乳牙根管充填材料的抗菌性能、生物相容性及临床选择策略

Antibacterial properties, biocompatibility, and clinical selection strategies of root canal filling materials for primary teeth

摘要

乳牙根管治疗是一种旨在清除感染组织、缓解疼痛并保留乳牙至正常替换的关键治疗方法，其疗效很大程度上取决于根管充填材料的选择。近年来，随着材料科学与生物医学的发展，乳牙根管充填材料的研究取得显著进展，传统材料(如氧化锌丁香酚、氢氧化钙碘仿等)不断优化，新型材料(如硅酸钙生物陶瓷、生物活性玻璃等)不断开发并推广应用。目前临床常用材料各具特点：氧化锌-丁香酚类抗菌性强但吸收慢，氢氧化钙类生物相容性好但吸收过快，碘仿类临床成功率较高但证据多基于短期随访，硅酸钙生物陶瓷具有良好生物活性但抗菌性较弱，抗生素类适用于非器械治疗但存在耐药与变色风险。临床选择需综合考虑材料性能、患牙状况、患儿配合度及治疗成本等因素。总结乳牙根管充填材料的抗菌性能、生物相容性及临床研究进展，并结合前沿材料设计理念(如抗菌-成骨双功能微球、可注射生物陶瓷、光响应纳米酶系统等)展望其未来发展方向，可为儿童口腔临床诊疗与新材料研发提供参考。

Abstract

Root canal treatment for primary teeth is a critical therapy aimed at eliminating infected tissue, relieving pain, and preserving the primary tooth until its natural exfoliation and replacement. The success of this treatment largely depends on the choice of root canal filling materials. In recent years, driven by advances in materials science and biomedicine, research on primary-tooth root canal filling materials has made substantial progress, including optimization of traditional materials such as zinc oxide-eugenol (ZOE) and calcium hydroxide-iodoform mixtures, as well as the development and increasing clinical adoption of novel materials such as calcium silicate bioceramics and bioactive glass. Currently used clinical materials show distinct characteristics: ZOE exhibits strong antibacterial activity but slow resorption; calcium hydroxide materials demonstrate favorable biocompatibility but overly rapid resorption; iodoform-based materials present relatively high short-term clinical success, though supporting evidence is mainly derived from short-term follow-up; calcium silicate bioceramics possess good bioactivity but weaker antibacterial effects; and antibiotic-based materials are applicable in non-instrumental treatment but carry risks including resistance, discoloration, and tooth staining. Clinical selection requires integrated consideration of material performance, tooth condition, child cooperation, treatment cost, and economic burden. Summarizing the antibacterial properties, biocompatibility, and recent clinical research progress of primary-tooth canal filling materials, and outlining their future development directions based on emerging material-design concepts (such as antibacterial-osteogenic dual-functional microspheres, injectable bioceramics, and light-responsive nanozyme systems), may provide references for pediatric dental clinical practice and new material research and development.

Graphical abstract

关键词

乳牙 / 根管充填材料 / 抗菌性能 / 生物相容性 / 可吸收性 / 氧化锌-丁香酚 / 氢氧化钙-碘仿 / 硅酸钙生物陶瓷

Key words

primary teeth / root canal filling materials / antibacterial properties / biocompatibility / resorbability / zinc oxide-eugenol / calcium hydroxide-iodoform / calcium silicate bioceramics

乳牙根管充填材料是应用于乳牙根管治疗过程中填充根管系统的生物材料，旨在封闭根管空间、清除或抑制细菌感染、促进根尖周组织愈合，并维持乳牙的功能直至正常脱落^[1]。在乳恒牙替换过程中，乳牙根被生理性吸收后，继承恒牙方可萌出至正常位置，因此，乳牙与恒牙根管充填材料的选择具有很大差别。

理想的乳牙根管充填材料应具有良好的可吸收性，其吸收速率应与乳牙牙根的生理性吸收相匹配，不妨碍恒牙胚的发育及恒牙的正常萌出^[2]。其次，由于乳牙根管解剖结构复杂，常规的机械预备、冲洗和消毒通常无法彻底清除感染的牙髓组织^[3-4]，加之部分儿童的配合度较差，因此，乳牙根管充填材料应具有优异的抗菌特性，对乳牙根管内残留的细菌有较好的包埋和杀灭作用^[5]。此外，材料的选择应更注重低刺激性和生物安全性，可具备一定的促矿化活性，能较好地促进根尖周病变的愈合。乳牙根管充填材料还应具有良好的X射线阻射性，不会导致牙齿变色^[2]。目前临床应用的乳牙根管充填材料可分为氧化锌-丁香酚(zinc oxide-eugenol，ZOE)类、氢氧化钙类、碘仿类、硅酸钙生物陶瓷类及抗生素类，但上述材料尚不能满足理想乳牙根管充填材料的所有要求，临床医师需根据患牙的实际情况进行选择，以获得较好的治疗效果。因此，系统梳理目前乳牙根管充填材料的特性及其临床研究进展，对于指导材料选择和开发新型充填剂具有重要意义。

