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。     

恒牙撕脱性损伤临床特征的回顾性分析

目的:分析恒牙撕脱性损伤的分布特征。方法:对131名患者共179个撕脱性损伤患牙进行临床特征回顾性研究,包括年龄、性别、病因、牙保存方法、牙离体时间及是否伴有软硬组织伤等,并对观察半年以上且伴有牙槽骨骨折的撕脱性患牙愈后进行统计分析。结果:主要病因为摔伤(59%),好发于上颌中切牙(78%)。仅3%的人能够在30 min内就医;45%伴发软组织损伤;34%伴发牙槽骨骨折,其中10%牙槽骨骨折在初诊中被漏诊;撕脱性损伤伴牙槽骨骨折牙根吸收率略高于无牙槽骨骨折(P>0.05)。结论:多数患者由于就诊延误再植牙属于延迟再植;牙撕脱性损伤多伴发软硬组织的损伤,但撕脱性损伤患牙是否伴有牙槽骨损伤与其远期根吸收无明显关联。     

牙及牙槽外科

埋伏牙46例临床分析；上颌前部埋伏多生牙167例临床报告；冲击法在拔牙术中的应用；牙撕脱的辅助治疗方法（综述）；[编者按]     

口腔颌面部神经疾病

下牙槽神经、舌神经干注射阿霉素联合颊神经撕脱治疗第Ⅲ支三叉神经痛的疗效观察，变速牵引与常速牵引成骨对下牙槽神经影响的比较研究，上颌窦径路上颌神经撕脱术12例临床报告，实验性牙移动三叉神经节内神经生长因子受体mRNA的改变……     

完全脱位牙再植的牙髓、牙周膜愈合:从生物学基础到牙外伤指南

牙完全脱位又称牙撕脱伤,是一种严重的牙外伤,指在外力作用下,牙齿从牙槽窝中脱出,导致牙髓血运中断,牙周膜细胞暴露于体外。首选治疗方法是根据国际牙外伤协会(IADT,2012年)和美国牙髓病协会(AAE,2013年)修订的完全脱位牙再植治疗指南对患牙进行再植,以增大牙周膜愈合及牙髓血运重建的可能。但是完全脱位牙的预后受到多种临床因素影响。在某些情况下,即使按照指南进行规范治疗,完全脱位牙的术后并发症仍无法完全避免。因此,本文详细介绍牙外伤指南制定的相关生物学基础,结合临床病例,帮助临床医生理解和应用上述指南来治疗完全脱位牙及评估患牙的预后,以期为临床提供参考。     

牙撕脱性损伤延迟再植的根面处理

牙撕脱性损伤是指在外力的突然作用下,牙齿完全脱出牙槽骨,牙周膜和牙髓同时损伤,牙槽窝变得空虚或伴有牙槽突的骨折。对牙撕脱性损伤的理想治疗方案是将撕脱牙即刻再植入牙槽窝,以保持附着在牙根表面牙周组织的活性。根面处理是指用药物浸泡或覆盖牙根表面,     

牙骨质撕脱的临床特征和治疗方法

牙骨质撕脱是牙骨质发生完全或不完全的断裂，逐渐脱离牙根表面，通常撕脱片会促使局部牙周组织快速破坏，最终导致牙齿的咬合疼痛和牙齿松动。目前，其病因及发病机制尚不明确，病情隐匿，临床表现和指征均不典型，对牙骨质撕脱进行早期诊断和预判，是临床医生的极大挑战。本综述从牙骨质撕脱的病因、临床表现、影像学与组织学特征、治疗方法等方面进行总结，旨在为临床医生提供具体且全面的信息，提高对牙骨质撕脱的认识和诊断，选择最佳治疗方案，尽可能保留天然牙。     

经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支

目的:评价经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支的疗效。方法:选择1994-08—2009-05期间我科收治的60例经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支的患者进行疗效观察。结果:60例患者手术后均无疼痛,随访1～3年,术后2年疼痛复发6例,术后3年疼痛复发4例,复发率为16.67%。但复发后疼痛均较术前明显减轻,患者能够忍受。所有患者术后除患支区皮肤和黏膜有麻木感外均无其他并发症,麻木感在0.6～1年后逐渐减轻。结论:经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支,效果较好,复发率低,并发症少,是安全有效的治疗方法。     

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。     

老年人原发性三叉神经痛改进撕脱术治疗的临床疗效观察

目的:探讨改进的三叉神经周围支撕脱术治疗老年人原发性三叉神经痛的临床疗效.方法:在三叉神经周围支撕脱术的基础上,采用局部骨碎块填塞神经孔治疗32例老年原发性三叉神经痛患者,其中第Ⅱ支17例,第Ⅲ支10例,第Ⅱ、Ⅲ支5例,均为单侧病变.结果:本组术后随访观察最长6年,最短5个月,显效12例,有效16例,无效4例,有效率87.5%.术后患者撕脱神经所支配区域的面部遗有不同程度的感觉麻木,无其它并发症.结论:改进撕脱术是一种治疗老年人原发性三叉神经痛简单、安全而有效的方法.     

Evaluation of the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil

Abstract –  Tooth avulsion is common in children, and emergency management in these cases is critical. This management can be made, not only by a dentist but by people who are present where the accident occurs. Consequently, knowledge of tooth avulsion is fundamental for school professionals working with children. The purpose of the present study was to evaluate the knowledge of tooth avulsion of school professionals from Adamantina, São Paulo, Brazil. For that purpose a questionnaire, including questions regarding emergency procedures for tooth avulsion, was answered by 117 teachers. The results demonstrated that 75.2% of school professionals knew the importance of emergency management and 60.6% would look for a dentist for treatment of the cases; 18.8% would reimplant the tooth and 7.6% would keep it in milk. This study showed the lack of knowledge of teachers on tooth avulsion; educational campaigns are necessary to improve the emergency management of tooth avulsion.     

