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2024_06_03_fc25968c5c9c46ce1a6eg

Assessment of the Survival and Sensibility of Mature Anterior Teeth with Periapical Lesion after One Step Regenerative Approach Using Different Disinfection Maneuvers : A Randomized Clinical Trial
使用不同消毒操作一步再生方法评估具有根尖周病变的成熟前牙的存活率和敏感性：一项随机临床试验

Mohamed Mohsen Abielhassan , Nihal Ezzat Sabet , Alaa Abdelsalam El Baz
穆罕默德·穆赫森·阿比哈桑 ， 尼哈尔·埃扎特·萨贝特 ， 阿拉·阿卜杜勒萨拉姆·巴兹 Assistant Lecturer, Professor of Endodontics, Faculty of Dentistry, Cairo University
开罗大学牙科学院牙髓病学教授助理讲师

Abstract 抽象

Aim: evaluate outcomes of single visit regenerative endodontic procedures using conventional irrigation protocol in comparison to LASER disinfection in comparison to Nano Chitosan irrigating solution for treatment of necrotic mature anterior teeth with periapical lesions.
目的：评估使用传统冲洗方案的单次就诊再生牙髓手术的结果，与激光消毒相比 ，与纳米壳聚糖冲洗液相比，用于治疗根尖周病变的坏死成熟前牙。

Methodology: 45 patients were recruited in this trial. Preoperative standardized cone beam computed tomography (CBCT) was performed for the patients after fulfillment of inclusion criteria.
方法：本试验招募了 45 名患者。在满足纳入标准后，对患者进行术前标准化锥形束计算机断层扫描 （CBCT）。
After complete diagnostic steps and signing of consent forms and performance of access cavity preparation,patients were randomly distributed into three groups with three disinfection maneuvers:
在完成诊断步骤并签署同意书并进行通路腔准备后，将患者随机分为三组，进行三次消毒操作：
  1. Group A (Intervention 1)final disinfection using Low Power Diode LASER disinfection.
    A组（干预1）使用低功率二极管激光消毒进行最终消毒。
  2. Group B (Intervention 2 ) final rinseusing Nano Chitosan irrigation disinfection in a side perforated needle.
    B 组（干预 2）最终冲洗 纳米壳聚糖冲洗消毒在侧穿孔针中消毒。
  3. Group C (Control) conventional irrigation protocol using sodium hypochlorite irrigating solution and EDTA only.
    C组（对照）常规灌溉方案仅使用 次氯酸钠灌洗溶液和 EDTA。
Platelet rich fibrin was packed inside the root canals followed by collagen plug and Biodentin. Teeth were restored using resin modified glass ionomer.
富含血小板的纤维蛋白被填充在根管内，然后是胶原蛋白栓和生物牙本质。使用树脂改性玻璃离聚物修复牙齿。
Patients were recalled for regular follow ups at 6 and 12 months. Patients were examined for survival of treated teeth and any inflammatory signs or symptoms. All samples were tested for sensibility. All data were statistically analyzed.
患者在 6 个月和 12 个月时被召回进行定期随访。检查患者治疗牙齿的存活率和任何炎症体征或症状。所有样品都经过敏感性测试。所有数据均经过统计分析。
Results: Single visit regenerative endodontics possessed an overall percentage of success in all groups in terms of survival of treated teeth. Regarding sensibility nano chitosan also possessed the highest percentage of cases regaining sensitivity by followed by laser group followed by the control group with also with no statistical significant difference between all groups.
结果：就治疗牙齿的存活率而言，单次就诊再生牙髓病学在所有组中都具有总体成功 率。在敏感性方面，纳米壳聚糖恢复敏感的病例比例最高， 其次是激光组 ，其次是对照组， 所有组之间也没有统计学上的显著差异。
Conclusion: Within limitations of this study single visit regenerative endodontics can be applied to cases with necrotic pulps and periapical lesions where thorough disinfection is recommended in cases of single visit approach to ensure maximum elimination of bacterial cells from root canal hindering successful
结论：在本研究的局限性内，单次就诊再生牙髓病学可应用于坏死牙髓和根尖周病变的病例，建议在单次就诊方法的情况下进行彻底消毒，以确保最大限度地消除根管中的细菌细胞，从而阻碍成功
regenerative process. 再生过程。
Keywords: Regenerative endodontics, revascularization, single visit regeneration, Platelet rich fibrin, nano chitosan , LASER
关键词：再生牙髓病学，血运重建，单次就诊再生，富血小板纤维蛋白，纳米壳聚糖，激光
disinfection 消毒

Introduction 介绍

Preservation of the natural dentition had always been a primary objective in endodontic practice. The most important drawback of conventional root canal treatment is that the survival of affected pulp is hindered . Thus a new treatment approach was introduced utilizing the body ability to regenerate, called Pulp Regeneration. Regeneration was first introduced in the dental field as a solution for immature apex treatment, due to difficulties encountered during its conventional root canal treatment.
保护天然牙列一直是牙髓治疗实践的首要目标。常规根管治疗最重要的缺点是受影响的牙髓的存活受到阻碍 。因此，引入了一种新的治疗方法，利用身体的再生能力，称为牙髓再生。再生最初是作为未成熟根尖治疗的解决方案引入牙科领域的，因为在传统的根管治疗中遇到了困难。
American Dental Association adopted the tissue engineering concept and pulp regeneration in . Regeneration was focused on improving both the functionality and durability of the affected tooth. Based on the success of pulp regeneration in treating immature teeth, ambitious dentists started to look forward on regenerating the pulp of mature teeth .Doubts about treating mature teeth with the same protocol, as the small apical foramen might not provide a good portal for the entry of stem cells and growth factors, which in turn is very important for the success of pulp regeneration .
美国牙科协会采用了 组织工程的概念和牙髓再生。再生的重点是改善受影响牙齿的功能和耐久性。基于牙髓再生在治疗未成熟牙齿方面的成功，雄心勃勃的牙医开始期待成熟牙齿 的牙髓再生。怀疑用相同的方案治疗成熟的牙齿，因为小的根尖孔可能无法为干细胞和生长因子的进入提供良好的门户，而这反过来又对牙髓再生 的成功非常重要。
The majority of articles present in literature concerning regenerative endodontics is concerned about treatment of affected teeth with immature apex, after proper systematic search online, insufficient evidence and randomized controlled trials were found supporting the methodological steps for regenerative approach for mature teeth. Most available studies are case reports. Very few randomized controlled trials which are the gold standard of interventional trials resulting in the highest level of evidence that contributes effectively in the clinical decision-making process. Since the main challenge in single visit regenerative process is the canal disinfection as a fundamental for success of the regenerative process. The aim of this study was to evaluate the outcomes of single visit regenerative endodontic procedures using conventional irrigation protocol of sodium hypochlorite combined with EDTA in comparison to LASER disinfection, or Nano Chitosan irrigating solution for treatment of necrotic mature anteior teeth with periapical lesions.
文献中关于再生牙髓病学的大多数文章都涉及对根尖不成熟的受影响牙齿的治疗，在网上进行适当的系统检索后，发现证据不足，随机对照试验支持成熟牙齿再生方法的方法学步骤。大多数可用的研究都是病例报告。很少有随机对照试验是介入试验的黄金标准，从而产生最高水平的证据，有效地促进临床决策过程。由于单次就诊再生过程的主要挑战是运河消毒，这是再生过程成功的基础。本研究的目的是评估使用次氯酸钠联合 EDTA 的常规冲洗方案与激光消毒或 纳米壳聚糖冲洗液治疗坏死的成熟前牙的单次就诊再生牙髓手术的结果根尖周病变。

