正畸牵引治疗埋伏倒置阻生的上中切牙的受力分析

目的:通过对无萌出能力的埋伏倒置阻生上中切牙正畸牵引治疗的受力分析,探讨倒置阻生上中切牙正畸牵引治疗的最佳方法.方法:对19颗无萌出能力上颌埋伏倒置阻生牙作牵引治疗前的受力分析,进行摄片定位、拓展间隙后.行外科开窗术 正畸牵引治疗.结果:19颗埋伏牙中,治疗成功13颗(占68.4%),一般4颗(占21.1%),失败2颗(占10.5%);19颗埋伏牙平均破龈时间为6.5个月,最长12个月,最短3个月;19颗埋伏牙牙髓活力测验全部正常,未见根吸收、黏连.2颗唇侧出现2mm和3mm的牙龈退缩,1颗出现1mm的边缘骨丧失,1颗未能完全进入相应的牙位,需以后配合光固化或烤瓷再度修复.1例因牙根严重弯曲,不能进入相应的牙位,被迫拔除,1例牵引3个月后萌出,因无时间复诊而放弃治疗,未排齐,其余均牵引入列.结论:准确的定位、恰当的牵引方向和位置、适当的牵引力将直接决定埋伏倒置阻生牙的移动状况.     

上颌中切牙埋伏阻生的正畸治疗:28例报道

目的:通过对无萌出能力的埋伏阻生上颌中切牙进行外科开窗术 正畸牵引治疗,探讨埋伏上颌中切牙正畸牵引治疗的效果。方法:对28例30颗无萌出能力埋伏阻生的上颌中切牙进行外科开窗术 正畸牵引治疗。结果:28例埋伏牙中,1例已牵引萌出,因间隙不足,家长拒绝拔牙而未排齐;1例牵引3个月后萌出,因无时间复诊而放弃治疗,未排齐;其余均牵引入列,28例埋伏牙平均破龈时间为4.5个月,最长为10个月,最短为1个月;28颗埋伏牙牙髓活力测试全部正常,未见根吸收、黏连;4颗唇侧出现1￣4mm的牙龈退缩;2颗分别出现1.0mm和2.5mm的边缘骨丧失。结论:治疗的时机、合理的矫治方法、减少手术创伤、牵引力的大小以及支抗和炎症的有效控制是治疗成功的关键。     

Endodontic-orthodontic relationships: a review of integrated treatment planning challenges

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention. Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a reduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress. A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment. During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patient signs and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.     

外科导萌和正畸联合矫治上颌埋伏弯曲牙的疗效评价

目的:通过对无萌出能力的上颌埋伏弯曲牙的临床治疗分析,探讨弯曲牙正畸牵引治疗的效果。方法:对24例26颗无萌出能力的上颌埋伏弯曲牙进行摄片定位,拓展间隙后行外科开窗术 正畸牵引治疗。结果:24例埋伏牙中,成功17颗,占65.4%;效果一般6颗,占23.1%;失败3颗,占11.5%;24例埋伏牙平均破龈时间为7.5个月,最长13个月,最短3个月;26颗埋伏牙牙髓活力测验全部正常,未见根吸收、黏连。3颗唇侧出现2～4mm的牙龈退缩;2颗分别出现1.0mm和2.5mm的边缘骨丧失;1颗未能完全进入相应牙位,需以后配合光固化或烤瓷再度修复。3例不能进入相应的牙位,其中2例被迫拔除,其余均牵引入列。结论:选择良好的适应证、准确的定位、足够的间隙、适当的牵引力、支抗和有效控制炎症,循序渐进是治疗埋伏弯曲牙成功的关键。     

19例儿童及青少年期含牙囊肿的外科-正畸联合导萌治疗分析

目的: 观察闭合式开窗导萌术联合正畸牵引治疗儿童及青少年含牙囊肿的效果。方法: 收集永康市第一人民医院2014—2016年收治的19例儿童及青少年期含牙囊肿,采取闭合式开窗导萌术治疗。术中开窗并去除部分囊壁,充分暴露粘接牙面,粘接正畸牵引附件,将黏膜瓣复位缝合,待1~2个月后开始正畸牵引助萌。结果: 19例患者经治疗后囊腔均逐渐减小直至消失,愈合良好。牙成功达到正常咬合位置;所有萌出牙均牙周健康,牙髓活力正常,牙根形态满意。结论: 使用闭合式开窗导萌术联合正畸牵引治疗儿童及青少年含牙囊肿,可取得良好的临床疗效,为其治疗提供了新的方法。     

