再植牙牙根替代性吸收的发生与防治

近年来由于交通事故不断上升 ,使外伤脱位牙的发生率逐渐上升。据报道 ,在所有外伤中 ,造成恒牙脱位的占 0 .5 %～ 1 6 % [1] 。牙外伤脱位最常用的治疗方法是牙再植术。在临床上 ,牙根替代性吸收是再植牙常见的一个并发症。本文进一步阐明牙根替代性吸收发生的机制以及相应的防治措施综述如下。1　牙根替代性吸收的发生机制　　造成牙再植失败的原因很多 ,其中炎症性吸收和替代性吸收是造成牙再植失败的主要原因。根骨粘连也叫替代性吸收。根骨粘连的过程是在牙糟壁上形成的骨小梁 ,逐渐生长 ,越过牙周膜间隙 ,与牙根表面融合。然后这些骨…     

Vitapex糊剂预防全脱位再植牙牙根吸收的效果评价

目的:研究Vitapex糊剂在预防全脱位牙再植后牙根吸收的效果.方法:选择急诊因外伤致上前牙完全脱位5h内牙根发育完成的患者30例,患牙36颗.用生理盐水冲洗完全脱位牙及牙槽窝,局麻下复位,不锈钢丝加树脂夹板固定患牙.2周后行牙髓摘除及常规根管预备和消毒,1周后,随机分为A、B 2组,A组采用氢氧化钙糊剂暂时根充,B组采用Vitapex糊剂暂时根充.每3个月复诊,拍摄牙片,观察评价牙根吸收程度并更换充填糊剂.1.5a后,X线片观察牙根吸收稳定后改作永久性根管充填.采用SPSS12.0软件包对数据进行X2检验.结果:比较2组不同时间点的成功率,尽管氢氧化钙在随访1.5a后成功率略高(分别为88.9%和83.3%),但2组差异无统计学意义.Vitapex糊剂具有氧氧化钙和碘仿两者的优点,碘仿的X线阻射性便于充填效果及药物吸收情况的观察,而且操作方便.结论:本研究表明,Vitapex糊剂具有较好的预防脱位牙牙根吸收的效果,值得临床推广使用.     

脱位再植牙牙髓不同处理方法对比研究

目的 探讨脱位再植牙牙髓治疗的最佳方法。方法 61例67颗再植牙随机分为四组，A组：术前不做牙髓治疗直接再植，出现牙髓病变时常规根充，B组：术前去髓，根充碘仿氢氧化钙，（Metapaste)半年后常规根充，C组；术前去髓，根充氢氧化钙，半年后常规根充，D组；术前去髓常规根充，结果 当牙脱位时间超过30分钟后，术前牙髓治疗组的疗效显著优于术后牙髓治疗组。术前去髓充入根管过渡性药物氢氧化钙或碘仿氢氧化钙组的疗效显著优于即刻常规根管治疗组，单纯使用氢氧化钙与使用Metapaste做根管过渡性药物，二者间疗效无显著性差异。结论 牙脱位时间大于30分钟后，术前去髓，先充入氢氧化钙类根管过渡性药物，半年后行根充糊剂加牙胶尖永久充填为较理想的牙髓治疗方法。     

正畸治疗中再植牙发生严重根吸收1例

病人女,12岁,因牙列不齐求治。自述3年前左侧上颌中切牙外伤脱位,经医生处理后再植入牙槽骨内,术后愈合良好,无明显自觉症状,未拍X线片检查。     

枸椽酸处理牙根对即刻再植牙愈合影响的实验研究

本文用枸椽酸对牙根表面进行脱矿处理，研究其对即刻再植牙愈合的影响。实验选用２只成年猕猛然，实验组牙根刮除其表面附着的牙周组织后，用ｐＨ为１．０的枸椽酸溶液脱矿，另一颗牙齿用生理直水浸泡作为对照。牙齿原位再植，术后４，８周标本行组织学和图像处理分析。     

