根尖刮治术治疗难治性根尖周炎的临床观察

目的探讨根尖刮治术对难治性根尖周炎的治疗效果。方法难治性根尖周炎患者40例患牙47颗,完成根管治疗后,即刻行根尖刮治术,术后3、6、12个月复查,摄根尖片,进行疗效评价。结果随访1年,39颗患牙临床症状消失,无任何不适,根尖片显示患牙根尖周有新骨形成或原有根尖周透射影缩小;5颗患牙临床症状明显改善,咀嚼时偶感不适,根尖片显示患牙根尖周有新骨形成或原有根尖周透射影缩小;总有效率为93.6%。2颗患牙术后症状无减轻,经患者同意后拔除。1颗患牙术后6个月复发,患者出现咀嚼痛,颊侧牙龈出现瘘管,根尖片示根尖周透射影与术前比较没有变化。结论完善根管治疗后即刻行根尖刮治术,可有效治疗难治性根尖周炎。     

刻意再植术治疗难治性根尖周炎的预后及相关因素分析

目的：评价刻意再植术治疗难治性根尖周炎的疗效以及影响再植预后的相关因素。方法：回顾分析2001年因难治性根尖周炎,临床建议拔除患者5例7个患牙,经即刻拔除再植术＋根管充填治疗5年后的临床资料。其中,5例患者均为45岁以上,年龄最大56岁,女性3例,5个患牙,3个磨牙,2个前磨牙;男性2例,前磨牙和磨牙各1个。上述患牙均在局麻下拔除术、牙齿离体后30min内完成根尖周变性组织湿法刮除术、根管充填术、牙体缺损即刻解剖性外形修复术,再植复位术。结果：术后5年复查,所有患牙均存留,牙龈附着正常,牙体活动度在Ⅰ度内,咀嚼功能良好,X光检查均达到牙周膜或骨性愈合。结论：根尖生物膜与难治性根尖周炎的发生密切相关,牙齿再植术能有效地清除病灶区的整个生物膜,彻底根治生物膜引起的难治性和慢性感染,为临床降低医源性牙齿缺失提供了一种新途径。     

显微根尖手术联合MTA治疗难治性慢性根尖周炎的研究

目的:研究在显微根尖手术治疗难治性慢性根尖周炎时应用MTA的可行性、特点、成功率及相关影响因素。方法:分析2013年1月~2015年12月间本院牙体牙髓科完成的显微根尖外科手术106例计146颗难治性慢性根尖周炎患牙的临床资料,其中上颌前牙75例、下颌前牙13例、上颌前磨牙6例、下颌前磨牙4例、上颌磨牙4例、下颌磨牙4例。手术包括根尖切除、根尖倒预备、根尖倒充填主要步骤,术后1年回访,通过临床症状和放射学检查评估疗效,并对预后影响因素进行卡方检验分析。结果:显微根尖外科手术联合MTA应用的1年成功率达95.9％(140/146),根据患者性别、年龄、牙位、根尖病灶范围分别统计手术疗效,组间差异均无统计学意义。失败5例6颗患牙,主要原因为根折及合并重度牙周炎。结论:在治疗难治性慢性根尖周炎时采用显微根尖手术联合MTA应用可取得满意效果;显微根尖手术是治疗慢性根尖周炎的有效手段。     

磨牙根尖切除术和倒充填术的临床疗效观察

目的观察根尖切除术和倒充填术在难治性磨牙牙髓病和根尖周病治疗中的临床疗效。方法选择41颗难治性牙髓病和根尖周病的磨牙,经常规根管治疗无效,进行根尖切除术和根尖倒充填术,术后随诊观察。结果本组41颗患牙,其中28颗手术治疗后无自觉症状且完全恢复功能,组织附着紧密。10颗患牙经治疗后咀嚼基本正常,瘘管消失,疼痛消失,根尖阴影缩小。临床成功率为92.68。结论根尖切除术和倒充填术在难治性磨牙牙髓病和根尖周病治疗中,具有满意的疗效。     

