牙髓血运重建术用于根尖孔宽大的年轻恒牙临床疗效分析

目的:通过对根尖孔未发育完全的年轻恒牙实施牙髓血运重建治疗,并追踪随访患牙9~24个月,观察牙髓血运重建术的临床疗效。方法:对9例(11颗牙)患牙进行常规开髓,清除坏死的牙髓组织,2.5%的次氯酸钠和17%的EDTA溶液冲洗后封入三联抗生素糊剂。待患牙临床症状消失后,对其进行牙髓血运重建术,严密冠方封闭,定期复诊观察。结果:9例(11颗牙)年轻恒牙经牙髓血运重建术治疗后,临床症状全部消失。其中,6颗牙根尖孔闭合,牙根发育,牙髓电活力测试有反应;4颗牙根尖孔闭合,牙根发育,牙髓电活力测试无反应;1颗牙治疗失败。结论:牙髓血运重建术能使牙根继续发育,为治疗牙髓炎症、坏死和根尖周感染的年轻恒牙提供了可选择的方法。     

年轻恒牙活髓保存治疗

年轻恒牙活髓保存的目的是为了保护冠部或根部剩余牙髓组织的活性和功能,促进牙根生理性发育。传统观点认为,活髓保存只适用于牙髓正常或可逆性牙髓炎、无根尖病变的患牙,以保留患牙剩余未被感染的健康牙髓组织。但迄今为止,并没有可靠的手段能准确判断牙髓状态。此外,多个研究显示龋源性露髓、伴有不可逆性牙髓炎及根尖周感染的患牙活髓保存治疗成功。临床上应充分利用年轻恒牙牙髓组织再生修复能力强的组织学特点,对年轻恒牙牙髓治疗采取更为保守的方法,以期获得更好的预后。     

不可复性牙髓炎恒牙的活髓保存治疗

传统观点认为,活髓保存治疗（VPT）主要用于年轻恒牙的牙髓治疗,但近些年来,VPT治疗也越来越多地应用于发育完全的恒牙。此外,以往只有牙髓正常或可复性牙髓炎的患牙才能进行VPT,但越来越多的证据显示不可复性牙髓炎或根尖周炎患牙VPT成功。哪些不可复性牙髓炎或根尖周炎患牙可以尝试进行VPT、临床如何评估和操作,本文拟对这些问题进行阐述。     

年轻恒牙直接盖髓术的临床疗效探讨

年轻恒牙常因龋坏、外伤而意外露髓 ,由于年轻恒牙的牙根尚未完全发育 ,根尖孔尚未形成 ,如果此时贸然进行根管治疗效果不佳 .对于牙髓尚未产生不可逆性炎症的患牙 ,如能通过直接盖髓术促进牙髓组织修复 ,牙根继续发育 ,根尖形成 ,将有利于保留患牙 ,对于患者的牙颌健康具有重要的意义 .材料和方法1　病例选择 :　来本院口腔科就诊的儿童患者 ,因去除龋坏组织、外伤冠折致恒牙的牙髓暴露 ,而无自发性疼痛 ,作牙髓活力电测试表明牙髓活力正常 ,并且穿髓孔不大于 2 mm,基本无渗血 ,摄 X线片示 :患牙髓腔较大 ,牙根未完全发育 ,根管粗大 ,根尖…     

牙髓血运重建术在年轻恒牙牙髓坏死伴/不伴根尖周炎治疗中的临床疗效

目的:评价牙髓血运重建术在牙髓坏死伴/不伴根尖周炎的年轻恒牙牙髓治疗中的临床疗效。方法:回顾进行牙髓血运重建术治疗的10颗患牙,术后每3～6个月复查,随访10～27个月。通过问诊、临床检查和影像学检查评估治疗前后,患牙不适临床症状的转归以及牙根发育的情况。结果:牙髓血运重建术后,所有患牙不适临床症状消失,临床有效率和患牙临床生存率达100%,且影像学检查显示根尖周病变愈合,牙根继续发育,根尖孔直径减小,牙根长度增加(P<0.05),根管壁厚度增加不显著(P>0.05)。结论:牙髓血运重建术在牙髓坏死伴/不伴根尖周炎年轻恒牙的治疗中取得了较好的临床疗效。     

