分根技术保留并修复重度根分叉病变磨牙的研究

目的观察分根术后采用单冠或联冠、联合冠桥修复治疗下颌磨牙重度根分叉病变的临床疗效。方法 将53颗Ⅲ、Ⅳ度根分叉病变的下颌磨牙,经完善的根管治疗、牙周基础治疗后,将近远中根分离,然后保留单根或双根实行单冠或联冠、联合冠桥修复。结果经1～5年随访咀嚼功能良好,修复体稳固。有效率94.3%。结论分根术后保留重度根分叉病变磨牙并固定修复的治疗方法,适用于经牙周治疗后,牙周袋仍不能消除的重度根分叉病变的磨牙,是提高磨牙保存率的有效方法之一,可以延长磨牙的寿命,恢复一定的咀嚼功能。     

因重度牙周炎拔除的磨牙根分叉解剖研究

本文测量和分析了１０８颗因重度牙周炎而拔除的人类恒磨牙根分叉解剖结构（根分叉宽度和根面凹陷），结果发现：２３７个根分叉中，其开口以下２ｍｍ处宽度小于牙周刮匙可能的最小宽度０．７５ｍｍ者，仅占３．６％；牙根面凹陷有较高的发生率，且均位有分叉内侧面。由此推论：磨牙根分叉开口过于狭小，并非是导致磨牙根分叉病变治疗困难的主因；集中于根分叉内侧面的根面凹陷，可能是牙为根分叉病变治疗困难和预后不良的主要原因。     

下颌第一磨牙残冠保存疗法的临床体会

目的探讨有根分叉病变的下颌第一磨牙残冠经牙体牙周牙髓治疗后的修复方法。方法随机选择临床建议拔除的有根分叉病变的下颌第一磨牙残冠病例,经完善的根管、牙周治疗后半个月无症状者进行残冠分根,以前磨牙形态修复。结果保存修复3年后的总有效率达88%,患牙无不良自觉症状,能较好地行使咀嚼功能。结论下颌第一磨牙经完善的根管、牙周联合治疗后行分根修复术,患牙可以较长时间保存。     

分根术治疗磨牙根分叉病变对咀嚼效率的影响

目的探讨分根术后单冠或联冠修复下颌磨牙根分叉病变对咀嚼效率的影响。方法将21颗Ⅲ、Ⅳ度根分叉病变的下颌磨牙经完善的根管治疗、牙周基础治疗后,把近、远中根分离,然后行单冠或固定桥修复。并在分根术前后进行咀嚼效率测定。结果经1~2年随访,21颗修复牙咬合、咀嚼功能良好。结论分根术后固定修复是治疗下颌磨牙Ⅲ、Ⅳ度根分叉病变的有效方法之一,有利于提高咀嚼效率。     

下颌磨牙Ⅲ度根分叉病变手术治疗的效果观察

目的探讨隧道成形术结合根向复位瓣术治疗下颌磨牙Ⅲ度根分叉病变的效果。方法下颌第一磨牙Ⅲ度根分叉病变的患者40例共40颗患牙,随机分为对照组和试验组各20例20颗。试验组患牙行隧道成形术及根向复位瓣术,对照组患牙再次做龈下刮治及根面平整治疗,记录术前（基线水平）、术后1个月、术后3个月的探诊深度（probing depth,PD）、出血指数（bleeding index,BI）和附着丧失（attchament loss,AL）。结果术后3个月复查：试验组和对照组PD较术前均有明显减少,且差异有统计学意义（P〈0.01）。试验组PD减少量较对照组PD减少量大,差异有统计学意义（P〈0.01）。试验组与对照组BI均较术前减少,差异有统计学意义（P〈0.01）。试验组与对照组AL较术前变化均不明显,试验组AL甚至有所增加,但差异无统计学意义,且两组之间差异也无统计学意义。结论牙周手术治疗下颌第一磨牙Ⅲ度根分叉病变效果明显。     