Methodology 方法论

This trial design was Prospective, parallel, randomized, double blinded clinical trial as the participants and outcome assessors will be blinded. The Allocation ratio was 1:1 and the frameworkwas superiority to prove that intervention and added disinfection maneuvers resulted in better results than control and conventional disinfection maneuver.
该试验设计是前瞻性、平行、随机、双盲临床试验，因为参与者和结果评估者将是盲法的。分配比例为1：1，该框架具有优越性，证明干预和增加消毒操作比对照和常规消毒操作产生更好的结果。
The Inclusion criteria were18-50 years old patients free from any physical or mental handicapping condition with no underlying systemic diseases, Single canalled anterior teethhaving non-vital, mature, radiographic evidence of periapical lesion.
纳入标准是 18-50 岁的患者，没有任何身体或精神障碍，没有潜在的全身性疾病，单管前牙具有根尖周病变的非重要、成熟的影像学证据。
The exclusion criteria were any known sensitivity or adverse reactions to pharmaceuticals necessary to complete the trial , Non-restorable coronal portion of teeth and radiographic evidence of external or internal root resorption.
排除标准是完成试验 所需的任何已知药物的敏感性或不良反应、牙齿 的不可修复冠状部分以及外部或内部牙根吸收的放射学证据。
A total of 45 Samples from outpatient clinic of Cairo university were recruited and referred for preoperative CBCT for accurate assessment and standardization of follow up records.
共招募了开罗大学门诊部的45份样本，并转诊进行术前CBCT，以准确评估和规范随访记录。
After access cavity and chemo-mechanical preparation, 45 participants were randomly and equally assigned using paper folded numbers arranged according to a random sequence generator (random.org) into either of three groups:
在通路腔和化学机械准备之后，45 名参与者使用根据随机序列生成器 （random.org） 排列的纸质折叠数字随机且平均地分配到三组中的任何一组：
  1. Group A final disinfection using Low Power Diode LASER disinfection.
    使用低功率二极管激光消毒的 A 组最终消毒。
  2. Group B final flush was performed using Nano Chitosan irrigation disinfection in a side perforated needle inserted shorter than the working length.
    B组最后冲洗使用 纳米壳聚糖冲洗消毒，插入短于工作长度的侧穿孔针 头。
  3. Group C (Control)disinfection was performed only by conventional irrigation protocol using sodium hypochlorite irrigating solution and 17% EDTA only as disinfection means.
    C组（对照组）消毒仅通过常规冲洗方案进行，使用 次氯酸钠冲洗溶液和仅使用17%EDTA作为消毒手段。
All Participants were anaesthetized using Articaine solution.Preoperative isolation, Access cavity preparation was done. Working length was determined using an electronic apex locator.Conventional mechanical instrumentation was performed by controlled memory Ni Ti instruments that were used as a single use.
所有参与者均使用阿替卡因 溶液麻醉。术前隔离，做好通路准备。使用电子顶点定位器确定工作长度。传统的机械仪器由一次性使用的受控存储器Ni Ti仪器执行。
Irrigation using by side perforated needle was done in between each file with 20 mlas final flush and EDTA solution.
在每个文件之间使用侧穿孔针进行冲洗 ，最终冲洗 20 mlas 和 EDTA 溶液。
First Interventional group samples were disinfected with diode LASER wavelength using Siro Laser Blue Device to augment the canal disinfection prior to regenerative process .TheLASER fiber was inserted shorter than the W.L , created a circumferential disinfecting beam along the root canal for 2 seconds.
首先，使用Siro Laser Blue Device用二极管LASER 波长对干预组样品进行消毒，以在再生过程 之前增强运河消毒。LASER光纤插入 的时间比W.L短，沿根管产生环形消毒光束2秒。
Interrupted 10 cycles of laser application were done to ensure preservation of stem cells viability as well as canal disinfection with a 5 seconds gap inbetween with total contact time of 20 seconds .
中断了 10 个周期的激光应用，以确保干细胞活力的保存以及管道消毒，中间间隔 5 秒，总接触时间为 20 秒 。
Second interventional group final rinse using of Nano Chitosan irrigation delivered over 4 interrupted injections at time interval of 3 minutes each using side perforated needle . For the control group only conventional irrigation protocol was used.
第二介入组最终冲洗使用 纳米壳聚糖冲洗 ，使用侧穿孔针以 3 分钟的时间间隔进行 4 次间断注射 。对于对照组，仅使用常规灌溉方案。
Figure 1 : Procedural steps for LASER disinfection followed by PRF preparation
图1：激光消毒后PRF制备的程序步骤
All participants undergone single visit regenerative endodontic procedures using autologous platelet-rich fibrin according to Narang et al protocol . A blood sample was collected in glass tubes without anticoagulant. The blood sample was immediately centrifuged in an electric powered centrifuge at 4500 rpm for 12 mins. The resultant product consisted of
根据 Narang 等人的方案 ，所有参与者都使用富含自体血小板的纤维蛋白接受了单次就诊再生牙髓手术。在没有抗凝剂的玻璃管中 收集血样。立即将血液样本在电动离心机中以 4500 rpm 离心 12 分钟。所得产品包括
PRFwas put in a sterile cup for 10 minutes to allow the release of the proper serum contained within.PRF was packed inside the dry canals to the apical canal end using different sized pluggers. A collagen plug and Biodentin was placed at the level of the cervical line.Pulp chamber was restored using resin modified glass ionomer or resin composite.
将PRF放入无菌杯中10分钟，以释放其中所含的适当血清。使用不同尺寸的塞子将PRF填充在干管内至顶端管末端。将胶原蛋白栓和生物牙本质放置在宫颈线水平。使用树脂改性玻璃离聚物或树脂复合材料恢复纸浆室。
Figure 2: Packing of PRF inside canal followed by Biodentin
图 2：PRF 在耳道内的填充，然后是生物牙本质
Assessment of primary [survival] and secondary outcomes were done for each participant after 6 and 12 months. Survival was assessed by evaluating integrity of the remaining tooth structure and restoration, Absence of cracks and fractures in tooth structure and restoration, Absence of tenderness to biting, Absence of swelling and absence of spontaneous pain.
在6个月和12个月后对每个参与者进行主要[生存]和次要结局的评估。通过评估剩余牙齿结构和修复体的完整性、牙齿结构和修复体中没有裂缝和断裂、咬合无压痛、无肿胀和无自发性疼痛来评估生存率。
Sensibility testing was done by placement of electric rod of the pulp tester on the labial surface of the tooth after tooth isolation and application of a spot of conducting material. A reference of contra lateral tooth was also been assessed .According to the manufacturer's instructions, the readings between 0-80 were interpreted as sensibility regain.Above 80result interpreted as non regain of sensibility .
敏感性测试是通过在牙齿隔离后将牙髓测试仪的电棒放置在牙齿的唇面上并施加导电材料点来完成的。还评估 了对侧牙的参考。根据制造商的说明，0-80之间的读数被解释为敏感性恢复。高于 80 的结果被解释为不恢复感性 。
Sample size calculation was done to test the null hypothesis. Computation of power is based on a hazard ratio of 3.32. It assumes instantaneous hazard rates of 0.180 for the control group versus 0.598 for the laser group. Since the hazard rate is constant across intervals this is equivalent to median survival times of 3.85 intervals for the control group versus 1.16 intervals for the laser group. It is also equivalent to a cumulative survival at 4 intervals of 0.49 for the control group versus 0.09 for the laser group. The computation assumes an attrition rate of 0.10 per interval. The study had power of to yield a statistically significant result.
进行样本量计算以检验原假设。功率的计算基于 3.32 的风险比。它假设对照组的瞬时危险率为 0.180，而激光组的瞬时危险率为 0.598。由于风险率在间隔内是恒定的，这相当于对照组的中位生存时间为 3.85 个间隔，而激光组的中位生存时间为 1.16 个间隔。这也相当于对照组 0.49 和 0.09 激光组在 4 个间隔下的累积生存期。计算假设每个间隔的损耗率为 0.10。该研究 具有产生统计学意义的结果的能力。
Study discontinued in case of severe persistent immediate post operative swelling, severe persistent immediate postoperative pain that didn't decrease by analgesic.Regarding implementation the participant enrollment was performed by the principal investigator, the participants assignment was done by drawing folded papers.
如果出现严重的持续性术后即刻肿胀，严重的持续性术后即刻疼痛且镇痛剂未减轻，则停止研究。关于实施，参与者登记由主要研究者进行，参与者分配通过绘制折叠纸来完成。