年轻恒牙嵌入性脱位的X线追踪观察分析

目的:通过对年轻恒牙嵌入性脱位的X线片进行回顾性研究,观察患牙复位、牙根发育和牙根吸收情况,并分析其影响因素。方法:收集2013年1月~2019年3月发生嵌入性脱位的年轻恒牙病例,分析其X线片,了解患牙复位、牙根发育及牙根吸收情况。结果:所有患牙基本复位,牙根继续发育占66.7%,发生替代性吸收占25%;嵌入程度较轻的患牙利于牙髓存活(P=0.008);自然再萌的患牙可减少替代性吸收(P=0.005);牙髓存活的患牙牙根可发育,且无替代性吸收(P<0.001)。结论:嵌入性脱位的年轻恒牙牙髓可存活,且牙根可继续发育。牙髓存活的患牙利于牙根发育、减少替代性吸收。重度嵌入的年轻恒牙可有萌出潜力。     

年轻恒牙牙髓血运重建术临床效果初步观察

目的:评价因外伤、发育畸形所致根尖周炎或牙髓坏死的年轻恒牙牙髓血运重建术后的疗效及影响因素.方法:回顾分析66例因根尖周炎或牙髓坏死行血运重建治疗的年轻恒牙,采用Mimics软件重建患牙治疗前后的根尖周病损三维模型并测量体积,采用Dolphin软件测量患牙治疗前后的牙根长度、根管壁厚度及根尖孔大小,评估治疗后患牙根尖周...     

龋源性露髓成熟恒牙活髓保存治疗的研究进展

保存牙髓活力、维持牙髓功能、尽可能保留患牙的微创治疗理念是当代成熟恒牙牙髓治疗的重要发展趋势。本文基于最新研究,归纳龋源性露髓的成熟恒牙活髓保存治疗的临床疗效及其影响因素,简要介绍相关研究的新进展,以期为临床开展活髓保存治疗及今后该领域的发展提供参考。     

龋源性露髓成熟恒牙活髓保存治疗的研究进展

保存牙髓活力、维持牙髓功能、尽可能保留患牙的微创治疗理念是当代成熟恒牙牙髓治疗的重要发展趋势。本文基于最新研究, 归纳龋源性露髓的成熟恒牙活髓保存治疗的临床疗效及其影响因素, 简要介绍相关研究的新进展, 以期为临床开展活髓保存治疗及今后该领域的发展提供参考。     

恒牙牙髓炎的活髓保存治疗

活髓保存治疗是尽最大限度保留健康牙髓组织、提高患牙远期保存率的方法,但其被认为适应范围有限,疗效不确定。牙髓组织的病理学改变是决定临床治疗方案和评估疗效的组织学基础,而常用的检查方法无法全面反映牙髓的病理学改变。随着对牙髓生物学研究的深入、现代诊疗技术及盖髓材料的革新,活髓保存治疗越来越多地被应用在以往被认为需要摘除牙髓的患牙上。本文根据循证文献,就牙髓炎病理改变、恒牙牙髓炎活髓保存治疗的临床研究等方面进行分析讨论和总结。在活髓保存治疗的过程中综合运用包括激光多普勒血流仪、组织氧检测仪、核磁共振成像、牙科显微镜等技术与方法准确判断牙髓炎症状态,并依此决定牙髓的去留程度;结合严格的感染控制与高生物相容性盖髓材料的使用,活髓保存治疗可运用在部分龋源性露髓患牙与出现不可复性牙髓炎症状的恒牙上。未来的研究则需从牙髓修复再生机制、牙髓炎诊断精准化、盖髓材料的升级等方面提高恒牙牙髓炎活髓保存治疗的成功率。     