根分叉病变发生、发展与治疗研究进展

根分叉病变是牙周炎病变波及多根牙根分叉区,导致根分叉处的牙周附着丧失和牙槽骨破坏。由于多根牙根分叉区解剖结构复杂,彻底清创难度较大,一旦伴有根分叉病变,病情进展较单根牙更快且附着丧失更明显。因此,伴有根分叉病变牙齿的失牙率也更高。根据根分叉病变的严重程度,临床医生可以选用相应的治疗方法,牙周非手术治疗是最基本的治疗,其他治疗手段包括牙周手术治疗（根据根分叉病变程度选择不同的术式）、牙周-牙体联合治疗、牙周-正畸联合治疗等,各种治疗方法的预后不尽相同。文章就根分叉病变的发生、发展、临床诊断、治疗及预后等相关问题做一综述。     

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根分叉病变是牙周炎病变波及多根牙根分叉区,导致根分叉处的牙周附着丧失和牙槽骨破坏。由于多根牙根分叉区解剖结构复杂,彻底清创难度较大,一旦伴有根分叉病变,病情进展较单根牙更快且附着丧失更明显。因此,伴有根分叉病变牙齿的失牙率也更高。根据根分叉病变的严重程度,临床医生可以选用相应的治疗方法,牙周非手术治疗是最基本的治疗,其他治疗手段包括牙周手术治疗(根据根分叉病变程度选择不同的术式)、牙周-牙体联合治疗、牙周-正畸联合治疗等,各种治疗方法的预后不尽相同。文章就根分叉病变的发生、发展、临床诊断、治疗及预后等相关问题做一综述。     

正畸关闭成人第一恒磨牙缺失间隙的临床疗效

目的研究正畸方法关闭成人第一恒磨牙早失或者拔除间隙的疗效及其影响因素。方法成人正畸患着19例,第一恒磨牙早失11颗（磨牙早失组）,其中5颗第二恒磨牙治疗前存在附着丧失;第一恒磨牙严噩龋齿被拔除16颗（磨牙拔除组）,其中5颗第二恒磨牙治疗前存在附着丧失。两组均应用直丝弓矫治技术,治疗前后拍摄全景片,治疗前后和关闭间隙前后检查第二恒磨牙牙龈指数和附着丧失,使用SPSS13．0软件进行双因素方差分析,因素1为治疗前第二恒磨牙有无附着丧失（有为牙用炎组,无为牙周健康组）,因素2为第一恒磨牙缺失是由于拔除或早失。结果磨牙间隙完全关闭,牙龈指数较治疗前改善。磨牙早失组较磨牙拔除组的间隙关闭疗程长,第二恒磨牙附着丧失量较多;牙周炎组较健康牙周组疗程短（P〈0．05）,第二恒磨牙附着丧失量更多。各因素对间隙关闭速度和治疗后第二恒磨牙附着丧失量的影响贡献从大到小为：治疗前第二恒磨牙附着匙失与否、磨牙早失或拔除、两者交互效应。结论通过正畸方法关闭成人第一恒磨牙缺失间隙,甚至骨缺损间隙足可行的．治疗前附着丧失的程度和牙周炎的易感程度是治疗效果的重要影响因素。     

下磨牙根分叉病变治疗与修复的临床探讨

目的:寻求下磨牙根分叉病变的保存治疗及修复方法.方法:将46例较为严重难治性根分叉病变下颌磨牙经完善根管治疗后分离近、远中根,根管预备后制备铸造桩核,以类似前磨牙形态进行桩冠修复.结果:经8～36个月的随访,成功率为94.57%.结论:对下颌磨牙难治性根分叉病变采取根管治疗后分根,桩冠修复可以保留患牙,恢复磨牙功能.     

分根术后联冠修复治疗重度根分叉病变的临床探讨

目的 探讨分根术后联冠修复治疗下颌磨牙重度根分叉病变的疗效.方法 将50颗Ⅲ、Ⅳ度根分叉病变的下颌磨牙经完善的根管治疗、牙周基础治疗后,把近、远中根分离,然后行联冠修复.结果 经1～3年随访,有效率为94.0%.结论 下颌磨牙Ⅲ、Ⅳ度根分叉病变采用分根术后联冠修复,可以保留患牙,恢复功能.     