上颌埋伏阻生前牙正畸治疗的临床研究

目的：观察上颌埋伏阻生前牙应用固定正畸方法进行矫治的临床疗效,探讨埋伏阻生前牙有效的治疗方法。方法：对49例58颗上颌前牙埋伏阻生病例,应用固定正畸进行矫治,结合牙槽外科开窗术,对埋伏牙进行牵引。其中20颗进行开拓间隙使之自然萌出,38颗进行开窗封闭式牵引导萌矫治。结果：55颗阻生牙矫治后牙髓活力正常、未见埋伏牙及邻牙牙根吸收、牙周组织正常。开窗封闭式牵引导萌有3颗牙治疗失败,总体成功率94.8%。结论：应用固定正畸技术开拓间隙或结合牙槽外科开窗术导萌埋伏阻生牙,可有效保存上颌埋伏阻生前牙。     

自体牙移植的临床研究

目的 评价自体牙移植的临床效果。方法 对19颗牙进行自体牙移植,其中,埋伏阻生牙移植15颗,前磨牙移植前牙缺失区4颗。将埋伏牙或前磨牙完整拔出后移植于缺牙 区,方丝弓托槽和澳大利亚圆丝固定6～8周,移植4周时行根管治疗。结果 经1.5～5年的随访,19颗移植牙均未发现牙根吸收、松动等并发症。结论 自体牙移植临床效果满意,在前牙缺失和埋伏阻生牙无法正畸治疗时,是一种较好的治疗方法。     

改良舌弓在治疗下颌埋伏牙的作用

目的 探讨改良舌弓在矫治下颌埋伏牙中的作用.方法 5例下颌埋伏牙患者均采用外科-正畸联合治疗,配合戴入改良舌弓,利用改良舌弓位于舌侧不锈钢丝上的附钩,将埋伏牙牙冠朝向正常的位置方向牵引,直到接近其正常的位置.采用直丝弓技术排齐牙列,调整咬合关系.对治疗后牙齿的松动度、牙髓活力等进行观察.结果 5例下颌埋伏牙均被牵引至牙弓的正常位置,牙髓活力测试正常,牙周附着良好,无邻牙和埋伏牙牙根吸收.结论 改良舌弓在矫治下颌埋伏牙时,在矫治力方向设计和支抗控制方面有独特优点和作用.     

袋形术与正畸治疗促进含牙囊肿内阻生牙萌出

含牙囊肿是口腔内常见的颌骨囊性病变之一，通常伴有阻生牙。刮除术虽能根除病变，但易造成牙列缺损、神经损伤、邻牙损伤或牙髓活力丧失等。近年来临床上常用的袋形术，可减少邻近结构的创伤及提高囊内阻生牙的存留率，对于位置深或无法自行萌出的阻生牙配合正畸牵引可取得满意的效果。文章简要介绍含牙囊肿的形成、袋形术的适应证以及囊肿内阻生牙的正畸牵引等临床问题。     

袋形术与正畸治疗促进含牙囊肿内阻生牙萌出

 含牙囊肿是口腔内常见的颌骨囊性病变之一，通常伴有阻生牙。刮除术虽能根除病变，但易造成牙列缺损、神经损伤、邻牙损伤或牙髓活力丧失等。近年来临床上常用的袋形术，可减少邻近结构的创伤及提高囊内阻生牙的存留率，对于位置深或无法自行萌出的阻生牙配合正畸牵引可取得满意的效果。文章简要介绍含牙囊肿的形成、袋形术的适应证以及囊肿内阻生牙的正畸牵引等临床问题。     