Results 结果

Regarding the age distribution there was no statistically significant difference between the three groups. ( );In group A the mean and standard deviation values of age were ( ), while in group B they were and in group C they were .
关于年龄分布，三组之间没有统计学意义差异。（ ）;在A组中，年龄的平均值和标准差值为（ ），而在B组 中为，在C组中为 。
Regarding gender distribution; In group A the gender distribution showed 7 males ) and 8 females and in group B it showed 5 males ( ) and 10 females (66.7%) While in group C it showed 8 males and 7 females ( . Using Chi square test here was no statistically significant difference between the three groups. .
关于性别分布;在A组中，性别分布显示7名男性 和8名女性 ，在B组中显示5名男性（ ）和10名女性（66.7%），而在C组中显示8名男性 和7名女性 （。使用卡方检验，三组之间没有统计学上的显着差异。 。
Regarding survival in group A 15 patients (100%) showed survival and no patients showed no survival while in group B 14 patients ) showed survival and 1 patient (6.7%) showed no survival, And in group C 14 patients ( ) showed survival and 1 patient showed no survival. Using chi square test results showed that there was no statistically significant difference between the three groups. .
关于生存，A组15例患者（100%）显示生存，没有患者显示生存 ，而B组14例患者 ）显示生存，1例患者（6.7%）显示无生存，C组14例患者（ ）显示生存，1例患者 无生存。采用卡方检验结果显示，三组间差异无统计学意义。 。
Figure (3) Samples of Healing from groups; A0 LASER group preoperatively, A6 at 6 month and A12 at 12 months interval. B0 nano chitosan group group preoperatively, B6 at 6 month and at 12 months interval. C0 control group preoperatively, C6 at 6 month and at 12 months interval
图（3）组的愈合样本;术前 A0 LASER 组，6 个月 A6 组，A12 术前 12 个月组。术前B0纳米壳聚糖组组，B6在6个月和 12个月间隔组。术前 C0 对照组，6 个月和 12 个月间隔 C6
Regarding SensibilityIn group A 10 patients (66.7%) showed sensibility and 5 patients (33.3%) showed no sensibility while in group B 11 patients ( ) showed sensibility and 4 patients (26.7%) showed no sensibility. In group C 7 patients (46.7%) showed sensibility and 8 patients (53.3%) showed no sensibility Using chi square test analysis showed that there was no statistically significant difference between the three groups. ( ).
关于感性：A组10例（66.7%）患者表现出感性，5例（33.3%）患者无感性，而B组11例患者（ ）表现出感性，4例患者（26.7%）无感性。C组7例（46.7%）患者（46.7%）感性，8例（53.3%）无感性 卡方检验分析显示，三组患者无统计学意义差异。（ ）.
Table (1): Showing results of primary and secondary outcomes
表（1）：显示主要和次要结局的结果
Outcome 结果 LASER Group LASER集团 Nano Chitosan Group 纳米壳聚糖集团 Control Group 控制组
Survival 生存 Yes
No
Sensibility Regain 感性恢复 Yes
No