用再植术治疗后牙慢性根尖炎85例临床分析

牙再植术是将外伤脱落或用人工方法拔除体外的患牙 ,经过适当处理后 ,再植入原牙槽窝使其再愈合的一种方法 .适用于外伤脱落而牙完好 ,慢性根尖炎经药物或者用其他方法治疗不能治愈的患牙 .笔者对 85颗后牙慢性根尖炎进行再植手术现报告如下 :1　临床资料与治疗方法 :1.1　临床资料 :　自 1978年～ 1989年间收治门诊病人 84人 ,其中男 43人 ,女 41人 ,患牙 85颗 .年龄 15～ 41岁 ,均为青壮年 .下颌第一磨牙 48例 ,下颌第二磨牙 8例 ,下颌牙根发育不全的第二双尖牙 18例 ,上颌第一磨牙 2例 ,第二磨牙 5例 ,上颌第一双尖牙 4例 .均为慢性根尖…     

根管外科手术的临床疗效观察

目的 :观察根管外科手术在慢性根尖周炎治疗中的临床疗效。方法 :对 40例 42个难治性慢性根尖周炎患牙 ,分别采用根尖刮治术、根尖切除术和根尖倒充填术进行治疗 ,术后随诊观察 ,比较疗效。结果 :根尖手术成功率为 90 .47%。根尖刮治术、根尖切除术和根尖倒充填术的成功率分别为 85 .71%、90 .91%、10 0 % ,经 χ2检验三者无显著差异。结论 :根管外科手术在难治性慢性根尖周炎治疗中 ,具有满意的疗效。     

智齿拔除后羟基磷灰石恢复牙槽骨高度的临床研究

目的:研究拔除下颌智齿后,用羟基磷灰石人工骨填塞牙槽窝,修复第二磨牙牙槽骨高度的方法。方法:拔牙术后即刻植入羟基磷灰石微粒于牙槽窝内,术后12周进行第二磨牙牙槽高度、牙周袋深度、牙龈附着、龈指数的检查。结果:第二磨牙牙槽高度得到较好修复。结论:智齿拔除后即刻植入羟基磷灰石人工骨有利于第二磨牙远中牙槽高度的恢复。     

Vitapex、派丽奥联合治疗严重根尖周炎伴牙周炎病例的疗效观察

严重根尖周炎伴牙周炎的患牙临床常予以拔除。我科采用Vitapex、派丽奥联合治疗此类患牙18例。术后观察8个月,牙槽嵴顶骨质修复,根尖周区及分叉区骨密度增高,吸收的根尖周区钙化,牙齿松动<Ⅰ度。     

意向性牙再植的研究现状

Grossman早在1982年就提出了＂意向性牙再植＂这种说法,也有学者称之为＂刻意性牙再植＂,意思是指针对部分常规方法难以治愈的疑难患牙,故意将牙完整拔出,经过体外一系列诊断、检查及治疗后再将其植入原牙槽窝以期获得保存患牙的目的。长期以来,意向性牙再植被视为最后的一种补救措施,给予保存患牙一线希望。近年来随着人们对牙周组织认识的深入和相关技术的发展,意向性牙再植已经越来越多的应用于临床,研究报道其成功率已和根尖外科手术相接近。因此意向性牙再植作为一种临床治疗程序为许多根尖手术难以进行的病例提供了一种非常规的治疗思路。     

年轻恒牙深龋伴根尖周异常的间接盖髓治疗

本文从134例196个年轻恒牙间接盖髓治疗的患牙中选出52例,74个根尖周异常的下颌磨牙进行总结,结果成功48例,68牙,占91.9％,失败4例,6牙,占8.1％,术后约4～6周症状消失,6～12月根尖周恢复正常。本组病例的观察结果为根尖周异常深龋年轻恒牙的保存治疗提供了有效的临床依据。     

