| The special anatomy of deciduous teeth and the diversity of children’s living and eating habits often lead to a high incidence of caries in children,which progresses rapidly and can involve the pulp in a short time..Therefore,caries is the primary disease that harms children’s oral health.For deciduous teeth with dental pulp exposed due to caries or mechanical,AAPD guidelines recommend pulpotomy.However,the investigation results showed that deciduous incisor was not widely used in China due to the difficulties in determining the pulp status of the affected teeth,the strict requirements on sterility,the poor coordination degree of children,the inadequate mastery of this technique by doctors,and the doubts about the selection of pulp capsulotomy materials.At the same time,in recent years,more and more doctors and parents have paid attention to the comfort diagnosis and treatment of children.How to complete the treatment of children with teeth in a comfortable environment and state has gradually become a research hotspot.The study shows that Er:YAG laser has the characteristics of safety,painless,no mechanical contact,stimulating the regeneration of pulp cells and so on.It may be comfortable,painless and have a high success rate when applied to children’s deciduous tooth pulpotomy.Er:YAG laser has been gradually applied in the treatment of deciduous pulp excision,but the space is very limited,and there is a lack of systematic clinical and histological studies.IRoot BP Plus,a new bioceramics material,has similar mineralization ability,biocompatibility,antibacterial and antibacterial ability as MTA,as well as good aesthetics and easy operation.It has a good prospect in the application of pulpotomy in children’s deciduous teeth.In recent two years,there have been occasional reports on the application of iRoot BP Plus in pulpotomy of deciduous teeth,but there is a lack of relevant studies on its histological level.Therefore,this subject intends to solve the problems existing in the pulpotomy of deciduous teeth through animal experiments.Firstly,the application of Er:YAG laser the pulpotomy of deciduous teeth was evaluated comprehensively by means of surgical comfort,clinical effect,especially histopathological results.Secondly,the clinical effect and histopathological results were used to comprehensively evaluate the application of iRoot BP Plus,MTA and calcium hydroxide in pulpotomy of deciduous teeth.In order to provide clinical and histological support for the application and promotion of deciduous pulpotomy in children’s oral cavity.Part one Study on the applicatioin of Er: YAG laser in pulpotomy of deciduous teeth Purpose:To explore the clinical effect of Er: YAG laser in pulpotomy of deciduous teeth.Methods: The comfort of Er: YAG laser in pulpotomy was evaluated by comparing the pulp cutting time,hemostatic time,and the total time from pulp cutting to pulp covering,and the influence on the heart rate of experimental animals during the operation.The clinical efficacy of Er: YAG laser in deciduous pulpotomy was evaluated by clinical examination and imaging results.HE staining and immunohistochemical technique were used to evaluate the histological results of Er: YAG laser in pulpotomy of deciduous teeth.Results: Er:YAG laser medullary duration was significantly longer than that of the mechanical group(32.11 ± 5.21 s vs 9.06± 1.65 s,P < 0.0001),but the hemostasis duration(253.50 ± 74.44 s vs 390.38 ± 126.05 s,P = 0.006)and the duration from medullary dissection to precapping(285.61 ± 74.81 s vs 399.44 ± 126.42 s,P = 0.003)was significantly shorter than that of the mechanical group.There was no significant difference in mean heart rate between the two groups under local anesthesia(77.83 ±9.53 beats/min vs 79.31 ± 11.11 beats/min,P = 0.679).The results of clinical and imaging examinations at 1 week,4 weeks and 12 weeks after pulpotomy of deciduous teeth were similar,and the success rate was 100%.The results of HE staining showed that the pulomyelitis response after Er:YAG laser treatment was lighter than that of the mechanical group,the formation time of dentine bridge was significantly earlier than that of the mechanical group(1 week vs 4 weeks),and the final thickness of dentine bridge formed was significantly greater than that of the mechanical group(1507.59 ± 108.43μm vs 1110.55 ± 117.38 μm,P < 0.0001).Immunohistochemical results showed that there was no statistically significant difference in the mean optical density values of DSPP and Runx2 expression between the groups at 1,4 and 12 weeks after surgery(P >0.05).Conclusion: Er:YAG laser pulpotomy can shorten the treatment time and improve the comfort level of pulpotomy for decidustomy teeth.Besides,the postoperative inflammatory reaction is less severe and pulp tissue reconstruction is more ideal.It is an alternative method for pulp excision treatment of decidustomy teeth.Part two Study on the application of bioceramics material iRoot BP Plus in pulpotomy of deciduous teeth Objective: To evaluate the clinical effect of iRoot BP Plus in pulpotomy of deciduous teeth.Methods: Clinical examination and imaging results were used to compare the clinical effects of calcium hydroxide,MTA and iRoot BP Plus in pulpotomy of deciduous teeth.HE staining and immunohistochemical technique were used to evaluate the histological results of three kinds of pulp capping materials in pulpotomy of deciduous teeth.Results: In terms of clinical efficacy,within 12 weeks after surgery,the clinical success rate of calcium hydroxide,MTA and iRoot BP Plus was 100%.With MTA pulp cap,crown discoloration was observed 1 week after surgery.No crown discoloration was observed 12 weeks after surgery with iRoot BP Plus and calcium hydroxide.In terms of postoperative inflammatory response,the calcium hydroxide group was the heaviest,and the inflammatory response of dental pulp tissues in the MTA group and the iRoot BP Plus group was similar,which was lighter than the calcium hydroxide group.In terms of dentine bridge formation time,the MTA group and the iRoot BP Plus group were similar(4 weeks),both earlier than the calcium hydroxide group(12 weeks).In terms of dentine bridge thickness,iRoot BP Plus group was the thickest,followed by MTA group,and calcium hydroxide group was the thinest(1641.86 ± 187.98 μ m vs 1138.08 ±105.11 μ m vs 658.35 ± 133.83 μ m,P < 0.0001).In terms of dentine bridge porosity,the MTA group and the iRoot BP Plus group were similar,which were significantly lower than the calcium hydroxide group(4.59% ± 3.05% vs 2.75% ±1.78% vs 10.50% ± 2.01%,P < 0.0001).Immunohistochemical results showed that the mean optical density values of DSPP and Runx2 at 1 week after surgery were significantly higher than those of the MTA group and the calcium hydroxide group(P <0.05),but there was no significant difference between 4 weeks and 12 weeks after surgery(P > 0.05).Conclusion: IRoot BP Plus and MTA have a good application prospect in pulpotomy of deciduous teeth,and iRoot BP Plus has good aesthetic properties.Based on histopathological results,iRoot BP Plus and MTA were superior to calcium hydroxide. |
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