Discussion 讨论

This is an innovative study assessingthe different methods of disinfection along regenerative endodontic process and the applicability of SRPs. The most important objective of root canal therapy is to minimize the number of microorganisms in root canal systems to prevent or treat apical periodontitis. In mature teeth, disinfection is carried out with a combination of mechanical instrumentation, irrigation, and the placement of an intracanal medicament.
这是一项创新研究，评估了再生牙髓过程中的不同消毒方法以及 SRP 的适用性。根管治疗的最重要目标是尽量减少根管系统中的微生物数量，以预防或治疗根尖牙周炎。在成熟的牙齿中，消毒是通过机械器械、冲洗和放置管内药物相结合进行的。
Regenerative endodontic therapy in mature teeth likely encounter more challenges than in immature teeth; less stem/progenitor cells in mature teeth, less probability of blood clot formation and narrower apical pathways for stem/progenitor cell migration will be major limitations .
与未成熟牙齿相比，成熟牙齿的再生牙髓治疗可能遇到更多的挑战;成熟牙齿中干细胞/祖细胞较少，血凝块形成的可能性较小，干细胞/祖细胞迁移的根尖通路较窄将是主要限制 。
SRP has been reported in immature teeth in several successful case reports and case series. Irrigation is crucial for the management of intra-canal infection, especially in the presence of apical periodontitis. Successful singlevisit REP incorporated effective irrigation protocols, including the use of the high concentrations of and EDTA together with suitable agitation techniques.
在一些成功的病例报告和病例系列研究中，已报告了未成熟牙齿的 SRP。冲洗对于管理管内感染至关重要，尤其是在存在根尖牙周炎的情况下。成功的单次REP结合了有效的灌溉方案，包括使用高浓度的 EDTA和适当的搅拌技术。
The irrigation protocols used for all groups involved the use of sodium hypochlorite and EDTA 17%. Sodium hypochlorite was the main irrigant in the current study. Its germicidal ability is related to the formation of hypochlorous acid when in contact with organic debris. Copious irrigation with a total volume of of for 5 minutes with a closed end sidevented needle, to minimize the possibility of extrusion of irrigant into the periapical space. The reduction of intracanal microbiota is not greater when is used as an irrigant as compared to .
用于所有组的灌溉方案都涉及使用次氯酸钠和EDTA 17%。次氯酸 钠是本研究中的主要冲洗剂。其杀菌能力与次氯酸与有机物接触时形成有关。用闭合端侧向针头进行总体积 为 5 分钟的大量冲洗，以尽量减少冲洗剂挤出到根尖周空间的可能性。与相比，用作冲洗剂时 ，运河内微生物群的减少并不大 。
Concerning REP, concentration was found to be cytotoxic to stem cells in the apical tissues and decrease odontoblastic differentiation .This indirect effectis likely related to various deleterious effects of on the dentin matrix leading to decrease in release of dentin matrix-derived growth factors such as TGF- , consequently reducing cell attachment. was then flushed away from the root canal with saline in an attempt to reduce any lingering toxicity that can reduce the regeneration responses as recommended by Garcia et al . Sufficient disinfection protocols for REP can be successful without use of antibiotic pastes .
关于 REP， 发现浓度对顶端组织中的干细胞具有细胞毒性并降低成牙细胞分化 。这种间接效应可能与 牙本质基质上的各种有害作用有关，导致牙本质基质衍生的生长因子（如TGF- ）的释放减少，从而减少细胞附着。 然后用生理盐水从根管冲洗掉，以试图减少任何挥之不去的毒性，这些毒性可以减少 Garcia 等人建议的再生反应 。在不使用抗生素糊剂的情况下，可以成功进行充分的REP消毒方案 。
LASERhas the potential to kill microorganisms and to remove debris and smear layer from root canals. Diode laser is considered the most common type of laser used for root canal disinfection. It is associated with least heat generation which is in favor of stem cells in root canals. In this trial wavelength. diode laser had the ability of bacterial elimination from root canal as well as bacterial cells penetrated inside the root canal dentinal tubules .
激光具有杀死微生物并去除根管中的碎屑和涂抹层的潜力。二极管激光被认为是用于根管消毒的最常见激光类型。它与最少的热量产生有关，这有利于根管中的干细胞。在这个试验 波长。二极管激光器具有从根管中消除细菌以及穿透根管牙本质小管内的细菌细胞的能力 。
Nano chitosan was selected as the second variable for disinfection due to the wide antibacterial effect as well as it's potentiating role in regenerative endodontics. Impregnation of chitosan along the regenerative skeleton resulted in rendering the scaffolds composition more impressive for cell adhesion which can enhanced initial cell attachment and proliferation of the DPSCs. Regarding the cytotoxic effect of nano chitosan particles showed the least cytotoxic effect on cells.
纳米壳聚糖因其广泛的抗菌作用以及在再生牙髓病中的增强作用而被选为消毒的第二个变量。壳聚糖沿再生骨架浸渍使支架组成对细胞粘附更令人印象深刻，这可以增强DPSC的初始细胞附着和增殖。 关于纳米壳聚糖颗粒 的细胞毒性作用，对细胞的细胞毒性作用最小。
For all groups, a solution of EDTA was used as its chelating effect promotes the release of dentinderived growth factors that were previously embedded into dentin during the process of dentinogenesis . These growth factors such as transforming growth factor-beta1 (TGF-b) , dentin sialoprotein (DSP), platelet derived growth factors (PDGF), vascular endothelial growth factor (VEGF), placenta growth factor (PlGF) and fibroblast growth factor (FGF2), have been shown to stimulate proliferation, survival, and differentiation of dental stem cells . Smear layer removal by EDTA greatly enhanced the attachment of Mesenchymal stem cells (MSCs) to the dentinal matrix , because these cells express several integrin and attachmentmolecules in their plasma membrane .
对于所有组，使用 EDTA溶液，因为其螯合作用促进了牙本质衍生生长因子的释放，这些生长因子在牙本质发生过程中先前嵌入牙本质 中。这些生长因子如转化生长因子-β1 （TGF-b）、牙本质唾液蛋白 （DSP）、血小板衍生生长因子 （PDGF）、血管内皮生长因子 （VEGF）、胎盘生长因子 （PlGF） 和成纤维细胞生长因子 （FGF2） 已被证明可以刺激牙科干细胞 的增殖、存活和分化。EDTA去除涂片层大大增强了间充质干细胞（MSCs）在牙本质基质上的附着 ，因为这些细胞在其质膜中表达几种整合素和附着分子 。
Platelet rich fibrin (PRF) is a highly resistant and elastic membrane which does not dissolve quickly after application ; allowing cellular migration, cytokine enmeshment, and slow continuous release of cytokines such as platelet derived growth factor (PDGF), transforming growth factor b1 (TGFb1), Fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) from 7 to 28 days . These growth factors achieve peak level at 14 th day coinciding with cell in growth; so it directs more efficiently stem cell
富血小板纤维蛋白（PRF）是一种高抗性和弹性膜，使用 后不会迅速溶解;允许细胞迁移、细胞因子缠绕和细胞因子的缓慢连续释放，例如血小板衍生生长因子 （PDGF）、转化生长因子 b1 （TGFb1）、成纤维细胞生长因子 （FGF） 和血管内皮生长因子 （VEGF） 从 7 天到 28 天 。这些生长因子在第 14 天达到峰值水平，与细胞生长相吻合;因此，它可以更有效地指导干细胞
migration, proliferation, differentiation and supplements the angiogenesis .
迁移、增殖、分化和补充血管生成 。
Biodentine, a tricalcium silicate bioactive cement with mechanical properties similar to those of healthy dentin was used in the present study. Its microhardness as well as flexural and compressive strength allow us to name this material a 'dentin substitute' . Observations made in several studies suggesting that Biodentine demonstrates better mechanical properties, easier application and a shorter setting time than previously used mineral trioxide aggregate (MTA) . Biodentine also has a broadspectrum antibacterial effect and low cytotoxic activity.
本研究使用了生物牙本质，一种硅酸三钙生物活性水泥，其机械性能与健康牙本质相似。它的显微硬度以及弯曲和抗压强度使我们能够将这种材料命名为“牙本质替代品” 。在几项研究中的观察表明，与以前使用的三氧化二矿物聚集体 （MTA） 相比，Biodentine 表现出更好的机械性能、更易于应用和更短的凝固时间。生物牙本质还具有广谱抗菌作用和低细胞毒性活性。
Out the recruited 45 samples only 2 teeth didn't survive. The first unsurvived tooth was in the control group and showed recurrent swelling and was marked as failure and shifted to conventional root canal treatment. The second case was in the nanochitosan group and a fracture resulted from a trauma for the patient rendered the tooth non restorable. A hypothesis for this result could be that if the intracanal bacterial load is effectively reduced, the inflammatory periapical lesions may heal even without root canal fillings as mentioned in previous trials
在招募的 45 个样本中，只有 2 颗牙齿没有存活。对照组中第一颗未存活的牙齿显示复发性肿胀，并被标记为失败并转向常规根管治疗。第二例是纳米壳聚糖组，由于患者的创伤导致牙齿无法修复，导致骨折。这一结果的一个假设可能是，如果有效减少管内细菌负荷，即使没有根管填充物，炎性根尖周病变也可能愈合，如先前试验 所述
Results are in disagreement with the results reported by the study performed by Botero et who reported only of success with single visit regenerative process. The results cannot be compared as the selected cases were immature and blood column was selected as scaffold, this might be the reason for such low percentage of success. In referral to the systematic review analyzing the reasons of failure of regenerative endodontic cases by Almutairi et who attributed of failed reported regenerative cases to the use of blood column as scaffold and recommended the use of platelet concentrates.
结果与 Botero 等人 进行的研究报告的结果不一致，后者仅 报告了单次访问再生过程的成功。由于所选病例不成熟，并且选择血柱作为支架，因此无法比较结果，这可能是成功率如此之低的原因。在参考系统评价时，Almutairi 等人 分析了再生性牙髓治疗失败的原因，他们将失败的再生病例归因于 使用血柱作为支架，并建议使用血小板浓缩物。
Sensibility assessment revealed that 28 cases out of the 45 cases of all groups have regained tooth sensibility at the end of the 12 months follow up. Previous studies reported immature teeth with necrotic pulp treated with PRF revascularization responded positively to sensibility testing at 12 -month follow-up . The results of sensibility for interventional groups may be attributed to higher level of disinfection and more favorable environment for regeneration process and thus faster development of neural component of regenerated tissues which is last to form. More time is needed for sensibility regain which sometimes may reach two years as previously reported .
敏感性评估显示，在所有组的45例病例中，有28例在12个月的随访结束时恢复了牙齿敏感性。先前的研究报告称，接受 PRF 血运重建治疗的牙髓坏死的未成熟牙齿在 12 个月的随访中对敏感性测试有积极反应 。干预组的敏感性结果可归因于更高水平的消毒和更有利的再生过程环境，从而加快了再生组织的神经成分的发育，这是最后形成的。恢复敏感性需要更多的时间，有时可能达到两年，正如之前报道 的那样。

