牙髓病变对局限型牙周炎的影响

目的：研究局限型牙周炎患牙的侧枝根管、副根管在其根管系统中的数量及发生率,探讨牙髓病变在局限型牙周炎发生、发展过程中的作用。方法按照统一标准收集因局限型牙周炎（局限组）及广泛型牙周炎（广泛组）而拔除的患牙各30颗。拔除前通过影像学检查分析牙槽骨的吸收状况,制作透明体外牙标本后,在解剖显微镜下对侧枝根管及副根管情况观察计数。结果局限型牙周炎患牙中牙槽骨角型吸收发生比率（76.7%）明显高于广泛型牙周炎患牙（36.7%）;在所收集的磨牙中,局限型牙周炎患牙侧枝根管及副根管的发生率为80%,广泛型牙周炎患牙侧枝根管及副根管的发生率约为52%,二者间存在显著差异。结论侧副根管在局限型牙周炎患牙中的发生率较高,患牙的牙髓病变及其额外的解剖通道在局限型牙周炎的发生、发展过程中可能起了重要的作用,对于局限型牙周炎的治疗应尽早进行牙髓治疗以消除感染源。     

牙槽骨吸收与吸烟状况的研究

目的: 评价不同程度牙槽骨吸收的牙数与每日吸烟量和血浆中cotinine水平的关系。方法: 120名未治疗的慢性牙周炎患者,男 48,女 72,平均年龄 42. 3岁。根据自述的吸烟状况分组。116人检测了血浆cotin ine水平。根据骨吸收达根长的冠 1 /3、中 1 /3和根 1 /3, 牙槽骨吸收分为轻、中、重度骨吸收。结果:cotinine水平与自述的吸烟状况呈正相关(P<0. 001)。重度吸烟组较非吸烟组,中度骨吸收的牙齿数明显增多;而非吸烟组,无骨吸收的牙齿多(P值均<0. 001)。结论:吸烟>10支 /d是牙槽骨吸收牙数增加的重要危险因素。     

中重度慢性牙周炎上颌中切牙区解剖形态的锥形束CT测量分析

目的应用锥形束CT（CBCT）测量分析中重度慢性牙周上颌中切牙区牙槽骨的骨量和牙齿偏移度,为上颌中切牙区的种植治疗和方案制定提供解剖学依据。 方法选取2015年1月至2017年12月深圳爱康健口腔医院内150例中重度牙周炎患者的CBCT影像资料,测量共290颗上颌中切牙唇/腭侧骨壁厚度、牙槽骨骨宽/高度、骨内根长、牙体长轴和牙槽骨走行方向的夹角共7个项目,采用SPSS 19.0统计软件包对测量结果进行相关统计分析。 结果中重度慢性牙周炎上颌中切牙牙槽嵴顶处和根尖处的唇腭向骨厚度分别为（7.68 ± 0.78）mm和（8.52 ± 1.55）mm,牙槽骨高度平均为（18.35 ± 3.45）mm,骨内根长1/2处的唇侧和腭侧的骨壁厚度分别为（0.62 ± 0.45）mm和（3.18 ± 1.00）mm,牙体长轴与牙槽骨走行方向夹角的平均值为18.80° ± 5.46°。不同性别间对比测量结果,在牙槽嵴顶骨宽度和根尖区骨宽度处差异均有统计学意义（P<0.05）,男性优于女性。 结论中重度慢性牙周炎上颌中切牙的唇侧骨壁菲薄甚至缺如,骨量条件不理想,牙体长轴与牙槽骨偏移度明显,在制定种植方案时有必要充分利用CBCT了解骨量情况并评估解剖形态,为达到上颌中切牙种植效果长期美观、稳定的需求应有更多的考量。     

铸造粘结夹板治疗晚期牙周炎的疗效观察

我们用铸造粘结夹板固定松动牙 ,并施以牙周手术 ,治疗40余例晚期牙周炎松动牙患者 ,随访 16例 ,疗效满意。1　材料和方法1.1　病例选择所有病例均是口腔科门诊牙周病患者。患者要求无慢性系统病 ,晚期牙周炎患牙数在前牙区≤ 4个 ,在后牙区≤ 2个。晚期牙周炎的标准为 :①牙槽骨吸收超过根长 1/ 2 ,有垂直型骨吸收 ;②有大于 5ｍｍ的牙周袋 ;③牙齿松动≥Ⅱ度。在随访的 16例患者中 ,男性 6人 ,女性 10人 ,年龄 3 2～ 5 5岁 ,平均 46岁 ,患牙位于前牙区 10例 ,后牙区 6例。1.2　治疗方法检查牙齿松动度 ,检查并记录菌斑指数 (ＰＬＩ) ,牙龈…     