上颌尖牙埋伏阻生的外科-正畸联合治疗

目的:探讨尖牙埋伏阻生的外科-正畸联合治疗方法。方法:20例患者28颗上颌埋伏阻生尖牙,先用滑动直丝弓矫治器初步排齐牙列后,再局部间隙扩展,采用外科闭合式助萌技术,暴露埋伏尖牙牙冠,粘贴托槽,再进行正畸牵引导萌。结果:24颗埋伏尖牙均牵引入正常牙列,牙髓、牙周情况正常。有4颗尖牙因横位阻生和根冠成角采用外科拔除。结论:通过外科手术暴露和正畸牵引导萌联合治疗,能有效矫治埋伏阻生尖牙。     

正畸治疗对根管治疗牙及对侧同名活髓牙根吸收影响的Meta分析

目的    分析正畸治疗对根管治疗牙及对侧同名活髓牙根吸收的影响。方法    计算机检索Cochrane Library、PubMed、Embase、Google Scholar、中国知网、万方等数据库,查找研究根管治疗牙经正畸治疗后牙根吸收情况的相关文献。应用Meta分析比较正畸治疗对根管治疗牙及对侧同名活髓牙根吸收的影响。结果    纳入了10篇相关文献。Meta分析结果发现,正畸治疗患者根管治疗牙根吸收情况与对侧同名活髓牙比较,差异无统计学意义（P > 0.05）。在男性正畸治疗患者中,根管治疗牙牙根吸收量小于对侧同名活髓牙,差异有统计学意义（P < 0.05）;而女性正畸治疗患者两侧牙根吸收量比较,差异无统计学意义（P > 0.05）。正畸治疗方式（拔牙矫治与非拔牙矫治）和牙位（前牙与后牙）对正畸治疗患者根管治疗牙及对侧同名活髓牙根吸收的影响比较,差异均无统计学意义（均P > 0.05）。结论    正畸治疗过程中移动根管治疗后的牙齿是一种相对安全的操作。     

预置支点介导下的上颌近远中阻生尖牙的矫治

目的 探讨预置支点在矫治上颌水平阻生尖牙的作用.方法 水平埋伏阻生上颌尖牙5例,均位于邻牙根方.用直丝弓矫治器进行间隙预备,外科开窗暴露埋伏尖牙的牙冠,将预置支点置于牙颈部,进行正畸牵引,曲面断层片观察邻牙牙根吸收情况.结果 水平阻生尖牙以预置支点为转动中心而移动至正常位置,牙髓和牙周情况良好,邻牙牙根无吸收现象.结论 预置支点水平阻生上颌尖牙的转动中心,对正畸临床治疗有指导意义.     

Nonsurgical management of ectopic teeth

Four cases have been presented involving malpositioned premolars and molars that were brought into the arch. From the cases presented, it appears that aggressive surgical intervention to redirect ectopic premolars creates significant secondary problems. Interference with the bone surrounding the ectopic tooth may compromise the adjacent teeth and bone level. Pressure against the root of the impacted tooth may cause resorption. If the buccal or labial plate is removed, orthodontic movement will be impeded. Specific biochemical changes in bone are induced by the application of orthodontic forces. In these cases, creating space with coiled spring appliances resulted in remarkable reorientation and proper eruption of ectopic, impacted teeth. When surgical intervention is required in cases involving ectopic teeth, close collaboration between orthodontist and oral and maxillofacial surgeon is imperative to achieve successful results without negative sequelae.     

闭合式开窗术在完全骨内阻生埋伏牙导萌中的应用

目的：探讨闭合式开窗术配合正畸牵引在骨内阻生埋伏牙导萌中的应用效果。方法：对需要进行导萌的22例23颗完全骨内埋伏牙进行闭合式开窗术,粘接正畸附件,并对没有自主萌出倾向的埋伏牙进行牵引治疗。结果：20例患者21颗埋伏牙成功达到正常咬合位置,牙周健康,牙髓活力正常,无邻牙损伤,1例放弃治疗后再次开窗取出牵引装置,1例因与邻牙牙根关系密切牵引未成功而拔除埋伏牙。结论：闭合式开窗术配合正畸牵引是一种较好的埋伏牙导萌方法,成功率高,容易获得较好的治疗效果。     

Decoronation for the management of an ankylosed young permanent tooth.

