纵折后牙粘接再植的长期疗效评价

目的 评价纵折后牙粘接再植的长期疗效并分析预后的影响因素.方法 对接受纵折后牙粘接再植手术患者的折裂牙进行定期临床随访,对再植牙进行牙体、牙周、松动度和咀嚼功能等方面的检查,记录病史和临床检查结果,并保存X线影像学检查资料.通过资料分析对折裂牙粘接再植技术的长期疗效进行评价.结果 40颗患牙3年保存了32颗(80%),成功16颗,有功能11颗,失败5颗.其中20颗患牙5年保存了15颗(75%),成功9颗,有功能3颗,失败3颗.结论 折裂时间、咬合力、患者身体和口腔卫生状况均可影响预后.纵折后牙粘接再植技术的3年保存率和疗效均令人满意,能够保留一些原来需要拔除的牙齿,维持了牙列完整,恢复了患者的咀嚼功能,是目前治疗后牙纵折一种较好的方法;5年保存率基本令人满意,但预后效果还有待进一步观察.     

口内粘接加全冠修复治疗纵折后牙28颗报告

目的：观察口内直接粘接加全冠修复治疗纵折后牙的临床疗效。方法：采取全酸蚀技术和流动复合树脂,将26例、共28颗纵折后牙,进行复位粘接,然后采用铸造金属烤瓷冠或金属冠进行修复,随访9-38个月,评价修复效果。结果：术后9-38个月随访,成功19颗、有效8颗、失败（拔除）1颗。其中,折裂时间≤3d的纵折后牙治疗成功率（88.2%;15/17）明显高于折裂时间〉3d的纵折后牙成功率（36.4%;4/11）,而患者的性别、牙位以及折裂类型等对疗效无明显影响。结论：口内粘接加全冠修复是保存治疗纵折后牙的有效方法,而且纵折后尽早治疗是提高其临床成功率的关键。     

��������61����������������

目的探讨后牙纵折的保存治疗方法。方法回顾2004年3月至2010年3月沈阳皇姑仁和口腔门诊部收治的后牙纵折患者61例（61颗患牙）,行即刻根管治疗,戴临时冠观察1周,无痛后全冠修复,并随访观察2年。结果随访2年,61例患者中48例治疗后效果良好,无咀嚼障碍,13例不适,治疗成功率为78．68％。折裂后Ⅰ度松动患牙治疗成功率高于Ⅱ度松动患牙（P〈0．01）;后牙纵折后1周内就诊的患者治疗成功率高于超过1周就诊的患者（P〈0．01）。结论选好适应证并尽早就医行完善的根管治疗及全冠修复,多数纵裂后牙可有效保存并发挥正常的咀嚼功能。     

纵折后牙粘结再植术的初步观察

目的评价纵折后牙粘结再植术的愈合情况。方法将49例患者51颗纵折后牙完整拔出,体外行根管治疗,采用Super-BondC&B粘结系统粘结折裂牙体,调牙合,再植入牙槽窝,术后2～6个月行全冠修复。结果术后6个月复查,磨牙组、前磨牙组牙活动度较术前显著下降(P<0.05),但各组X线片骨吸收水平无统计学差异。49例患者治疗后18个月随访结果,再植牙保存率90.2%。结论纵折后牙粘结近期疗效满意,远期疗效还有待进一步观察。     

铸造桩核修复牙体大面积缺损的临床疗效观察

目的探讨铸造桩核修复牙体大面积缺损的临床疗效。方法选择牙体大面积缺损的患牙76颗,修复前完善根管治疗,牙体预备后直接法完成铸造桩核,临床试戴合适后粘接,修整后取模行金属或烤瓷全冠修复。经6～37个月观察,进行临床疗效评价。结果修复成功74颗,失败2颗,其中牙根折裂1颗,松动脱落1颗,成功率97.4%。单纯铸造桩核修复与修复后作为固定或活动义齿修复的基牙,其成功率差异无统计学意义。结论铸造桩核能和根管及剩余的牙体组织紧密贴合,粘接后固位力强,具有良好的抗折能力,为全冠修复提供了良好的固位形和抗力形,是修复牙体大面积缺损的一种较为理想的方法。     

磨牙纵折保存修复治疗的临床体会

目的　探讨磨牙纵折后保存修复治疗的治疗效果。方法　39颗纵折磨牙,结扎丝双股结扎经常规根管治疗,行核桩内固定加全冠修复。结果　经1~4年的随访,成功修复36颗,临床总有效率92.3%。3颗分别因再次根折、患者感觉不适、Ⅲ°松动而导致修复失败。结论　磨牙纵折后经根管治疗结合桩核内固定加全冠修复,可保存患牙,维持正常咀嚼功能。     