牙周夹板固定与非固定的临床疗效观察

本文通过牙周夹板固定和非固定两种方法治疗牙周病,经过两年的临床观察,统计分析两种方法的优劣。材料及方法门诊选取67名患者,临床上确诊为成人牙周炎,年龄在18～60岁之间,经基础治疗控制炎症后患牙仍有松动的一组前牙或者个别牙,牙槽骨吸收超过根长的1/2～3/4,包括牙周病前牙移位,经正畸治疗已基本复位的Ⅱ°～Ⅲ°松动的患牙。有牙髓症状的要进行牙髓治疗。调牙合解除早接触。将患牙随机分为两组:一组采用牙周夹板固定,另一组不采用夹板固定。其余维持治疗两组相同。牙周夹板固定方法:前牙采用钢丝“8”字结扎,光敏树脂固定,后牙采用牙合…     

牙弓夹板固定及HA颗粒植入治疗牙周炎伴创伤

牙周炎伴创伤常导致牙槽骨严重吸收使牙齿松动甚至脱落，严重影响咀嚼功能和美观。临床常将牙槽骨吸收达根长２／３，松动Ⅱ°～Ⅲ°的患牙拔除。作者对这些牙槽骨严重吸收并松动的牙，采用牙弓夹板固定、牙周翻瓣术配合羟基磷灰石（ＨＡ）颗粒植入，疗效较理想，现报道...     

慢性牙周炎患牙经牙髓治疗后疗效观察

慢性牙周炎患牙经牙髓治疗后疗效观察王锦明对慢性牙周炎患牙经牙髓治疗后的疗效进行观察，报告如下：１临床资料、分组和方法１．１临床资料慢性牙周炎１８５例患者２００个牙，均无全身症状，无其他系统慢性疾病或免疫疾病。男１１２例１２７个患牙，女７３例７３个患牙...     

自体骨及人工骨修复牙槽骨缺损的临床分析

重度牙周炎导致牙槽骨吸收，牙齿松动，严重影响咀嚼功能。以往常常将牙槽骨吸收达根长2／3，松动Ⅱ°～Ⅲ°的患牙认为无法保留而予以拔除。为保留这类患牙我科自1995年以来，用自体同源骨及羟基磷灰石（HA）作为修复牙槽骨缺损的材料治疗患牙共32例，71个牙齿，经过一年的临床观察，疗效满意，现报告如下：1材料和方法1．1HA采用四川大学材料科学系和华西医科大学口腔医学院共同研制的20～60目致密多晶羟基磷灰石。1．2自体骨采自上颌梨状孔边缘骨1．3一般资料：共治疗病人32例，其中男性17例，女性15例，年龄22～62岁；71个牙齿中前牙2…     

金属烤瓷联冠修复牙周病松牙的体会

牙周病发展至晚期 ,牙齿松动、移动 ,咀嚼无力甚至无法挽救而被拔除或自行脱落 ,严重危害胃肠功能和影响美观[1 ] 。我科自 1 998年起对牙周病松牙进行金属烤瓷联冠修复 ,取得了较好的效果。材料和方法1 材料　选用贺利氏镍铬烤瓷合金和ＶＩＴＡ瓷粉等。2 适应征　①中、重度牙周炎患者 ,牙槽骨吸收达根长的 1 / 3～ 2 / 3 ,牙齿松动Ⅱ°～Ⅲ° ;②修复牙列中无缺失牙 ;③能保持口腔清洁并定期复诊。3 牙髓、牙周治疗　对牙周病松牙进行仔细检查 ,并拍全景Ｘ线片 ,了解牙周、根尖周的情况 ,并建立档案。所有松动牙都要进行完善的根管治疗 …     

牙周炎患牙拔除后行位点保存研究进展

重度牙周炎造成牙周软硬组织的严重破坏,患牙拔除后会进一步导致牙槽骨不可逆吸收和软组织塌陷缺如,若拔牙同期行位点保存术可减少牙周炎患牙剩余牙槽骨的过度吸收,有效保存牙龈组织,为后期种植修复创造良好的牙周基础条件,从而获得令人满意的种植修复的功能和美学效果。文章就牙周炎患牙拔除后位点保存的意义,牙周炎对位点保存的影响,牙周炎患牙拔除后位点保存技术操作要点、种植时机及效果评价等做一综述。     