异体牙移植牙根吸收的临床与动物实验研究

作者根据1250例异体牙及自体牙移植病例的临床观察及动物实验表明：异体牙与自体牙牙根吸收的速度开始时间基本相同．甚至自体牙及重植牙的牙根吸收较异体牙范围更大，速度更快，进一步说明了这种现象是自身免疫反应．而并非异体排斥现象．供牙经过抗原处理后仍未能减缓牙根吸收的速度及范围．甚至有些药物反而使牙根吸收速度增快。使植牙愈合缓慢。     

前牙脱位再植牙髓不同处理方法研究

牙再植时有效的牙髓治疗方法目前研究较少 ,作者针对去髓的时机 ,根充方式进行探讨 ,以寻求脱位再植牙牙髓治疗的最佳方法。1　资料和方法1 1　一般方法患者 5 8例 ,男 40例 ,女 18例 ,年龄 8～ 45岁 ,平均 16.5岁。脱位再植牙 66颗 ,其中 112 8颗 ,2 2 8颗 ,3 3 9颗 ;119颗 ,2     

外伤牙脱位再植后3 年牙根完全吸收1例

患者,男性,13 岁.因车祸致左上中切牙离体脱位1 d,就诊时把离体牙用自来水泡在水杯中带来.     

外伤性脱位再植牙根管处理的时机选择

目的:探讨脱位再植牙根管处理的最佳时机。方法:42例49颗脱位再植牙随机分为3组,A组:术前去髓,根充氢氧化钙,半年后常规根充。B组:直接再植,再植术后1周去髓,根充氢氧化钙,半年后常规根充。C组:直接再植,出现牙髓病变时根充氢氧化钙,半年后常规根充。结果:A组与B组的有效率分别为81.25%和94.44%,两者间疗效无显著差异;且A、B两组的疗效均显著优于C组(53.33%),P值均<0.05。结论:牙脱位时间在3h内,再植术后1周行去髓根充氢氧化钙,半年后再行常规根充为较理想的根管处理时机及治疗方法。     

根管内Ca(OH)2去除效果对根尖封闭性能影响的研究

目的:研究不同冲洗方法对根管内氢氧化钙封药的去除效果及残留药物对根尖封闭性能的影响.方法:200 颗离体单根管前磨牙,根管预备后随机分为A、B 2 个实验组(每组96 颗,剩余8 颗为对照组),分别水调氢氧化钙和成品氢氧化钙制剂Multi- Cal根管内封药.7 d后,根据冲洗方法不同将A、B 2 组分别均分为6 组,去除氢氧化钙.每组随机选8 颗牙扫描电子显微镜(SEM)观察;剩余8 颗与对照组,采用冷牙胶侧方加压法根管充填后,进行染料渗透实验.结果:SEM观测显示,相同冲洗条件下,不同剂型氢氧化钙的去除情况无统计学差异(P>0.05).在其他条件相同时,超声根管冲洗组去除效果好于注射器冲洗组,有统计学差异(P<0.05);次氯酸钠与EDTA联合应用组的效果最好,单独使用次氯酸钠组的效果次之,使用蒸馏水组的效果最差,有统计学差异(P<0.05).染料渗透实验结果无统计学差异(P>0.05).结论:超声根管冲洗配合次氯酸钠与EDTA,去除根管内氢氧化钙效果最好;无论哪种方法,均无法完全去除根管内的氢氧化钙封药,但残留的氢氧化钙对根管充填短期内的封闭性能无明显影响.     

Comparison of pH Changes Induced by Calcium Enriched Mixture and Those of Calcium Hydroxide in Simulated Root Resorption Defects

Introduction

External resorption usually occurs after dental trauma and the loss of root cementum. Because it has the ability to induce alkaline pH, calcium hydroxide is used in treatment of external resorption, which is reportedly not free from disadvantages. Driven by such understanding, the aim of this in vitro study was to compare the pH changes induced by calcium enriched mixture (CEM) and those of calcium hydroxide in simulated root resorption defects.