石英纤维桩与铸造桩在前牙修复中的应用比较

目的探讨石英纤维桩与镍铬合金铸造桩用于前牙修复的临床疗效。方法 80颗牙冠缺损2/3～4/5的前牙,分为2组,纤维桩组40颗,石英纤维桩树脂核修复,铸造桩组40颗,镍铬合金铸造桩核修复,2组均采用全瓷冠修复。修复后6、12、24个月复诊,观察有无龈缘着色、冠松动、桩冠脱落、根折及X线片评价根尖周状况。结果随访2年,2组80颗患牙的X线片根尖周均未显示异常;纤维桩组有1个全冠松动脱落,重新粘接后未再脱落;无龈缘着色及桩折断;无根折发生。铸造桩组有5个修复体龈缘着色,1个桩冠脱落,2颗患牙发生根折。修复后24个月,纤维桩组成功率97.5%,铸造桩组成功率80.0%,2组差异有统计学意义（χ2=6.13,P〈0.05）。结论石英纤维桩用于前牙修复,临床疗效较好。     

断端部分粘结联合内外固定治疗上前牙冠根折的临床研究

目的观察断端部分粘结联合内外固定治疗上前牙冠根折的临床疗效。方法采用断端部分粘结、内外固定综合治疗外伤时间在24 h以内,牙根基本或已经完全形成的儿童及青少年上前牙冠根折病例12例13颗牙,术后6、12、24个月分别记录患牙的松动度、牙龈指数、牙周探诊深度（CPI探针检查）及x线片上患牙牙根周围牙槽骨情况,并进行临床分析评估。结果术后24个月,13颗患牙复查的情况显示断端粘结效果理想,患牙松动度均正常;患牙牙周组织健康,牙龈指数（G I）均小于3,牙周探诊深度（PPD）仅一颗牙术后6个月为3mm（之后均为2mm）,其他12颗均在3mm以内,X线片未见明显异常改变。结论保留牙冠的断端部分粘结联合内外固定治疗儿童及青少年上前牙冠根折,是一种保守治疗上前牙冠根折的理想方法。     

玻璃纤维桩用于前牙残根、残冠修复的临床观察

目的研究玻璃纤维桩在前牙残根、残冠修复中的临床应用效果。方法临床选择69例患者,共136颗患牙,均为上下前牙残根或残冠,备牙后龈上剩余牙体组织小于3 mm的10颗,备牙后龈上剩余牙体组织3 mm以上者126颗,经过完善的根管治疗,采用玻璃纤维桩制作桩核,Procera氧化锆全冠修复。对修复效果进行随访评价。结果随访12~48个月,未发现根折;131个修复体边缘密合,未见松动,无脱落无继发龋损,牙周健康;有4颗牙发生纤维桩核松动脱落,有1颗纤维桩折断。成功率为96.32%。所有患者对修复体美学效果均感满意。结论对前牙残根残冠使用玻璃纤维桩Procera氧化锆全冠修复美学效果良好,不易造成根折,可以获得较高的成功率,达到满意的修复效果。     

两种方法保留纵折后牙的临床初步研究

目的：比较口内直接粘结法和口外粘结再植法治疗纵折后牙的临床疗效.方法：将符合适应症的纵折后牙随机纳入口内直接粘结组（口内组）和口外粘结再植组（口外组）,口内组患牙超强粘结后直接冠修复,口外组拔除折裂牙后在体外粘结,再植入牙槽窝,术后2周进行全冠修复.术后6月、12月复查,根据临床表现、牙周状况分级,并进行统计分析.结果：6个月随访结果表明,两种方法的半年成功率没有显著差异（P＞0.05）.1年随访结果显示,口外法成功率较口内法高（p＜0.05）.结论：口内直接粘结法和口外粘结再植法是目前临床常见的保存纵折后牙的两种方法,口外粘结再植法的远期疗效可能好于口内粘结法.     

