外伤牙正畸治疗的研究进展

口腔科临床工作中常可遇到牙外伤。12％～33％儿童存在牙外伤,10．8％正畸治疗的患儿有牙外伤史。这些患者中多数只是牙釉质折裂／缺损,对正畸治疗无明显影响。然而,一些患者因外伤而错位的牙或错位牙的外伤都会使正畸治疗更加复杂,需要多名口腔专科医师协作才能完成治疗。本文综述了目前外伤牙正畸的风险和治疗原则,但是目前多数文献为个案报道或样本数目小,缺少大样本、设计严谨的研究文献,治疗原则多来自临床经验或专家个人意见,缺乏实验依据。     

北京市地区牙体牙髓医生需要量的研究

目的 预测不同模式下龋病治疗所需要牙科人力,进行供震匹配分析。方法 分层、整群、随机抽取北京市区实际人口1517人进行龋病治疗需要与需求状况调查,工时测定采用现场写实法与经验估计法,利用卫生服务需要与需求法计算牙体髓医生需要量。结果 龋病患病率64.9％,57.5％的人有牙体牙髓治疗需要。一年就诊率20.2％,潜在需求64.9％。预测到2010年的配置参考范围为987－1628人（WHO工作时间）和1029－1697人（CHcT工作时间）。结论 龋病治疗需要与有效需求之间有较大差距,并将继续扩大,牙体牙髓医生供不应求,牙体牙髓医生的培养应是牙科人力发展的增量投向之一。     

牙体牙髓-正畸-修复治疗恒上前牙龈下牙折的临床观察

笔者在临床上采用牙体牙髓治疗断根-正畸牵引-桩冠修复治疗上前牙龈下牙折，达到了较满意的临床效果。一、资料与方法1．病例纳入标准：①单发性恒上前牙折断，完全折断，折断线最低点在龈下2.0mm-4.0mm，根无弯曲畸形，牙根发育完成，根尖周和牙周组织健康；②断根足够长（能保证修复后的冠根比即折断线以下的断根不短于同名牙的冠长）。     

3种人群对正畸治疗中白垩斑的认知度调查

目的调查正畸医生、患者和患者父母对正畸治疗中白垩斑的认知度。方法对51名正畸医生,247名正畸患者和223名患者父母进行白垩斑认知度的问卷调查,对结果进行统计分析。结果 3组人群均认为白垩斑降低了整齐牙齿的美观度,患者自身要对白垩斑的发生负主要责任(P<0.01)。导致白垩斑最主要的因素是刷牙不正确、次数和时间不够。结论正畸医生、患者和患者父母均认为白垩斑降低了正畸治疗后牙齿的美观度,其责任主要归结于患者自身,患者口腔日常保健不足是导致白垩斑最主要的原因。     

广东省口腔医学会牙体牙髓病学专业委员会学术活动通知

为推广根管治疗的新理念和新技术。提高牙髓根尖周病治疗的理论和技术水平,在广东省口腔医学会牙体牙髓病学专业委员会第二届委员会成立一周年之际。由广东省口腔医学会牙体牙髓病学专业委员会、中山大学附属15腔医院牙体牙髓病科、上海埃蒙迪材料科技有限公司、广州市和茂医疗器械有限公司于2010年8月17日联合举办学术讲座。欢迎各位同行踊跃参加．具体安排如下。     

先天性牙缺失患者的单纯正畸治疗与正畸-修复联合治疗浅探

目的:探讨先天失牙患者的缺牙特征及单纯正畸或正畸修复联合治疗的临床效果。方法:收集2006~2014年在我科矫治的先天失牙患者24人,拍全口曲面断层片、颞下颌关节开闭口位片及头颅定位侧位片,并根据面型及牙列拥挤度等决定治疗方案,通过正畸治疗将间隙集中后再义齿修复,观察临床疗效。结果:24例先天失牙患者采用上述方法进行治疗,均获得正常覆盖、覆牙合关系,面型协调,软组织侧貌得到改善。结论:先天缺失1~2牙的错牙合畸形, 根据面型、错牙合情况、缺牙数目设计不同矫治治疗方案, 能够获得满意的矫治效果。多牙先天牙缺失,常需正畸-修复联合治疗才能获得较好疗效。     

牙颌面畸形正颌治疗的正畸处理

单纯的正畸治疗有其局限性。在骨性畸形严重时,成年患者由于生长发育停止而正畸治疗困难时,患者后牙缺失使支抗丧失时,患者需要牙或牙—牙槽骨的大幅度移动如压入移动等正畸治疗很难达到要求的情况下,正颌治疗则可解决上述问题而会使这些牙颌面畸形的治疗取得较为理想...     