Treatment of molar furcation involvement using root separation and a crown and sleeve-coping telescopic denture. A longitudinal study.

Because of the inconsistent results of periodontal and prosthetic therapy, periodontists may choose to treat maxillary molar furcation involvements (FI) with poor root morphology utilizing a root resection technique (RRT). In addition, poor root morphology of the remaining root following RRT is usually considered a high risk factor for long-term periodontal and prosthetic success. The purpose of this retrospective study was to investigate the differences in the clinical periodontal parameters between molar abutments with and without molar root separation and/or resection (RSR) before and after periodontal and prosthetic therapy, using a crown and sleeve-coping telescopic denture (CSCTD). A total of 85 molars (47 maxillary and 38 mandibular) were treated in 25 subjects. There were 33 abutments without root separation/resection and 52 abutments with RSR. Forty-three CSCTD were placed, 23 in the maxillary arch and 20 in the mandibular arch. The mean observation period was 6.7+/-1.9 years (range, 5 to 13 years). The plaque index, gingival index, probing depth, clinical attachment level, and alveolar bone change were recorded. The differences in these parameters before and after periodontal and prosthetic therapy between the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarkable improvement in the periodontal parameters in advanced Class II and Class III FI in molars with RSR as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed telescopic device provide a modified approach for treating molars with advanced Class II and III FI.     

Loss of molars in periodontally treated patients: a retrospective analysis five years or more after active periodontal treatment

OBJECTIVES: Evaluation of tooth loss in molars and prognostic factors for molar survival. MATERIAL AND METHODS: Five hundred and five molars in 71 patients (mean age 46 years; 40 females) were evaluated. The following inclusion criteria were required: periodontal therapy of at least one molar, at least 5 years of supportive periodontal therapy, and baseline assessment of furcation involvement (FI). RESULTS: At baseline 200 of 505 molars exhibited no FI, 116 degree I, 122 degree II, and 67 degree III FI. Twenty-seven molars did not receive periodontal treatment; 127 molars were subjected to non-surgical therapy, and 227 to flap surgery. Tunnel preparation was performed on 14 molars, root resection on 20, regenerative therapy on 57 teeth, and 33 molars were extracted. During the average follow-up period of 107 months 38 molars were lost additionally. Molars with degree III FI had the highest mortality. A multi-level proportional hazard model revealed smoking, baseline bone loss, number of molars left, and degree III FI as risk factors influencing the retention time of molars. CONCLUSION: Overall periodontal therapy results in a good prognosis of molars. Degree III FI leads to a significant deterioration of prognosis. Beyond FI smoking, baseline bone loss, and number of molars left influence molar survival.     

Association between signs of trauma from occlusion and periodontitis

The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern or occlusal contacts and severity of periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had a deeper probing depth, more loss of clinical attachment and less radiographic osseous support than teeth without these findings, teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of periodontitis than teeth without these contacts, teeth with both functional mobility and radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographic osseous support than teeth without these findings and given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographic osseous support than teeth without these findings.     

Periodontal surgery in furcation-involved maxillary molars revisited—an introduction of guidelines for comprehensive treatment

