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。     

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。     

牙体牙髓-正畸方法联合处理恒上前牙冠根折的临床观察

目的：观察牙体牙髓－正畸方法联合处理恒上前牙冠根折的临床疗效。方法：21颗冠根折的恒上前牙，在完善根充后，利用正畸方法对患牙牙根进行垂直He向牵引，达到理想牙冠修复条件，在此基础上进行牙冠延长术和修复治疗。结果：21颗患牙垂直He向移动距离2mm-5mm，所需时间4周－8周；三年复查，部分患牙牙齿或牙龈相对位置有轻微变化，所有患牙根尖周正常。结论：牙体牙髓－正畸方法联合处理恒上前牙冠根折，作为修复治疗的辅助方法有效可行，但18岁以下的患者需延长牵引后的保持时间，并用临时冠进行过渡性修复。     

根管内钛钉在前牙根折中的应用

目的：观察国产根管内钛钉治疗前牙根折的远期效果。方法：对36例切牙根折用钛钉行根管内固定，1例前磨牙残根、2例切牙根折行根骨内种植术，并长期追踪观察。结果：36例行根管内固定后观察3。9年：3年成功率根中1／3折为94．11％(16／17)，儿童冠根折为100％(14／14)，颈1／3折为50％(2／4)，2例钛钉折断，根尖1／3折1例失访；3例行根骨内种植术：1例前磨牙残根的三年效果、1例根中1／3折的两年效果稳定，1例根中1／3折术后半年出现瘘管。结论：国产根管内钛钉治疗切牙根中1／3折、儿童切牙冠根折的远期疗效肯定；治疗颈1／3折容易发生钛钉折断。     

根管内加齿槽骨钛桩内固定即刻修复年轻恒前牙根折

目的：探讨年轻恒前牙根折内固定的新方法。方法：选取门诊外伤后2小时之内就诊的年轻患13例，17颗患牙，采用预制钛桩即刻行根管内加齿槽骨贯穿固定将断牙固定于原位。结果：13例患，共17颗患牙，经半年至3年的随访观察，成功15颗，失败2颗。结论：根管内加齿槽骨钛桩内固定即刻修复年轻恒前牙根折，方法简单可行，临床应用效果好。     

牙齿(牙合)向牵引--牵引方法改进及临床疗效观察

目的：观察用改进的固定矫治器进行牙根殆向牵引治疗前牙冠根折的临床疗效。方法：16个冠根折前牙,完善根管治疗后于根管内粘固牵引钩,邻牙粘贴方丝托槽,殆向牵引牙根,达到修复条件后固定2～3个月,然后进行桩冠修复。结果：16个患牙牙根殆向移动距离2～5mm,所需时间2～6个月。进行桩冠修复后位置稳定,功能及美观良好。结论：使用改进的固定矫正器进行牙根腊向牵引治疗前牙冠根折的方法有效可行。     

前牙冠根联合折断的修复治疗

<正> 牙根牙冠联合折断是牙折中较常见的折断形式,保存治疗较为困难。近年来,有些学者对冠根联合纵折后牙的保存治疗进行了临床和病理学研究并取得了很大进展。但前牙冠根联合折断的保守治疗国内外则少见报道。我们自1981年开始对前牙冠根联合斜折和纵折的9例10颗患牙分别采用牙根垂直拉出桩冠修复法和钢丝结扎切割样修复法治疗,通过6～25个月的观察获得成功。现报告如下:     

正畸牵引复位法治疗外伤性上前牙嵌入的疗效观察

目的 观察正畸牵引复位联合固定术治疗外伤性上前牙嵌入的效果。方法 用正畸牵引复位联合树脂夹板固定，治疗外伤性上前牙嵌入病例24例、27颗牙，观察2a后的疗效。结果 27颗嵌入牙，牙根尚未形成者16颗。牙根形成者ll颗，治疗后11颗达到成功标准，16颗达有效标准，无失败病例。结论 正畸牵引复位联合树脂夹板固定是一种积极的、温和的治疗外伤性上前牙嵌入的方法，其疗效较理想。     

前牙冠折即时烤瓷桩冠修复的体会

在临床中,因外伤致使前牙冠折的病例比较常见,鉴于前牙在功能和美观方面的重要性,对此类患牙的尽快修复具有重要意义。作者自1997年以来,对61例患者81颗前牙冠折病例,采用一次法根管治疗再立即作带桩烤瓷冠直接修复。经2-5年追踪复查,效果满意,现报道如下:1.临床资料1.1病例选择:前牙冠折伤后72小时内就诊,牙周基本健康,无松动,断根面不低于牙槽嵴顶下方1mm,经X线片检查排除根折及牙槽骨骨折。1.2作者自1997年至2001年,采用一次法根管治疗再立即作烤瓷桩冠修复方法,治疗符合上述条件的前牙冠折患者61例81颗患牙,男性38例47颗,女性23例34颗,…     

磨牙根折治疗的临床观察

目的：探讨磨牙根折的保存治疗。方法：采用切割牙冠后,清除病变牙根,保留健康牙根并进行根管治疗,通过修复,恢复咀嚼功能。结果：治疗22例,成功19例,有效3例。结论：对磨牙根折的病例,采用切割牙冠后清除病变牙根的方法保留患牙,恢复咀嚼功能是行之有效的。     