本文拟针对乳牙根管充填材料的抗菌性能、生物相容性、可吸收性、X射线阻射性等进行概述，对乳牙根管充填材料的临床选择策略进行归纳，以期为儿童口腔科医师的临床诊疗提供参考，也为新一代理想的乳牙根管充填材料的开发提供思路。

1 乳牙根管充填材料分类、特性及临床研究进展

1.1 ZOE类

ZOE类充填材料由氧化锌粉末与丁香酚液体调拌而成，凭借其良好的抗炎、抗菌(尤其对革兰氏阴性菌及粪肠球菌)、镇痛及X射线阻射性能，成为传统常用乳牙根管充填的代表性材料之一^[6-8]。其抗菌作用主要源于丁香酚可使细菌蛋白质变性的特性^[2]。然而，ZOE也存在明显不足：一是氧化锌与丁香酚的化学结合不稳定可导致牙冠变色^[9]；二是其细胞毒性较高，体外研究^[10-11]证实其可显著抑制人牙龈成纤维细胞及骨肉瘤细胞的增殖活力，动物试验^[11-12]亦提示其可引起局部明显的炎性浸润及牙槽骨吸收。

由于丁香酚与二价锌离子反应可形成不溶性螯合物，ZOE糊剂充填后材料的降解速度略滞后于乳牙牙根的生理性吸收^[13-14]，超出根尖孔的ZOE需要数月甚至数年才可被完全吸收^[15-16]，可影响恒牙胚的发育，改变其萌出路径^[17-18]。但同时，这一延迟吸收的特性也可用于充填无继生恒牙胚的乳牙根管，以延迟牙根吸收，延长乳牙在口内的存留时间^[19]。

为优化ZOE类充填材料的性能，改良型产品不断涌现。例如，在ZOE中加入氢氧化钙和碘仿制成的改良糊剂，利用钙离子与丁香酚形成的螯合物溶解度更高及碘仿溶解产生多孔结构的特点，可改善材料的可吸收性^[15]。Endoflas作为预混合商品，含有ZOE、碘仿及氢氧化钙，其吸收速率与牙根生理性吸收更匹配^[2]，且多项为期9个月的临床研究^[20-21]显示其成功率优于单纯ZOE或碘仿糊剂。此外，采用芦荟、印楝油、蜂胶等天然抗菌成分替代丁香酚与氧化锌粉混合所获得的新材料，不仅增强了抗菌性能，还提高了材料的安全性^[22-23]，并成功应用于临床^{[14, 24]}，但其长期疗效有待证实。

1.2 氢氧化钙类

氢氧化钙类材料因其优异的抗菌性、良好的生物相容性及对恒牙胚发育无干扰的特点，被广泛用于乳牙根管治疗。其作用机制在于解离产生高pH值的碱性环境，该环境不仅能有效抑制根管内常见需氧菌及厌氧菌，还能促进牙本质再矿化^[25-26]。通过调整溶剂(如丙二醇)或与抗生素、氧化锌等联用，可增强其抗菌性能^[27-29]。该材料生物相容性良好，在体外细胞实验^[30]和动物皮下及下颌骨植入实验^[31-32]中均显示低刺激性及促修复倾向。

然而，氢氧化钙溶解度过高，吸收过快，易在根管内形成空腔导致再感染^[15]。长期随访研究^[33](26个月)显示其总体成功率较低(尤其对于牙髓坏死患者)。但在12个月的随访期内，氢氧化钙类(如Apexcal)糊剂在临床应用中显示出较高的成功率^[34]。以上结果提示，单独使用氢氧化钙在短期内可能取得一定的临床疗效，但其远期效果并不理想。

