190例牙隐裂临床特征及疗效分析

［摘要］ 目的 探讨牙隐裂的临床特征、治疗及预后分析。方法 根据病情发展程度将190颗患牙分为分为牙髓正常隐裂牙组（Ａ组）64颗和牙髓异常隐裂牙组（Ｂ组）126颗。根据治疗原则和患者自身情况选择不同的治疗方法,并对1年后治疗效果进行统计学分析。结果 A组全冠修复治疗的成功率为78.9%,高于充填治疗和调牙合治疗的成功率,差异有统计学意义（P<0.05）。B组全冠修复的成功率为94.0%,明显高于单纯充填治疗的成功率,差异有统计学意义（P<0.05）。结论 牙隐裂需早期诊断早期治疗,准确判断裂纹的深度和范围,可利用全冠修复最大限度的保留患牙。     

一次法根管治疗联合全冠修复隐裂后牙的疗效观察

目的探讨一次法根管治疗联合全冠修复隐裂引起牙髓疾病的后牙疗效。方法107颗隐裂引起牙髓疾病的后牙,经一次法根管治疗后全冠修复,随访2年,观察临床疗效。结果随访2年,患牙治疗成功率为95．3％（102／107）。5颗失败患牙均为根尖周炎患牙。结论隐裂引起牙髓病的后牙,在诊断明确后及时完善根管治疗并行全冠修复,患牙保存效果好。     

老年人隐裂牙综合治疗的临床分析

目的：评价老年人隐裂牙综合治疗的临床效果。方法：对114例隐裂牙进行综合治疗，1年后随访观察。结果：114颗隐裂牙中，根管治疗全冠修复的有效率为92．86％，充填治疗组有效率为87．5％。结论：综合治疗可以保留牙体组织并恢复咬合力，是老年人隐裂牙治疗较理想的方法。     

早期牙隐裂的综合治疗及疗效观察：附42例患者临床资料

对４２人４７颗早期牙隐裂患牙，用作者提出的综合方法治疗后定期追踪２年以上，观察结果：总的牙齿保存率为９５．７４％，其中有２６例患牙功能良好，临床检查和牙髓活力正常。结果提示：３８．３０％的早期牙隐裂患牙，其隐裂继续加深和牙髓病变的发生均不易控制，宜及早做牙髓治疗和全冠修复。     

P60复合树脂充填法治疗牙隐裂的疗效观察

目的观察P60复合树脂充填法治疗牙隐裂的临床疗效。方法 72例86颗无明显症状的隐裂牙随机分为治疗组和对照组：治疗组56颗隐裂牙行P60复合树脂充填,对照组30颗隐裂牙采用银汞合金充填。治疗6、12个月后复诊,评价患牙充填治疗的临床疗效,分析裂隙深浅与疗效的关系。结果裂隙止于牙釉质的患牙充填治疗成功率为100%,裂隙止于牙本质浅层、中层者分别为82.4%和66.7%,裂隙达牙本质深层者治疗均失败。治疗组成功率为78.6%,对照组成功率为56.7%,2组比较差异有统计学意义（2χ=4.55,P=0.033）。结论牙隐裂充填治疗的疗效与裂隙深浅密切相关,P60复合树脂充填治疗的疗效优于银汞合金。     

牙髓治疗后咬合调整对预防后牙折裂的分析

目的 观察牙髓治疗后咬合调整对预防后牙折裂的临床效果。方法 牙髓治疗后进行咬合调整,2年后复查。结果 调(牙合)组88颗牙,牙折数4颗,牙折发生率4.5％;未调(牙合)组80颗牙,牙折数18颗牙,牙折发生率22.5％;调(牙合)组疗效明显优于未调(牙合)组。结论 牙髓治疗后咬合调整对预防后牙折裂有较好的疗效。     

