临床评价不同活髓牙漂白术的效果

本文研究的目的是比较家庭漂白和诊室漂白的有效性和颜色改变后的稳定性,评估光源的使用是否会改变漂白效果。根据预先制定的标准,选择40名患者,并根据漂白治疗方案随机分为4组：①诊室漂白用10％过氧化脲,②诊室漂白用35％的过氧化氢（HP）,不带光源照射;③诊室漂白用35％过氧化氢,带石英卤钨光照射：④诊室漂白用35％的HP,带LED或激光照射。在漂白前,漂白后第1天,漂白后第3周,这3个时间点的牙齿颜色用VITA标准比色板进行评估。在完成漂白治疗后的第1个月和第6个月,再次用同一比色板评估牙齿的颜色,并对其进行统计分析。采用完全随机设计的非参数检验（KruskaI—WalliS检验）分析,得出的结果显示各组间在任何时间点上的差异无统计学意义（P〉0.01）。并且得出,所有组都没有出现颜色反弹现象;以上4种漂白方案都产生了有效的漂白效果;牙齿漂白不一定需要光源照射。     

Mechanical Allodynia in Healthy Teeth Adjacent and Contralateral to Endodontically Diseased Teeth: A Clinical Study

IntroductionThe aims of this study were to examine whether teeth adjacent and contralateral to endodontically diseased teeth showed co-occurring mechanical allodynia and to determine whether demographic and clinical variables were involved in such associations.MethodsPatients with irreversibly inflamed or necrotic permanent first molars or second premolars were examined. From the 348 eligible patients (160 men and 188 women; mean age ± standard deviation = 30.4 ± 10.0 years), data on age, sex, health status, current presence of pain, tooth type, dental arc, and pulpal diagnosis were collected. Percussion testing was applied to all posterior teeth, and the degrees of pain were recorded using a 4-point verbal scale as follows: none to slight (coded as 0) and moderate to severe (coded as 1). Following association rule mining (with minimum support and confidence levels of 0.1), univariate and multiple logistic regression analyses were performed at various stringency levels (α = 0.05).ResultsThe number of painful associations was greater ipsilaterally than contralaterally and distally than mesially and increased with the severity of percussion pain in the diseased tooth. Successful regression models were established for the ipsilateral (between the diseased tooth and adjacent teeth; current pain: odds ratio = 3.37; 95% confidence interval, 1.94–5.83) and contralateral (between the diseased tooth and the tooth distal to the contralateral symmetrical tooth; dental arc: odds ratio = 2.40; 95% confidence interval, 1.21–4.76) sides (P < .05).ConclusionsHealthy teeth adjacent and contralateral to symptomatic diseased teeth exhibited percussion sensitivity. Patients' current pain and dental arc, respectively, were involved in such painful associations.     

Positional Variations of Impacted Hyperodontic Teeth: A Clinical and Radiological Study

Cryostat sections from 14 surgical specimens were examined to determine whether selected factors of the immune response related to histopathological reactions are present in the palatal mucosa affected by hyperplastic denture stomatitis. By means of various immunological techniques the presence of IgG, IgA, IgM, complement factor C3c, receptors for the Fc region of IgG (FcR) and for complement factor C3b (C3bR), T lymphocytes, and macrophages were studied. The inflammatory infiltrate was mainly located in the papillary part of the lamina propria. IgG, IgA, and IgM appeared both in plasma cells and intercellularly. FcR, C3bR, and T lymphocytes were present in the areas with inflammatory cell infiltrate. Macrophages were found in the papillary part of the lamina propria and within the epithelium. The immunological response in the mucosa affected by denture stomatitis was in many respects similar to that of marginal and apical periodontitis. We conclude that hyperplastic denture stomatitis is a complex inflammatory lesion showing elements of both humoral and cellular immune responses.     

Pulp Revascularization of Immature Teeth With Apical Periodontitis: A Clinical Study

IntroductionThe purpose of this study was to examine the effect of a pulpal revascularization procedure for immature necrotic teeth with apical periodontitis.MethodsTwelve patients, each with an immature permanent tooth with chronic or acute apical periodontitis, were recruited. A triantibiotic mix (ciprofloxacin, metronidazole, and minocycline) was used to disinfect the pulp for 1 week. Then a blood clot was created in the canal, over which grey mineral trioxide aggregate was placed. Patients were recalled periodically.ResultsSix patients dropped from the study (as a result of pain or failure to induce bleeding after canal disinfection) and instead received a standard apexification procedure. Another 3 patients did not attend any recall appointments. The remaining teeth (n = 3) were found to exhibit complete root development, with a positive response to pulp testing.ConclusionsRevascularization could be effective for managing immature permanent teeth with apical periodontitis with appropriate case selection.     

