Abstract:

Objective    To determine the clinical advance of regenerative endodontics by evidence-based medicine through retrieving the related literature. Methods    The key words of“regenerative endodontics”、“revascularization and pulpal regeneration”、“apexification”、“apical barrier approaches”、“antibiotics combination”、“calcium hydroxide”、“blood clot”、“PRP”、“PRF”、“MTA”and“GIC”were used. PubMed，Embase，Cochrane Library，SinoMed and CNKI data library were searched for relative trials from 1 January 2004 to now. Inclusion criteria: the related researches on “comparison of curative effect of regenerative endodontics and apexification or apical barrier approaches”、“the choice of intracanal medications in regenerative endodontics”、“the choice of scaffold materials in regenerative endodontics”、“the choice of canal-sealing materials in regenerative endodontics”. The evidences were evaluated by modified SIGN’s classification system of evidence level and recommendation grade. Results    Totally 245 literatures were found; 9 controlled clinical trials、2 evidence-based reviews、 8 retrospective studies and 2 lab researches met our inclusion criteria. Conclusion    Regenerative endodontics and apexification or apical barrier approaches have the same efficacy in the treatment of clinical symptoms while regenerative endodontics has obvious advantages in promoting the regeneration of the root；antibiotics combination and calcium hydroxide can effectively promote disinfection of root canal and root development，and antibiotics combination is better，but it has high cell toxicity and low clearance rate；PRP or PRF and blood clots can improve clinical symptoms and promote root development，the effect of PRP is better than that of blood clots，and PRF has the best curative effect；the long-term effect of MTA is better than that of GIC in choosing the root sealing materials in regenerative endodontics.

Key words: evidence-based medicine, regenerative endodontics, revascularization and pulpal regeneration, apexification, apical barrier approaches, antibiotics, calcium hydroxide, blood clot, PRP, PRF, MTA, GIC

摘要：

目的    通过检索己发表的相关文献，以循证医学为主要路径来探讨牙髓再生治疗的临床进展。方法    以“牙髓再生治疗”、“牙髓血运重建术”、“根尖诱导成形术”、“根尖屏障术”、“抗生素”、“氢氧化钙”、“血凝块”、“富集血小板血浆（PRP）”、“富集血小板纤维蛋白（PRF）”、“矿物三氧化物凝聚体（MTA）”、“玻璃离子水门汀（GIC）”为关键词，限制为人类，检索2004-01-01至今收录在PubMed、Embase、Cochrane Library以及中国生物医学文摘数据库（SinoMed）和中国期刊网（CNKI）数据库中的文献。纳入标准：“牙髓再生治疗与根尖诱导成形术或根尖屏障术疗效对比”、“牙髓再生治疗根管消毒药物选择”、“牙髓再生治疗支架材料选择”和“牙髓再生治疗根管封闭材料选择”的相关研究。结果    共获得相关文献245篇，通过改良的SIGN证据等级和推荐强度分级方式，选取证据等级分级为1++、1+、1-及2++级，推荐强度分级为A或B的相关研究。最终符合纳入标准的文献21篇，其中系统评价2篇、随机对照试验（RCT）研究9篇、病例对照或队列研究8篇及实验室研究2篇。结论    牙髓再生治疗在临床症状的减轻方面同根尖诱导成形术或根尖屏障术具有相同疗效，在促进牙根继续发育方面有明显优势；抗生素糊剂与氢氧化钙都可对根管内进行有效消毒并且促进牙根继续发育，抗生素糊剂效果略好，但细胞毒性高、清除率低；PRP或PRF和血凝块都能改善临床症状，在促进牙根继续发育方面，PRP疗效略优于血凝块，而PRF疗效最好。牙髓再生治疗根管封闭材料选择方面，MTA的远期疗效优于GIC。

关键词: 循证医学, 牙髓再生治疗, 牙髓血运重建术, 根尖诱导成形术, 根尖屏障术, 抗生素, 氢氧化钙, 血凝块, 富集血小板血浆, 富集血小板纤维蛋白, 矿物三氧化物凝聚体, 玻璃离子水门汀