牙周牙髓联合治疗与单纯牙周治疗对重度牙周炎疗效的临床对比研究

目的 探索重度牙周炎牙齿的牙髓治疗时机及牙周牙髓联合治疗对重度牙周炎的疗效。方法 采用多中心研究方法,选择重度牙周炎患牙180颗,随机分为牙周牙髓联合治疗组（试验组）和单纯牙周治疗组（对照组）,各90颗患牙。对照组仅进行牙周治疗;试验组记录牙髓状态,行根管治疗及牙周治疗;两组分别在治疗前和治疗后1、3、6及12个月进行检查,记录临床指标。结果 试验组90颗患牙中,22颗牙髓完全坏死,45颗部分坏死（冠髓坏死或根髓部分坏死）,23颗为活髓。治疗前,对照组和试验组各项临床指标的差异均无统计学意义（P>0.05）;治疗后3个月,试验组和对照组的临床指标开始出现差异（P<0.05）。结论 牙髓活力迟钝的重度牙周炎患牙及时进行完善的牙髓治疗,可控制炎症的发展,有利于牙周组织的愈合。     

牙槽嵴保存在非牙周炎与牙周炎患牙拔牙位点的应用进展

随着种植技术的普及应用及其良好的临床效果,临床医师着力探寻可以降低种植治疗的难度及风险,减少并发症,提高患者手术接受度的诊疗策略。牙槽嵴保存技术随之成为临床关注的热点。临床试验也证实牙槽嵴保存技术能有效减缓拔牙术后牙槽嵴的吸收,达到维持牙槽嵴体积形态的目的。目前关于牙槽嵴保存的综述都集中在手术术式、材料应用以及相关程序的选择上。本综述针对非牙周炎患牙与牙周炎患牙牙槽嵴保存技术,从组织学和形态学的角度分析两者之间的差异,以期为临床上处理不同拔牙位点牙槽嵴保存提供思路。     

重度牙周炎的牙髓治疗研究进展

文章对重度牙周炎患牙的牙髓状态、感染根管与牙周组织的关系、重度牙周炎时牙髓治疗的特点及行牙髓治疗后对牙周治疗效果的影响进行讨论。     

重度牙周炎患牙拔除或挽救之思考

重度牙周炎病损患牙的舍与留是口腔界亘古至今争议热点之一,从不同观点、专业、技术、时间、经济等角度出发考虑则会有不同抉择,尚无统一的共识。本文基于笔者自己的理解、经验、文献复习等,从重度牙周炎病损患牙舍与留的影响因素、舍弃时需考量什么、尽量保存是否可能、如何发现和预防病损发展等方面提出一些交流看法,旨在引发同行间的更多思考和积累临床循证资料,以利合作与促进口腔健康。     

意向性牙再植术保留重度牙周炎患牙的临床应用策略

随着牙周组织再生技术的发展与进步,越来越多的学者报道可通过意向性牙再植术治疗重度牙周炎患牙。对于已经具备拔牙指征的重度牙周炎患牙,意向性牙再植术已经成为保存天然牙最后的可能手段。然而意向性牙再植术的适应证要求严格,手术能否成功与病例的选择和医生的操作技能密不可分。本文探讨意向性牙再植术治疗重度牙周炎患牙的适应证和操作步骤,并结合文献和病例分析影响重度牙周炎患牙意向性牙再植术预后的相关因素,为临床医生了解和掌握该项手术技术提供参考。     

107例牙周-牙髓联合病变患牙的临床治疗体会

目的：观察牙周-牙髓联合病变患牙的联合治疗效果。方法：对107例牙周-牙髓联合病变的139个牙的临床资料进行分析,采取牙周牙髓联合治疗,观察临床疗效。结果：经过1年的随访,联合治疗总有效率82.73%,其中根尖周病变引起的牙周病变治疗效果好,且前牙好于后牙。结论：临床上对牙周-牙髓联合病变患牙及时采用系统的综合治疗可以最大限度保存患牙,取得良好的临床疗效。     