225颗隐裂牙治疗疗效观察

目的：分析隐裂牙的治疗疗效。方法：根据临床表现及检查，对225颗隐裂牙分为早期隐裂牙(77颗)和晚期隐裂牙(148颗)．进行治疗和观察、分析疗效。结果：早期隐裂牙77颗，经充填术或全冠修复术，3a疗效有显著差异；晚期牙隐裂148颗，经环扎处理行根管治疗或干髓术，最后行全冠修复，经3a观察效果良好。结论：对牙隐裂正确分期，采取相应治疗，定期复诊，患牙得以良好保存。     

双尖牙隐裂的临床探讨

牙隐裂是引起牙痛的常见原因之一。临床医生在检查牙隐裂时，常常着重检查磨牙，而对双尖牙有所忽略，易发生漏诊。因此，对双尖牙隐裂是值得临床医生多加关注的。材料与方法１－一般资料：近５年来，经作者诊断为隐裂的双尖牙，共计６３颗。根据患者有咬合不适、激发痛或自发痛、夜间痛等主诉，以及冷热测试、侧叩痛、隐裂线染色等临床检查，初步诊断为牙隐裂。并根据治疗效果进一步证实当初的诊断。此６３颗隐裂牙均不伴有龋坏、深楔状缺损、畸形中央尖或深牙周袋等可引起牙痛的疾病。同时检查与患牙同一区的磨牙，排除其隐裂的可能性。２…     

口腔手术显微镜应用于隐裂牙临床诊断和治疗的效果观察

目的：探讨口腔手术显微镜在隐裂牙临床诊断和治疗中的应用效果。方法对136颗无龋、无充填、无牙周疾病的患牙,采用隐裂牙的一般诊断方法和染色法结合口腔手术显微镜进行诊断,根据临床症状和裂纹深度对隐裂牙分类治疗,其中58颗中浅层无牙髓炎临床症状的隐裂患牙,经调牙合后在显微镜下磨除隐裂裂隙,光固化复合树脂充填后行全冠修复;78颗近髓或有牙髓炎、根尖周炎症状的隐裂牙,在显微镜下一次性完成根管治疗后全冠修复。所有病例随访观察6个月。结果136颗患牙中有15颗患牙通过隐裂牙的一般诊断方法无法明确诊断,采用染色法结合口腔手术显微镜检查后诊断,58颗中浅层隐裂牙,成功46颗,成功率79．31％;78颗近髓或有牙髓炎、根尖周炎症状的隐裂牙,成功73颗,治疗成功率93．59％。结论口腔手术显微镜的应用对隐裂牙的诊断及治疗有指导意义。     

早期牙隐裂活髓保存的临床疗效观察

目的:探讨早期牙隐裂活髓保存的临床治疗方法.方法:对诊断为早期牙隐裂的56例患者的隐裂牙共计63颗,据病史及临床检查分别采用光固化树脂直接充填或MTA垫底后光固化树脂充填,然后以贵金属冠进行修复治疗,随访2年,观察其疗效.结果.63颗患牙经治疗后临床随访2年,成功57颗,失败6颗,治疗有效率达90.4％.结论:早期牙隐裂的治疗以光固化树脂充填或MTA垫底后以光固化树脂充填,然后以贵金属冠修复是保存活髓和防止牙齿折裂的有效方法.     

荧光素钠检测牙隐裂的临床应用观察

目的　观察荧光素钠检测牙隐裂的效果。方法　对疑有牙隐裂的患牙进行诊疗。用随机、单盲的方法,对疑似有牙隐裂的患牙分别应用荧光素钠和茂康碘进行检测。结果　105例患牙应用荧光素钠检测出有牙隐裂95例 ,检测准确率为90.48%;96例患牙应用茂康碘检测出有牙隐裂68例,检测准确率为70.83% ,两组经统计分析有显著性差异（P<0.01）。结论　荧光素钠检测牙隐裂的方法是安全、有效、快捷的,可避免牙隐裂漏诊和误诊。     