促进撕脱性损伤牙延期再植后牙周愈合的研究进展#br#

牙撕脱性损伤是牙外伤中预后较差的一种,目前对于恒牙撕脱性损伤的治疗一般采用牙再植术,再植时根面牙周组织活性对其预后至关重要。临床调查显示,撕脱性损伤牙再植多为延期再植,离体牙根面牙周膜在干燥状态下脱水坏死是导致术后病理性牙根吸收的主要原因。国际牙外伤协会建议在延期再植时采取适当措施,促进再植牙的牙周愈合再生,减少病理性吸收,延长再植牙使用寿命。文章结合2020版国际牙外伤协会撕脱性损伤牙治疗指南对现有促进撕脱性损伤牙延期再植后牙周愈合相关研究做一综述,包括根面处理、药物及干细胞治疗在牙再植术中的应用。     

Periodontal healing after bonding treatment of vertical root fracture

Abstract – Vertical root fractures lead to advanced periodontal breakdown with deep periodontal pockets and vertical bone defects. The purpose of this study is to evaluate clinically the periodontal healing of root fracture treatment using adhesive resin cement. In 22 patients, 23 teeth with vertical root fractures were treated with 4-META/MMA-TBB resin cement. Eleven fractured roots were bonded through the root canal (group A) and 12 fractured roots were bonded extra-orally and replanted (group B). All teeth were then restored with full cast crowns ( n =20) or coping ( n =3). Mean probing depth was 6.6 mm at pre-treatment and 4.4 mm 6 months after the treatment in group A, and 7.4 mm and 4.6 mm, respectively, in group B. Bleeding scores were 100% at pre-treatment and 36.4% after 6 months in group A and 91.7% and 8.3%, respectively in group B. Radiographic bone level was 56.8% at pre-treatment and 59.1% after 6 months in group A, and 18.8% and 29.2%, respectively, in group B. Two roots of group A and three roots of group B were extracted due to refracture, deterioration of periodontal inflammation, mobility, and luxation. The remaining roots ( n =18) presented no discomfort to the patients and there was no deterioration of periodontal conditions over a mean period of 33 months (range 14–74 months) in group A and over a mean period of 22 months (range 6–48 months) in group B. There was no ankylosed teeth nor was any root resorption detected. The results suggested that the treatment of vertical root fracture using 4-META/MMA-TBB resin has good prognostic possibilities.     

牙根牵引联合龈切治疗上前牙冠根联合折的临床研究

目的观察牙根牵引联合龈切、树脂冠修复治疗儿童及青少年上前牙冠根联合折的临床疗效。方法患牙根管治疗后,应用牙根牵引方法使牙根延伸2～4 mm不等,平均3.125 mm,再联合患牙舌侧牙龈切除2 mm和树脂冠修复,治疗上前牙冠根联合折病例16例,16颗患牙。结果 2年后临床检查树脂冠修复情况、患牙牙周和根尖周健康情况,X线片上牙根和根周牙槽骨情况。16颗患牙治疗后,疗效达成功标准的有5颗,有效10颗（患牙唇侧牙龈轻微增生）,失败的1颗（患牙再次外伤拔除）。结论牙根牵引联合龈切、树脂冠修复是保守治疗儿童及青少年上前牙冠根联合折的一种理想方法。     

Treatment of replacement resorption with Emdogain® − a prospective clinical study

The present clinical study investigated the outcome of intentional replantation using Emdogain for periodontal healing following trauma‐related ankylosis. Sixteen ankylosed teeth affected by replacement resorption were treated as follows: After tooth extraction, the root canal was obturated with a retrograde titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. The mean follow‐up period was 15 months (range 4–24 months). Eleven teeth showed no signs of recurrence of ankylosis: they were in full function and exhibited no pathological clinical findings. Four severely traumatized teeth demonstrated a recurrence of ankylosis after a mean period of 6 months, one tooth was lost in a second accident after 7 months. The estimated probability of 1 year without recurrence of ankylosis was P = 0.66 (95% confidence interval [0.40; 0.94]). The mean survival time was 10.2 months (SD 1.1). The results indicate that treatment of replacement resorption following light to moderate trauma with replantation and Emdogain appears to prevent or delay recurrence of ankylosis in many cases.     

Prognosis of intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin

There is no particular treatment established to preserve vertically fractured teeth. We evaluated the long-term prognosis of the intentional replantation of 26 vertically fractured roots after reconstruction with 4-META/MMA-TBB dentin-bonded resin. Replanted teeth were evaluated according to clinical criteria and radiographic examinations for periods ranging from 4 to 76 months. Eighteen cases were functional and retained, with six fully successful; the others needed further observation. Eight cases failed to respond to treatment because of refracture, recurrence of gingival inflammation, or both. Longevity was calculated as 88.5% at 12 months after replantation, 69.2% at 36 months, and 59.3% at 60 months. All failures occurred in premolar and molar teeth. Longitudinal fractures extending more than 2/3 from the cervical portion toward the apex showed significantly shorter longevity compared with fractures within the 2/3 area (log-rank test, p = 0.02). Intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin may be considered for incisors as an alternative to extraction, although the long-term success is not optimal.     

