牙髓根尖周病的诊疗进展概述

doi:10.13591/j.cnki.kqyx.2025.07.001

口腔医学 ›› 2025, Vol. 45 ›› Issue (7): 481-487.doi: 10.13591/j.cnki.kqyx.2025.07.001

• 述评 • 下一篇

牙髓根尖周病的诊疗进展概述

李梦圆¹, 刘洁², 张悦蓉¹, 江飞¹, 张光东¹()

1 南京医科大学附属口腔医院综合诊疗科,口腔疾病研究与防治国家级重点实验室培育建设点,江苏省口腔转化医学工程研究中心,江苏南京(210029)
2 南京医科大学附属口腔医院第一门诊部,口腔疾病研究与防治国家级重点实验室培育建设点,江苏省口腔转化医学工程研究中心,江苏南京(210029)

收稿日期:2025-04-26 出版日期:2025-07-28 发布日期:2025-07-24
通讯作者: 张光东 E-mail:egd_zhang@njmu.edu.cn
作者简介:张光东,博士,南京医科大学附属口腔医院主任医师,副教授,硕士生导师,口腔急诊综合科主任,《口腔医学》杂志编委,中华口腔医学会口腔急诊专业委员会常委,中华口腔医学会牙体牙髓病学专业委员会委员,江苏省口腔医学会口腔急诊专业委员会主任委员。2003年6月在第四军医大学口腔医学院获得医学博士学位。2006年10月至2007年10月作为访问学者在英国伯明翰大学牙科学院进行为期一年的访问研究工作。2016年6月至8月在意大利锡耶纳大学医院进行为期3个月的交流访问。主持江苏省自然科学基金等课题3项,参与国家自然科学基金等课题8项。获教育部高等学校科学研究优秀成果奖(自然科学奖)和江苏省科技进步二等奖等奖励9项。近年来已发表论著90余篇,其中SCI论文20余篇(第一或通信作者10余篇);参编专著3部,主译、副主译专著各1部;指导研究生30余名。
基金资助:
国家自然科学基金(82270955);江苏省科教能力提升工程——江苏省研究型医院(YJXYYJSDW4);江苏省医学创新中心(CXZX202227);南京市卫生科技发展专项(YKK24293)

Overview of technical advances in the diagnosis and treatment of pulp and periapical diseases

LI Mengyuan¹, LIU Jie², ZHANG Yuerong¹, JIANG Fei¹, ZHANG Guangdong¹()

Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China

Received:2025-04-26 Online:2025-07-28 Published:2025-07-24

摘要/Abstract

摘要：

牙髓根尖周病是口腔疾病的重要组成部分。随着诊疗技术的革新和模式的优化,牙髓治疗正逐步向个性化、精准化、微创化方向发展,牙髓保存成功率和患牙的留存率得到显著提高。多模态影像技术、人工智能辅助诊断及分子生物学检测技术的应用,为牙髓病的诊疗提供了新维度;牙科显微镜和静/动态导航的结合进一步提升了根管清创效率;生物活性材料的研发提升了牙髓及根尖周组织感染控制与组织修复的双重能力;基于组织工程的干细胞递送与仿生支架材料的结合则为牙髓-牙本质复合体再生治疗提供了新策略。本文就近年来相关技术的进展进行总结回顾,为优化诊疗提供科学依据。

关键词: 牙髓疾病, 根尖周疾病, 诊断, 治疗

Abstract:

As a critical component of oral diseases, the management of pulp and periapical diseases is undergoing a transformation toward personalized, precise, and minimally invasive therapies, driven by advancements in diagnostic and treatment technologies. These innovations have significantly improved the success rate of pulp preservation and tooth retention. The application of multimodal imaging, artificial intelligence, and molecular biology detection technologies has introduced new dimensions to the diagnosis and treatment of pulp diseases. The integration of dental microscopes with static/dynamic guided endodontics systems has enhanced root canal debridement efficiency. Breakthroughs in bioactive material development have achieved dual progress in infection control and tissue regeneration for pulp and periapical lesions. Furthermore, tissue engineering strategies combining stem cell delivery with biomimetic scaffold materials offer novel approaches for regenerating the pulp-dentin complex. This review summarizes recent technological advances to provide a scientific basis for optimizing clinical diagnosis and treatment.

Key words: dental pulp diseases, periapical diseases, diagnosis, treatment

中图分类号:

R781.3

李梦圆, 刘洁, 张悦蓉, 江飞, 张光东. 牙髓根尖周病的诊疗进展概述[J]. 口腔医学, 2025, 45(7): 481-487.