Vitapex、派丽奥联合治疗严重根尖周炎伴牙周炎病例的疗效观察

严重根尖周炎伴牙周炎的患牙临床常予以拔除。我科采用Vitapex、派丽奥联合治疗此类患牙18例。术后观察8个月,牙槽嵴顶骨质修复,根尖周区及分叉区骨密度增高,吸收的根尖周区钙化,牙齿松动<Ⅰ度。     

Clinical diagnosis of trauma from occlusion and its relation with severity of periodontitis

The purpose of the present study was to determine the reliability of several selected signs of trauma from occlusion and their relations with severity of periodontitis. 32 moderate to advanced chronic periodontitis patients participated in the study. All teeth present were evaluated for various abnormal occlusal contacts, signs of trauma from occlusion, and the severity of periodontitis. Standardized periapical radiographs were also taken for each tooth. The results demonstrated that: (1) no significant difference occurred in probing pocket depth (PD), clinical attachment loss (AL), or percentage of alveolar bone height (BH) between teeth with and without various abnormal occlusal contacts, i.e., premature contacts in centric relation occlusion, non-working contacts in lateral excursions, premature contacts of anterior teeth or posterior protrusive tooth contacts; (2) teeth with either significant mobility, functional mobility, or radiographically widened periodontal ligament space (PDLS) had deeper PD, more AL and lower BH than teeth without these signs, while teeth with pronounced wear or radiographically thickened lamina dura had less AL than teeth without these findings; (3) 2 combined indices, i.e., the trauma from occlusion index (TOI) and the adaptability index (AI), were proposed for the identification of occlusal trauma and the response of periodontium to excessive biting forces in heavy function, respectively; TOI-positive teeth exhibit deeper PD, more AL and less osseous support than TOI-negative teeth; however, AI-positive teeth had less AL and more osseous support than AI-negative teeth; (4) with identical attachment level, TOI-positive teeth had less osseous support than TOI-negative teeth while the magnitude of difference became greater with an increase of attachment loss.     

应用锥形束CT浅析牙周基础治疗对慢性牙周炎牙槽骨骨量的影响

目的:应用锥形束CT及Simplant软件测量分析不同类型、不同年龄段的慢性牙周炎患者,经过牙周基础治疗后牙槽骨的骨量恢复情况,以期为进一步治疗计划的制定提供临床依据。方法:采用单纯随机抽样法选取2012年2月~2013年2月就诊于中国医科大学附属口腔医院的慢性牙周炎患者50例,其中轻度牙周炎患者15例,中度牙周炎患者18例,重度牙周炎患者17例。采用Simplant软件及t检验观测并比较基线及牙周基础治疗后6个月慢性牙周炎个体的牙槽骨缺损程度,是否进行了统计学分析,请简要补充统计方法及检验水准。结果:不同年龄、不同病损程度的慢性牙周炎患者治疗后6个月与治疗前相比, 牙槽骨高度和相对骨密度均有改善。<50岁的轻度、中度牙周炎患者治疗后6个月的牙槽骨密度均显著高于治疗前(P<0.05),牙槽骨距釉牙骨质界的缺损高度均有降低,但与治疗前相比差异均无统计学意义;重度牙周炎患者治疗前后牙槽骨密度和牙槽骨缺损高度均有改善但差异均无统计学意义。随着年龄的增长,牙槽骨缺损高度及相对骨密度的改善程度呈下降趋势且治疗前后差异无统计学意义;前磨牙及磨牙的近中、远中位点治疗后6个月牙槽骨缺损高度及相对骨密度较其他位点改善明显(P<0.05)。结论:牙周基础治疗在一定程度上可有效改善慢性牙周炎的牙槽骨缺损高度和相对骨密度;锥形束CT及Simplant软件的应用有助于评估治疗前后牙槽骨骨量的变化。     