Conculusion 结语

Within the limitations of this study the following can be concluded; Single visit regenerative endodontics can be applied to cases with necrotic pulps and periapical lesions where thorough disinfection is recommended in cases of single visit approach to ensure maximum elimination of bacterial cells from root canal hindering successful regenerative process., Single visit regenerative endodontics coupled with adequate disinfection maneuvers presented an overall percentage of success in all groups in terms of survival of treated teeth. Finally samples regained sensibility with varying degrees. Nano Chitosan and laser groups were able to regain sensibility faster than the conventional irrigation protocol group.
在本研究的局限性内，可以得出以下结论;单次就诊再生牙髓病学可应用于坏死牙髓和根尖周病变的病例，在单次就诊方法的情况下建议进行彻底消毒，以确保最大限度地消除根管中的细菌细胞，从而阻碍成功的再生过程。 在所有组中，就治疗牙齿的存活率而言。最后，样品不同程度地恢复了敏感性。纳米壳聚糖和激光组能够比传统的灌溉方案组更快地恢复敏感性。
Ethical Clearance: Approved from ethical committee of faculty of dentistry, Cairo University.
伦理许可：经开罗大学牙科学院伦理委员会批准。
Acknowledgement: The authors deny any conflict of interest.
致谢：作者否认任何利益冲突。
Funding: The clinical trial is self-funded.
资金：临床试验是自筹资金的。