LI Mengyuan, LIU Jie, ZHANG Yuerong, JIANG Fei, ZHANG Guangdong. Overview of technical advances in the diagnosis and treatment of pulp and periapical diseases[J]. Stomatology, 2025, 45(7): 481-487.

参考文献 58

[1]	Versiani MA, Martins J, Ordinola-Zapata R. Anatomical complexities affecting root canal preparation: A narrative review[J]. Aust Dent J, 2023, 68(Suppl 1): S5-S23.
[2]	Patel S, Brown J, Pimentel T, et al. Cone beam computed tomography in Endodontics: A review of the literature[J]. Int Endod J, 2019, 52(8): 1138-1152. doi: 10.1111/iej.13115 pmid: 30868610
[3]	Tay KX, Lim LZ, Goh BKC, et al. Influence of cone beam computed tomography on endodontic treatment planning: A systematic review[J]. J Dent, 2022, 127: 104353.
[4]	Cotti E, Schirru E. Present status and future directions: Imaging techniques for the detection of periapical lesions[J]. Int Endod J, 2022, 55(Suppl 4): 1085-1099.
[5]	El-Kateb NM, El-Backly RN, Amin WM, et al. Quantitative assessment of intracanal regenerated tissues after regenerative endodontic procedures in mature teeth using magnetic resonance imaging: A randomized controlled clinical trial[J]. J Endod, 2020, 46(5): 563-574. doi: S0099-2399(20)30080-7 pmid: 32173020
[6]	Yoshii S, Fujimoto M, Okuda M, et al. evaluation of a novel root canal endoscope for visualizing the apex of curved root canal models and an extracted tooth[J]. J Endod, 2018, 44(12): 1856-1861.
[7]	Kalyoncuoğlu E, Keskin C, Keleş AL, et al. Efficacy of endoscope and periapical radiography to detect residual root canal filling using micro-CT as reference[J]. J Endod, 2023, 49(2): 212-218. doi: 10.1016/j.joen.2022.11.014 pmid: 36572378
[8]	姜葳, 梁景平. 牙髓根尖周病的诊断技术进展概述[J]. 中华口腔医学杂志, 2022, 57(3): 227-232.
[9]	Ghouth N, Duggal MS, BaniHani A, et al. The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review[J]. Dent Traumatol, 2018, 34(5): 311-319. doi: 10.1111/edt.12424 pmid: 29953720
[10]	Yang K, Guo FF, Zhou ZF, et al. Laser Doppler flowmetry to detect pulp vitality, clinical reference range and coincidence rate for pulpal blood flow in permanent maxillary incisors in Chinese children: A clinical study[J]. BMC Oral Health, 2023, 23(1): 283. doi: 10.1186/s12903-023-02747-z pmid: 37173683
[11]	Dzeletovic B, Stratimirovic DJ, Stojic D, et al. Linear and nonlinear analysis of dental pulp blood flow oscillations in ageing[J]. Int Endod J, 2020, 53(8): 1033-1039. doi: 10.1111/iej.13306 pmid: 32281658
[12]	Stella JPF, Barletta FB, Giovanella LB, et al. Oxygen saturation in dental pulp of permanent teeth: Difference between children/adolescents and adults[J]. J Endod, 2015, 41(9): 1445-1449. doi: 10.1016/j.joen.2015.04.024 pmid: 26093471
[13]	Yang JH, Liu ZY, Chen Z, et al. Application of oxygen saturation test after replantation of avulsed immature permanent teeth: A prospective observational study[J]. J Endod, 2024, 50(7): 954-961. doi: 10.1016/j.joen.2024.04.003 pmid: 38604473
[14]	Dindaroğlu FÇ, Güngör NÖ. Comparison of the vitality test with sensitivity tests in mature and immature teeth: Clinical trial[J]. BMC Oral Health, 2024, 24(1): 613. doi: 10.1186/s12903-024-04317-3 pmid: 38802767
[15]	Fontenele RC, Jacobs R. Unveiling the power of artificial intelligence for image-based diagnosis and treatment in endodontics: An ally or adversary?[J]. Int Endod J, 2025, 58(2): 155-170. doi: 10.1111/iej.14163 pmid: 39526945
[16]	Mohammad-Rahimi H, Sohrabniya F, Ourang SA, et al. Artificial intelligence in endodontics: Data preparation, clinical applications, ethical considerations, limitations, and future directions[J]. Int Endod J, 2024, 57(11): 1566-1595.
[17]	Asgary S. Artificial intelligence in endodontics: A scoping review[J]. Iran Endod J, 2024, 19(2): 85-98.
[18]	Nawal RR, Yadav S, Duncan HF, et al. Discriminatory performance of the pulpal inflammatory biomarkers;Interleukin-8 and TNF-α in patients with symptoms indicative of reversible and irreversible pulpitis: A diagnostic accuracy study[J]. Int Endod J, 2024, 57(9): 1200-1211.