Replacement resorption rate is a variable process, and is dependent on age, basal metabolic rate, extra-alveolar time, treatment prior to replantation, amount of root dentin, severity of trauma, and extent of periodontal ligament necrosis. In patients 7-16 years old a tooth is lost 3-7 years after the onset of root resorption. The complications that may develop as a consequence of ankylosis of a permanent incisor in children are due to the inevitable early loss of the traumatized tooth and local arrest of alveolar bone development. An ankylosed tooth should be removed before the changes become so pronounced that they compromise future prosthetic treatment. The treatment options may involve: interceptive regenerative treatment, early extraction of the ankylosed tooth, orthodontic space closure, intentional replantation, extraction of the ankylosed tooth followed with immediate ridge augmentation/preservation, auto-transplantation, single tooth dento-osseous osteotomy, and decoronation. The purpose of this article was to review the considerations involved in the decision-making concerning the use of the decoronation technique for the treatment of a permanent incisor diagnosed as ankylosed.     

上颌埋伏尖牙的外科—正畸治疗

目的　对上颌埋伏尖牙进行外科—正畸治疗。方法　先用方丝弓固定矫治器进行间隙扩展 ,然后根据上颌埋伏尖牙的位置及与邻牙的关系 ,分析其阻生的病因 ,采用外科翻瓣导萌术 ,暴露埋伏尖牙的牙冠 ,粘贴托槽 ,再选择不同的方向和方法对 12例患者的 14颗上颌埋伏尖牙进行正畸牵引导萌。结果　 11颗埋伏尖牙均已萌出后排齐 ,牙髓和牙周情况正常。结论　只有通过从上颌埋伏尖牙的位置关系 ,分析其阻生的病因 ,选择正确的外科手术暴露和正畸牵引导萌的方法 ,才能有效地矫治上颌埋伏尖牙。     

上颌阻生尖牙牵引治疗后邻近切牙牙根吸收情况的研究

目的 分析上颌阻生尖牙正畸牵引治疗后邻近切牙的牙根吸收情况及可能的相关因素。方法 选取上颌尖牙阻生且符合标准的43例患者,年龄10～23岁,共60颗上颌埋伏阻生尖牙。上颌阻生尖牙正畸牵引治疗前后分别拍摄锥形束CT,分析阻生尖牙邻近切牙的牙根吸收程度,并对可能存在的相关因素进行分析。结果 上颌阻生尖牙正畸牵引治疗后,上颌中切牙发生轻、中、重度牙根吸收的概率分别为71.7%、15.0%、13.3%,上颌侧切牙发生轻、中、重度牙根吸收的概率分别为48.3%、36.7%、15.0%,上颌中切牙与侧切牙牙根吸收严重程度存在差异(P<0.05)。位于腭侧及颌骨内、低位且靠近面中线的阻生尖牙,在正畸牵引治疗后,侧切牙牙根吸收程度较重(P<0.05)。低位阻生尖牙牵引治疗后,中切牙牙根吸收较重(P<0.05)。牵引时间较长时,中切牙牙根吸收程度较重(P<0.05)。治疗前已发生牙根吸收的切牙,在阻生尖牙牵引治疗后发生的牙根吸收程度较重(P<0.05)。结论 上颌侧切牙在阻生尖牙正畸牵引治疗后,发生的牙根吸收程度较重。上颌阻生尖牙正畸牵引治疗后,邻近切牙牙根吸收情况与阻生尖...     

上颌倒置埋伏阻生中切牙的序列治疗

目的探讨上颌倒置埋伏阻生中切牙的综合序列治疗方案。方法 10例患者共11颗倒置埋伏阻生上颌中切牙为研究对象,经摄片定位、拓展间隙后,采用外科开窗、隧道牵引、选择性根管治疗及根尖切除术、修复等序列治疗。结果 11颗埋伏牙通过治疗后7颗成功牵引入牙列,排列整齐,牙周健康及牙髓活力正常;1颗唇侧出现1~2 mm的牙龈退缩;2颗需配合烤瓷冠修复;1颗进行了预防性根管治疗和根尖切除术,并进行烤瓷冠修复。结论上颌倒置埋伏阻生中切牙采用序列治疗可以取得良好的美观和功能效果。