References 引用

  1. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Comparison of Radiographic and Survival Outcomes of Immature Teeth Treated with Either Regenerative Endodontic or Apexification Methods: A Retrospective Study. J endod. 2012;38(10):1330-1336. doi:10.1016/j. joen.2012.06.028
    Jeeruphan T， Jantarat J， Yanpiset K， Suwannapan L， Khewsawai P， Hargreaves KM. 用再生牙髓或根尖化方法治疗的未成熟牙齿的放射学和生存结果的比较：一项回顾性研究。J endod.2012;38(10):1330-1336.doi：10.1016/j. joen.2012.06.028
  2. Bose R, Nummikoski P, Hargreaves K. A Retrospective Evaluation of Radiographic Outcomes in Immature Teeth With Necrotic Root Canal Systems Treated With Regenerative Endodontic Procedures. J endod. 2009;35(10):13431349. doi:10.1016/j.joen.2009.06.021
    Bose R， Nummikoski P， 哈格里夫斯 K.回顾性评估接受再生牙髓手术治疗的根管系统坏死的未成熟牙齿的影像学结果。J endod.2009;35(10):13431349.doi：10.1016/j.joen.2009.06.021
  3. Richards D. American Dental Association evidencebased dentistry website. Evidence-Based Dentistry. 2009;10(2):59-60. doi:10.1038/sj.ebd. 6400658
    Richards D. 美国牙科协会循证牙科网站。循证牙科。2009;10(2):59-60.doi：10.1038/sj.ebd.6400658
  4. Velmurugan N. Revascularization of Necrotic Immature Permanent Teeth: An Update. Journal of
    Velmurugan N. 坏死性未成熟恒牙的血运重建：更新。期刊
Operative Dentistry & Endodontics. 2016;1(1):1824. doi:10.5005/jp-journals-10047-0006
牙科手术和牙髓病学。2016;1(1):1824.doi：10.5005/jp-journals-10047-0006
  1. BANCHS F, TROPE M. Revascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol? J endod. 2004;30(4):196-200. doi:10.1097/00004770200404000-00003
    BANCHS F， TROPE M. 未成熟恒牙的血运重建伴根尖牙周炎：新的治疗方案？J endod.2004;30(4):196-200.doi：10.1097/00004770200404000-00003
  2. Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: A clinical study. Contemporary Clinical Dentistry. 2015;6(1):63. doi:10.4103/0976-237X. 149294
    纳朗一世、米塔尔 N、米什拉 N.血凝块、富血小板血浆和富血小板纤维蛋白在坏死未成熟恒牙再生中的比较评估：一项临床研究。当代临床牙科。2015;6(1):63.doi：10.4103/0976-237X.149294
  3. Botero TM, Tang X, Gardner R, Hu JCC, Boynton JR, Holland GR. Clinical Evidence for Regenerative Endodontic Procedures: Immediate versus Delayed Induction? J endod. 2017;43(9):S75-S81. doi:10.1016/j.joen.2017.07.009
    Botero TM， Tang X， Gardner R， 胡 JCC， Boynton JR， Holland GR. 再生牙髓手术的临床证据：即刻诱导与延迟诱导？J endod.2017;43（9）：S75-S81.doi：10.1016/j.joen.2017.07.009
  4. Gutknecht N, Franzen R, Schippers M, Lampert F. Bactericidal Effect of a 980 -nm Diode Laser in the Root Canal Wall Dentin of Bovine Teeth. Journal of Clinical Laser Medicine & Surgery. 2004;22(1):913. doi:10.1089/104454704773660912
    Gutknecht N， Franzen R， Schippers M， Lampert F. 980 nm二极管激光器在牛牙齿根管壁牙本质中的杀菌作用。临床激光医学与外科杂志。2004;22(1):913.doi：10.1089/104454704773660912
  5. DACOSTARIBEIRO A, NOGUEIRA G, ANTONIAZZI J, MORITZ A, ZEZELL D. Effects of Diode Laser (810 nm) Irradiation on Root Canal Walls: Thermographic and Morphological Studies. J endod. 2007;33(3):252-255. doi:10.1016/j. joen. 2006.09.002
    DACOSTARIBEIRO A， NOGUEIRA G， ANTONIAZZI J， MORITZ A， ZEZELL D. 二极管激光 （810 nm） 辐照对根管壁的影响：热成像和形态学研究。J endod.2007;33(3):252-255.doi：10.1016/J. Joen.2006.09.002
  6. Genc Sen O, Kaya M. Effect of Root Canal Disinfection with a Diode Laser on Postoperative Pain After Endodontic Retreatment. Photobiomodulation, Photomedicine, and Laser Surgery. 2019;37(2):85-90. doi:10.1089/ photob. 2018.4539
    Genc Sen O， Kaya M. 用二极管激光进行根管消毒对牙髓再治疗后术后疼痛的影响。光生物调节、光医学和激光手术。2019;37(2):85-90.doi：10.1089/ photob.2018.4539
  7. Attiguppe PR. Comparative Evaluation of Different Modes of Laser Assisted Endodontics in Primary Teeth: An In vitro Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Published online 2017. doi:10.7860/JCDR/2017/24001.9755
    乳牙激光辅助牙髓病学不同模式的比较评估：一项体外研究。临床与诊断研究杂志。2017年在线发布。doi：10.7860/JCDR/2017/24001.9755
  8. FOLWACZNY M, MEHL A, JORDAN C, HICKEL R. Antibacterial Effects of Pulsed Nd:YAG Laser Radiation at Different Energy Settings in Root Canals. J endod. 2002;28(1):2429. doi:10.1097/00004770-200201000-00006
    FOLWACZNY M， MEHL A， JORDAN C， HICKEL R. 脉冲 Nd：YAG 激光辐射在根管中不同能量设置下的抗菌作用。J endod.2002;28(1):2429.doi：10.1097/00004770-200201000-00006
  9. Udart M, Stock K, Graser R, Hibst R. Inactivation of bacteria by high-power laser irradiation. Medical Laser Application. 2011;26(4):166-171. doi:10.1016/j.mla.2011.08.004
    Udart M， Stock K， Graser R， Hibst R. 通过高功率 激光照射灭活细菌。医疗激光应用。2011;26(4):166-171.doi：10.1016/j.mla.2011.08.004
  10. Geethapriya N, Subbiya A, Padmavathy K, Mahalakshmi K, Vivekanandan P, Sukumaran V. Effect of chitosan-ethylenediamine tetraacetic acid on Enterococcus faecalis dentinal biofilm and smear layer removal. Journal of Conservative Dentistry. 2016;19(5):472. doi:10.4103/0972-0707.190022
    Geethapriya N， Subbiya A， Padmavathy K， Mahalakshmi K， Vivekanandan P， Sukumaran V. 壳聚糖-乙二胺四乙酸对粪肠球菌牙本质生物膜和涂片层去除的影响。保守牙科杂志。2016;19(5):472.doi：10.4103/0972-0707.190022
  11. Kamble A, Abraham S, Kakde D, Shashidhar C, Mehta D. Scanning electron microscopic evaluation of efficacy of Ethylenediaminetetraacetic acid and chitosan for smear layer removal with ultrasonics: An In vitro study. Contemporary Clinical Dentistry. 2017;8(4):621. doi:10.4103/ ccd.ccd_745_17
    Kamble A， Abraham S， Kakde D， Shashidhar C， Mehta D. 乙二胺四乙酸和壳聚糖用超声波去除涂片层功效 的扫描电子显微镜评估：体外研究。当代临床牙科。2017;8(4):621.doi：10.4103/ ccd.ccd_745_17
  12. Praveen M, Aarthi G, Meenapriya P, Kumar Ss, Mohan Kumar N, Karunakaran J. A comparative evaluation of intraradicular smear removal efficacy of chitosan (low molecular weight), Chitosan Citrate, and 10% Citric Acid when Used as Final Rinse in Irrigation Protocols: A Field Emission Scanning Electron Microscopic Study. Journal of Pharmacy And Bioallied Sciences. 2017;9(5):73. doi:10.4103/jpbs.JPBS 158_17
    普拉文 M、阿尔蒂 G、米纳普里亚 P、库马尔 Ss、莫汉库马尔 N、卡鲁纳卡兰 J. 壳聚糖（低分子量）、 柠檬酸壳聚糖和 10% 柠檬酸在灌溉方案中用作最终冲洗时根内涂片去除效果的比较评估：现场发射扫描电子显微镜研究。药学与生物联合科学杂志。2017;9(5):73.doi：10.4103/jpbs.JPBS 158_17型
  13. Hassan H, Negm A. A comparative study to evaluate the effect of different irrigating solutions on the smear layer. Egyptian Dental Journal. 2018;64(1):457-465. doi:10.21608/edj.2018.78048
    哈桑 H， Negm A.评估不同灌溉溶液对涂片层影响的比较研究。埃及牙科杂志。2018;64(1):457-465.doi：10.21608/edj.2018.78048
  14. RatihDN,EnggardiptaRA,KartikaningtyasAT.The Effect of Chitosan Nanoparticle as A Final Irrigation Solution on The Smear Layer Removal, Microhardness and Surface Roughness of Root Canal Dentin. The Open Dentistry Journal. 2020;14(1):1926. doi:10.2174/1874210602014010019
