mineral trioxide aggre-gate (MTA): against five oral bacteria[J]. Arch Oral Biol, 2015,60(10):1497-1502. doi: 10.1016/j.archoralbio.2015.07.014 URL pmid: 26263538
[13]	Koruyucu M, Topcuoglu N, Tuna EB , et al. An assessment of antibacterial activity of three pulp capping materials on Enterococcus faecalis by a direct contact test: an in vitro study[J]. Eur J Dent, 2015,9(2):240-245. doi: 10.4103/1305-7456.156837 URL pmid: 4439853
[14]	Swarup SJ, Rao A, Boaz K , et al. Pulpal response to nano hydroxyapatite, mineral trioxide aggregate and calcium hydroxide when used as a direct pulp capping agent: an in vivo study[J]. J Clin Pediatr Dent, 2014,38(3):201-206. doi: 10.17796/jcpd.38.3.83121661121g6773 URL pmid: 25095313
[15]	Hilton TJ, Ferracane JL, Mancl L , et al. Comparison of CaOH with MTA for direct pulp capping: a PBRN rando-mized clinical trial[J]. J Dent Res, 2013,92(7 Suppl):16S-22S. doi: 10.1177/0022034513484336 URL
[16]	Kundzina R, Stangvaltaite L, Eriksen HM , et al. Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide[J]. Int Endod J, 2017,50(10):924-932. doi: 10.1111/iej.12719 URL pmid: 27891629
[17]	Zhu C, Ju B, Ni R . Clinical outcome of direct pulp capping with MTA or calcium hydroxide: a systematic review and meta-analysis[J]. Int J Clin Exp Med, 2015,8(10):17055-17060. URL pmid: 26770296
[18]	Jefferies SR . Critical appraisal. comparative performance of mineral trioxide aggregate versus calcium hydroxide as a direct pulp capping agent[J]. J Esthet Restor Dent, 2016,28(2):131-135. doi: 10.1111/jerd.12202 URL pmid: 26876369
[19]	Rasaratnam L . Review suggests direct pulp capping with MTA more effective than calcium hydroxide[J]. Evid Based Dent, 2016,17(3):94-95. doi: 10.1038/sj.ebd.6401194 URL pmid: 27767114
[20]	Esmaeili B, Alaghehmand H, Kordafshari T , et al. Coronal discoloration induced by calcium-enriched mixture, mineral trioxide aggregate and calcium hydroxide: a spectrophoto-metric analysis[J]. Iran Endod J, 2016,11(1):23-28. doi: 10.7508/10.7508/iej URL pmid: 4731529
[21]	Shin JH, Jang JH, Park SH , et al. Effect of mineral trioxide aggregate surface treatments on morphology and bond strength to composite resin[J]. J Endod, 2014,40(8):1210-1216. doi: 10.1016/j.joen.2014.01.027 URL pmid: 25069935
[22]	Oskoee SS, Bahari M, Kimyai S , et al. Shear bond strength of calcium enriched mixture cement and mineral trioxide aggregate to composite resin with two different adhesive systems[J]. J Dent (Tehran), 2014,11(6):665-671.
[23]	Malkondu Ö, Karapinar Kazandağ M, Kazazoğlu E . A review on biodentine, a contemporary dentine replacement and repair material[J]. Biomed Res Int, 2014,2014:160951. doi: 10.1155/2014/160951 URL pmid: 25025034
[24]	Laurent P, Camps J, About I . Biodentine (TM): induces TGF-β1 release from human pulp cells and early dental pulp mine-ralization[J]. Int Endod J, 2012,45(5):439-448. doi: 10.1111/j.1365-2591.2011.01995.x URL pmid: 22188368
[25]	Luo ZR, Kohli MR, Yu Q , et al. Biodentine induces human dental pulp stem cell differentiation through mitogen-activated protein kinase and calcium-/calmodulin-dependent protein kinaseⅡpathways[J]. J Endod, 2014,40(7):937-942. doi: 10.1016/j.joen.2013.11.022 URL pmid: 24935539
[26]	De Rossi A, Silva LA, Gatón-Hernández P , et al. Compari-son of pulpal responses to pulpotomy and pulp capping with biodentine and mineral trioxide aggregate in dogs[J]. J Endod, 2014,40(9):1362-1369. doi: 10.1016/j.joen.2014.02.006 URL pmid: 25146016
[27]	Kaup M, Dammann CH, Schäfer E , et al. Shear bond strength of Biodentine, ProRoot MTA, glass ionomer cement and composite resin on human dentine ex vivo[J]. Head Face Med, 2015,11:14. doi: 10.1186/s13005-015-0071-z URL pmid: 25908430