[19]	Sabeti MA, Nikghalb KD, Pakzad R, et al. Expression of selected inflammatory mediators with different clinical characteristics of pulpal inflammation[J]. J Endod, 2024, 50(3): 336-343.
[20]	Zhao Y, Song LT, Li MC, et al. Injectable CNPs/DMP1-loaded self-assembly hydrogel regulating inflammation of dental pulp stem cells for dentin regeneration[J]. Mater Today Bio, 2024, 24: 100907.
[21]	Salem EM, Abdelfatah OM, Hanafy RA, et al. Comparative study of pulpal response following direct pulp capping using synthesized fluorapatite and hydroxyapatite nanoparticles[J]. BMC Oral Health, 2025, 25(1): 17. doi: 10.1186/s12903-024-05285-4 pmid: 39754111
[22]	Zhang L, Lin C, Chen Z, et al. Expert consensus on pulpotomy in the management of mature permanent teeth with pulpitis[J]. Int J Oral Sci, 2025, 17(1): 4. doi: 10.1038/s41368-024-00333-9 pmid: 39762213
[23]	Takahashi Y, Okamoto M, Komichi S, et al. Application of a direct pulp capping cement containing S-PRG filler[J]. Clin Oral Investig, 2019, 23(4): 1723-1731.
[24]	Wang JH, Chen YJ, Zhang BZ, et al. Clinical efficacy of Er: YAG laser application in pulpotomy of primary molars: A 2-year follow-up study[J]. Lasers Med Sci, 2022, 37(9): 3705-3712.
[25]	Connert T, Weiger R, Krastl G. Present status and future directions-Guided endodontics[J]. Int Endod J, 2022, 55(S4): 995-1002.
[26]	Fernández-Grisales R, Rojas-Gutierrez WJ, Mejía P, et al. Guided endodontics, precision and predictability: A case series of mineralized anterior teeth with follow-up cone-beam computed tomography[J]. Restor Dent Endod, 2025, 50(1): e4.
[27]	Llaquet Pujol M, Vidal C, Mercadé M, et al. Guided endodontics for managing severely calcified canals[J]. J Endod, 2021, 47(2): 315-321. doi: 10.1016/j.joen.2020.11.026 pmid: 33278454
[28]	Fonseca Tavares WL, de Oliveira Murta Pedrosa N, Moreira RA, et al. Limitations and management of static-guided endodontics failure[J]. J Endod, 2022, 48(2): 273-279.
[29]	Huth KC, Borkowski L, Liebermann A, et al. Comparing accuracy in guided endodontics: Dynamic real-time navigation, static guides, and manual approaches for access cavity preparation: An study using 3D printed teeth[J]. Clin Oral Investig, 2024, 28(4): 212.
[30]	Yang XX, Zhang YC, Chen X, et al. Limitations and management of dynamic navigation system for locating calcified canals failure[J]. J Endod, 2024, 50(1): 96-105.
[31]	杜宇, 韦曦, 凌均棨. 动静态导航技术在牙髓根尖周病治疗中的应用及展望[J]. 中华口腔医学杂志, 2022, 57(1): 23-30.
[32]	Versiani MA, Alves FF, Andrade-Junior CV, et al. Micro-CT evaluation of the efficacy of hard-tissue removal from the root canal and isthmus area by positive and negative pressure irrigation systems[J]. Int Endod J, 2016, 49(11): 1079-1087. doi: 10.1111/iej.12559 pmid: 26459183
[33]	Ng WNI, Marruganti C, Grandini S, et al. Root canal debridement by negative pressure irrigation, ultrasonically activated irrigation and their combination[J]. J Oral Sci, 2021, 63(3): 286-288.
[34]	Mancini M, Cerroni L, Palopoli P, et al. FESEM evaluation of smear layer removal from conservatively shaped canals: Laser activated irrigation(PIPS and SWEEPS)compared to sonic and passive ultrasonic activation: An ex vivo study[J]. BMC Oral Health, 2021, 21(1): 81.
[35]	Liu JY, Watanabe S, Mochizuki S, et al. Comparison of vapor bubble kinetics and cleaning efficacy of different root canal irrigation techniques in the apical area beyond the fractured instrument[J]. J Dent Sci, 2023, 18(3): 1141-1147. doi: 10.1016/j.jds.2022.10.032 pmid: 37404607
[36]	Abat VH, Bayrak GD, Gündoğar M. Assessment of apical extrusion in regenerative endodontics: A comparative study of different irrigation methods using three-dimensional immature tooth models[J]. Odontology, 2025, 113(1): 213-221.
[37]	Rödig T, Westbomke V, Haupt F, et al. Effect of preparation size on the removal of accumulated hard-tissue debris from the mesial root canal system of mandibular molars using SWEEPS technology[J]. Clin Oral Investig, 2023, 27(6): 2787-2796.
[38]	Erkan EH, Gündoğar M, Uslu G, et al. Postoperative pain after SWEEPS, PIPS, sonic and ultrasonic-assisted irrigation activation techniques: A randomized clinical trial[J]. Odontology, 2022, 110(4): 786-794. doi: 10.1007/s10266-022-00700-0 pmid: 35267110