A retrospective study on the prognosis of teeth with root fracture in patients during the maintenance phase of periodontal therapy

Abstract –  Teeth with root fracture generally have a poor prognosis requiring extraction; however, some patients do not wish to have these teeth extracted. Dentists do not have enough information regarding the prognosis of teeth with root fracture. This study retrospectively examined the prognosis of teeth with root fracture in the maintenance phase of periodontal treatment and assessed the factors influencing the prognosis of teeth with root fracture. The clinical records of 100 patients, who had entered the maintenance phase of periodontal therapy in a university hospital and had experienced fracture of tooth root, were analyzed. The following parameters were included in the evaluation: age and gender of the subjects, tooth type, restoration and root-filling of the teeth with root fracture, and number of teeth present. Survival probability was assessed using Kaplan–Meier analysis. The median survival time (95% confidence interval) was 42 months (22–62 months). Teeth with horizontal fracture had a significantly higher survival probability compared with teeth with vertical fracture. No significant differences were found in the survival probability with regard to gender and tooth type. In conclusion, teeth with horizontal root fracture have a better prognosis compared with teeth with vertical root fracture in patients undergoing periodontal maintenance.     

������ά׮�������׸�����֬�޸���ͯ���˺�ǰ���ٴ���Ч�۲�

目的    探讨玻璃纤维桩联合纳米复合树脂对儿童年轻外伤恒前牙临时过渡性修复的临床效果。方法    2004年９月至2008年３月于杭州市口腔医院儿童牙科对65例78颗儿童外伤冠折恒前牙行完善的根尖诱导和根管治疗后,使用玻璃纤维桩修复后直接用纳米复合树脂修复外形作为至18岁的过渡性修复,随访3年,观察其临床修复效果。结果    术后3个月复查,未见纤维桩折断、根折、根吸收。术后6个月有1例因二次外伤发生根折。术后24个月复查,仅3例出现表面着色,未见树脂脱落,边缘渗漏偶有发生,经处理均使患者满意。术后36个月,未见纤维桩脱落、根折。结论    玻璃纤维桩和纳米复合树脂联合修复儿童外伤恒前牙是成功有效的过渡性修复方法。它能够避免直接树脂修复或断冠修复造成的反复脱落,又能降低根折风险,最大限度的保留牙体组织。     

套筒冠义齿修复轻中度牙周炎伴多数牙缺失的疗效观察

目的:探讨多数牙缺失伴牙周病的牙列缺损患者应用套筒冠修复的临床效果。方法:选择多数牙缺失并有可摘局部义齿修复史的轻中度牙周炎患者36例,行牙周基础治疗和根管治疗后设计、制作套筒冠义齿,比较分析修复前和修复后6、12、24个月菌斑指数(PLI)、牙龈指数(GI)、探诊深度(PD)、龈沟出血指数(SBI)、牙齿松动度,并进行问卷调查。结果:36例患者在修复后3次复查时牙齿松动度和牙周袋深度(PD)逐渐变小(P<0.05),与修复前相比有明显改善,差异有统计学意义;菌斑指数(PLI)、牙龈指数(GI)、龈沟出血指数(SBI)无明显的变化(P>0.05);随访问卷调查结果显示,患者对套筒冠义齿满意度明显高于活动义齿。结论:套筒冠义齿修复轻中度牙周炎伴多数牙缺失的牙列缺损具有较好的临床效果。     

年轻上颌切牙冠折露髓的预后及影响因素回顾分析

目的回顾分析年轻恒牙冠折露髓后的预后及其影响因素。方法对1991-2008年就诊于北京大学口腔医院儿童口腔科的冠折露髓年轻恒牙的病历资料进行回顾分析,要求患者初诊治疗为活髓切断术或直接盖髓后改行活髓切断术且患者复诊时间大于2年。记录患者的年龄、初诊距外伤时间（即初诊时间）、牙根发育程度、松动度及叩痛,分析治疗效果及牙髓预后情况,并用Logistic回归分析预后的影响因素。结果共收集118例符合标准的病例,涉及患牙136颗。患儿年龄（8.8±1.2）岁,复诊时间（46.1±22.0）个月。冠折露髓后行活髓切断术的成功率为85.3%,20颗患牙发生牙髓坏死,发生时间为外伤后（25.0±19.0）个月。叩痛程度与牙髓坏死呈显著相关,患儿年龄、初诊时间及松动度是牙髓坏死的非相关因素。结论年轻恒牙冠折露髓后行活髓切断术的成功率较高。初诊时重度叩痛是牙髓坏死的重要信号,患儿年龄、初诊时间及松动度与预后之间无明显相关性。