Surgical extrusion of crown-root-fractured teeth: a clinical review

AIM: In this clinical study combined surgical and endodontic treatment was performed in 20 cases of crown-root fracture and the outcomes reviewed. METHODOLOGY: Surgical treatment involved a conventional extraction and stabilization technique. Root canal treatment using calcium hydroxide was performed. Before root canal obturation, a calcium hydroxide dressing was maintained for 3 months. RESULTS: Follow-up examinations, which varied between 6 and 36 (mean 14.5) months, showed that there were no radiographic and clinical signs of progressive root resorption, marginal bone loss or periapical disease in all except one case. CONCLUSIONS: The favourable results of this study demonstrate that surgical extrusion in teeth with crown-root fractures may be an alternative treatment to orthodontic extrusion.     

前牙残根正畸牵引后修复11例的临床分析

目的通过正畸牵引术使前牙残根美学修复。方法 7例外伤、4例根面龋残根位于龈下患者采用正畸牵引残根后行桩冠修复。结果 11例中,有1例发生根尖周炎拔除,其余牵引出2.0～3.5 mm后行桩冠修复,效果良好,患者满意率达91%。结论残根周围骨量的增加,冠根比例与天然牙接近,有效提高了修复体与邻牙的协调性、美观性和舒适性。     

Management of a complicated crown-root fracture in a young permanent incisor using intentional replantation.

The purpose of this case presentation is to review the rationale for and illustrate the clinical procedures involved in intentional replantation of a maxillary central incisor following a complicated crown-root fracture. The treatment of complicated crown-root fractures in children often is compromised by a fracture below the gingival margin and/or bone. This makes isolation difficult and comprises the hermetic seal that is critical for a successful endodontic treatment. Orthodontic or surgical extrusion with gingivectomy has been suggested; however, these approaches can be expensive, time-consuming, esthetically compromising, and unsatisfactory when the fracture line is deep below the gingiva. Our presentation will discuss the treatment options for such cases and introduce the concept of intentional replantation as an option to manage complicated crown-root fractures in young permanent anterior teeth.     

A biological conservative approach to complex traumatic dento-alveolar lesions

Of all the kinds of traumatic dental injury, luxation injuries associated with crown-root fractures deserve special attention due to the particular need for complex multidisciplinary treatment. Clinical experience has demonstrated the need for repositioning of luxated teeth and treatment of crown-root fractures by orthodontic or surgical extrusion and completed with periodontal plastic surgery (gingivoplasty). In many cases the outcome is good conservation and excellent esthetic results. This approach cannot however, always be recommended, for example because of the age of the patient. For this reason, a different protocol is proposed that involves, in addition to orthodontic repositioning of the luxated teeth, (as is required to return teeth to the physiological position), the extrusion, restoration and subsequent re-intrusion to the natural position (without the need for further surgery) of those teeth involved with associated crown-root fractures. Two cases illustrate the use of this proposed technique.     

Changes in the vertical position of the anterior teeth after surgical correction of mandibular protrusion

A group of patients who had undergone an oblique vertical ramus osteotomy for correction of mandibular protrusion was examined 2 years postoperatively in order to clarify whether the treatment resulted in vertical changes of the front teeth. 1. The results indicate an extrusion of both the upper and lower anterior teeth, as the distance from the upper and lower incisors to the NL and ML lines increased postoperatively (0.3 to 2.3 mm.). 2. The clinical crown height increased (0.3 to 0.4 mm.). 3. The root length decreased (0.5 to 0.9 mm.). 4. There were only insignificant changes in the height of the interproximal marginal bone. 5. There was no significant correlation between the changes in crown height and the amount of tooth extrusion; nor was there any correlation between these changes and the changes in mandibular inclination or root length reduction.     

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目的采用三维有限元法模拟不同方向牵引力内收上前牙,分析前牙位移趋势及应力分布,为临床治疗提供指导。方法研究于2012年在福建医科大学进行。建立唇侧直丝弓矫治器、6个上前牙及其牙周膜和前颌骨的三维有限元模型。模拟在0.48 mm×0.64 mm英寸主弓丝上,以种植钉为支抗、1.47 N矫治力整体内收上前牙,设定前牙区牵引钩为0-6 mm、后牙区种植钉高度分别为8和14 mm。加载后求解,计算出各前牙的位移及牙周膜第一主应力。结果滑动法整体内收上前牙时,牵引钩长度主要影响前牙的矢状向位移方式：牵引钩长度增加至6 mm的过程中,侧切牙在唇舌向上由舌向倾斜运动变为舌向整体平移和舌向控根运动外,中切牙和尖牙的三维位移只有数量的增大,趋势基本保持不变。支抗种植钉高度主要影响前牙垂直向位移：种植钉位置越高,侧切牙的压低位移增大,尖牙的伸长位移减小,即前牙整体压低的趋势更明显。结论种植支抗整体内收前牙时,单纯调整牵引钩长度和支抗种植钉高度难以实现前牙段的整体内收,有必要对前牙段增加适当的垂直向压低力量。     

Surgical extrusion: A reliable technique for saving compromised teeth. A 5-years follow-up case report

Aim

To present a long term follow up clinical case in which a compromised anterior tooth was saved by a surgical extrusion procedure.