[28]	Yoldaş SE, Bani M, Atabek D , et al. Comparison of the potential discoloration effect of bioaggregate, biodentine, and white mineral trioxide aggregate on bovine teeth: in vitro research[J]. J Endod, 2016,42(12):1815-1818. doi: 10.1016/j.joen.2016.08.020 URL pmid: 27776876
[29]	Tziafa C, Koliniotou-Koumpia E, Papadimitriou S , et al. Dentinogenic responses after direct pulp capping of minia-ture swine teeth with biodentine[J]. J Endod, 2014,40(12):1967-1971. doi: 10.1016/j.joen.2014.07.021 URL pmid: 25308154
[30]	Katge FA, Patil DP . Comparative analysis of 2 calcium silicate-based cements (biodentine and mineral trioxide aggregate): as direct pulp-capping agent in young permanent molars: a split mouth study[J]. J Endod, 2017,43(4):507-513. doi: 10.1016/j.joen.2016.11.026 URL pmid: 28216271
[31]	Sowmya B, Hegde S, Mathew S , et al. Clinical evaluation of mineral trioxide aggregate and biodentine as direct pulp capping agents in carious teeth[J]. J Conserv Dent, 2017,20(2):91-95. doi: 10.4103/0972-0707.212243 URL pmid: 5564251
[32]	Brizuela C, Ormeño A, Cabrera C , et al. Direct pulp capping with calcium hydroxide, mineral trioxide aggregate, and biodentine in permanent young teeth with caries: a rando-mized clinical trial[J]. J Endod, 2017,43(11):1776-1780. doi: 10.1016/j.joen.2017.06.031 URL pmid: 28917577
[33]	Jung JY, Woo SM, Lee BN , et al. Effect of Biodentine and Bioaggregate on odontoblastic differentiation via mitogen-activated protein kinase pathway in human dental pulp cells[J]. Int Endod J, 2015,48(2):177-184. doi: 10.1111/iej.12298 URL pmid: 24738842
[34]	Kim J, Song YS, Min KS , et al. Evaluation of reparative den-tin formation of ProRoot MTA, Biodentine and BioAggregate using micro-CT and immunohistochemistry[J]. Restor Dent Endod, 2016,41(1):29-36. doi: 10.5395/rde.2016.41.1.29 URL
[35]	Tuloglu N, Bayrak S . Partial pulpotomy with BioAggregate in complicated crown fractures: three case reports[J]. J Clin Pediatric Dent, 2016,40(1):31-35. doi: 10.17796/1053-4628-40.1.31 URL pmid: 26696104
[36]	Simsek N, Alan H, Ahmetoglu F , et al. Assessment of the biocompatibility of mineral trioxide aggregate, bioaggregate, and biodentine in the subcutaneous tissue of rats[J]. Nigerian J Clin Pract, 2015,18(6):739-743. doi: 10.4103/1119-3077.154219 URL pmid: 26289510
[37]	Utneja S, Nawal RR, Talwar S , et al. Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement—review of its composition, properties and applications[J]. Restor Dent Endod, 2015,40(1):1-13. doi: 10.5395/rde.2015.40.1.1 URL pmid: 4320271
[38]	Madani ZS, Haddadi A, Mesgarani A , et al. Histopathologic responses of the dental pulp to calcium-enriched mixture (CEM) and mineral trioxide aggregate (MTA) in diabetic and non-diabetic rats[J]. Int J Mol Cell Med, 2014,3(4):263-271. URL pmid: 4293614
[39]	Mehrdad L, Malekafzali B, Shekarchi F , et al. Histological and CBCT evaluation of a pulpotomised primary molar using calcium enriched mixture cement[J]. Eur Arch Paediat Dent, 2013,14(3):191-194. doi: 10.1007/s40368-013-0038-3 URL pmid: 23595622
[40]	Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S , et al. Treat-ment outcomes of primary molars direct pulp capping after 20 months: a randomized controlled trial[J]. Iran Endod J, 2013,8(4):149-152. URL pmid: 3808671
[41]	Asgary S, Eghbal MJ . Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial[J]. Acta Odontol Scand, 2013,71(1):130-136. doi: 10.3109/00016357.2011.654251 URL pmid: 22339289
[42]	Machado J, Johnson JD, Paranjpe A . The effects of endose-quence root repair material on differentiation of dental pulp cells[J]. J Endod, 2016,42(1):101-105. doi: 10.1016/j.joen.2015.08.007 URL pmid: 26410154
[43]	Shokouhinejad N, Nekoofar MH, Razmi H , et al. Bioactivity of EndoSequence root repair material and bioaggregate[J]. Int Endod J, 2012,45(12):1127-1134. doi: 10.1111/j.1365-2591.2012.02083.x URL pmid: 22803801