Methods

Twenty-one paired extracted human premolars were cut to the length of 14 mm. Root canal preparation was performed by using ProTaper rotary system. Cavities of 0.7-mm depth and 1.4-mm diameter were prepared on the external root surface, 5 mm from the apex. Half of the teeth were filled with CEM and the other half with calcium hydroxide. Five premolars were also assigned as the negative control group and filled with normal saline. To be assured of the filling quality, a radiograph was obtained from each tooth. Subsequently, pH of the cavity was measured with a microelectrode at 20-minute, 3-hour, and 1-, 7-, 14-, 21-, and 28-day intervals after filling.

Results

Mean pH in the CEM and in the calcium hydroxide groups were significantly varied during the study period, with pH of the calcium hydroxide group significantly higher than that of CEM in all of the measurements. However, no significant difference was observed between the pH of the calcium hydroxide group and that of the control group at the 7-day and 14-day measurements and between those of the CEM group and the control group at days 7, 21, and 28.

Conclusions

In comparison with calcium hydroxide, CEM hardly maintained alkaline pH during the first month of use, and so CEM may be an inappropriate material in treatment of external root resorption.     

The Effect of Long-term Dressing with Calcium Hydroxide on the Fracture Susceptibility of Teeth

Introduction

Calcium hydroxide has been widely used to treat immature teeth to achieve periodontal healing and to promote the formation of an apical barrier. However, retrospective clinical studies have shown a high incidence of cervical root fractures with long-term calcium hydroxide dressing. The alkalinity of calcium hydroxide has been suggested to weaken the root. In vitro studies using ovine teeth show conflicting results on fracture strength of dentine, although different commercial products may have influenced the results. The purpose of this study was to investigate the effects of 2 commercial products used in prior studies (Calasept Plus and UltraCal XS), as well as a new product (Calmix) that uses a nonaqueous vehicle that allows for a higher pH, on the fracture strength of dentine over time.

Vitapex糊剂和氢氧化钙诱导年轻恒牙根尖形成疗效观察

目的：比较Vitapex糊剂和普通氢氧化钙2种材料诱导根尖成形的疗效。方法：选择76颗牙外伤或已有牙髓病变的年轻恒牙,随机分成两组,分别用Vitapex糊剂、氢氧化钙糊剂行根尖诱导术。结果：经2年的随访观察,根尖诱导成功率Vitapex组为94.73%、氢氧化钙组78.95%,结果经χ2检验差异有统计学意义（P〈0.05）。结论：Vitapex糊剂诱导年轻恒牙根尖成形较普通氢氧化钙糊剂效果更好。     

Efficacy of XP-endo Finisher File in Removing Calcium Hydroxide from Simulated Internal Resorption Cavity

Introduction

The aim of this study was to evaluate the effect of supplementary use of XP-endo Finisher file, passive ultrasonic activation (PUI), EndoActivator (EA), and CanalBrush (CB) on the removal of calcium hydroxide (CH) paste from simulated internal resorption cavities.

乳牙釉、牙本质钙含量之分析研究

目的:分析探讨乳牙釉质、牙本质钙含量状况与龋病关系。方法:对37例5~7岁幼儿园乳恒牙替换所拔除的下颌乳中切牙,用电子探针X线显微分析仪检测各牙之近中侧、远中侧、唇侧和舌侧之釉质和牙本质不同深度之钙含量。受检测牙37颗(1|18颗,|119颗)。37例中dft=0者14名,为无龋组;dft>0者23名,为有龋组。有龋组中0相似文献   

氢氧化钙对根管牙本质pH的影响

目的：旨在确定氢氧化钙置于髓腔内或根管内对根管牙本质不同位置pH的影响。方法：取新鲜拔除的人单根管牙，常规根管预备，在牙根冠1／3、中1／3、尖1／3钻三个小孔，根管内或髓腔内封人氢氧化钙糊剂，分别在8h、1、2、3、7、14、21天测定小孔内牙本质pH。结果：所有根管牙本质pH均显著升高，冠1／3、中1／3、尖1／3pH随时间呈现相同的变化趋势，但无显著性差异；根管内和髓腔内封入氢氧化钙，根管牙本质PH无显著性差异。结论：氢氧化钙封人髓腔内其羟基亦能有效扩散至根管牙本质中发生作用，对单根管而言不失为一种简便的根管消毒方法。     