重度牙周炎病例牙周牙髓联合治疗与单纯牙周治疗的临床对比研究

目的：本研究比较了重度牙周炎病例牙周牙髓联合治疗法与单纯牙周治疗法治疗效果的差异，旨在探讨牙髓状态对牙周治疗效果的影响。方法：半年随访重度牙周炎病例14例，共计试验牙20颗，随机进入实验组(牙周牙髓联合治疗组)12颗，对照组(单纯牙周治疗组)8颗。于治疗后3个月、6个月通过牙周袋探诊深度(probing pocket depth，PDD)、相对附着水平(relative attachment level，RAL)，影像学指标釉牙骨质界到骨缺陷底的距离(cementum enamal junction to bottom of born，defects，CEJ-BD)，釉牙骨质界到牙槽嵴顶的距离(cementum enamal junctioa to alveolar crest，CEJ-AC)及计算机辅助骨密度影像分析值(computer assisted densitometric image analysis，CADIA)对比两组治疗效果的差异。结果：观察期内临床指标PPD、RAL及CEI-AC未出现显著性差异，而CEJ-BD及CADIA于治疗后3个月，6个月出现显著性差异。结论：重度牙周炎病例选择牙周牙髓联合治疗法较单纯牙周治疗法更有利于牙周骨组织的再生。     

慢性牙周炎患牙经牙髓治疗后疗效观察

慢性牙周炎患牙经牙髓治疗后疗效观察王锦明对慢性牙周炎患牙经牙髓治疗后的疗效进行观察，报告如下：１临床资料、分组和方法１．１临床资料慢性牙周炎１８５例患者２００个牙，均无全身症状，无其他系统慢性疾病或免疫疾病。男１１２例１２７个患牙，女７３例７３个患牙...     

Anterior tooth wear and retention type until 5 years after orthodontic treatment

Objectives. To study occlusal wear of anterior teeth in orthodontic patients retained with different retainers until 5 years post-treatment, and to investigate whether type of retention influences occlusal wear. Material and methods. Orthodontic patients (n=222), aged 15 years maximally at the start of treatment, were followed until 5 years post-treatment. In the maxilla, a retainer bonded on all six teeth or a removable retainer was used; in the mandible, a lingual retainer was bonded on all anterior teeth or on canines only. Dental casts were analyzed before treatment (T₀), after treatment (T₁), and 5 years post-treatment (T₅). Incisal and canine wear were scored by applying a grading scale. Intercanine width, overjet, and overbite were measured with an electronic caliper. Statistics used were: Paired samples t-test for differences over time; Pearson correlation coefficients for associations between wear and retention type; and backward linear regression for influence of retention type on wear. Results. There was an increase in wear during all time periods and for all teeth. From T₀ to T₅ an increase in maxillary intercanine width and maxillary retention had an effect on changes in canine wear. Incisal wear was associated with an increase in upper intercanine width (T₁–T₅). For both arches, an increase in maxillary intercanine width during treatment was associated with less progression of canine and incisal wear, but the explained variance was low, 13.4% and 19.3%, respectively. Conclusions. Retention type and, occasionally, an increase in intercanine width influence anterior teeth wear post-treatment. However, the clinical significance and impact of the examined retention methods on occlusal wear are small.     

中重度慢性牙周炎单根牙120颗牙髓病理分析

目的观察中重度慢性牙周炎患牙的牙髓变化。方法采集120个牙槽骨吸收达根长1/2及以上单根牙进行组织学检测。结果当牙周炎患牙牙槽骨吸收大于等于根长1/2时,牙髓变性概率随着牙齿松动度的增加而增高,随着牙槽骨吸收水平的增加而增高,但它不随着附着丧失水平的增加而增高。结论中重度慢性牙周炎患牙的牙髓有较高的变性概率,牙髓治疗不宜保守。     

牙列重度磨损咬合重建修复治疗方法的探讨

目的 探讨牙列重度磨耗患者行固定义齿咬合重建修复的可行性.方法 结合1例牙列重度磨耗患者,咬合垫佩戴3个月后,制作过渡性修复体,口内观察1年,然后行上下颌固定义齿最终修复,经过这一序列诊疗过程完成咬合重建.结果 患者使用最终修复体2年,美观满意,咀嚼效率良好,无咀嚼系统肌肉及颞下颌关节不适症状.结论 牙列重度磨耗的固定义齿咬合重建修复是一个复杂的序列治疗过程,治疗效果是满意的.     