    壳聚糖纳米颗粒作为最终灌溉溶液对根管牙本质涂片层去除、显微硬度和表面粗糙度的影响.开放牙科杂志。2020;14(1):1926.doi：10.2174/1874210602014010019
  15. Darrag AM. Effectiveness of different final irrigation solutions on smear layer removal in intraradicular dentin. Tanta Dental Journal. 2014;11(2):93-99. doi:10.1016/j.tdj.2014.06.002
    达拉格AM。不同最终冲洗液对根内牙本质涂片层去除的有效性。坦塔牙科杂志。2014;11(2):93-99.doi：10.1016/j.tdj.2014.06.002
  16. Gopikrishna V, Tinagupta K, Kandaswamy D. Evaluation of Efficacy of a New Custom-Made Pulse Oximeter Dental Probe in Comparison With the Electrical and Thermal Tests for Assessing Pulp Vitality. J endod. 2007;33(4):411-414. doi:10.1016/j.joen.2006.12.003
    Gopikrishna V， Tinagupta K， Kandaswamy D. 与评估牙髓活力的电学和热学测试相比，评估新型定制脉搏血氧仪牙科探头的功效。J endod.2007;33(4):411-414.doi：10.1016/j.joen.2006.12.003
  17. Salgar A, Singh S, Podar R, Kulkarni G, Babel S. Determining predictability and accuracy of thermal and electrical dental pulp tests: An in vivo study. Journal of Conservative Dentistry. 2017;20(1):46. doi:10.4103/0972-0707.209067
    Salgar A， Singh S， Podar R， Kulkarni G， Babel S. 确定热和电牙髓测试的可预测性和准确性：一项体内研究。保守牙科杂志。2017;20(1):46.doi：10.4103/0972-0707.209067
  18. Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J endod. 2019;45(5):567-577. doi:10.1016/j. joen. 2019.02.004
    Almutairi W， Yassen GH， Aminoshariae A， Williams KA， Mickel A. 再生牙髓病学：失败病例的系统分析。J endod.2019;45(5):567-577.doi：10.1016/J. Joen.2019.02.004
  19. Paryani K, Kim SG. Regenerative Endodontic Treatment of Permanent Teeth after Completion of Root Development: A Report of 2 Cases. J endod. 2013;39(7):929-934. doi:10.1016/j. joen. 2013.04 .029
    Paryani K， Kim SG. 牙根发育完成后恒牙的再生牙髓治疗：2 例报告。J endod.2013;39(7):929-934.doi：10.1016/J. Joen.2013.04 .029
  20. BYSTRÖM A, SUNVQVIST G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. International Endodontic Journal. 1985;18(1):35-40. doi:10.1111/j.1365-2591.1985.tb00416.x
    BYSTRÖM A， SUNVQVIST G.次氯酸钠和EDTA在60例牙髓治疗中的抗菌作用。国际牙髓病杂志。1985;18(1):35-40.doi：10.1111/j.1365-2591.1985.tb00416.x
  21. BYSTRÖM A, SUNDQVIST G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. European Journal of Oral Sciences. 1981;89(4):321-328. doi:10.1111/j.1600-0722.1981.tb01689.x
    BYSTRÖM A， SUNDQVIST G. 牙髓治疗中机械根管器械疗效的细菌学评估。欧洲口腔科学杂志。1981;89(4):321-328.doi：10.1111/j.1600-0722.1981.tb01689.x
  22. Trevino EG, Patwardhan AN, Henry MA, et al. Effect of Irrigants on the Survival of Human Stem Cells of the Apical Papilla in a Plateletrich Plasma Scaffold in Human Root Tips. J endod. 2011;37(8):1109-1115. doi:10.1016/j. joen. 2011.05 .013
    Trevino EG、Patwardhan AN、Henry MA 等。冲洗剂对人根尖富含血小板的血浆支架中顶端人类干细胞存活的影响。J endod.2011;37(8):1109-1115.doi：10.1016/J. Joen.2011.05 .013
  23. Garcia-Godoy F, Murray PE. Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dental Traumatology. 2012;28(1):33-41. doi:10.1111/ j.1600-9657.2011.01044.x
    加西亚-戈多伊 F，默里 PE。在永久性未成熟创伤牙齿中使用再生牙髓手术的建议。牙科创伤学。2012;28(1):33-41.doi：10.1111/ j.1600-9657.2011.01044.x
  24. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative Endodontics: A Review of Current Status andaCall for Action. Jendod. 2007;33(4):377390. doi:10.1016/j.joen.2006.09.013
    Murray PE， Garcia-Godoy F， Hargreaves KM. 再生牙髓病学：现状回顾和行动呼吁。 詹多德。2007;33(4):377390.doi：10.1016/j.joen.2006.09.013
  25. da Silva LAB, Nelson-Filho P, da Silva RAB, et al. Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs' teeth with apical periodontitis. Oral Surgery,
    da Silva LAB、Nelson-Filho P、da Silva RAB 等。使用根尖负压冲洗与常规冲洗加三抗生素根管内敷料对患有根尖牙周炎的狗的牙齿进行牙髓治疗后的血运重建和根尖周修复。口腔外科，
    Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2010;109(5):779-787. doi:10.1016/j.tripleo.2009.12.046
    口腔医学、口腔病理学、口腔放射学和牙髓病学。2010;109(5):779-787.doi：10.1016/j.tripleo.2009.12.046
  26. El A, Ossama R, Mekkawi E, et al. Evaluation of the Efficacy of Diode Laser in Maturogenesis of Immature Teeth with Necrotic Pulps: An in Vivo Study "Part One." Vol 11.; 2020. Accessed August 17, 2020. http://medicopublication.com/index.php/ ijphrd/article/view/1721
    El A、Ossama R、Mekkawi E 等人。二极管激光在坏死牙髓未成熟牙齿发生中的功效评估：体内研究“第一部分”。第 11 卷;2020. 2020 年 8 月 17 日访问。http://medicopublication.com/index.php/ ijphrd/article/view/1721
  27. Kaiwar A, Usha H, Meena N, Ashwini P, Murthy C. The efficiency of root canal disinfection using a diode laser: In vitro study. Indian Journal of Dental Research. 2013;24(1):14. doi:10.4103/09709290.114916
    凯瓦尔 A、乌莎 H、米娜 N、阿什维尼 P、穆尔蒂 C.使用二极管激光器进行根管消毒的效率：体外研究。印度牙科研究杂志。2013;24(1):14.doi：10.4103/09709290.114916
  28. Tondnevis F, Keshvari H, Mohandesi JA. Physico-mechanical and in vitro characterization of electrically conductive electrospun nanofibers of poly urethane/single walled carbon nano tube by great endothelial cells adhesion for vascular tissue engineering. Journal of Polymer Research. 2019;26(11):256. doi:10.1007/s10965-019-1916-0
    通德涅维斯 F， 凯什瓦里 H， 莫汉德西 JA.聚氨酯/单壁碳纳米管的导电静电纺丝纳米纤维的物理力学和体外表征，通过大内皮细胞粘附进行血管组织工程。高分子研究杂志。2019;26(11):256.doi：10.1007/s10965-019-1916-0
  29. Alhomrany R, Zhang C, Chou L. Cytotoxic Effect of Chitosan Nanoparticles on Normal Human Dental Pulp Cells. Nanoscience and Nanotechnology. 2019;3(1). doi:10.18063/nn.v3i1.940
    Alhomrany R， Zhang C， Chou L. 壳聚糖纳米颗粒对正常人牙髓细胞的细胞毒性作用.纳米科学和纳米技术。2019;3(1).doi：10.18063/nn.v3i1.940
  30. Tomson PL, Grover LM, Lumley PJ, Sloan AJ, Smith AJ, Cooper PR. Dissolution of bio-active dentine matrix components by mineral trioxide aggregate. Journal of Dentistry. 2007;35(8):636642. doi:10.1016/j.jdent.2007.04.008
    Tomson PL， Grover LM， Lumley PJ， Sloan AJ， Smith AJ， Cooper PR. 通过矿物三氧化物聚集体溶解生物活性牙本质基质组分。牙科杂志。2007;35(8):636642.doi：10.1016/j.jdent.2007.04.008
  31. Smith AJ, Leaver AG. Distribution of the EDTAsoluble non-collagenous organic matrix components of rabbit incisor dentine. Archives of Oral Biology. 1981;26(8):643-649. doi:10.1016/00039969(81)90160-6
    史密斯 AJ，Leaver AG。兔门牙牙本质EDTA可溶性非胶原有机基质成分的分布。口腔生物学档案。1981;26(8):643-649.doi：10.1016/00039969（81）90160-6
  32. Roberts-Clark DJ, Smith AJ. Angiogenic growth factors in human dentine matrix. Archives of Oral Biology. 2000;45(11):1013-1016. doi:10.1016/ S0003-9969(00)00075-3
    罗伯茨-克拉克 DJ，史密斯 AJ。人牙本质基质中的血管生成生长因子。口腔生物学档案。2000;45(11):1013-1016.doi：10.1016/ S0003-9969（00）00075-3
