自体年轻恒牙再植术的临床观察

目的:探讨影响年轻恒牙再植术成功率的原因,以提高临床治愈率。方法:对26例34个外伤脱位年轻恒牙常规处理后原位再植,复位固定,随访观察。结果:经1～2年随访观察,34个外伤脱位牙再植后,生长良好26个牙,较好5个牙,失败3个牙,成功率91.18%。结论:离体时间短、尽量保护根面牙周膜细胞活性、良好的固定和调牙合、必要时进行根管治疗,是保证年轻恒牙再植成功的重要因素。     

外伤全脱位年轻恒牙再植的临床研究

目的：观察不同离体时间的年轻恒牙再植后的成功率。方法：详细记录60颗全脱位牙离体时间、手术及牙愈合情况,对患者进行1～2年的随访。结果：60颗脱位牙（离体时间为15min～16h）再植后牙周膜愈合26颗（43．3％）,其中牙髓成活19颗（31．67％）;骨性愈合31颗（51．67％）;纤维愈合3颗。术后对38颗牙进行了根管治疗。结论：缩短脱位牙的离体时间、尽可能保存牙周膜的活性等是再植成功的重要因素。     

离体再植年轻恒牙根尖诱导临床观察

选择20 例离体再植年轻恒牙,用Vitapex糊剂进行根尖诱导.其中外伤脱位牙18 例,离体时间0.5 h～5 d;手术离体牙2 例,即刻复位.16 例治疗成功,4 例失败,成功率80%.18 例外伤脱位再植牙中治疗成功15 例(83.3%),2 例手术再植牙中治疗成功1例(50%).根尖发育完成所需时间为3～18 个...     

年轻恒牙与年轻人恒牙的区别和联系

近日读到一篇题目为“年轻恒牙活髓切断术……”的文章，文中选择7～25岁病人的牙齿，进行切髓术并观察疗效。读罢文章不免心起疑虑，作者似对“年轻恒牙”的概念有所误解。     

老年恒牙、年轻恒牙及乳牙釉质磨损性能的体外对比研究

目的探讨并比较各个年龄组人牙釉质磨损行为的异同.方法采用老年恒牙、年轻恒牙及乳牙各8个釉质样本,经体外模拟摩擦试验测得其磨损量,通过测量硬度和断裂韧性以及分析磨斑形貌和釉质中Ca、P、Si元素含量等揭示釉质的摩擦磨损机制.结果老年恒牙、年轻恒牙、乳牙牙釉质磨损量分别为(2.40±1.10)×10-12 m3、(3.50±1.83)×10-12 m3、(4.86±2.49)×10-12 m3,其中老年恒牙磨损明显小于乳牙(P＜0.05),年轻恒牙与乳牙、老年恒牙与年轻恒牙磨损量间差异无显著性(P＞0.05),但三者在机械性能和磨损特征方面均有所不同.结论各年龄组人牙釉质与陶瓷牙对摩时,主要发生磨粒磨损和断裂磨损,各类牙釉质超微结构的差异决定了其抗磨性能的不同.人牙釉质的硬度和断裂韧性测量值与磨损量无对应关系.     

年轻恒牙根尖诱导成形的临床研究

根尖诱导成形术是治疗牙根尚未形成而牙髓根尖周有感染的年轻恒牙的一种方法。诱导方法的改进和诱导药物探寻一直是临床医生的一大难题。作者采用氧化锌丁香油碘仿糊剂对 4 3颗年轻恒牙行根尖诱导术 ,报告如下 :材　料　和　方　法研究对象 :　作者临床诊治的 4 3颗年轻恒牙 ,其中上前牙 2 1颗 ,下前牙 2颗 ,双尖牙 12颗 ,磨牙 8颗 ,其年龄段及临床分型情况如表 1。表 1　 43颗年轻恒牙年龄组别和临床分型牙髓炎根尖周炎牙槽脓瘘型合　计6～ 85 0 0 59～ 10 8611511～ 13 12 92 2 3合　计 2 5 15 3 4 3　　选用的材料是目前临床常用的樟脑酚…     

年轻恒牙的外伤治疗

在许多国家,牙外伤已经严重影响着青少年的口腔健康,外伤所累及的年轻恒牙在形态和结构上尚未完全发育成熟,根尖孔开放,髓腔宽大,根管壁薄。当年轻恒牙发生冠折和脱位性损伤时,治疗方法的选择对其预后显得尤为重要。年轻恒牙的牙本质小管比成熟恒牙的粗大,外伤冠折累及牙本质时,细菌容易进入牙本质小管感染牙髓;牙本质长期暴露,可造成牙髓坏死和牙冠变色。年轻恒牙外伤后应尽量保存暴露的活髓,选择氢氧化钙行盖髓术或活髓切断术;年轻恒牙即便发生牙髓坏死,也应选择根尖诱导形成术,促进牙根继续发育完成。     