47例冠根纵折的临床分析

目的：对47例冠根纵折的患牙进行分析，探讨最佳的治疗方法和预防措施。方法：通过观察47例冠根纵折的病例，对牙位、牙髓状态、牙髓治疗情况进行回顾性分析。结果：牙冠纵折多见后牙，以上颌第一磨牙为多见，其中无髓牙33例，牙折裂前有近一半曾作过根管治疗，活髓牙14例，存在不同程度的牙隐裂，牙周炎和咬合创伤。结论：牙折裂只要采取及时有效的治疗，部分患牙是可以保留的。积极诊治牙隐裂、合理的牙髓治疗及全冠修复是预防牙折裂的有效方法。     

126例后牙牙冠隐裂的处理与疗效观察

目的 探讨牙隐裂的治疗及疗效。方法 对１５８例共１６２颗后牙隐裂牙,包括牙釉质隐裂和牙本质隐裂,所有病例均进行综合治疗,并分期复查,最长观察时间２．５ａ。结果 １６２颗隐裂牙的治疗成功与改善率为９０．７４％,在失败病例中,急性牙髓炎６颗（３．７％）,牙槽脓肿３颗（１．８５％）,性慢根尖周炎２颗（１．２４％）,牙折裂４颗（２．４％）。结论 牙隐裂因多种因素所致,因此早期发现,综合治疗,定期复查是治疗     

预成金属冠在隐裂牙治疗中的应用

目的 在治疗隐裂牙引起的牙髓炎或根尖周炎前用预成金属冠,用以防止治疗过程中及治疗后牙体折断。方法选择在口腔门诊首次就诊的具有牙髓炎或根尖周炎症状的隐裂牙,采用预成金属冠修复后再作牙髓病治疗。结果 用预成金属冠治疗的牙髓炎、根尖周炎的患牙的保存和咀嚼功能均较好。结论 预成金属冠在隐裂所引起的牙髓炎及根尖周炎的治疗中的作用是明显的,在治疗后应及时用铸造或烤瓷冠修复。     

Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration

The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.     

Analysis of 154 cases of teeth with cracks

Abstract –  It is well known that cracked teeth occur most frequently in the mandibular molars with large or poor restorations, in those over 50 years of age. However, with increasing knowledge and experience with cracks of teeth, cracks appear to be found frequently in intact teeth without restorations. The aim of this study is to analyze the cases of tooth cracks in a dental hospital in a year, and to find out the characteristic features of cracks of teeth. For 1 year, each tooth that were identified as a cracked tooth was recorded and analyzed in terms of the classification of cavity and restorative material, the nature of opposing tooth, the location in the arch, the age and gender, and the clinical signs and symptoms, and treatment result. Cracked teeth were observed most frequently in the teeth with no restorations (60.4%) and with class I restorations (29.2%). The most prevalent age was in those over 40 years of age (31.2% in their 40s, 26.6% in their 50s) and the prevalence was similar in men (53.9%) and women (46.1%). Cracked teeth were found most frequently in the maxillary molars (33.8% in first molar, 23.4% in second molar) than in the mandibular molars (20.1% in first molar, 16.2% in second molar). 96.1% of the cracked teeth responded to the bite test, and 81.1% of the cracked teeth were observed in the mesiodistal direction. The prevalence of cracked tooth was highest in the intact teeth with no restoration, in maxillary molars, and in those over 40 years of age. When examining a intact maxillary posterior tooth that is sensitive to a bite and thermal change, crack in the mesiodistal direction need to be considered one of the causes.     