伴牙槽嵴吸收的牙周炎患者上前牙龈乳头缺陷程度影响因素初探

目的探讨有牙槽嵴吸收时上前牙不同程度龈乳头缺陷的相关影响因素。方法选择2019年6至12月就诊于北京大学口腔医学院·口腔医院牙周科,且经治疗后牙周炎控制稳定并定期进行牙周维护的14例牙周炎患者的64个上前牙龈乳头,通过标准化临床图像及锥形束CT影像资料综合分析,评价邻接触点至骨嵴顶的距离(distance from contact point to bone crest,CP-BC)、邻面釉质牙骨质界至骨嵴顶的距离(distance from proximal cemento-enamel junction to bone crest,pCEJ-BC)、骨嵴顶水平的根间距(distance between roots,RD)、骨嵴顶水平龈乳头高度(height of gingival papilla,PH)、骨嵴顶水平颊舌向骨宽度(width of bone crest,BCW)等指标与龈乳头充满和轻中重度缺陷的关系。结果纳入研究的64个上前牙龈乳头,充满率为28%(18/64),缺陷率为72%(46/64),其中轻、中、重度缺陷率分别为36%(23/64)、27%(17/64)和9%(6/64)。当CP-BC≥7.0 mm或pCEJ-BC≥4.5 mm时,龈乳头均为中、重度缺陷;而当CP-BC<5.0 mm或pCEJ-BC<1.5 mm时,龈乳头为充满或轻度缺陷。上前牙CP-BC与pCEJ-BC存在显著正相关关系,Pearson相关系数为0.812(P<0.01),线性拟合系数为0.93(R2=0.659)。64个上前牙龈乳头不同程度缺陷时,其骨嵴顶水平RD差异无统计学意义(P>0.05)。骨嵴顶水平BCW随龈乳头缺陷程度增加略有增加,龈乳头充满与中重度缺陷时BCW差异有统计学意义(P<0.05)。骨嵴顶水平PH随龈乳头缺陷程度增加略有减少,龈乳头充满与中重度缺陷时PH差异有统计学意义(P<0.05)。结论伴牙槽嵴吸收的牙周炎控制稳定患者的龈乳头缺陷率高,且主要与龈乳头根方骨嵴顶的吸收有关。     

The incidence of local plaque retentive factors in chronic periodontitis

One of the leading local risk factors for chronic periodontitis is the presence of plaque retentive factors in the oral cavity. The main objective of the study was to assess how the local irritation and plaque retention caused by untreated carious lesions, subgingival and approximal overhanging crown margins can affect the attachment loss at patients with chronic periodontitis. The incidence of plaque retentive factors were evaluated on 200 panoramic radiographs randomly selected from the archive of the Department of Periodontology. On the radiographs each fully erupted tooth were studied under magnifying glasses (1:2 magnification), and the distance between CEJ and the most coronal bone level was measured with a ruler with mm scales. The quality of restorations were evaluated based on the approximal adaptation of their margins. During the clinical examination the presence of local plaque retentive factors were registered by tooth, and the radiological alveolar bone level were recorded around both the healthy and restored or filled teeth. Statistical analyzes were made with linear regression analysis and ANOVA. Only 177 out of the randomly selected 200 radiographs met the incursion criteria and could be evaluated. The average age of patients was 49.98 years and the average approximal bone loss was 5.439 mm, showing increasing tendency with age. The 177 patients had a total of 3618 teeth and 1407 teeth presented plaque retentive factors including 164 untreated approximal carious lesions, and 1243 faulty restorations with approximal overhangs or open margins. Radiographically 82.5% of the restorations had incorrect approximal marginal adaptation. The majority of the untreated carious lesions occurred in the molar as well as in the front regions. The average bone loss at the teeth with faulty restorations were higher than at the sound teeth. 113 patients had an average bone loss higher than >4 mm. In those patients the differences between sound and restored teeth were smaller than those in the groups of patients with mild bone loss. Nevertheless neither group showed statistically significant differences between restored and sound teeth. In mild to moderate periodontitis local plaque retentive factors, overhanging crown margins or carious lesions are decisive aggregating factors both in gingivitis and periodontitis, especially in the susceptible population. In severe periodontitis according to our data there were only minimal differences between the attachment level around sound teeth and teeth with faulty restorations and local plaque retentive factors.     