Metapex糊剂用于年轻恒牙活髓切断术的临床研究

观察Metapex糊剂用于活髓切断术的临床疗效。方法：对因各种原因引起冠折露髓的年轻恒牙患者28例3l颗患牙行活髓切断术治疗,用Metapex糊剂作为活髓保存剂。术后对患牙进行定期随访观察。结果：26例患者29颗患牙均于1～3个月在x线片上观察到牙本质钙化桥的形成并持续增厚,牙根继续发育直至根尖孔闭合,整个过程约1．5～3．0年,无根内外吸收和根管钙化出现,成功率93．55％。结论：Metapex糊剂用于活髓切断术可取得较满意的疗效。     

年轻恒牙活髓切断术的临床研究

本文对１６２颗年轻恒 牙行活髓切断术,治疗后经１－５年跟踪随访,结果：成功１４２颗,成功率为８７．６５％,失败２０颗,失败率为１２．３５％,表明年轻恒牙的活髓切断术的疗效好,活髓切断术疗效与前后牙差异无关;与冠髓切除深度无关;与药物配方无关。     

根管内血运重建用于年轻恒牙牙髓坏死的治疗

近年来随着生命科学、材料科学以及相关各学科的发展,人们对年轻恒牙的再生能力有了新的认识。再生性牙髓治疗作为牙髓坏死后一种新的治疗方式,因其可能带来的较传统治疗方法更为理想的预后开始成为研究的热点。其中根管内血运重建以其简便易行,成本相对较低,不涉及免疫排斥和伦理问题等优势获得了人们的关注。本文将就该治疗方式的发展历史及其在年轻恒牙牙髓坏死治疗中的应用等方面作一综述。     

根尖闭合型恒牙完全脱位再植术的临床研究

[摘要] 目的 研究分析不同固定方式、固定时间和牙髓摘除、根管充填的时机对外伤性根尖闭合型完全脱位牙再植术后愈合方式和远期存留率的影响。方法 收治56位患者83颗外伤性根尖闭合型完全脱位牙再植治疗,随机分为两组：常规治疗组采用传统治疗方法;改良治疗组采用再植后弹性固定2~3周,2周时去髓并用Vitapex（碘仿氢氧化钙糊剂）根充,1月时常规根管充填,随访观察5年,比较两组再植牙术后愈合方式及近、远期存留情况。结果 改良治疗组再植牙术后牙周膜愈合率高于常规治疗组,骨性粘连率与炎症性吸收率低于常规治疗组,有显著性差异(P<0.05);两组再植牙术后1年、2.5年的存留率,改良治疗组略高于常规治疗组,但无显著性差异(P>0.05);5年存留率,改良治疗组(86.50%)优于常规治疗组(67.50%),有显著性差异(P<0.05)。结论 对于根尖闭合型完全脱位牙再植术,改良治疗方法可促进再植牙牙周膜愈合,减少牙根吸收的发生,提高远期疗效。[关键词] 完全脱位;再植;固定;根管治疗     

Socio-economic burden of permanent incisor replantation on children and parents

Abstract – This study describes the socio‐economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6–17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first‐year post‐trauma management was $1465 CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post‐trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty‐one patient–parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over $2000 CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio‐economic burden and responsibilities of patient/parent and dentist and their role in informed consent.     

Relationship between clinical–radiographic evaluation and outcome of teeth replantation

Abstract –  The aim of this retrospective study was to evaluate clinical and radiographic results related to avulsed and replanted teeth in patients who sought treatment at the Dental Trauma Center of the Dental School of Piracicaba, State University of Campinas, Piracicaba, SP, Brazil. One hundred replanted teeth were studied from 48 individuals (18 females and 30 males, with a mean age of 15 years and 9 months). Post-replantation factors (clinical and radiographic) were observed. The clinical aspects evaluated were crown discoloration, pulp necrosis, mobility changes, presence of fistulae and tooth infra-position. Radiographic examination aimed to identify replacement and inflammatory root resorptions, pulp canal obliteration and the presence of radiolucent areas. Depending on clinical and radiographic findings, results were classified as: complete success, acceptable success, uncertain success or failure. During anamnesis, other factors such as stage of root formation, period extra-alveolar, storage medium, type of splintation, and period after replantation time were recorded. The data obtained were statistically analyzed in order to determine the relationship between the post-replantation factors and outcome of teeth replantation. Linear logistic regression revealed that the majority of replanted teeth were associated with root resorptions and its occurrence duplicated proportionally as the time after replantation increased. Based on these findings, replantation procedures must be submitted to an accurate follow-up, as the success of replanted teeth, which already tends to be limited, may be even more jeopardized if cases are not controlled.     