牙异常间隙修复前正畸治疗探讨

牙异常间隙不仅影响人的颜面部美观和咀嚼功能、发音功能,还会导致颞下颌关节病,不但给临床修复治疗带来一定的困难,并且使修复治疗不能达到恢复功能和美观的满意效果.自1990年以来,我们收治了因各种原因引起的牙异常间隙,经临床正畸和修复治疗均收到了良好的效果.一 资料与方法1 临床资料 共收治75例不同牙异常间隙的患者,女性42例,男性33例.前牙异常间隙55例,后牙异常间隙20例.其中唇腭裂6例.年龄14-38岁,平均18.2岁.前牙异常间隙表现为:散在性间隙;邻牙向缺牙间隙移位,缺牙间隙变小.后牙异常间隙多表现为缺牙造成的间隙大小不均,牙齿倾斜、伸长,少数为散在小间隙.2 疗效评定原则2.1 前牙以恢复自然、对称、协调、美观.2.2 后牙以恢复平衡、咬合功能稳定.     

氟缓释型粘结剂预防正畸治疗中釉质脱矿的疗效观察

目的观察含氟离子释放型的正畸粘结剂在预防固定正畸治疗中牙釉质表面脱矿的临床疗效。方法选择24例固定矫治的正畸患者,采用自身对照法分别用树脂增强型玻璃离子粘结剂(GC)和含自酸蚀底涂剂的树脂粘结剂(Transbond)粘固托槽,于正畸治疗前、治疗后3个月及治疗后6个月应用DIGNOdent激光龋齿诊断仪检测牙釉质表面,分析前后仪器读数(DD)的变化反映牙釉质脱矿的情况,同时观察并记录牙釉质脱矿指数(EDI)及釉质白斑(WSL)的检出率。结果在治疗前及治疗3个月后两组间的EDI值、DD值、WSL值比较,差异均无统计学意义(P>0.05),而在治疗6个月后,GC组的EDI值、DD值、WSL值显著小于Transbond组,差异有统计学意义(P<0.05)。结论树脂增强型玻璃离子粘结剂和含自酸蚀底涂剂的树脂粘结剂对预防固定正畸过程中的釉质脱矿均具有较好的防护作用,但从长期性而言,树脂增强型玻璃离子优于含自酸蚀底涂剂的树脂粘结剂。     

Dental trauma: an overview of its influence on the management of orthodontic treatment. Part 1

Abstract

This is the first of two papers discussing the implications of dental trauma for patients requiring orthodontic treatment. This paper will focus on the factors the orthodontic specialist should consider when contemplating movement of traumatized teeth. The prevalence of dental trauma and the recognition and prevention of traumatic injuries are discussed. The evidence available in the literature relating to orthodontic tooth movement in vital and endodontically treated traumatized teeth is explored. The interdisciplinary management of root fractured and intruded teeth receive special attention. The second paper will look at the role of the specialist team in the management of failing anterior teeth and will outline possible treatment options for children and adolescents encountering such situations. Avulsion injuries and tooth transplantation are considered in particular detail.     

Cariogram caries risk profiles in adolescent orthodontic patients with and without some salivary variables

Objective:To compare the Cariogram caries risk profiles with and without salivary buffer capacity and mutans streptococci (MS) counts in adolescents with fixed orthodontic appliances.Materials and Methods:The sample consisted of 90 healthy Greek adolescents who were undergoing orthodontic treatment. The Cariogram risk model was applied through a questionnaire and clinical and salivary examinations. The actual chance of avoiding new caries was calculated, and participants were categorized into three groups (0–40%  =  high caries risk, 41–60%  =  medium caries risk, and 61–100%  =  low caries risk) using a nine-item Cariogram or by excluding either salivary buffer capacity or MS or both. Cohen''s Kappa statistical analysis was used for comparing the Cariogram outcome with and without salivary variables. The distribution of variables was compared by nonparametric marginal homogeneity tests.Results:Using the Cariogram with nine variables, 62% of the patients were assigned to the high caries risk category, 13% to the medium risk category, and 24% to the low risk category. Omission of salivary buffer capacity did not alter the risk categories significantly, while more subjects were assigned to the medium risk category when MS counts were excluded. The difference between the nine-item Cariogram and the MS-reduced version, however, was not statistically significant (P  =  .07).Conclusions:The Cariogram model may be used both with and without salivary tests for risk grouping in orthodontic practice.     

Delayed endodontic and orthodontic treatment of cross-bite occurring after luxation injury in permanent incisor teeth

Abstract A case is presented in which combined endodontic and orthodontic therapy was performed in traumatically injured teeth 12 months after an accident. Calcium hydroxide treatment was used to halt any possible resolution during orthodontic treatment. The teeth were repositioned in a desirable manner without any complication by orthodontic treatment. Root canal obturation was accomplished after the completion of active orthodontic treatment. Recall examination 12 months after completion of root canal treatment showed clinical and radiographic evidence of healing.     