[44]	Elshamy FM, Singh G, Elraih H , et al. Antibacterial effect of new bioceramic pulp capping material on the main cario-genic bacteria[J]. J Contemp Dent Pract, 2016,17(5):349-353. doi: 10.5005/jp-journals-10024-1854 URL pmid: 27443359
[45]	Lovato KF, Sedgley CM . Antibacterial activity of EndoSe-quence root repair material and ProRoot MTA against cli-nical isolates of enterococcus faecalis[J]. J Endod, 2011,37(11):1542-1546. doi: 10.1016/j.joen.2011.06.022 URL pmid: 22000459
[46]	Shokouhinejad N, Yazdi KA, Nekoofar MH , et al. Effect of acidic environment on dislocation resistance of endosequence root repair material and mineral trioxide aggregate[J]. J Dent (Tehran), 2014,11(2):161-166. doi: 10.1364/JOSAA.2.000833 URL pmid: 24910691
[47]	Beatty H, Svec T . Quantifying coronal tooth discoloration caused by biodentine and EndoSequence root repair mate-rial[J]. J Endod, 2015,41(12):2036-2039. doi: 10.1016/j.joen.2015.08.032 URL pmid: 26472676
[48]	Gandolfi MG, Siboni F, Prati C . Chemical-physical pro-perties of TheraCal, a novel light-curable MTA-like material for pulp capping[J]. Int Endod J, 2012,45(6):571-579. doi: 10.1111/j.1365-2591.2012.02013.x URL pmid: 22469093
[49]	Yang YW, Yu F, Zhang HC , et al. Physicochemical pro-perties and cytotoxicity of an experimental resin-based pulp capping material containing the quaternary ammonium salt and Portland cement[J]. Int Endod J, 2018,51(1):26-40. doi: 10.1111/iej.12777 URL pmid: 28375561
[50]	Lee H, Shin Y, Kim SO , et al. Comparative study of pulpal responses to pulpotomy with ProRoot MTA, RetroMTA, and TheraCal in dogs’ teeth[J]. J Endod, 2015,41(8):1317-1324. doi: 10.1016/j.joen.2015.04.007 URL pmid: 26015158
[51]	Bakhtiar H, Nekoofar MH, Aminishakib P , et al. Human pulp responses to partial pulpotomy treatment with TheraCal as compared with biodentine and ProRoot MTA: a clinical trial[J]. J Endod, 2017,43(11):1786-1791. doi: 10.1016/j.joen.2017.06.025 URL pmid: 28822566
[52]	Bajić MP, Danilović V, Prokić B , et al. Histological effects of enamel matrix derivative on exposed dental pulp[J]. Srp Arh Celok Lek, 2015,143(7/8):397-403. doi: 10.2298/SARH1508397P URL
[53]	Al-Hezaimi K, Al-Tayar BA, Bajuaifer YS , et al. A hybrid approach to direct pulp capping by using emdogain with a capping material[J]. J Endod, 2011,37(5):667-672. doi: 10.1016/j.joen.2011.02.003 URL pmid: 21496668
[54]	Bollu IP, Velagula LD, Bolla N , et al. Histological evalua-tion of mineral trioxide aggregate and enamel matrix deriva-tive combination in direct pulp capping: an in vivo study[J]. J Conserv Dent, 2016,19(6):536-540. doi: 10.4103/0972-0707.194031 URL pmid: 5146769
[55]	Javed F, Kellesarian SV, Abduljabbar T , et al. Role of laser irradiation in direct pulp capping procedures: a systematic review and meta-analysis[J]. Laser Med Sci, 2017,32(2):439-448. doi: 10.1007/s10103-016-2077-6 URL pmid: 27659037
[56]	Deng Y, Zhu XD, Zheng D , et al. Laser use in direct pulp capping[J]. J Am Dent Assoc, 2016,147(12):935-942. doi: 10.1016/j.adaj.2016.07.011 URL
[57]	Cengiz E, Yilmaz HG . Efficacy of erbium, chromium-doped: yttrium, scandium, gallium, and garnet laser irradiation combined with resin-based tricalcium silicate and calcium hydroxide on direct pulp capping: a randomized clinical trial[J]. J Endod, 2016,42(3):351-355. doi: 10.1016/j.joen.2015.11.015 URL pmid: 26723484

材料	主要成分	X线阻射性	单/双组分	凝固时间	凝固后是否可直接
材料	主要成分	X线阻射性	单/双组分	凝固时间	粘接及树脂充填
Dycal	氢氧化钙	弱	双组分	2~3 min	是
MTA	波特兰水门汀,少量硫	有（氧化铋）	粉液双组分	ProRoot MTA超过4 h,MTA Angelus	否（需先用Dyract Flow或
	酸钙、氧化铋			初凝10 min,终凝15 min	其他类似光固化玻璃离子
					隔离）
Biodentine	硅酸三钙粉末、氯化钙水溶	有（氧化锆）	粉液双组分	初凝12 min	是
	液,赋形剂
BioAggregate	硅酸三钙、硅酸二钙	有（氧化钽）	粉液双组分	初凝4 h,终凝28 d	否（需先覆盖一薄层光固
					化的充填材料）
CEM	氧化钙,少量三氧化硫、五	有	粉液双组分	约50 min	不详
	氧化二磷、二氧化硅等
ERRM	硅酸钙,磷酸二氢钙,氧化	有	单组分	2~4 h,快凝膏体仅20 min	否（需先覆盖一薄层玻璃
	锆、氧化钽以及填料等				离子）
TheraCal	波特兰水门汀、聚乙二醇二	弱	单组分	光固化20 s	是
	甲基丙烯酸酯、锆酸钡等