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影响牙再植的因素众多,牙再植的成功率并不高。如何改善牙再植的预后一直是儿童牙科临床面临的一大挑战。牙再植的过程一般包括患牙及牙槽窝的处理、惠牙再植和固定。辅助治疗则包括全身性抗生素的应用、局部抗菌措施、破伤风疫苗的强化等。由于牙根发育程度的不同以及惠牙根面牙周膜细胞活性状态的差异等原因,患牙的根面处理及再植后的固定措施有所差异。此外,还需根据患牙牙根发育是否完全、患牙根面是否有活性牙周膜细胞覆盖等对患牙牙髓进行相应的观察或处理。本文拟就这些方面进行简要的介绍。     

Avulsed permanent teeth: a review of the literature and treatment guidelines

Abstract Dental trauma represents one of the few situations where dentists are called upon to make unscheduled diagnostic and treatment decisions in an area that is outside their routine experience. Since patients who sustain an avulsion present infrequently, except in child-oriented or emergency-based practices, clinicians often make diagnostic and management decisions based upon their previous rare treatment experiences. Clinicians also rely on published guidelines for this aspect of their practice and expect these standards to be up-to-date and based on current research information. None of the current protocols has been tested by a prospective longitudinal outcome study in humans. Nevertheless, current guidelines have become the standard for clinical practice around the world. An effort must be made to develop treatment protocols that are based upon the biological mechanisms that underlie periodontal wound healing.     

自体富血小板纤维蛋白用于延迟牙再植1例

富血小板纤维蛋白(PRF)是一种立体三维网状结构的第二代血小板浓缩物,它能够调节炎症,促进组织愈合。并且能够缓慢持续释放多种生长因子。大量文献报道PRF可以促进口腔软硬组织的愈合,但尚未将其应用于临床牙再植的治疗中。本文联合自体PRF颗粒对1例撕脱2 h且干燥保存的离体牙进行延迟再植、复位固定及后续牙髓治疗。随访1年,脱位牙恢复良好,达到牙周膜性愈合,没有出现牙根吸收,且牙槽骨高度得到恢复。     

Survival of avulsed permanent maxillary incisors in children following delayed replantation

Abstract The purpose of this study was to identify the variables that significantly influenced the survival of incisors replanted after extended extraalveolar duration at The Hospital for Sick Children, Toronto, Canada, between June 1988 and December 1993. Survival analysis was used to identify variables that significantly influence the retention of replanted incisor teeth. Survival was defined as the time that elapsed between the replantation of an avulsed incisor and the time it was finally lost. Information on 9 variables was collected for 3H patients (25 males; 13 females) and 52 replanted permanent maxillary incisors. The mean extraalveolar duration for the sample was 123 min. The mean follow-up interval was 942 days (range: 364–2126 days). Incisors replanted with open apices had a significantly decreased survival compared with teeth with mature apices (P=0.04; relative risk 4.2). There was also a significant association between increased survival and obturation of the root canal with gutta-percha and sealer P=0.006 relative risk 10.0). A trend towards improved survival of replanted incisors was found for children older than I 1 years old at the time of replantation (P= 0.09; relative risk 2.8). These results are consistent with previous studies and may assist clinicians and parents in the decision-making process associated with the management of avulsed teeth in children.     

辅助治疗方法对脱位再植牙愈合和疗效的影响

目的：观察氢氧化钙根管内封药、引导性组织再生术（guided tissue regeneration,GTR)和高压氧（hyperbaric oxyen,HBO）治疗联合应用对再植牙的疗效。方法：选择脱位时间超过6小时的358颗前牙，随机分成实验组和对照组，前者以Ca(OH)2根管内封药后在再植术中配合使用不全胶原膜行GTR术，术后给予HBO治疗10天；后者常规根管充填后进行常规牙再植术。对两组手术后临床指标和牙根吸收及失牙情况进行跟踪观察并分析其原因。结果：术后3、6、12个月实验组探诊深度减少和附着获得与对照组差异显著；牙根吸收率、2年失牙率和再植牙总成功率两组亦有非常明显的差异。结论：配合Ca(OH)2根管内封药和GTR、HBO治疗可使脱位离体时间较长牙再植术获得较好疗效。