隐裂牙临床特征分析及CBCT影像学研究

目的: 通过对临床上非外伤性隐裂牙的临床特征进行分析并对其锥形束CT(Cone beam computed tomography, CBCT)的影像学表现进行总结。方法: 对105名患者的105颗明确冠隐裂牙的临床特征及CBCT影像学特征进行统计,收集临床资料包括患者的性别、年龄、牙位,同时对其CBCT上牙根折裂情况,牙槽骨及根尖周骨质吸收情况进行评价和统计。结果: 105例患者中,男性49.52%,女性50.48%;在50岁之前,随着年龄增加,隐裂牙发生比例增加,其中41~50岁发生率最高(34.29%),之后下降。105例隐裂牙中有5例发生在前磨牙区,其余均发生在磨牙区,其中第一磨牙发生率最高(59.05%)。105颗隐裂牙,CBCT检查有16颗(15.24%)可观察到牙根存在不完全折裂,仅4颗(3.81%)可见牙根完全折裂。其余85颗(80.95%)隐裂牙牙根未见明显异常。结论: 隐裂牙好发于上下颌第一磨牙,CBCT检测下大多数的冠隐裂牙并没有发生牙根折裂。     

Survival of root filled cracked teeth in a tertiary institution

AIM: To assess the survival rate of root filled cracked teeth over a 2-year period in a tertiary institute. METHODOLOGY: Forty-nine patients who had root canal treatment completed on their cracked teeth at the National Dental Centre (Singapore) were recalled for a 2-year review. Collected review data included presence of periodontal pocketing, sinus tract and swelling associated with the teeth. The date of extraction was noted if a tooth was missing at review. Pre-treatment data collected were number, extent and location of crack, presence of periodontal pocketing, patients' age and gender, location of cracked teeth, type of teeth and presence of terminal cracked tooth. RESULTS: Fifty teeth in 49 patients were included. The Kaplan-Meier estimate of 2-year survival rate was 85.5% (95% confidence interval: 75.5-95.5). Cracked teeth which were the terminal teeth in the dental arch (RR = 4.9, 95% CI: 1.2-2.0, P = 0.04), teeth with pre-root filling periodontal pocketing (RR = 4.9, 95% CI: 1.2-2.0, P = 0.04) and teeth with multiple cracks (RR = infinity, 95% CI: 1.9-infinity, P = 0.01) were more likely to be extracted. CONCLUSIONS: Within the limitations of this study, multiple cracks, terminal teeth and pre-root filling pocketing were significant prognostic factors for the survival of root filled cracked teeth.     

Success and Survival of Endodontically Treated Cracked Teeth with Radicular Extensions: A 2- to 4-year Prospective Cohort

IntroductionThere are no long-term, prospective clinical studies assessing outcomes of endodontically treated cracked teeth with radicular extensions. The purpose of this prospective study was to examine the 2- to 4-year success and survival rates of endodontically treated, coronally restored, cracked teeth, specifically where the crack extends beyond the level of the canal orifice internally.MethodsSeventy consecutive teeth requiring endodontic treatment with cracks extending to the level of the canal orifice and up to 5 mm beyond were included in the cohort. Treatment was performed by a single endodontist using current techniques, and cases were followed over time. Specific treatment and posttreatment protocols were used. A tooth was “survived” if it was present, asymptomatic, and functional. The category of “success” was given to a case if strict radiographic and clinical criteria were met.ResultsFifty-nine teeth were eligible for survival analysis, and 53 teeth were available for success analysis. There was a 100% survival rate in the first 2 years and 96.6% survival up to the 4-year period; 90.6% were classified as “success” in the 2- to 4-year term. No significant differences (P < .05) were found for periodontal pocketing (up to 7 mm) at the site of the crack, marginal ridge involvement, crack depth, or pretreatment diagnoses.ConclusionsThis study showed that the success and survival rates for cracked teeth with radicular extensions may be similar to endodontically treated teeth in general and may be higher than previously reported in cracked tooth studies. Treatment outcomes in cracked teeth with radicular extensions may be improved by using the following protocols: microscope-assisted intraorifice barriers placed apical to the extent of the crack, complete occlusal reduction, specific postoperative instructions, and expeditious placement of a full-coverage restoration.