氢氧化钙碘仿糊剂根管封药的临床观察

目的:比较氢氧化钙碘仿(CHI)糊剂与传统的根管消毒剂甲醛甲酚(FC)、樟脑酚(CP)的临床效果。方法:选择需作根管治疗的患者142例,患牙165颗,随机分为CHI、FC、CP组,常规镍钛根管预备后分别封入上述药物于根管及髓腔中,观察比较根管预备封药后发生根管治疗期间疼痛(EIP)的情况、临床疗效及完成根管治疗的复诊次数。结果:CHI组EIP的发生率最低、临床有效率最高、复诊次数最少,与FC组有显著性差异(P<0.05),但与CP组的差异无显著性(P>0.05)。讨论:与传统的酚类根管消毒药物(FC、CP)相比较,CHI封药不易导致EIP,临床疗效高、疗程短、操作简便、无细胞毒性及抗原性,是一种较理想的根管消毒剂。     

Outcome Assessment of Teeth with Necrotic Pulps and Apical Periodontitis Treated with Long-term Calcium Hydroxide

IntroductionThe aim of this retrospective, cohort case series was 2-fold: (1) to evaluate the outcomes of teeth with necrotic pulps and apical periodontitis using long-term calcium hydroxide (Ca[OH]₂) (healing was assessed via the periapical index [PAI] system) and (2) to explore the possible association of fractures in relation to long term Ca(OH)₂ exposure.MethodsA total of 242 cases, diagnosed with pulpal necrosis and apical periodontitis, were treated with long-term Ca(OH)₂ using a standardized protocol. Injectable and powdered Ca(OH)₂ were placed sequentially in the root canal system. All cases were re-evaluated within a 3-month period until radiographic healing was observed. Clinical and radiographic evaluations were performed annually. Pre- and postoperative periapical radiographs were evaluated using the PAI system.ResultsOf the 242 cases, 219 participants completed their treatment with annual follow-up. The average Ca(OH)₂ time was 5.4 months with a range of 1–12 months. Overall, by the latest follow-up visit, 90.0% (197/219) were classified as "healed." The overall mean preoperative and postoperative PAI scores were 4.07 (±0.80) and 1.76 (±0.70), respectively. Kappa statistics showed an almost perfect agreement for inter-rater (κ = 0.91) and intrarater (κ = 0.95) reproducibility for both examiners.ConclusionsWithin the limitations of this study, the use of long-term Ca(OH)₂ in the treatment of teeth with necrotic pulps and apical periodontitis resulted in a predictable high outcome. There was no association observed between long-term Ca(OH)₂ use and the incidence of fractures during this study. Ca(OH)₂ is a suitable material of choice as an interappointment dressing for teeth diagnosed with pulpal necrosis and apical periodontitis.     

氢氧化钙充填根管诱导根尖形成的临床观察

对４５例４８颗儿童期有症状畸形中央尖双尖牙行氢氧化钙根和充填根尖诱导形成术。经１至４年观察，牙根尖完全发育成形有７９．２％，根尖部分发育形成有１６．６％，失败有４．２％。认为临床上有效抗感染，恰当的根管预备和根管充填的条件下，氢氧化钙能有效的诱导有症状畸形中央尖牙根尖发育形成。     

C型利钠利尿肽在人乳牙根生理性吸收过程中的表达

目的：探讨C型利钠利尿肽（C-type natriuretic peptide,CNP）在人乳牙根生理性吸收过程中的表达及作用。方法：运用免疫组织化学方法检测人乳牙根生理性吸收过程中CNP蛋白的表达。结果：乳牙的破牙细胞、牙髓成纤维细胞及成牙本质细胞胞浆中CNP免疫组化染色阳性,且表达高于恒牙组,差异有统计学意义（P〈0.05）,乳牙牙周韧带成纤维细胞CNP染色亦阳性。结论：CNP在人乳牙牙根生理性吸收过程中有表达,可能对乳恒牙替换起到一定的促进作用。