Dental pulp response to traumatic injuries – a retrospective analysis with case reports

Abstract The reactions of the denial pulp to traumatic injuries can be extremely varied. They range from almost immediate pulp death to long-term slow pulp canal calcification. In this study the pulpal reactions were divided into three types: pulps with a very poor prognosis that required endodontic therapy soon alter the tooth was traumatized. Seventy-nine teeth were studied in this category, and all 79 teeth required endodontic therapy; pulps with a moderate prognosis that required endodontic intervention some 18 to 24 months after the traumatic episode. Forty-eight teeth were studied in this category, and 27 of them required endodontic therapy: pulps with a very good prognosis that rarely required endodontic therapy. Fifty-two teeth were studied in this category, and only 2 required endodontic therapy. The prognosis of a particular pulp depends on the degree and type of trauma.     

Root fracture with dentin-retained posts.

The purpose of this in vitro study was to compare the incidence of incomplete root fractures occurring in teeth with and without dentin-retained posts. Eighty extracted human mandibular canines were treated as follows: 20 teeth (controls) received pulpectomies using broaches and sodium hypochlorite; 60 teeth received endodontic therapy with laterally condensed gutta percha. Of those 60 teeth, 20 teeth received Flexi-posts, 20 received Vlock dentin-retained posts, and 20 teeth had no posts placed. All teeth were stained with 5% Oil-Red-O stain for 5 days and sectioned at four levels. The sections were then examined under a stereomicroscope at x20 power. No complete fractures were found. Incomplete fractures were found in two teeth from the endodontic treatment only group, two teeth from the Flexi-post group, and two teeth from the Vlock group. None of the teeth in the control group were fractured. Based upon these results, it was concluded that: 1) Flexi-post and Vlock post placement is no more likely to cause root fracture than is conventional endodontic therapy alone; and 2) incomplete root fractures are more likely to be found in teeth with conventional endodontic therapy than in teeth not treated endodontically.     

一次性和多次性根管治疗应用于根尖周炎的临床评价

目的评价根管治疗一次法和多次法对无症状根尖周炎疗效的影响,探讨一次性根管治疗的适应症。方法选取无症状根尖周炎的患牙160颗,分层随机法分为两组,分别采用一次法和多次法完成根管治疗。所有患牙均使用镍钛机动根管器械预备,牙胶冷侧方加压法充填根管。比较两组术后疼痛发生情况,根据患者主观症状、临床表现和术前术后X线片评价疗效。结果一次法和多次法在术后疼痛、根管治疗效的差异上没有统计学意义。结论一次性根管治疗应用于无症状根尖周炎的患牙是可行的,但要注意控制适应症。     

One-appointment endodontic therapy: biological considerations

BACKGROUND: The authors conducted a literature review to present the best available biological evidence concerning one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. TYPES OF STUDIES REVIEWED: Because of recent advances in technology, such as rotary engines and nickel-titanium instruments, some practitioners are performing one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. The authors reviewed the literature, which revealed only a small number of randomized, controlled clinical trials that have been conducted on one-appointment versus multiple-appointment endodontic therapy. RESULTS: As the apical canal preparation is enlarged, a greater percentage of bacteria is eradicated from infected root canals. In addition, sufficiently large apical root canal enlargement facilitates the delivery of antimicrobial irrigant to the apical portion of the canal. However, an association between positive or negative preobturation root canal culture results and the outcome of endodontic treatment has not been well-established. CLINICAL IMPLICATIONS: The best available evidence, based on a systematic literature review, indicates that one-appointment endodontic therapy may be feasible in selected cases of apical periodontitis in asymptomatic teeth. However, additional randomized, controlled clinical trials are required.     