全冠牙预备体表面涂布极固宁TM后对其固位力的影响

目的探讨涂布极固宁TM后对全冠固位力的影响。方法制作面聚合度(TOC)为10°和20°的全冠牙预备体各10个,随机分为实验组和对照组。每组TOC10°和20°的全冠牙预备体各5个。制作铸造全冠20个。实验组涂布极固宁TM后玻璃离子黏固剂黏固全冠,对照组直接玻璃离子黏固剂黏固全冠。材料实验机上测两组全冠拉脱时的最大拉力值。扫描电镜观察表面并能谱仪分析。结果TOC为10°的实验组全冠和对照组全冠拉脱时的最大拉力值分别为(443.59±74.20)N和(509.07±69.05)N,两组间的差异无统计学意义(P=0.056);TOC为20°时实验组和对照组全冠拉脱时最大拉力值分别为(291.57±49.27)N和(390.82±91.44)N,两组间的差异有统计学意义(P=0.009)。结论TOC为10°的牙预备体表面经极固宁TM处理后对玻璃离子黏固剂黏固的全冠的固位力没有影响;而TOC为20°时牙预备体表面经极固宁TM处理后的固位力显著下降。     

Ridge preservation in cases requiring tooth extraction during endodontic surgery: a case report

Aim To provide a treatment option to endodontists performing surgery that will enhance ridge preservation when tooth extraction is required. Summary A 47‐year‐old woman was referred to an endodontic practice for apical root‐end resection of tooth 22 because of refractory periradicular disease. Radiographic examination revealed a large periradicular lesion, 5 mm in diameter and a root‐end filling at the root apex. The treatment plan included exploratory surgery and apical root‐end resection. A vertical root fracture was diagnosed and the decision was made to extract the tooth. The socket was grafted with a cancellous bovine bone and covered with a resorbable collagen membrane. Follow‐up examination revealed favourable bone healing with formation of a new cortical plate and the preservation of soft tissue width and height in the aesthetic area. Key learning points

• • The principles of guided bone regeneration.
• • Preserving or reconstructing the extraction socket.
• • Enhances the ability to restore function and provide aesthetically pleasing restorations to patients without violating the predictability and function of the prostheses.

     

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目的建立实验性正畸牙移动保持期的动物模型,以利于研究保持期骨改建规律。方法于2008年4月在吉林大学口腔医院动物实验室,选用36只8周龄雄性Wister大鼠,以上颌前牙为支抗牵引第一磨牙向近中移动,加力21d后去除加力装置。以每只大鼠的左侧牙弓为实验侧,右侧牙弓为对照侧。在实验侧安装保持装置,分别保持1、3、7、14、21、28d;对照侧不做任何处理。在加力结束后和保持结束后即刻制取上颌石膏模型,测量所有模型的第一磨牙面近中沟与第二磨牙面远中沟的距离,计算加力结束后与保持结束后的距离,比较实验侧与对照侧的牙齿移动距离,评价保持装置的有效性。结果实验侧在保持结束后第一磨牙复发距离明显小于对照侧,二者差异有统计学意义(P<0.05)。结论以Wister大鼠为实验对象,采用正畸结扎丝结扎法建立的正畸牙移动保持期动物模型是有效的。     

Professionally defined dental treatment needs of middle-aged and older patients attending 21 general practitioners, as related to tooth retention

Data from routine examinations of 497 45–89 year old patients attending 21 South Australian general dental practitioners showed a positive association of the degree of tooth retention with the frequency of dental visits, the seeking of care for a check-up or preventive service (as opposed to a curative service) and professionally defined needs for prophylaxes and restorative care, particularly complex restorative care. Degree of tooth retention among dentate subjects was negatively related to the need for extractions, especially extractions for periodontal reasons, and to the need for denture services. The importance of using data from general dental practices as well as population-based surveys when assessing workforce requirements and when reviewing the appropriate content of undergraduate and postgraduate education programmes has been emphasized.     

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提要：拔牙的微创技术开启了拔牙的新时代,使拔牙这一古老的手术更加走向标准化、微创化、舒适化和个性化。目前,微创拔牙的理念和技术在国内的应用和推广亟待提高。本文对微创拔牙的发展、微创拔牙器械的进步、微创拔牙技术的应用等做一述评,为进一步在国内推广微创拔牙的理念和应用微创拔牙的技术抛砖引玉。