老年人根管治疗失败患牙的牙再植术

目的：探讨老年人根管治疗失败病例的牙再植术的临床效果。方法：对56颗经临床常规根管治疗无治愈希望的根尖周炎患牙，行即刻原位牙再植术。结果：经5-10年观察，根尖周炎根管治疗失败后，采用牙再植术治疗的临床成功率为87．50％；再植5年以内、5-10年、10年以上患牙的成功率无显著差异（P〉0．05）。结论：对老年人根管治疗失败患牙开展牙再植术，可以挽救许多治疗无希望的患牙。     

三氧化矿物凝聚体在显微根尖术治疗难治性慢性根尖周炎中的应用研究

目的 探究显微根尖手术（Dental operating microscope,DOM）治疗难治性慢性根尖周炎时应用三氧化矿物凝聚体的可行性。方法 选择2016年2月~2017年2月在扬州友好医院口腔科就诊的难治性慢性根尖周炎89例（89颗患牙,每人1颗患牙）患者,行DOM同时应用三氧化矿物凝聚体（Mineral Trioxide Aggregate,MTA）作为倒填充材料,术后3个月、半年、一年定期随访复查,以临床检查和影像学检查评价患者根尖周病损的愈合情况,其中临床检查以患者主诉疼痛和视诊、扪诊及咬诊对患牙进行判断,并根据影像学及临床检查分为治愈、改善和失败3个等级,评价临床治疗效果,同时分析性别、年龄、患牙牙位分布对治疗效果的影响。结果 1年后随访复查结果显示治疗成功率达95.51%,性别、年龄及患牙牙位分布均未对DOM治疗效果产生明显影响,4例治疗失败患者中1例磨牙因根折被拔除,2例前牙因根折或重度牙周炎症造成术后再次出现瘘管,1例因牙周袋较深被拔除。结论 DOM治疗难治性慢性根炎周炎时应用MTA封闭技术是一种较为可靠有效的方法,值得在临床推广使用。     

Florid cemento‐osseous dysplasia mimicking apical periodontitis: A case report

Cemento‐osseous dysplasia may present as a focal, periapical or florid lesion in the mandible or maxilla. The lesion may sometimes appear similar to peri‐radicular lesions on a periapical radiograph. This report presents a case with irreversible pulpitis and root resorption as well as a mixed radiolucent/radiopaque lesion around a mandibular molar tooth root. Root canal treatment was performed and because of the radiographic signs of root resorption and the patient's fear of having a malignant disease, periapical surgery was also performed. The histopathology report confirmed the presence of florid cement‐osseous dysplasia which was mimicking apical periodontitis. Follow‐up radiography 12 months after the surgery illustrated complete healing of the radiolucent area.     

Intentional replantation for the management of maxillary sinusitis

AIM: To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY: This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. Key learning points: *When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases.     

Vitapex配合超声治疗窦道型根尖周炎的临床分析

目的观察Vitapex配合超声治疗窦道型根尖周炎的临床疗效。方法 Vitapex糊剂＋超声震荡治疗窦道型根尖周炎。治疗后2～3周、6个月、1年后回访,通过临床和X线检查评价其疗效。结果经治156例患牙,成功142例,2～6周窦道消失,6个月后经X线片检查可见尖周稀疏区减少或消失,成功率达91.03%,14例失败,6例出现牙根纵裂,后行牙半切术后部分保留,8例为多窦道患牙拔除。结论 Vitapex配合超声震荡法治疗窦道型根尖周炎疗效确切。     

炎症期拔牙后即刻种植：禁忌症或适应症？

目的：探讨炎症期拔牙后即刻种植的可能性及手术技巧，为即刻种植手术适应症的科学界定提供参考依据。方法：12例患者各一枚前牙或前磨牙拔除后即刻种植。拔牙原因为慢性牙周炎、慢性根尖周炎及根管内吸收伴感染等。术后随访l—2年，观察种植体周围炎、GI、种植体稳定性及X线变化等临床指标，评价临床疗效。结果：除1例种植体周骨壁侧穿失败外，其余11枚种植体均获临床成功。结论：由于121腔内血运丰富，抗感染能力强，加之拔牙后激活的炎性反应，故除急性期外，炎症期拔牙并非即刻种植绝对手术禁忌症。非翻瓣式一期法术式及微创手术操作，有利于避免术后感染。     