为改善氢氧化钙类材料吸收较快的特点，联合使用氧化锌(如氢氧化钙糊剂/氧化锌)被认为是一种有效的方式。该联合策略在12~18个月的随访中可取得满意效果，但相较于ZOE或碘仿类糊剂并未展现出显著优势^[35-36]。因此，材料的吸收速率与乳牙牙根生理性吸收速率的长期适配仍是氢氧化钙类新材料开发需重点突破的难点，开展长期的临床随访研究对该类材料的开发具有重要的指导意义。

1.3 碘仿类

碘仿类糊剂凭借其缓慢释放游离碘产生的广谱、持久抗菌作用，良好的X射线阻射性，以及减少根尖渗出的能力，常与氢氧化钙组成复合糊剂(如Vitapex、Metapex)，成为临床常用选择^[37-38]。碘仿类糊剂对感染的乳牙根管中常见菌的生长具有较好的抑制作用，且其抗菌性能优于氢氧化钙类糊剂，但低于ZOE及抗生素类糊剂^[39-41]，在碘仿中添加ZOE、蜂胶等成分可进一步增强抗菌效果^{[34, 42]}。在生物相容性方面，多项细胞学实验(如对牙龈成纤维细胞^[11]、原代成骨细胞^[30])及动物实验(大鼠皮下^[11]、犬根尖周^[12])均证实其刺激性低、组织反应温和。

碘仿与氢氧化钙混合糊剂被认为是一种较为理想的碘仿类乳牙根管充填材料^{[17, 43]}。与非碘仿类充填材料相比，碘仿类糊剂在6~18个月的随访期内表现出较高的临床成功率^[44-46]；然而，在更长的随访期(18~30个月)，其疗效优势不再明显^[43]，且现有研究普遍存在偏倚风险较高、长期高质量证据缺乏的问题。因此，需要开展多中心、大样本量的高质量临床研究来准确评估碘仿类材料的长期效果。

1.4 硅酸钙生物陶瓷类

硅酸钙生物陶瓷[如三氧矿物聚合物(mineral trioxide aggregate，MTA)、Bio-CP及iRoot FM]是一类具有生物活性的无机材料，可与组织液发生水化反应，溶解后形成局部碱性微环境，获得一定的抗菌活性^[47-48]，并提供生物矿化所需的钙、硅等离子，具有良好的促矿化潜力^[49-50]。然而，其抗菌性能通常弱于ZOE、氢氧化钙及抗生素类材料^[51-52]。

研究^[53]表明，一定浓度的MTA可促进牙髓干细胞的成骨分化，展现出良好的细胞相容性。在大鼠背部皮下结缔组织植入实验^[54]中，MTA显示出诱导骨桥蛋白表达的能力。有研究^[55-56]将其用于无继承恒牙的乳磨牙根管充填，在长达3年的随访中显示出一定的功能保留潜力(患牙功能良好，没有临床症状或体征)。但其临床推广受限于固化时间长、操作后不易取出、可能引起牙体变色及成本较高等问题^[57-59]。Bio-CP及iRoot FM均为可注射即用型生物陶瓷类材料，体外研究^{[10, 60]}显示这2种材料均表现出良好的细胞相容性与促成骨分化能力。但Bio-CP过高的溶解度可能增加根管再感染的风险^{[48, 61]}，目前仍缺乏临床试验。iRoot FM可以随比格犬乳牙牙根的生理性吸收而降解，在14周的随访期内展现出了良好的疗效^[62]，但需临床试验进一步验证。

总体而言，硅酸钙生物陶瓷是一类极具潜力的乳牙根管充填材料，未来需在增强其抗菌性能，精确调控降解速率，以及改善临床操作性等方面进行深入研发。生物活性玻璃/玻璃陶瓷因其组分与性能可灵活设计，降解后可释放各类功能离子^[63](如钙和磷离子，可促进生成羟基磷灰石；氟和铜离子，具有抗菌性)，且具有优异的生物安全性^[64]，是值得关注的研发方向。

1.5 抗生素类

抗生素糊剂，尤其是三联抗生素糊剂(triple antibiotic paste，TAP)和氯霉素-四环素-氧化锌丁香酚(chloramphenicol, tetracycline and zinc oxide eugenol，CTZ)糊剂，抗菌力强^[2]，主要与不依赖机械预备的病变灭菌和组织修复(lesion sterilization and tissue repair therapy，LSTR)技术联合应用，适用于患儿配合度差或医疗资源有限的场景^[65]。