  33. Almushayt A, Narayanan K, Zaki AE, George A. Dentin matrix protein 1 induces cytodifferentiation of dental pulp stem cells into odontoblasts. Gene Therapy. 2006;13(7):611-620. doi:10.1038/ sj.gt. 3302687
    Almushayt A， Narayanan K， Zaki AE， George A. 牙本质基质蛋白 1 诱导牙髓干细胞细胞分化为成牙细胞。基因治疗。2006;13(7):611-620.doi：10.1038/ sj.gt.3302687
  34. von Marschall Z, Fisher LW. Dentin matrix
    冯·马绍尔 Z，费舍尔 LW。牙本质基质
    protein-1 isoforms promote differential cell attachment and migration. Journal of Biological Chemistry. 2008;283(47):32730-32740. doi:10.1074/jbc.M804283200
    蛋白-1 亚型促进差异细胞附着和迁移。生物化学杂志.2008;283(47):32730-32740.doi：10.1074/jbc.M804283200
  35. Arthur A, Shi S, Zannettino ACW, Fujii N, Gronthos S, Koblar SA. Implanted Adult Human Dental Pulp Stem Cells Induce Endogenous Axon Guidance. STEM CELLS. 2009;27(9):2229-2237. doi:10.1002/stem. 138
    Arthur A， Shi S， Zannettino ACW， Fujii N， Gronthos S， Koblar SA.植入的成人人牙髓干细胞诱导内源性轴突引导。干细胞。2009;27(9):2229-2237.doi：10.1002/stem.138
  36. Ayoub S, Cheayto A, Bassam S, Najar M, Berbéri A, Fayyad-Kazan M. The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update. Stem Cell Reviews and Reports. 2020;16(4):650660. doi:10.1007/s12015-020-09982-9
    阿尤布 S， 谢托 A， 巴萨姆 S， 纳贾尔 M， 贝尔贝里 A， 法耶兹-喀山 M.在再生牙髓病学中，管内冲洗剂和药物对牙源性干细胞命运的影响：更新。干细胞评论和报告。2020;16(4):650660.doi：10.1007/s12015-020-09982-9
  37. Mazor Z, Horowitz RA, del Corso M, Prasad HS, Rohrer MD, Dohan Ehrenfest DM. Sinus Floor Augmentation With Simultaneous Implant Placement Using Choukroun's Platelet-Rich Fibrin as the Sole Grafting Material: A Radiologic and Histologic Study at 6 Months. Journal of Periodontology. 2009;80(12):2056-2064. doi:10.1902/jop.2009.090252
    Mazor Z、Horowitz RA、del Corso M、Prasad HS、Rohrer MD、Dohan Ehrenfest DM。 使用 Choukroun 富含血小板的纤维蛋白作为唯一移植材料同时放置植入物的鼻窦底增强：6 个月时的放射学和组织学研究。牙周病学杂志。2009;80(12):2056-2064.doi：10.1902/jop.2009.090252
  38. M. Dohan Ehrenfest D, Bielecki T, Jimbo R, et al. Do the Fibrin Architecture and Leukocyte Content Influence the Growth Factor Release of Platelet Concentrates? An Evidence-based Answer Comparing a Pure Platelet-Rich Plasma (P-PRP) Gel and a Leukocyte- and PlateletRich Fibrin (L-PRF). Current Pharmaceutical Biotechnology. 2012;13(7):1145-1152. doi:10.2174/138920112800624382
    M. Dohan Ehrenfest D、Bielecki T、Jimbo R 等人。纤维蛋白结构和白细胞含量是否会影响血小板浓缩物的生长因子释放？比较纯富血小板血浆 （P-PRP） 凝胶与白细胞和富血小板纤维蛋白 （L-PRF） 的循证答案。当前制药生物技术。2012;13(7):1145-1152.doi：10.2174/138920112800624382
  39. Jayadev M, Marshal Vr, Naik B, Karunakar P. Role of Platelet rich fibrin in wound healing: A critical review. Journal of Conservative Dentistry. 2013;16(4):284. doi:10.4103/0972-0707.114344
    Jayadev M， Marshal Vr， Naik B， Karunakar P. 富含血小板的纤维蛋白在伤口愈合中的作用：批判性评论。保守牙科杂志。2013;16(4):284.doi：10.4103/0972-0707.114344
  40. Nowicka A, Lipski M, Parafiniuk M, et al. Response of Human Dental Pulp Capped with Biodentine and Mineral Trioxide Aggregate. J endod. 2013;39(6):743-747. doi:10.1016/j. joen. 2013.01 .005
    Nowicka A、Lipski M、Parafiniuk M 等人。用生物牙本质和矿物三氧化物聚集体覆盖的人牙髓的响应。J endod.2013;39(6):743-747.doi：10.1016/J. Joen.2013.01 .005
  41. Camilleri J, Sorrentino F, Damidot D. Investigation of the hydration and bioactivity of radiopacified tricalcium silicate cement, Biodentine and MTA Angelus. Dental Materials. 2013;29(5):580-593. doi:10.1016/j.dental.2013.03.007
    Camilleri J， Sorrentino F， Damidot D. 放射性安抚硅酸三钙水泥、Biodentine 和 MTA Angelus 的水合作用和生物活性研究。牙科材料。2013;29(5):580-593.doi：10.1016/j.dental.2013.03.007
  42. Koubi G, Colon P, Franquin J-C, et al. Clinical evaluation of the performance and safety of a new dentine substitute, Biodentine, in the restoration of posterior teeth — a prospective study. Clinical Oral Investigations. 2013;17(1):243-249. doi:10.1007/ s00784-012-0701-9
    Koubi G、Colon P、Franquin J-C 等人。对新型牙本质替代品 Biodentine 在后牙修复中的性能和安全性的临床评估——一项前瞻性研究。临床口腔调查。2013;17(1):243-249.doi：10.1007/ s00784-012-0701-9
  43. Aly MM, Taha SEE, el Sayed MA, Youssef R, Omar HM. Clinical and radiographic evaluation of Biodentine and Mineral Trioxide Aggregate in revascularization of non-vital immature permanent anterior teeth (randomized clinical study). International Journal of Paediatric Dentistry. 2019;29(4):464-473. doi:10.1111/ipd. 12474
    Aly MM， Taha SEE， el Sayed MA， Youssef R， Omar HM. 生物牙本质和矿物质三氧化物聚集体在非重要未成熟恒牙血运重建中的临床和放射学评估（随机临床研究）。国际儿科牙科杂志。2019;29(4):464-473.doi：10.1111/ipd.12474
  44. KLEVANT FJH, EGGINK CO. The effect of canal preparation on periapical disease. International Endodontic Journal. 1983;16(2):6875. doi:10.1111/j.1365-2591.1983.tb01299.x
    KLEVANT FJH，EGGINK CO.根管准备对根尖周疾病的影响。国际牙髓病杂志。1983;16(2):6875.doi：10.1111/j.1365-2591.1983.tb01299.x
  45. Sabeti MA, Nekofar M, Motahhary P, Ghandi M, Simon JH. Healing of Apical Periodontitis After Endodontic Treatment With and Without Obturation in Dogs. J endod. 2006;32(7):628-633. doi:10.1016/j.joen.2005.12.014
    萨贝蒂 MA、内科法尔 M、莫塔哈里 P、甘地 M、西蒙 JH。狗牙髓治疗后有和没有闭塞的根尖牙周炎愈合。J endod.2006;32(7):628-633.doi：10.1016/j.joen.2005.12.014
  46. Shivashankar VY. Comparison of the Effect of PRP, PRF and Induced Bleeding in the Revascularization of Teeth with Necrotic Pulp and Open Apex: A Triple Blind Randomized Clinical Trial. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Published online 2017. doi:10.7860/ JCDR/2017/22352.10056
    希瓦尚卡 VY。PRP、PRF 和诱导出血对坏死牙髓和开放顶点牙齿血运重建的影响比较：一项三盲随机临床试验。临床与诊断研究杂志。2017年在线发布。doi：10.7860/ JCDR/2017/22352.10056
  47. Keswani D, Pandey RK. Revascularization of an immature tooth with a necrotic pulp using plateletrich fibrin: a case report. International Endodontic Journal. 2013;46(11):1096-1104. doi:10.1111/ iej. 12107
    凯斯瓦尼 D，潘迪 RK。使用血小板纤维蛋白对具有坏死牙髓的未成熟牙齿进行血运重建：病例报告。国际牙髓病杂志。2013;46(11):1096-1104.doi：10.1111/ iej.12107
  48. Nageh M, Ahmed GM, El-Baz AA. Assessment of Regaining Pulp Sensibility in Mature Necrotic Teeth Using a Modified Revascularization Technique with Platelet-rich Fibrin: A Clinical Study. J endod. 2018;44(10):1526-1533. doi:10.1016/j. joen. 2018.06 .014
    Nageh M、Ahmed GM、El-Baz AA。使用富含血小板的纤维蛋白改良血运重建技术评估成熟坏死牙齿恢复牙髓敏感性：一项临床研究。J endod.2018;44(10):1526-1533.doi：10.1016/J. Joen.2018.06 .014
  1. Corresponding author: 通讯作者：
    Mohamed Mohsen Abielhassan
    穆罕默德·莫赫森·阿比哈桑
    Assistant Lecturer of Endodontics, Faculty of Dentistry, Cairo University, +201111677707
    开罗大学牙科学院牙髓病学助理讲师，+201111677707