根管消毒药物缓解乳磨牙根尖周炎临床症状的疗效分析

目的：对比四种临床常用的根管消毒药物缓解乳磨牙根尖周炎临床症状的效果。方法 选择根尖周炎乳磨牙160颗,随机分为四组,每组40颗,根管预备超声荡洗后,A组封入抗生素糊剂,B组封入Vitapex糊剂,C组封入氢氧化钙糊剂,D组封入樟脑酚棉球,10 d后复诊,对四种根管消毒药物缓解乳牙根尖周炎临床症状的效果进行评价。结果 在10d后脓肿消除方面抗生素糊剂组效果优于其他三组（P=0.005）,Vitapex组与氢氧化钙组效果,均优于樟脑酚组（P＜0.05）。术后24h内疼痛的发生率抗生素糊剂组术后24 h内疼痛发生率低于Vitapex组（P=0.014）和氢氧化钙组（P=0.045）。10 d后疼痛的比例各组之间无统计学差异。结论 抗生素糊剂能够有效缓解乳牙根尖周炎的临床症状。     

Calculus-like deposit at apex of tooth with refractory apical periodontitis

Abstract— It is generally accepted that bacteria in or outside the root canal are the reason for apical periodontitis and endodontic failures. This case report presents a 60-year-old woman with a periapical lesion and a fistulous tract which did not respond to conventional root canal treatment. During periapical surgery, granulomatous tissue was removed and a calculus-like deposit was observed on the root surface. A radicular cyst was diagnosed. Nine months after this calculus-like deposit had been removed and the cyst enucleated, complete recovery of the bone had occurred. It is suggested that the presence of the calculus-like deposit at the apex of the tooth or its effects may in part have delayed the healing of the periapical inflammation in spite of apparently adequate endodontic treatment.     

Retrospective Study of Intentional Replantation for Type IIIb Dens Invaginatus with Periapical Lesions

IntroductionIn recent years, intentional replantation (IR) has received more attention for its high tooth survival rate and wide range of indications. Type IIIb dens invaginatus (DI) is 1 of the most serious types of tooth malformation and is very challenging to treat. When root end surgery is not feasible, IR may be considered as an alternative to extraction. However, there is little information available on the use of IR for type IIIb DI. Therefore, this study investigated the treatment outcomes and clinical procedures used for the treatment of type IIIb DI with IR.MethodsIR was performed to treat 10 patients with type IIIb DI with periapical lesions. Each tooth was examined clinically and radiologically. IR was selected by these patients as their treatment plan after treatment procedures were discussed. An experienced endodontist and an experienced surgeon performed all treatments using the same protocol and surgical technique. Postoperative assessments were composed of clinical and radiographic examinations, tooth survival, and functional status.ResultsThe follow-up period ranged from 4–39 months. After IR, 8 teeth were functioning properly with no clinical or radiologic signs of pathology. The other 2 teeth had complications after IR comprising the recurrence of periapical radiolucency and sinus tract formation in 1 patient and the development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements.ConclusionsOur study evaluated the most clinical data to date and showed that IR may be a reliable alternative for type IIIb DI with a periapical lesion.     

根尖倒充填术用于慢性根尖周炎伴牙根外吸收治疗的临床报道

目的观察根尖手术治疗慢性根尖周炎伴牙根外吸收的临床效果。方法选择慢性根尖周炎伴牙根外吸收患者6例,术前常规根管治疗,局麻下翻瓣、去骨、清理病变肉芽组织,行根尖倒预备和倒充填。术后3个月、半年和1年复诊,行临床检查及拍摄X线片观察根尖周骨质恢复情况。结果6例患牙临床症状全部消失,X线片复查牙根外吸收停止,其中4例根尖周骨质破坏完全恢复,2例根尖周骨质破坏范围明显减小。结论根尖手术对慢性根尖周炎伴牙根外吸收有良好的治疗效果。