[39]	Bao PP, Liu H, Yang L, et al. efficacy of Er: YAG laser-activated irrigation versus passive ultrasonic irrigation and sonic-powered irrigation for treating multispecies biofilms in artificial grooves and dentinal tubules: An SEM and CLSM study[J]. BMC Oral Health, 2024, 24(1): 261.
[40]	Liu CH, Li Q, Yue L, et al. Evaluation of sonic, ultrasonic, and laser irrigation activation systems to eliminate bacteria from the dentinal tubules of the root canal system[J]. J Appl Oral Sci, 2022, 30: e20220199.
[41]	Huynh A, Poly A, Yamaguchi M, et al. Efficacy of laser activated versus sonic activated irrigation for debris removal in conservatively instrumented root canals[J]. J Endod, 2025, 51(3): 332-339.
[42]	Alkhudhairy F. Canal disinfection using Nd: YAG Laser, synchronized microbubble-photodynamic activation, and carbon quantum dots on microhardness, smear layer removal, and extrusion bond strength of zirconia post to canal dentin. An in vitro scanning electron microscopic analysis[J]. Microsc Res Tech, 2024, 87(9): 2043-2052.
[43]	Teed C, Hussein H, Kishen A. Synchronized microbubble photodynamic activation to disinfect minimally prepared root canals[J]. J Endod, 2023, 49(2): 198-204.
[44]	Wang YY, Fang LX, Wang PL, et al. Antibacterial effects of silica nanoparticles loading nano-silver and chlorhexidine in root canals infected by Enterococcus faecalis[J]. J Endod, 2025, 51(1): 54-63.
[45]	El-Fiqi A, Mandakhbayar N, Jo SB, et al. Nanotherapeutics for regeneration of degenerated tissue infected by bacteria through the multiple delivery of bioactive ions and growth factor with antibacterial/angiogenic and osteogenic/odontogenic capacity[J]. Bioact Mater, 2021, 6(1): 123-136. doi: 10.1016/j.bioactmat.2020.07.010 pmid: 32817919
[46]	Promta P, Chaiyosang P, Panya A, et al. The evaluation of anti-osteoclastic activity of the novel calcium hydroxide biodegradable nanoparticles as an intracanal medicament[J]. J Endod, 2024, 50(5): 667-673.
[47]	Babeer A, Bukhari S, Alrehaili R, et al. Microrobotics in endodontics: A perspective[J]. Int Endod J, 2024, 57(7): 861-871.
[48]	Babeer A, Oh MJ, Ren Z, et al. Microrobotics for precision biofilm diagnostics and treatment[J]. J Dent Res, 2022, 101(9): 1009-1014.
[49]	刘斌, 梁景平. 牙髓再生的临床应用与未来[J]. 中华口腔医学杂志, 2020, 55(1): 50-55.
[50]	黄定明, 杨懋彬, 周学东. 牙髓再生治疗的临床操作管理及疗效评价[J]. 中华口腔医学杂志, 2019, 54(9): 584-588,589,590.
[51]	Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification,pulpotomy, and other endodontic treatments for immature permanent teeth[J]. Int Endod J, 2023, 56(Suppl 2): 188-199.
[52]	Xuan K, Li B, Guo H, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth[J]. Sci Transl Med, 2018, 10(455): eaaf3227.
[53]	Meza G, Urrejola D, Saint Jean N, et al. Personalized cell therapy for pulpitis using autologous dental pulp stem cells and leukocyte platelet-rich fibrin: A case report[J]. J Endod, 2019, 45(2): 144-149. doi: S0099-2399(18)30796-9 pmid: 30711169
[54]	Brizuela C, Meza G, Khoury M. Revolutionizing endodontics: Innovative approaches for treating mature teeth with closed apices and apical lesions: A report of two cases[J]. J Endod, 2024, 50(5): 596-601. doi: 10.1016/j.joen.2024.02.012 pmid: 38387795
[55]	Gomez-Sosa JF, Cardier JE, Wittig O, et al. Allogeneic bone marrow mesenchymal stromal cell transplantation induces dentin pulp complex-like formation in immature teeth with pulp necrosis and apical periodontitis[J]. J Endod, 2024, 50(4): 483-492. doi: 10.1016/j.joen.2024.01.002 pmid: 38237659
[56]	Noohi P, Abdekhodaie MJ, Saadatmand M, et al. The develop-ment of a dental light curable PRFe-loaded hydrogel as a potential scaffold for pulp-dentine complex regeneration: An study[J]. Int Endod J, 2023, 56(4): 447-464.
[57]	Wang H, Xu X, Bian Z, et al. Expert consensus on apical microsurgery[J]. Int J Oral Sci, 2025, 17(1): 2. doi: 10.1038/s41368-024-00334-8 pmid: 39743567
[58]	张银春, 杨晓霞, 陈璇, 等. 实时动态导航技术辅助下显微根尖手术1例[J]. 实用口腔医学杂志, 2024, 40(5): 720-722.