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在牙体牙髓病治疗过程中,有效的局部麻醉技术是减轻患者疼痛的重要手段,也是确保治疗顺利进行的基本保障。本文对牙体牙髓治疗中局部麻醉的相关问题做一介绍,并针对牙髓治疗中局麻方法和局麻药物的选择给出建议。     

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牙髓再生治疗的一个重要操作步骤是刺破根尖周组织,使血液进入根管内,这将使根尖周的干细胞也同时进入根管,血凝块为干细胞的聚集提供基质和支架;此外,血液内含有丰富的生长因子,可促进干细胞的增殖和分化,对年轻恒牙牙髓再生治疗后根管内硬组织的沉积和牙根的继续发育起到关键作用。本文就牙髓再生治疗相关机制的研究进展做一综述。     

青少年正畸治疗中影响牙根吸收的因素探讨

目的：探讨影响青少年错[牙合]畸形患者正畸矫治后牙根吸收的相关因素。方法：选择已完成正畸固定矫治的青少年患者78例．在其矫治前后的曲面断层片上,对4个上切牙进行根尖形态的分析,以获得正畸矫治后牙根吸收的定性数据。在对受试者按年龄、性别、牙位、牙龄、拔牙与否及疗程分组后,利用SPSS12．0软件对所得数据进行非参数检验分析。结果：所有正畸患者都存在一定程度的牙根吸收,根尖形态分析显示：①牙龄ⅣA期患者比ⅢC期的患者存在更严重的牙根吸收（P〈0．01）,但按年龄比较不存在显著差异;②拔牙组比不拔牙组有更加严重的牙根吸收（P〈0．01）;③疗程越长,牙根吸收也越明显（P〈0．05）;④牙根吸收的严重程度与性别及上切牙牙位之间无相关性。结论：在第二恒磨牙完全建验前（ⅣA期前）进行正畸治疗、不拔牙矫治、缩短矫治疗程,均可以减少正畸治疗中的牙根吸收。     

正畸与种植技术在前牙缺失散在间隙修复中的临床应用

目的：探讨正畸与种植技术在前牙缺失散在间隙修复中的应用特点。方法：选取前牙缺失伴散在间隙病例17例,前期采用正畸技术集中和开拓修复间隙,矫正缺隙两侧倾斜扭转牙,调整咬合关系及中线;后期运用种植技术恢复牙列的完整,并视种植修复后的牙列情况采用正畸治疗进行相应的精细调整。结果：17例前牙缺失散在间隙患者经正畸与种植修复后,均获得良好的修复效果。结论：采用正畸与种植技术联合治疗前牙缺失散在间隙的患者,能够实现最大限度的美观、功能及稳定,提高修复效果。     

Long-term evaluation of endodontic and periodontal treatment

One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodntal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal codition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive suppportive periodontal treatment.     

Prevalence and quality of endodontic treatment in an urban adult population in Norway

Abstract There are few studies on the prevalence of chronic apical periodontitis and endodontic treatment in society. In this study, the periapical status of a representative sample of 35-year-olds in Oslo, Norway was studied by analyses of orthopantomograms and intraoral radiographs. The study also included quality assessment of root fillings and a correlation between quality and periapical status. Of the 3917 teeth evaluated, 133 (3.4%) were endodontically treated and 54 (1.4%) presented a periapical pathosis. More than half of these were associated with root-filled teeth. Endodontic treatment was considered successful with normal periapical structures in 64% of the cases. However, only 41% of the root fillings were of optimal quality, terminating 1–2 mm from the radiographic apex. Based on a survey of orthopantomograms, it was estimated that 30% of the subjects investigated presented an endodontic treatment need. The prevalence of endodontic treatment among 35-year-olds was unchanged from 1973 to 1984.     

Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery

Introduction

This study examined the clinical causes of failure and the limitation of a previous endodontic treatment by an inspection of the root apex and resected root surface at 26× magnification during endodontic microsurgery.

Methods

The data were collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and January 2011. All root-filled cases with symptomatic or asymptomatic apical periodontitis were enrolled in this study. All surgical procedures were performed by using an operating microscope. The surface of the apical root to be resected or the resected root surface after methylene blue staining was examined during the surgical procedure and recorded carefully with 26× magnification to determine the state of the previous endodontic treatment by using an operating microscope.

Results

Among the 557 cases with periapical surgery, 493 teeth were included in this study. With the exclusion of unknown cases, the most common possible cause of failure was perceived leakage around the canal filling material (30.4%), followed by a missing canal (19.7%), underfilling (14.2%), anatomical complexity (8.7%), overfilling (3.0%), iatrogenic problems (2.8%), apical calculus (1.8%), and cracks (1.2%). The frequency of possible failure causes differed according to the tooth position (P < .001).

Conclusions

An appreciation of the root canal anatomy by using an operating microscope in nonsurgical endodontic treatment can make the prognosis more predictable and favorable.