Langerhans Cell Histiocytosis Mimicking Periapical Pathology in a 39-year-old Man

Langerhans cell histiocytosis (LCH) is a clonal neoplastic proliferation of Langerhans-type dendritic cells, with more than 50% of cases of LCH seen in children younger than 15 years of age. The most common clinical presentation of LCH is solitary or multiple bony lesions. The jaws are affected in approximately 10%–20% of cases, with a strong predilection for the mandible. The maxilla is involved in only 1% of head and neck cases. When the jaws are involved, lesions of LCH may mimic periapical pathology as seen in patients requiring endodontic therapy or bone loss as seen in periodontal disease. We report the case of a 39-year-old man with LCH involving the posterior maxilla. This is a rare presentation of LCH with respect to both location and patient age. Clinicians should consider LCH when developing a differential diagnosis of an apical radiolucency of vital teeth or teeth that fail to respond to endodontic therapy and be aware of its clinical and radiographic mimics.     

逆行性种植体周围炎与根管治疗后邻牙关系的研究

目的:明确逆行性种植体周围炎与根管治疗后邻牙的关系。方法:对32例(39枚种植体:ITI28枚,MDIC11枚)邻牙根管治疗后种植体植入患者进行病例回顾性研究,分别对邻牙根管治疗后的时间进行记录,测量X线片中种植体与邻牙的距离。结果:39枚种植体中有10枚出现逆行性种植体周围炎症状,其中8枚(6枚ITI,2枚MDIC)邻牙是根管治疗完成时间不足3个月(P<0.05),X线片显示与邻牙的距离都小于3mm(P<0.05)。结论:邻牙根管治疗后至少3个月的观察时间进行种植体手术,控制好种植体与邻牙的距离是预防逆行性种植体周围炎发生的有效手段。     

Management of endodontic failures: case selection and treatment modalities

General dentists should realize that endodontic failures can be retreated successfully, avoiding tooth loss. Retreatment of endodontic failure and initial root canal therapy share similar biologic principles and treatment objectives. The criteria for successful root canal therapy are important factors that must be understood before teeth are retreated. This article demonstrates three retreatment modalities for managing endodontic failures as an alternative to tooth extraction.     

Dens invaginatus in first mandibular premolar

Abstract A case of dens invaginatus in a mandibular first premolar with periapical lesion is presented in which it was possible to perform non-surgical endodontic therapy. Dens invaginatus is a developmental malformation of teeth which results from abnormal morphodifferentation. Due to their abnormal anatomical configuration, invaginated teeth present technical difficulties in their clinical management. The treatment modalities available to the clinician include: endodontic therapy, endodontic surgery, combined treatment, or extraction. In this case the treatment of choice, selected according to clinical and radiographic considerations, was endodontic therapy of the main root canal.     

根管治疗牙最终被拔除的原因分析

目的 :以最终被拔除的根管治疗牙为研究对象 ,来评判其失败的原因。方法 :收集分析 77例拔除的根管治疗牙资料 ,进行分类研究。结果 :与修复有关的失败占 6 1.0 % ,其中主要是冠折。与牙周疾病有关的失败占 2 9.9% ,根管治疗的失败仅占 9.1%。结论 :根管治疗自身的失败比较少见 ,但一旦发生 ,后果严重 ,平均寿命较短。冠修复的根管治疗牙比未冠修复的根管治疗牙平均寿命长。     

Healthy roots: a solid foundation for the future

Advances in endodontic instrumentation, materials and technique have enabled the basic principles of endodontic therapy to be more readily and predictably achieved. This allows endodontic therapy to enjoy one of the highest success rates of all forms of dental treatment. A better appreciation of the responses following traumatic injury to the teeth, together with advances in management, have provided such teeth with an optimum prognosis enabling them to be retained as useful members of the dentition. Endodontic procedures in conjunction with periodontic, orthodontic and restorative techniques have enabled severely compromised teeth to be salvaged and returned to function. Teeth endodontically treated in a proper manner provide a solid foundation for correct restoration and the long term maintenance of a healthy dentition.