Diagnosis and treatment of pulp necrosis in permanent anterior teeth with root fracture

A follow-up study was made of 20 traumatized permanent incisors with pulp necrosis observed as a sequel to root fracture. The material included 19 patients aged 8–17 years (mean 11.6 years) at the time of injury. Negative response to electric stimulation was noted in 16 teeth from the first examination. In four teeth an initial positive response changed to negative within 2–9 months. The negative response was supported by additional signs and symptoms of necrosis in 19 teeth. Radiolucencies adjacent to the fracture line or coronal discolorations were the most important diagnostic factors. Discolorations occurred within 2 months, whereas radiographic changes in the fracture area took from 3 to .5 months. to develop. Four teeth were extracted without attempting endodontic therapy. Endodontic treatment confined to the coronal fragment was performed in 16 teeth. In most cases the canal was filled temporarily with calcium hydroxide until a closure at the fracture site was observed. Two apical fragments showing radiographic changes were surgically removed in conjunction with the permanent filling of the coronal fragments. During the postoperative observation period one tooth was extracted due to communication between the fracture area and the oral cavity. The treatment of the remaining 15 teeth was judged as successful after a mean observation period of 4.2 years, ranging from 2 to 5 years.     

恒前牙根中部以下折断临床修复体会

目的：探讨根中部以下折断的恒前牙保存活髓或经根管治疗后进行功能修复的临床效果。方法：收集近5年来恒前牙根中部以下折断60位病例共178颗牙,根据情况进行保存活髓或根管治疗后加用根管钉或联冠形式进行功能修复。结果：经以上治疗,患牙均可收到较好的功能修复。结论：牙根中部以下折断应及时准确复位,定期监测牙髓活力,死髓牙应尽早作根管充填诱导硬组织屏障形成,经合适治疗后绝大部分患牙均可行使咀嚼功能。     

Rapid orthodontic extrusion of crown root and cervical root fractured teeth

Abstract This study concerns the relapse tendency and extent of root resorption in 33 extruded non-vital crown root fractured or cervical root fractured teeth in 32 patients 10–20 years old. They constitute all orthodontically extruded teeth at the Orthodontic or Pedodontic Departments, Eastman Institutet, Stockholm (1982–1987). A simple extrusion mechanism exerted a force of 60–70 p along the root axis of the tooth. An extrusion of 2–3 mm was obtained in most patients; the most extreme effect was 6 mm. In 16 patients the extrusion was achieved within 3 weeks, in 12 it lasted for 4–6 weeks and in 5, 7–9 weeks. The treatment was more complicated in the lower jaw. After the extrusion, a fibrotomy was done and in most patients also a gingival recon–touring to create an optimal relation between the gingiva and the margin of the restoration. Periodically identical radiographs were taken immediately before and after the extrusion, after 3 months and after 1 year. A minor relapse, about 0.5 mm, was observed in 3 patients. Limited root resorption was found in 6 teeth and severe in only 1. The resorptions did not progress in the following 2 years of observation.     

The role of endodontics in the treatment of luxated permanent teeth

Abstract  – Pulp necrosis is a common complication following traumatic dental injuries and is related to the type and severity of the injury, as well as to the stage of development of the injured tooth. Endodontic intervention is required when there are clinical and radiographic signs of pulpal infection and its sequelae. Arrested tooth development with periradicular pathosis, external inflammatory root resorption, sinus tract formation and pain on percussion are indicative of root-canal infection in the post-traumatized teeth, and require immediate endodontic treatment. The use of calcium hydroxide in the treatment of teeth with post-traumatic pulp necrosis and its sequelae has been shown to be extremely beneficial for the long-term retention of the injured teeth. Calcium hydroxide has been shown to arrest and repair external inflammatory root resorptive defects, eliminate the endodontopathic microorganisms from the root canal system and induce hard-tissue barrier formation at the apex of non-vital immature teeth. This paper reviews the endodontic treatment required by post-traumatic non-vital permanent teeth.     

恒前牙外伤水平根折的序列治疗及预后评估影响因素

恒牙外伤根折是一种涉及到牙本质、牙骨质、牙髓组织、牙周膜韧带甚至周围牙槽骨的病损,高发于10～20岁,大多涉及美学要求较高的上颌前牙区域.对于根折的恒牙,治疗的目标是尽可能维持患牙的生理和功能的完整性,降低并发症的发生.由于根折线的位置较大程度决定了后续治疗方案及患牙的预后,临床医师多根据根折线的位置水平对根折前牙进行...     