TAP通常由甲硝唑(抗厌氧菌)、环丙沙星(抗革兰氏阴性菌)和米诺环素(广谱抗菌)组成，溶剂多为聚乙二醇或丙二醇(促进药物渗透)^[66]。TAP对乳牙根管内常见致病菌(如粪肠球菌、牙龈卟啉单胞菌)的抑制作用显著^[40]，大鼠皮下结缔组织植入试验^[67]显示其生物相容性与氢氧化钙糊剂类似。短期临床研究^[68-69](12~24个月)显示其对伴有严重根尖周病变的乳牙疗效良好；但长期随访(24~36个月)显示成功率明显降低，部分患儿出现了继承恒牙冠周骨吸收及萌出延迟^[70-71]。此外，米诺环素易与牙体组织螯合导致不可逆的牙冠变色^[72]；作为第一代硝基咪唑类抗生素的甲硝唑存在抗菌谱窄、半衰期短、不良反应多及耐药性问题突出等不足。有学者^{[68, 73]}使用克林霉素或奥硝唑替代配方中的米诺环素或甲硝唑，结果显示改良糊剂较TAP均表现出更高的短期(12~24个月)成功率，但长期疗效与安全性仍需观察。

CTZ糊剂由氯霉素、四环素、氧化锌和丁香酚混合而成，具有较强的抗菌作用^{[39, 14, 74]}，但因其含有ZOE和四环素，在生物相容性和致牙变色方面存在风险^[31-32]。虽然CTZ联合LSTR技术具有操作简便、成本低的优点^[75-76]，在短期随访(12~24个月)中成功率较高^{[75, 77]}，但长期随访中失败率有上升趋势^{[33, 78]}，疗效在不同研究中差异较大，安全性有待更多研究验证。因此，抗生素糊剂的应用需严格把握适应证，并警惕细菌耐药性、牙体变色及对继承恒牙胚的潜在影响，不宜作为乳牙常规根管治疗的长期替代方案。

乳牙根管充填材料抗菌性能、体内外生物相容性和临床研究进展的总结见附表1~4(https://doi.org/10.57760/sciencedb. xbyxb.00163)。

2 临床选择乳牙根管充填材料时应考虑的因素

目前尚无科学证据表明任何一种根管充填材料在治疗乳牙牙髓感染及坏死方面具有全面的优越性^[79]。临床上选择根管充填材料及治疗方式时需要综合考虑以下几个因素：患儿的配合程度、当地的医疗条件及治疗成本，乳牙在口内的存留时间及有无继承恒牙发育，术前牙齿松动、牙根吸收、牙体缺损情况及有无根尖周病变，材料的抗菌性能及生物安全性，降解速率与乳牙牙根吸收速率的匹配性等(图1)。

2.1 患儿配合程度、当地医疗条件及治疗成本

乳牙牙髓切除术需要对根管进行机械-化学预备，并使用可吸收的糊剂进行充填，多次的就诊过程通常需要患儿较高的配合度^[1]。相较于传统的牙髓切除术，抗生素糊剂联合非器械根管治疗(无需机械-化学预备)操作简单，节约治疗时间，成本更低^[65]，适用于那些因张口受限、严重的呕吐反射或紧张恐惧等原因无法有效配合治疗的儿童、医疗资源匮乏的地区及经济状况不佳的家庭^[75-76]。

2.2 有无继生恒牙发育

MTA类生物陶瓷材料凝固后质地较硬，难以从根管内取出，且具有良好的促矿化作用，可用于恒牙先天缺失的滞留乳牙根管充填，以延迟牙根吸收，延长乳牙在口内的存留时间^[55-56]。ZOE糊剂固化后质地坚硬且吸收缓慢，虽然适用于无继承恒牙的乳牙根管充填，但目前对其应用的研究仅限于犬类动物实验^[19]，尚未见临床研究报道。

2.3 术前牙齿松动、牙根吸收情况及有无明显的 根尖周病变

牙根的吸收程度及根尖周病变的严重程度可影响牙齿的松动度及在口内的存留时间，从而影响临床医师对根管充填材料和治疗方式的选择。根据术前检查结果，若无明显牙根吸收或牙齿松动，可考虑使用牙髓切除术并充填含氧化锌或ZOE的材料，以延缓充填材料及牙根的吸收^{[16, 80-81]}；当乳牙伴有明显的根尖周病变时，建议使用具有良好的消毒、抗菌、防腐作用的碘仿/氢氧化钙混合糊剂，或使用具有较强渗透、杀菌作用的抗生素糊剂联合LSTR技术进行充填，或选择拔除并进行间隙保持^{[43, 82-84]}。

