血浆基质在牙髓根尖周病治疗中的应用

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases

摘要

血浆基质作为一种自体血液离心产物，具有再生修复的功能，已被广泛应用于口腔颌面部软硬组织再生修复、皮肤美容等领域，并取得了较好的效果。目前，牙髓再生治疗和根尖手术已成为保存牙髓以及保存患牙的主要方法，生物活性材料的应用至关重要，血浆基质作为一种自体生物活性材料，较易获取，可塑性强，具有天然优势。血浆基质可应用于以下情况：①无法刺激根尖出血的根尖孔未闭合年轻恒牙的牙髓血运重建术；②存在骨缺损的根尖屏障术及大面积穿孔髓室底或根侧壁修补术；③大面积根尖病变，伴或不伴随牙周疾病患牙的根尖手术。因血浆基质为自身血液来源制品，使用方面无明显禁忌。虽然已有系统综述表明，相比传统血凝块，血浆基质作为天然再生支架，可有效促进牙髓根尖周病的再生性修复。然而，由于血浆基质的特性受不同制备方式的影响，其适用范围有所差异。此外，目前尚缺乏血浆基质长期的临床研究结果，且组织学证据较难获取，仍然需要大量的体内外研究进一步探索。本文将对不同血浆基质在牙髓再生、根尖手术中的骨组织再生等方面的应用进行阐述，以期为临床医生在适应证选择及预后评估时提供参考。

Abstract

The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

关键词

血浆基质 / 牙髓血运重建术 / 牙髓再生修复 / 根尖手术 / 牙体硬组织修复 / 根尖诱导成形 / 髓室底穿孔修补 / 富血小板血浆 / 富血小板纤维蛋白 / 浓缩生长因子

Key words

plasma matrix / pulp revascularization / pulp regeneration / apical surgery / repair of dental hard tissue / apexification / furcation perforation repair / platelet-rich plasma / platelet- rich fibrin / concentrated growth factor

Author summay

杨雪超，教授、主任医师、博士生导师，广州医科大学附属口腔医院越秀院区牙体牙髓科主任；获武汉大学及荷兰Radboud University博士学位；主要研究方向为牙髓炎症机制和牙体硬组织再生，主持多项国家、省部级科研课题，先后发表科研论文50余篇，其中SCI收录30篇；主编由人民卫生出版社出版的《微创牙体修复技术图解》、《‍镍钛根管预备和热牙胶根管充填技术》、《‍数字化口腔临床技术图解丛书》系列；兼任中华口腔医学会牙体牙髓病学专业委员会委员、口腔生物医学专业委员会委员、老年口腔专业委员会委员、中国医药生物技术协会3D打印分会常委等；2015年遴选为“广州市医学重点人才”；2018年遴选为首批“广东省杰出青年医学人才”。