Nightguard Vital Bleaching of Tetracycline-Stained Teeth: 54 Months Post Treatment

Abstract: Purpose: The purpose of this longitudinal whitening study was to determine the stability, post-treatment side effects, and patient satisfaction after 6 months of active treatment of tetracycline-stained teeth with 10% carbamide peroxide at 0 and 54 months post treatment.
Materials and Methods: Twelve patients who completed the study (80%) were contacted and asked to participate in a survey concerning their whitening experience. Subjects were asked whether there had been any change in the shade of their teeth after treatment, and if they had experienced any side effects that they believed were treatment-related. Eight of the twelve patients underwent clinical examination.
Results: Ten patients (83%) reported no obvious shade change or only a slight darkening not noticed by others. Two (17%) reported a slight darkening that is probably noticeable by other people, but no one reported moderate darkening or significant darkening back to original shade. All respondents (n = 12) denied having to have a crown or root canal that they believed was treatment-related. Examiners who compared preoperative and post-treatment photographs and Vita shade values were in agreement with the patients' perceptions of shade change. The degree of improvement was significant for both the immediate (0 mo) and the 54-month post-treatment comparison with the pretreatment shade (p < .005 and p < .01 respectively).     

保留受累活髓牙对颌骨囊肿治疗效果影响的临床观察

目的:探讨颌骨囊肿边缘受累活髓牙存留对颌骨囊肿治疗效果的影响。方法:我院5年来61例中小型颌骨囊肿手术患者,随机分为研究组和对照组,对囊腔边缘局部累及(根尖未暴露于囊腔,仅根侧或根中断累及)的活髓牙,采用不同方法处理,对比疗效。研究组32例共80颗局部累及活髓牙,保留活髓处理;对照组29例共73颗局部累及的活髓牙行根管治疗。观察经两种方法处理的存留活髓牙对囊肿手术治疗效果影响的差异性。结果:术后两组患者均无自觉症状,咀嚼功能恢复良好,黏膜完整覆盖囊壁,骨腔消失,骨密度恢复正常。3年随访均未复发,治愈率无明显差异。结论:颌骨囊肿的手术治疗过程中,如存在囊肿边缘受累活髓牙,对符合适应证的受累活髓牙可保留活髓,对颌骨囊肿的疗效无影响。     

Incidence of Pulpal Complications after Diagnosis of Vital Cracked Teeth

Introduction

This retrospective cohort study aimed to observe the incidence of pulpitis and necrosis in teeth with cracks that were not endodontically treated.

A Rationale For Not Connecting Implants to Natural Teeth

When restoring partially edentulous arches with implants, there are some practitioners who believe it is occasionally beneficial to connect implants to natural teeth. This connection is performed to gain shared support from the natural tooth and implant, prevent rotation of the restoration, or sometimes merely to retain the natural tooth. A discussion and review of the literature concerning this connection is presented, and a patient treatment is shown to illustrate potential complications.     

Incisal preparation design for ceramic veneers: A critical review

Background

The authors reviewed and identified the evidence for the various incisal preparation designs for ceramic veneers.

埋伏多生牙囊变的临床与病理研究

目的通过100例埋伏多生牙的临床与病理分析,寻找埋伏多生牙囊变的规律及与错畸形的关系,提出相应的治疗方法.方法通过临床资料的分析、X线检查、术中所见及病理细胞学变化的对照,为诊断埋伏多生牙囊变提供依据.结果100例埋伏多生牙中,经X线检查发现66%的病例多生牙冠部有不同程度的圆形透光阴影,而病理证实有囊变的仅为35%.结论本组埋伏多生牙有囊变的占相当大比例.因此对确定为埋伏多生牙的患者,如有手术适应证,应早期拔除.     

Regenerative Endodontic Procedures in Necrotic Mature Teeth with Periapical Radiolucencies: A Preliminary Randomized Clinical Study

IntroductionThis preliminary study compared clinical and radiographic outcomes of regenerative endodontic procedures (REPs) with that of conventional root canal treatment (CRCT) in necrotic mature teeth with periapical radiolucencies.MethodsFifty-six mature necrotic teeth with large periapical radiolucencies were distributed into 2 groups: group 1, REPs and group 2, CRCT (n = 28/group). Clinical and radiographic follow-up assessments were undertaken up to 12 months. Statistical analysis was performed using the independent samples t test and the chi-square test, and the level of significance was set at P = .05.ResultsWith a follow-up rate of about 73.4% of the total patients for 12 months, favorable clinical and radiographic outcomes were found in 92.3% and 80% in REPs and CRCT groups, respectively, and the difference was not statistically significant (P > .05). Half of the teeth treated with REPs responded to the electric pulp test.ConclusionsRegenerative endodontic procedures have the potential to be used as a treatment option for mature teeth with large periapical radiolucencies.     