Development of a calcified odontogenic hamartoma following avulsion of a permanent central incisor

The avulsion of a permanent immature tooth is a serious condition and a real emergency in dentistry. The management of a traumatized avulsed tooth is always a challenge to the clinician. This case report concerns the development of a calcified odontogenic hamartoma after the avulsion of an immature central incisor in an eight‐year‐old female. The patient presented for the treatment four months after the avulsion. Her intraoral examination showed complete healing of the area but an atypical appearance of the alveolar area of the missing tooth was observed in the periapical radiograph. A new radiographic scan performed six months later revealed the formation of a radiopaque irregular structure at the cervical level of the alveolar ridge at the site of the missing tooth. Surgical removal was performed, and the histopathological examination revealed a hamartomatous proliferation of odontogenic tissue with calcification. After healing, the lateral incisor was orthodontically moved mesially and restored to resemble the central incisor. An orthodontic device was installed to improve function and aesthetics of the patient.     

Vital reimplanted tooth in torsiversion: A one-and-half-year follow-up

A 10-year-old boy reported to the dental outpatient department with a chief complaint of a labially placed upper left central incisor and wanted treatment for esthetic reasons. No history of pain, bleeding, or any swelling was reported. Clinical examination revealed that the left upper central incisor was in torsoversion, that is, the palatal side of a tooth in labial position or a tooth rotated along its long axis by 180°. There was a history of traumatic avulsion followed by replantation 2.5 years earlier. No dental treatment was taken by the child. The radiograph showed root fracture in the apical one-third area but with no periapical radiolucent changes. As the tooth was completely asymptomatic and was vital with no periapical changes, no endodontic treatment was planned. Interceptive orthodontic treatment for the labially positioned tooth was undertaken followed by esthetic recontouring with labial crown forms. The case highlights the excellent results of immediate replantation. It also highlights the need for basic education about common dental emergencies, such as avulsion, to schoolchildren, teachers, and primary health-care providers.     

全脱出恒牙再植预后临床研究进展

牙齿全脱出（tooth avulsion）是指牙齿受外力从牙槽窝中脱出，牙髓和牙周膜同时损伤，牙槽窝空虚或伴有牙槽骨骨折。全脱出是牙齿常见创伤类型之一，发生率约为0.5% ~ 16%，多发于7 ~ 14岁儿童，以上颌中切牙最常见。牙齿全脱出后，再植是目前临床最常用且首选的治疗方式。再植的牙齿预后受多种因素影响，如脱位牙的牙根发育情况、离体干燥时间等。全脱出牙的牙髓及牙周预后情况复杂多样，现将全脱出牙预后及相关影响因素做一综述。     

Knowledge of first-aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren

Abstract –  The prognosis of replantation of an avulsed tooth is determined by which first-aid measures are taken during the first 15 min after avulsion. Knowledge of the correct first-aid measures is therefore crucial to successful replantation. The aims of this study were (i) to assess the present knowledge level of emergency measures for tooth avulsion in Kuwaiti schoolchildren, and (ii) to design and test an interview form with structured standardized questions. A total of 221 Kuwaiti schoolchildren (aged 7–15 years old) were interviewed by professionals using a standardized method to score several areas of knowledge about tooth avulsion and replantation. Earlier experience of first-aid information and subjection to dental trauma was registered. The following fields of knowledge were assessed: general body injury treatment principles, tooth avulsion and replantation principles, avulsed permanent/primary teeth, cleaning of avulsed tooth before replantation, extra alveolar time and storage media. The form for interviewing children proved to be sufficiently structured in performing the interviews and data management. The results of the interviews showed that 30.3% of the children had been exposed to dental trauma in the past. Among children 7–9 years of age, 25% had received information on general first aid as compared with 75% in children 10 years and older. Children 10 years and older, in general, had a high knowledge level of general principles of how to manage injuries to the body. Regardless of age group, there were generally a low knowledge level regarding tooth avulsion, replantation, extra-alveolar time and storage media. We conclude that first-aid knowledge in Kuwaiti schoolchildren is low on avulsion and replantation of teeth despite a high knowledge level of body injuries. The knowledge level of first-aid measures on avulsion and replantation of teeth could be increased through intervention programs.     

上海市12岁儿童家长对外伤全脱位牙应急处理认知的调查

目的：调查分析上海市12岁儿童家长对外伤全脱位牙应急处理的认知水平,为相关的健康教育项目的设计和实施提供依据。方法：采用分层等容随机抽样方法,抽取上海六个区,每个区随机抽取2所中学,每所学校随机抽取50名12岁儿童,共对548名儿童家长进行问卷调查。应用SPSS16.0软件包进行卡方检验。结果：3.28%家长的孩子发生过全脱位牙外伤,10.58%的家长采取即刻牙再植的全脱位牙应急措施,只有6.75%的家长选择牛奶作为全脱位牙的储存介质,38.87%的家长选择外伤全脱位牙最佳治疗时间是即刻,87.96%的家长从没有接触过牙外伤的急救知识。结论：上海市12岁儿童家长对外伤全脱位牙认知水平较低,应加强对家长的牙外伤健康教育,以促进提高家长对外伤全脱位牙的应急处理能力。     

Tooth autotransplantation using an interdisciplinary approach to rehabilitation in a young patient: Case report with 7-year follow-up

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.