2.3.1 术前无明显牙根吸收

当患牙无明显松动，且预计在口内的存留时间较久(多超过2年)时，可根据是否伴有根尖周病变选择合适的治疗方法。无明显根尖周病变：可考虑行传统牙髓切除术并充填含有ZOE/氧化锌的氢氧化钙糊剂、碘仿/氢氧化钙混合糊剂或含有天然抗菌成分的氧化锌糊剂，以减缓充填材料的吸收。存在明显根尖周病变：若伴有轻度的病理性松动，建议采用传统牙髓切除术并充填含有氧化锌的碘仿/氢氧化钙混合糊剂，避免使用具有细胞毒性的丁香酚。这种方法可以减少根管内渗出，促进炎症消退，并延缓充填材料的吸收。

2.3.2 术前牙根吸收不超过根长1/3，无明显病理性 牙根内/外吸收

患牙在口内的存留时间因根尖周病变严重程度和松动程度不同而有所差异，此时应综合考虑。1)无明显松动(预计在口内存留18个月)。当未见明显根尖周病变时，可考虑传统牙髓切除术并充填含氧化锌的碘仿/氢氧化钙混合糊剂或含有天然抗菌成分的氧化锌糊剂，以延缓充填材料的吸收。若伴有明显根尖周病变，建议进行传统的机械-化学预备后使用抗生素糊剂进行根管内消毒，以彻底清除乳牙根管内感染、坏死的牙髓组织，随后充填具有较强抑菌作用的TAP或碘仿/氢氧化钙混合糊剂^[85-86]；此外，也可以考虑使用含有ZOE的CTZ糊剂联合LSTR技术，并进行密切随访^{[75, 77]}。2)轻度松动(预计在口内存留12~18个月)。无论是否伴有根尖周病变，传统牙髓切除术联合碘仿/氢氧化钙混合糊剂充填，均可取得较好的治疗效果。3)中度及以上松动(预计在口内存留小于12个月)。当未见明显根尖周病变时，考虑行传统牙髓切除术并充填安全性较高及吸收性较好的氢氧化钙糊剂或碘仿/氢氧化钙混合糊剂；当伴有明显根尖周病变时，可考虑使用TAP联合LSTR技术，或进行传统牙髓切除术并充填碘仿/氢氧化钙混合糊剂，密切随访，直至乳牙自然脱落。

2.3.3 术前牙根吸收超过根长1/3

患牙多有松动，此时患牙在口内的预计存留时间较短(多短于18个月)，可根据松动程度及是否伴有明显的根尖周病变进行评估。1)轻度松动。当未见明显根尖周病变时，考虑使用TAP联合LSTR技术，或传统牙髓切除术并充填氢氧化钙糊剂、碘仿/氢氧化钙混合糊剂；若伴有明显根尖周病变，可考虑使用TAP联合LSTR技术，或传统牙髓切除术并充填碘仿/氢氧化钙混合糊剂，密切随访，直至乳牙脱落。2)若患牙存在中度及以上松动或存在病理性牙根吸收，建议拔除后行间隙保持。

2.4 术前牙体缺损情况

若术前患牙牙冠存在大面积缺损而无法修复，建议拔除后行间隙保持，直至继生恒牙正常萌出^[84]。

表1汇总了主要乳牙根管充填材料的特性及临床参考。

3 前沿与转化：未来乳牙根管充填材料的 探索方向

尽管以ZOE、氢氧化钙、碘仿及硅酸钙生物陶瓷为代表的现有材料体系基本满足了乳牙根管治疗的临床需求，但在抗菌时效性、生物功能协同性及个性化治疗方面仍有提升空间。结合材料科学、纳米技术与生物工程的最新进展，未来5~10年乳牙根管充填材料有望在以下方向取得突破。

3.1 抗菌-成骨双功能离子序释微球系统

传统材料往往难以同时优化抗菌与促成骨性能。受生物活性玻璃/玻璃陶瓷可控离子释放特性的启发，新一代材料可设计为具有核壳结构(内核和外壳)的复合微球，通过负载不同的功能离子或药物，以实现治疗离子或药物的时空程序化释放^[87-88]。例如，通过构建核壳给药系统，内核负载抗菌离子或药物(如 Ag⁺、抗生素)^[88-90]，外壳负载成骨/矿化离子(如Ca²⁺、Si⁴⁺)^{[87, 89, 91-92]}，利用材料在根管微环境中的差异化降解，有望实现早期快速释放抗菌离子以清除感染，后期持续缓释成骨离子以促进根尖周骨组织再生，从而精确匹配“抗感染-促修复”的治疗时序，有效克服了传统材料功能单一、释放行为不可控的局限。