Maxillary molars with interradicular loss of periodontal tissue have an increased risk of additional attachment loss with an impaired long-term prognosis. Since accurate clinical analysis of furcation involvement is not feasible due to limited access, morphological variations and measurement errors, additional diagnostics, e.g., with cone-beam computed tomography, may be required. Surgical treatment options have graduated from a less invasive approach, i.e., keeping as much periodontal attachment as possible, to a more invasive approach: (1) open flap debridement with/without gingivectomy or apically repositioned flap and/or tunnelling; (2) root separation; (3) amputation/trisection of a root (with/without root separation or tunnel preparation); (4) amputation/trisection of two roots; and (5) extraction of the entire tooth. Tunnelling is indicated when the degree of root separation allows for opening of the interradicular region. Alternatively, root separation is performed particularly in root-canal treated teeth with reduced coronal tooth substance requiring crown restorations. As soon as the attachment of one or two roots in maxillary molars is severely reduced, root removal is indicated and performed either as amputation or trisection including the corresponding part of the clinical crown. While the indication for regenerative measures in maxillary molars with furcation involvement is very limited, extraction and replacement with implants is restricted, particularly in sites requiring complex alveolar ridge augmentation and sinus elevation. A systematic approach for decision making in furcation-involved maxillary molars is described in this overview, including what constitutes accurate diagnosis and what indications there are for the different surgical periodontal treatment options.     

Periodontal tissue response to coverage of root cavities restored with resin materials: a histomorphometric study in dogs

BACKGROUND: The purpose of this study was to histomorphometrically evaluate the response of periodontal tissues covering Class V resin restorations in dogs. METHODS: After raising a mucoperiosteal flap, bony defects measuring 5 x 5 mm were created on the buccal aspect of the canines of five dogs followed by cavity preparations on the root surface measuring 3 x 3 x 1 mm. Before repositioning the flap to cover the bone defect, the cavities were restored with composite resin (CR) or resin-modified glass ionomer cement (RMGIC) or were left unrestored as control (C). The dogs were euthanized 90 days after surgery. Specimens comprising the tooth and periodontal tissues were removed, processed routinely, cut into longitudinal serial sections in the buccolingual direction, and stained with hematoxylin and eosin (H&E) or Masson's trichrome. The most central sections were selected for histomorphometric analysis. RESULTS: Histomorphometric analysis revealed apical migration of epithelial tissue onto the restorative materials (RMGIC and CR). The C group presented significantly longer connective tissue attachment (P <0.05) than the RMGIC and CR groups and significantly higher bone regeneration (P <0.05) compared to the RMGIC group. Histologically, the cervical third (CT) of all groups had the most marked chronic inflammatory infiltrate. CONCLUSIONS: Within the limits of this study, it can be concluded that the restorative materials used exhibit biocompatibility; however, both materials interfered with the development of new bone and the connective tissue attachment process.     

Evidence-based assessment of tooth-colored restorations in proximal lesions of primary molars

The purpose of this study was, using evidence-based dentistry, to compare the successes of glass ionomer cement (GIC), resin-modified GIC (RmGIC), composite resin (CR), and polyacid-modified composite resin (PAMCR) in primary molar proximal lesions. METHODS: The PICOT question was: P: in primary molar proximal lesions; I: does the use of 1 material (GIC, RmGIC, CR, or PAMCR); C: compared with the remaining materials; O (Outcome): result in higher success rates; T: when followed for at least 1 year? Relevant articles (256) were identified from databases then sieved by titles, abstracts, and full texts. Following exclusions, 36 dinical trials-including 25 randomized clinical trials (RCTs)-remained. Extracted data were meta-analyzed. RESULTS: GIC restorations had a significantly (P<.05) lower likelihood of success than RmGIC and CR restorations. Overall success rates were: (1) GIC (691 restorations)=75%; (2) RmGIC (276)=89%; (3) CR (620)=83%; (4) PAMCR (596)=87%. Mean success rates did not differ significantly (P>.05): (1) GIC (6 studies)=65+/-34%; (2) RmGIC (3 studies)=93+/-7%; (3) CR (7 studies)=85+/-12%; and (4) PAMCR (8 studies)=90+/-10%. CONCLUSIONS: Few articles were available to determine the best material. Recognizing material improvements since 1990, earlier data may be noncomparable. RmGIC had the highest success rates, but fewest studies and fewest restorations; only one product was assessable. Prospective RCTs should be of at least 5 years' duration to determine correctly the success rate of Class II restorations in primary molars.     