牙髓根尖周病的诊疗进展概述

Overview of technical advances in the diagnosis and treatment of pulp and periapical diseases

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 58

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈杰, 邢允波, 叶茂. 上颌第一磨牙颊侧额外尖伴C型根管1例[J]. 口腔医学, 2025, 45(6): 453-455.
[2]	周兴安, 德乐黑·巴特尔, 武旭, 马宏宇, 夏凤君, 申铁兵, 尚多. 肿瘤源性外泌体在口腔鳞状细胞癌中的研究进展[J]. 口腔医学, 2025, 45(6): 465-469.
[3]	王广鸣, 张光东. 塞来昔布超前镇痛对下颌后牙牙髓炎治疗术中和术后疼痛的影响[J]. 口腔医学, 2025, 45(5): 371-375.
[4]	黄淑慧, 朱珠, 汪云毅, 徐雨悦, 李竞, 俞刚, 张峰. 人工智能在颌面部骨折诊疗中的应用进展[J]. 口腔医学, 2025, 45(5): 386-393.
[5]	李玥, 骆小平, 杨小静, 赵强伟, 张力, 张红. 平板型治疗义齿在神经-肌肉功能紊乱的无牙颌病例中应用效果的初步研究[J]. 口腔医学, 2025, 45(4): 254-258.
[6]	黎金鹏, 江银华. 儿童腺样体肥大与错𬌗畸形相关性的研究进展[J]. 口腔医学, 2025, 45(4): 311-316.
[7]	陈玥, 孙雪倩, 陈敏敏. lncRNA UCA1在口腔鳞状细胞癌中的研究进展[J]. 口腔医学, 2025, 45(4): 317-320.
[8]	刘塬, 颜燕宏, 蒋备战. 牙髓再生支架材料的研究进展[J]. 口腔医学, 2025, 45(3): 218-222.
[9]	陈冬雷, 王慧, 陈勇军, 解东平, 王翔. 双针道导板下射频热凝治疗复发性下颌神经痛的临床应用[J]. 口腔医学, 2025, 45(2): 118-122.
[10]	车舜, 郭威. 半导体激光对根管内粪肠球菌杀菌效果的体外实验研究[J]. 口腔医学, 2025, 45(2): 81-88.
[11]	彭焱, 张驰, 高雳, 李希庭, 赵川江. Ⅳ期牙周炎患者的正畸考量和时机选择[J]. 口腔医学, 2025, 45(1): 25-36.
[12]	包佳琦, 王中秀, 冯贻苗, 雷利红, 陈莉丽. 正畸治疗中牙周硬组织相关并发症的处理[J]. 口腔医学, 2025, 45(1): 37-44.
[13]	周悦, 唐振兴, 李宇. 拔除前磨牙正畸病例的磨牙支抗丧失及其影响因素[J]. 口腔医学, 2025, 45(1): 64-68.
[14]	王盼, 吕炯, 朱慧勇. 靶向脂代谢逆转头颈鳞癌治疗耐药性的研究进展[J]. 口腔医学, 2024, 44(9): 705-709.
[15]	李远远, 刘月华. 儿童口呼吸的多学科诊疗原则[J]. 口腔医学, 2024, 44(8): 565-569.