年轻恒牙活髓保留技术的临床新进展

New Clinical Progress in Vital Pulp Preservation Techniques for Immature Permanent Teeth

摘要: 年轻恒牙因牙根未完全发育，龋病、外伤等引发的牙髓暴露易导致牙根发育停滞，传统活髓保留技术存在适应症窄、材料性能局限等问题。随着“保髓优先”理念普及，活髓保留技术近年取得显著进展：术式层面，牙髓切断术适应症拓展至部分不可复性牙髓炎，根尖诱导成形术通过材料迭代降低根折风险，牙髓血运重建术凭借生物支架实现牙根三维发育，形成分级治疗体系；材料层面，iRoot BP Plus、Biodentine等硅酸钙基生物陶瓷以低变色率、高矿化诱导能力替代传统氢氧化钙与MTA，CGF + PPP等复合生物材料进一步提升疗效；诊疗技术上，全麻舒适化治疗、微创技术与口腔显微镜结合，解决低龄患儿配合难题与操作精准度问题，预后评估以初诊叩痛为核心指标优化风险预判，整体治疗成功率超90%。未来该领域将向个性化、再生化、数字化方向发展，通过多中心长期随访、基层医师规范化培训等进一步提升活髓保留效果与诊疗可及性，为年轻恒牙临床个体化治疗提供参考。

Abstract: In immature permanent teeth, incomplete root development renders pulp exposure caused by caries, trauma, and other insults prone to result in arrested root development. Traditional vital pulp therapy has been constrained by narrow indications and material-related limitations. With the widespread adoption of the “vital pulp–preserving first” concept, vital pulp therapy has achieved substantial progress in recent years. Procedurally, the indications for pulpotomy have expanded to selected cases of partial irreversible pulpitis; apexification has reduced the risk of root fracture through successive material innovations; and regenerative endodontic procedures have enabled three-dimensional root development via biological scaffolds, collectively forming a tiered treatment strategy. At the material level, calcium silicate-based bioceramics such as iRoot BP Plus and Biodentine, characterized by low discoloration potential and strong mineralization-inducing capacity, have replaced traditional calcium hydroxide and mineral trioxide aggregate (MTA), while composite biomaterials such as CGF combined with PPP have further improved clinical outcomes. In terms of diagnostic and therapeutic techniques, the integration of comfortable treatment under general anesthesia, minimally invasive approaches, and dental operating microscopes has addressed cooperation difficulties in young children and enhanced operative precision. Prognostic assessment has been optimized by using percussion pain at the initial visit as a key indicator for risk prediction, with reported overall success rates exceeding 90%. Future developments are expected to focus on personalized, regenerative, and digitalized approaches, supported by multicenter long-term follow-up studies and standardized training for primary care dentists, to further improve the effectiveness and accessibility of vital pulp therapy for immature permanent teeth.