Mandibular disto-lingual root: a consideration in periodontal therapy

BACKGROUND: Developmental and morphological abnormalities may contribute to the progression of localized periodontal disease. Although the presence of a disto-lingual root in the mandibular first molar is rare, its role in periodontal destruction has not been examined. The purpose of this study was to evaluate whether the presence of this root contributes to localized periodontal destruction. METHODS: The presence of the disto-lingual root was identified by examination of two periapical radiographs in each of 197 Taiwanese patients with 332 mandibular first molars. Regression analysis was used to evaluate the relationship between the presence of the root and probing depth, gingival recession, and periodontal attachment loss at the disto-buccal and disto-lingual sites of the molars. The adjusted variables included patient characteristics (age, gender, diagnosis, and general periodontal conditions), tooth (right and left location, tooth mobility, and periodontal category of the molar), and site (bleeding on probing and adjacent furcation involvement). RESULTS: A disto-lingual root was present in 26.9% of patients and in 21.7% of molars examined. A significant interaction between periodontal category and the presence of disto-lingual root on probing depth and attachment loss at disto-lingual but not disto-buccal sites was observed. Multivariable regression analysis showed a significantly higher probing depth and attachment loss at the disto-lingual site in molars with the disto-lingual root than in molars without the root in teeth classified as having advanced periodontitis. CONCLUSIONS: Greater probing depth and attachment loss occurred at disto-lingual sites of molars with the roots. The presence of a disto-lingual root may contribute to localized periodontal destruction.     

Influence of Class II amalgam fillings on attachment loss

176 extracted teeth restored with Class II amalgam fillings, having identical distribution regarding tooth type, jaw and proximal surface localization, were investigated. The loss of attachment was measured on stained teeth under a stereomicroscope fitted with an ocular micrometer. The cervical margins of restorations were examined with a probe. Defective cervical margins were found in 85.8% of the 176 restorations. The mean loss of attachment on the restored surfaces (1.4 mm) was significantly higher (P less than 0.001) than on the sound unrestored surfaces of the same teeth (0.9 mm). Little difference was found between mesial and distal surfaces. The restored surfaces of the lower molars showed less loss of attachment, when compared to similar surfaces of upper molars and lower premolars (P less than 0.05).     

Dental restorations: a risk factor for periodontal attachment loss?

BACKGROUND: Dental caries and restorations in proximal tooth surfaces often impinge upon the periodontal biological width. AIM: This study examines whether these factors may contribute to risk for periodontal attachment loss at these sites. METHODS: The study is based upon data from the Dunedin Multidisciplinary Health and Development Study, a long-standing cohort study. Approximal tooth surfaces of 884 study members were evaluated for restorations and caries at age 26 and again at 32 years, and probing depth and gingival recession were recorded in millimetres at age 32. Attachment loss was computed as the sum of pocket depth and gingival recession. Data were analysed using generalized estimating equations. RESULTS: Where a caries/restorative event had occurred on an inter-proximal tooth surface before age 26, the age-32 attachment loss at the corresponding periodontal site was approximately twice more likely to be >or=3 mm than if the adjacent tooth surface had remained sound to age 32. This was also true where a caries/restorative event had occurred subsequent to age 26. The association remained after controlling for potential confounders, including smoking. CONCLUSIONS: Site-specific periodontal attachment loss due to dental caries or restorative events occurs in adults in their third and fourth decades of life.     

牙齿的邻面状态与牙周探诊深度关系的研究

本实验对508例后牙牙周组织的健康状态进行临床检查,测量牙周探诊深度及附着丧失水平,并记录相应的牙齿邻面状态.结果得出:牙齿邻面有充填体悬突和充填体合并继发龋的牙周探诊深度比对照组明显增加(P<0.01);牙齿的邻面有龋病和不良固位体牙周探诊深度较对照组有增加(P0.05).牙齿邻面充填体悬突和充填体合并继发龋的牙周探诊深度及附着水平大于3mm所占百分比值明显高于对照组.本研究结果表明:牙齿的邻面状态与牙周探诊深度及附着丧失有关.牙齿邻面充填体悬突、邻面龋是影响牙周组织健康的重要因素.