Conservative endodontic treatment of teeth fractured in the middle or apical part of the root

Abstract –  According to treatment type, root-fractured teeth with pulp necrosis or exposed pulps were divided into five groups, group 1: 17 teeth in which the root canal of the coronal fragment only was filled with gutta-percha (GP); group 2: seven teeth in which the root canals of the coronal and apical fragments were both filled with GP; group 3: 19 teeth in which the coronal fragment was filled with GP and the apical fragment was surgically removed; group 4: 68 teeth where the root canal of the coronal fragment was treated with calcium hydroxide and subsequently filled with GP; and group 5: five vital teeth with root and concomitant crown fractures in which the exposed pulps were treated by partial pulpotomy. The frequency of periodontal healing was 76% in group 1, zero in group 2, 68% in group 3 and 86% in group 4. Compared with groups 1 and 2 combined, healing in group 4 was significantly more frequent. In groups 1, 2 and 4, failures occurred significantly more often in teeth showing overfilling, i.e. protrusion of GP into the space between the fragments, compared with teeth without overfilling. All five teeth in group 5 showed healing. It was concluded that root canal filling with GP of the coronal fragment only, with or without surgical removal of the apical fragment, can be successful in selected cases. Treatment of the root canal with calcium hydroxide followed by GP filling appears to be the treatment of choice in root-fractured non-vital teeth. Partial pulpotomy of exposed pulps in five teeth showed results similar to root-unfractured teeth with pulp exposure treated with this technique.     

Repair characteristics of root fractures in permanent anterior teeth

abstract — A follow-up study was made of repaired root fractures in 51 permanent anterior teeth, with a mean observation period of 6 years. The material was subdivided into three repair types (Figs. 1–3): Type 1—invisible or hardly discernible fracture line (15 teeth), Type 2—fragments separated by a narrow radiolucent line and peripheral rounding of the fracture edges (33 teeth), and Type 3—fragments separated by a distinct bony bridge (3 teeth). The majority of repaired teeth gave a normal or slightly decreased response to electric pulp tests and the mobility was physiologic or slightly increased. Reduced transparency or slight yellowish discoloration was observed in 14 teeth. The most conspicuous radiographic finding was pulp obliteration which occurred in 86%. Two different patterns were observed: (1) partial obliteration located in the apical fragments and the fracture area, and extending 0.5–4 mm into the coronal fragment, and (2) progressive obliteration of the entire pulp cavity ending with almost total obliteration. Pulp necrosis did not develop as a sequel to progressive obliteration in any case. Several different characteristics of the fracture influenced the repair pattern, the most important being the degree of fragment dislocation and mobility, stage of root development and localization of the fracture. Correlation between type of repair and various treatment procedures was observed only with regard to reduction.     

松牙固定钛链用于儿童上颌外伤松动前牙固定的临床研究

目的:评价松牙固定钛链用于儿童外伤松动前牙固定的临床效果。方法:采用随机同期对照方法,纳入符合条件的30例连续病例(4～12岁;其中男25例,女5例;混合牙列26例,乳牙列4例);随机分为2组(每组15例),分别采用松牙固定钛链(实验组)与弓丝托槽(对照组)技术固定。测量治疗前及固定术后4周的牙松动度、材料脱落牙位数、患者舒适指数、牙龈指数和医生操作时间,所得结果进行统计学分析。结果:实验组与对照组均能对松动牙进行有效固定;对有效固定患者数、材料脱落牙位数进行卡方检验,实验组与对照组之间的差异无统计学意义(P>0.05);而在患者舒适指数、牙龈指数和操作时间方面松牙固定钛链优于弓丝托槽技术(P<0.05)。结论:松牙固定钛链用于儿童外伤松动前牙固定效果可靠,且较舒适,对牙周刺激小,可节省操作时间。     

Bone-like tissue growth in the root canal of immature permanent teeth after traumatic injuries

Abstract – Following a severe traumatic incident to permanent immature teeth, the growth of calcified tissue in the pulp space may occasionally occur. This calcified tissue may be diffuse or in intimate contact with the dentine. It has been suggested that a wide open apex, severe damage to the root sheath, and the absence of infection are only some of the predisposing factors leading to this metaplasia of pulp tissue into bone-like tissue. Five cases are described.     

根折影响因素及诊治

一旦发生根折则预后非常差。根折与牙齿的解剖形态、因素、生物力学、医源性等因素密切相关。国内外学者对根折原因进行了大量的研究。本文对根折病因及发生机制、诊断和治疗进行综述,为临床治疗提供一定参考。     

Prognosis of permanent teeth in the line of mandibular fractures

Abstract A total of 45 mandibular fracture patients with 54 teeth in the fracture line were evaluated retrospectively. One tooth in the fracture line was lost in the accident, 6 were extracted later and 47 could be saved (87%). At the follow-up examination 38% of the teeth were diagnosed to have pulp necrosis, which was found more frequently in the older patients and in cases in which the time elapsing between the injury and the follow-up was longer. Pulp necrosis was also more frequent in cases in which the fracture line ran through the apex or dislocation of the fracture parts existed after the injury.     