Assessment of bone loss in periodontitis from panoramic radiographs

Bone loss in chronic periodontitis was assessed from panoramic radiographs by direct measurement from the cemento-enamel junction (CEJ) and by measuring the proportion of the tooth length supported by bone. Mesial and distal bone levels of all available teeth were assessed for 50 patients aged 30-39 years referred for periodontal treatment. 85% and 74% of surfaces were measurable by the proportional and direct techniques, respectively. 27% of surfaces had no bone loss according to the proportional score, whereas 22% had a CEJ to alveolar bone distance of less than 2 mm. In addition, over half the surfaces with a proportional bone loss score of zero had a CEJ to alveolar bone distance of 2 mm or more, and for each proportional bone loss score, there was considerable overlap in the CEJ to alveolar bone distances recorded. The validity of the CEJ to alveolar bone measurements was established by comparison with direct measurements at periodontal surgery. The results support the use of direct measurement from the CEJ to alveolar bone rather than the assessment of the proportion of the tooth length within the bone when investigating bone loss from panoramic radiographs. This population of 30-40-year-old periodontal patients had a mean of 50% of sites with a CEJ to alveolar bone distance of 3 mm or more, and at such sites, there was a mean additional bone loss of 2.1 mm.     

188例中老年慢性牙周炎患者牙槽骨吸收情况及危险因素分析

目的：探讨牙槽骨吸收的危险因素。方法：选择188名35－75岁确诊为慢性牙周炎的患者为研究对象，对其进行口腔检查、问卷调查及X线曲面断层片的检查。应用计算机定点测量釉牙骨质界到牙槽嵴顶的距离，此距离＞3 mm，牙槽嵴顶骨硬板不清晰或消失为牙槽骨丧失。采用SPSS19．0软件对数据进行t检验、方差分析等统计学方法分析牙槽骨丧失的相关危险因素。结果：188例患者，9384个位点中7881个位点有牙槽骨吸收，轻度牙槽骨吸收位点数占51．38％（4049／7881），中度牙槽骨吸收位点数占33．00％（2601／7881），重度牙槽骨吸收位点数占15．62％（1231／7881）。男女性别中度牙槽骨吸收位点数差异有统计学意义，轻、重度差异无统计学意义；BMI与学历各组重度牙槽骨吸收位点数差异有统计学意义，轻、中度差异无统计学意义；年龄各组轻、中、重度牙槽骨吸收位点数差异均有统计学意义。结论：肥胖、受教育程度低可能是牙槽骨吸收的危险因素，年龄是影响牙槽骨吸收的重要因素。     

Pulpal pathosis and severe alveolar lesions: a clinical study

Gingivitis is widely believed to be the precursor of crestal alveolar bone destruction (periodontitis) in some individuals. However, there is no correlation between gingivitis and severe localized lesions of alveolar bone. Specific 'periodontopathogens' of the indigenous oral flora are hypothesized to be the cause of localized lesions but the evidence to date is one of association only. Acute and chronic pulpal inflammation are known causes of irritation to the periodontal ligament and alveolar bone; retrograde pockets may subsequently form. Contamination by indigenous organisms best adapted to the special environment of the deep pocket could be expected to follow the establishment of the new conditions. This study was undertaken to examine the clinical and histological status of the pulps of teeth affected by severe localized alveolar lesions. A total of 153 teeth in 90 subjects were studied; full periodontic and endodontic assessments were made. Seventy-seven teeth responded in the normal range to pulp testing, but 52% of these had no recoverable tissue from their root canal systems on endodontic opening. The findings indicated that pulpal pathosis was not clinically detectable in the majority of teeth studied when conventional endodontic diagnostic tests were applied. Rather, the presence of localized severe alveolar defects was a more accurate predictor of pulpal pathosis.     

Root Fractures in permanent teeth: a clinical review

A retrospective study of 22 root fractures in 21 patients was performed. Ten patients were less than 11 years of age, and boys were involved more often than girls. Ten patients had more than one injured tooth, but there was no case of alveolar fracture. Twenty-one of the teeth were upper central incisors. Only 11 teeth were seen within the first week, so that not all teeth were splinted and not all displaced teeth were repositioned. Long-term clinical and radiographic review showed that loss of vitality of the coronal pulp could not be reliably detected for at least 1 year. No tooth became abscessed or developed a sinus tract, and resorption of bone at the fracture line was observed in only one out of five non-vital teeth. Lack of displacement and placing of a splint increased the chances of the pulp remaining vital and healing of the fracture occurring with hard tissue. Sclerosis of the coronal pulp occurred mainly when healing was by connective tissue. The apical pulp always remained vital, and there was sclerosis of the apical pulp in almost every case.