3.2 可注射自固化Mg-Si-Ca多元生物陶瓷

针对硅酸钙生物陶瓷(如MTA)固化时间较长、操作性有待优化及可吸收性需精确匹配乳牙生理的挑战，可注射、自固化的镁(Mg)-硅(Si)-钙(Ca)多元生物陶瓷吸引了学者们的注意。该类材料以MgO-SiO₂- CaO体系为基础，常与其他生物相容性基质(如海藻酸盐、透明质酸或特定的水凝胶)复合，以优化材料的流变学性能(如可注射性)，发生水化反应后硫酸钙相固化并提供初始强度，同时MgO和SiO₂组分参与反应，形成具有生物活性的硅酸镁等产物，最终构建出具有三维(three dimensions，3D)多孔结构的支架^[93-94]。通过精确调控Mg/Ca/Si的元素比例，可同步优化其降解速率及机械强度^[95-96]，有望实现新材料的降解速率与乳牙牙根的吸收速度相匹配，并提供碱性抗菌微环境及释放促成骨离子，在操作便捷性与功能适应性上实现双重升级。

3.3 光响应纳米酶原位抗菌与免疫调节体系

为应对抗生素滥用导致的耐药性问题，发展非抗生素、高效且精准的抗菌策略至关重要。光响应纳米酶体系(负载光敏剂的金属有机框架材料如ZIF-8@MET，或具有类过氧化物酶活性的纳米材料)是该研究领域的一大前沿方向^[97-99]。该体系可通过低能量近红外光或可见光局部照射，在原位产生活性氧，对生物膜进行高效、物理性清除^[100-101]。此外，部分纳米材料本身可调控巨噬细胞等免疫细胞的极化，从“消除感染”和“调节炎症”双重途径创造有利于愈合的微环境^[102]。这一策略为实现安全、智能的“无抗生素”根管消毒提供了全新可能。

3.4 个性化与智能化制造技术的融合

随着数字化技术的发展，3D打印可吸收根尖支架等个性化治疗方案正从概念走向实践。结合锥形束CT(cone beam computed tomography，CBCT)影像与3D打印技术，未来有望为复杂根管形态或大面积根尖病变的乳牙，定制与牙根形态完全吻合、降解速率可控的生物活性支架^[103-104]。该支架可作为载体，负载功能微球或药物，实现药物递送与组织工程支架的一体化^[105]。此外，未来研究还应关注材料的智能化，例如开发对多种微环境信号(如温度、pH值、酶、氧化还原状态等)具有多重响应能力的核壳系统，这些系统能够动态调节局部微环境、按需释放生物活性因子^{[90, 106-108]}。

这些前沿性探索虽多处于临床前研究阶段或尚未应用于乳牙根管充填材料的研发，但清晰地展现了未来可能突破的方向，乳牙根管充填材料的发展有望从“被动填充”向“主动修复”、从“单一功能”向“智能响应”转变，为新一代理想材料的开发绘制了蓝图。

4 结 语

乳牙根管充填材料的研究在近年来取得了显著进展，传统材料如ZOE、氢氧化钙、碘仿等通过配方优化不断提升其临床适用性，新型材料如硅酸钙生物陶瓷、生物活性玻璃/玻璃陶瓷等逐步展现出良好的生物活性与抗菌潜力。然而，现有材料在抗菌时效性、降解可控性、生物功能协同性及个性化治疗等方面仍存在不足，尚无法完全满足理想充填材料的所有要求。临床选择需综合考虑材料的抗菌性、生物相容性、吸收速率、X射线阻射性等特性，并结合患牙状况、患儿配合度及医疗条件进行个体化决策。未来，随着材料科学、纳米技术与生物工程的交叉融合，乳牙根管充填材料将朝着多功能化、智能化、个性化的方向发展，为儿童口腔科治疗提供更安全、有效的解决方案。

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基金资助

湖南省科技人才托举工程项目(2023TJ-N18)

长沙市杰出创新青年培养计划(kq2305026┫。This work was supported by the Young Elite Scientists Sponsorship Program of Hunan Province ┣2023TJ-N18)

the Changsha Outstanding Innovative Youth Cultivation Program(kq2305026)

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