Autotransplantation of Teeth in 215 Patients: A Follow-up Study

Objective:To evaluate the success rate of autotransplantation of teeth in consecutive patients and to analyze factors affecting the outcome.Materials and Methods:The subjects consisted of 215 consecutive patients (101 women and 114 men; aged 9.1–56.4 years, median age 15.2 years [P₁₀  =  11.4, P₉₀  =  19.7]) who had undergone transplantation of a total of 269 teeth, all by the same surgeon. In patients with multiple transplants, only the first transplant was included, to ensure that all transplanted teeth were independent units. The transplants were recorded as unsuccessful if the tooth had been extracted or was surviving but with root resorption or ankylosis. The interval between transplantation and final follow-up was a median 4.8 years (P₁₀  =  2.0, P₉₀  =  5.5) for successful transplants and a median of 2.4 years (P₁₀  =  0.4, P₉₀  =  7.7) for unsuccessful transplants.Results:One-hundred seventy-five (81%) of the transplantations were recorded as successful and 40 (19%) as unsuccessful. Twenty-five teeth had been extracted and 15 had survived but did not fulfill the criteria for success.Conclusions:The success rate of 215 consecutively transplanted teeth was 81%. The highest success rate was for transplantation of premolars to the maxillary incisor region (100%). Complications at surgery such as difficult extraction, deviant root anatomy, or damaged root periodontium affected the outcome. During growth, a successful transplant preserves alveolar bone.     

Tactile Sensibility of Single‐Tooth Implants and Natural Teeth Under Local Anesthesia of the Natural Antagonistic Teeth

Introduction and Aim: The term osseoperception describes the capability of developing a subtle tactile sensibility over dental implants. The present clinical study aims at clarifying the question of how far tactile sensibility is to be attributed to the periodontium of the natural opposing tooth of the implant. Material and Method: Thirty‐two subjects with single‐tooth implants with natural opposing teeth were included in this clinical, single‐blind, split‐mouth study. The natural antagonistic tooth of the implant and the corresponding natural contralateral tooth were anesthetized with a locally infiltrated articaine anesthetic. In a computer‐assisted and randomized way, copper foils of varying thickness (0–100 µm) were placed interocclusally between the single‐tooth implant and the natural opposing tooth, and between the contralateral pair of natural opposing teeth in order to investigate the active tactile sensibility according to the psychophysical method of constant stimuli and evaluate it statistically by the Weibull distribution. Results: The average tactile sensibility of the implants with anesthetized antagonists at the 50% value calculated by means of the Weibull distribution was 20 ± 11 µm with a support area (90%–10% value) of 77 ± 89 µm. For the pair of natural teeth, the tactile sensibility at the 50% value was 16 ± 9 µm with a support area of 48.4 ± 93 µm. This resulted in an average intraindividual difference of 3.5 ± 7 µm at the 50% value and 29 ± 93 µm in the support area. The statistical calculations demonstrated an equivalent tactile sensibility (50% value) of the single‐tooth implant and the contralateral natural control tooth with the natural antagonists being anesthetized in each case (double t‐test, equivalence limit ± 8 µm, P < 0.01, power >80%). Conclusion: Apparently, the active tactile sensibility of single‐tooth implants with natural opposing teeth is not only to be attributed to the periodontium of the opposing tooth but also to a perception over the implant itself. This could support the hypothesis according to which the implant may have a tactile sensibility of its own.     

拔牙后即刻植入羟基磷灰石微粒人工骨的临床应用研究

目的:研究拔牙后即刻植入羟基磷灰石微粒人工骨的治疗效果和并发症。方法:65 例患者拔牙后牙槽窝内即刻植入羟基磷灰石微粒人工骨,术后1 周、1 月、3 月分别复诊,进行临床及X 线检查。结果:65 例患者伤口均顺利愈合,未发生术后出血、感染、羟基磷灰石微粒人工骨移位等术后并发症,同术前相比,牙槽嵴高度无明显降低。结论:拔牙后即刻植入羟基磷灰石微粒人工骨可以维持牙槽嵴的高度,减少术后并发症,为以后进行义齿修复提供一个良好的基骨条件,可以在临床推广应用。