Survival of intentionally retained permanent incisor roots following crown root fractures in children

Retaining tooth roots, following crown loss, confers a number of benefits including the preservation of alveolar bone. Intentional root retention in adults has been widely investigated but little is known about this treatment approach in children. Therefore, the aim of the present study was to investigate the clinical outcomes associated with permanent anterior root retention in a young population. The study group comprised 53 children who had received treatment in the paediatric dentistry clinic, Charles Clifford Dental Hospital, Sheffield, UK, over the past 10 years, following a complicated crown root fracture of a permanent maxillary incisor at or below the gingival margin. Data relating to patient age at crown root fracture, gender, previous trauma history, tooth vitality, treatments performed and clinical outcomes were obtained retrospectively using patient records. The mean age of the subjects at initial crown root fracture was 12.1 years (range 8.3–15.8 years) and there were more than twice as many males (n = 37, 70%) as females (n = 16, 30%). In just over half of the cases seen (n = 29, 54%), the tooth involved was already nonvital at the time of crown root fracture. For the majority of these nonvital teeth (n = 27, 93%), primary treatment had comprised placement/replacement of a calcium hydroxide root dressing. The remaining two teeth did not require root treatment as a satisfactory gutta percha root filling was already present. A variety of treatments was undertaken for the 24 vital roots: in 15 (63%) cases the pulp was extirpated and calcium hydroxide placed; three (12%) cases were subject to a pulpotomy; five (21%) cases were left untreated with the hope that vitality would be maintained following gingival healing and in one case the radicular pulp was extirpated and immediately obturated with gutta percha. The mean time that the roots were kept under review was 2.6 years (± 1.57, range 0.6–6.8). During this period, only five roots (9%) had to be removed due to persistent periapical infection. There were no complications associated with the five cases where vital root submergence had been permitted but all three cases which had initially undergone a pulpotomy subsequently presented with pulpal necrosis necessitating pulpal extirpation and calcium hydroxide therapy. These findings indicate that efforts to retain permanent anterior roots in a young population are justified in view of the high clinical success rate of over 90% over a 2‐year period.     

根折影响因素及诊治

一旦发生根折则预后非常差。根折与牙齿的解剖形态、因素、生物力学、医源性等因素密切相关。国内外学者对根折原因进行了大量的研究。本文对根折病因及发生机制、诊断和治疗进行综述,为临床治疗提供一定参考。     

不同方法探查上颌第一恒磨牙根管口的研究

目的 :比较临床上不同探查方法探查根管口的效率。方法 :采用肉眼观察 (上颌位 )、肉眼观察 (直视位 )、放大镜观察、# 15K型锉探查、牙科手术显微镜观察研究 80个离体上颌第一恒磨牙的髓腔系统。结果 :上颌第一恒磨牙近颊根有较高的多根管口率 ,五种方法多根管口的发现率分别为 :30 %、30 %、30 %、5 1.2 % ,6 6 .2 % ,K型锉和牙科手术显微镜多根管发现率与前三种方法比较差异有统计学意义 (P <0 .0 5 ) ,K型锉与牙科手术显微镜多根管发现率差异无统计学意义 (P >0 .0 5 )。手术显微镜还发现远颊根双根管口率为3.75 %。结论 :上颌第一恒磨牙根管系统复杂。临床使用小号K型锉能发现绝大部分根管口 ,而使用牙科手术显微镜对于完善的根管治疗术是有益的。     

铸造个别牙弓夹板在下颌骨前段骨折中的应用

目的:评价铸造个别牙弓夹板在下颌骨前段骨折治疗中的作用。方法:制取牙模型,在骨折线处锯开下颌模型,再按上下颌关系重新行模型拼对、联结,在联结后的模型上制取颊舌侧个别牙弓夹板代型,完成个别牙弓夹板的铸造,将其安放于经手法复位后的下颌牙弓的颊舌侧并结扎固定,以恢复牙弓的连续性及咬合关系。结果:经上述方法治疗的18例下颌骨骨折患者,4周后拆除个别牙弓夹板,6～8周后咬合关系完全恢复正常。结论:铸造个别牙弓夹板是治疗下颌骨前段线性骨折的有效方法。     

Variation in root length of the permanent maxillary central incisor

abstract — A metric study was performed on radiographs of permanent maxillary central incisors of a normal Swedish population of 1,038 children. The normal distribution of the root lengths revealed two extreme groups: 2.4% had short roots, formerly described as Short Root anomaly, most prevalent among girls with a boy:girl ratio of 1:2.6. In the opposite extreme group, i.e., with exceptionally long roots comprising 2.3% of the children, the boys dominate with a boy:girl ratio of 5:1. Clinical evidence suggests that variation in root length is of genetic origin.