儿童恒前牙冠折后牙髓活力的保存方法

目的：探讨儿童恒前牙冠折后不同受损程度牙髓活力的保存方法。方法：采用三种方法对不同受损程度的72例98个冠折恒前牙牙髓进行处理，并定期复查。结果：对14个单纯性釉质折断牙牙髓随访2年，牙髓活力不受影响；对23个牙本质折断但未露髓患牙护髓后2年成功率为82.6%，对61个牙本质折断并露髓患牙采取活髓切断术，其2年成功率为81.9%。结论：对损伤程度不同的冠折牙牙髓应采取不同的治疗方法；活髓切除术不仅适用于年轻恒牙，对于牙根已形成但仍处于儿童暑期的恒前牙同样适用；牙本质桥的形成并不意味其下方的牙髓组织正常。     

自酸蚀粘结剂与全酸蚀粘结剂修复牙本质缺损的术后敏感性比较

目的比较自酸蚀粘结剂和全酸蚀粘结剂修复牙本质缺损术后敏感情况,评价自酸蚀粘结剂对减轻术后敏感的效果。方法选择99例患者(257颗患牙)随机分成两组,实验组(135颗患牙)使用3M Adper Easy One自酸蚀粘结剂,对照组(122颗患牙)使用3M Adper Single Bond2全酸蚀粘结剂,两组都用3M-Z350纳米复合树脂充填。临床观察时间为术后1 d、1周、3个月。结果术后1d、1周,实验组敏感发生率和敏感度明显低于对照组(P<0.05),术后3个月两者无明显差异(P>0.05)。结论自酸蚀粘结剂比全酸蚀粘结剂能在术后短期内有效降低牙齿敏感性。     

两种粘结剂联合复合树脂充填修复乳前牙环状龋的疗效对比探析

目的探讨新型混合型粘结剂与自酸蚀粘结剂联合复合树脂充填修复乳前牙环状龋的临床疗效。方法选取2013年11月至2015年11月收治的乳前牙环状龋患儿74例,共221颗患牙。将所有患儿按数字随机表分为对照组、观察组,每组37例。对照组共108颗患牙,给予自酸蚀牙本质粘结剂联合复合树脂充填修复治疗;观察组共113颗患牙,给予新型混合型两种粘结剂联合复合树脂充填修复治疗。观察并记录两组治疗后6个月、12个月修复体固位评分、牙本质与修复体边缘密合性评分、牙髓活力评分情况,并进行比较分析。结果观察组治疗后6个月、12个月的修复体固位评分均低于对照组,差异有统计学意义(P<0.05);观察组治疗后6个月、12个月的牙本质与修复体边缘密合性评分低于对照组,差异有统计学意义(P<0.05);观察组治疗后6个月、12个月牙髓活力评分低于对照组,差异有统计学意义(P<0.05)。结论新型混合型粘结剂联合复合树脂充填修复乳前牙环状龋的临床疗效显著高于自酸蚀牙本质粘结剂联合复合树脂充填修复,可确保修复体固位完整,提高边缘密合性,增强牙髓活性,值得临床推广。     

全酸蚀和自酸蚀粘结剂在前牙修复的临床比较研究

目的 比较全酸蚀粘结剂和自酸蚀粘结剂在前牙树脂粘结修复的临床效果。方法 将前牙近中切端缺损需要行纳米树脂修复的330颗活髓恒牙随机分为2组,分别用全酸蚀粘结剂和自酸蚀粘结剂结合纳米树脂进行充填修复。于术后3个月、1年、3年对患者进行回访,检查充填物和牙体牙髓情况,并用Spss软件进行分析比较。结果 2组患牙的充填效果无显著性差异(P＞0.05),对牙髓的刺激性自酸蚀粘结剂小于全酸蚀粘结剂,有显著性差异（P<0.05）。结论 全酸蚀粘结剂和自酸蚀粘结剂用于前牙粘结修复治疗中的疗效均不错,自酸蚀粘接剂更易操作。     

自酸蚀粘结剂治疗牙本质过敏症的临床疗效观察

目的：对比观察3M Adper Prompt自酸蚀粘结剂和75%氟化钠甘油糊剂治疗牙本质过敏症的临床疗效.方法：颈部牙本质过敏症患者110例,共122颗牙,随机分为治疗组55例62颗牙,用3M Adper Prompt自酸蚀粘结剂脱敏治疗,对照组55例60颗牙,用75%氟化钠甘油糊剂脱敏治疗,在统一标准下进行即刻和1个月、3个月后的疗效对照分析.结果：两组之间即刻疗效无显著性差异,而1个月、3个月后的疗效具有显著性差异,3M Adper Prompt自酸蚀粘结剂脱敏效果明显优于氟化钠甘油糊剂的脱敏效果.结论：3M Adper Prompt自酸蚀粘结剂对牙本质过敏症具有较好的临床治疗效果.     

无钉修复切缘两年的临床评价

一名21岁女性患者的两个上中切牙外伤折断,右中切牙对髓试法无反应,而在中切牙则有反应。X线照片显示右中切牙的牙折累及牙髓,而左中切牙的牙髓正常。治疗:右中切牙麻醉后,安置橡皮障隔湿,以牙胶尖充填完成根管治疗,在左中切牙暴露的牙本质上放置氢氧化钙以保护牙髓。将折断线上约1.5毫米宽的牙釉质面作成斜面。然后作酸处理和涂敷粘合剂。先修复左中匈牙,用一个浸透50%磷酸溶液(含有由重量比为7%的氧化锌作缓冲剂)的小棉球贴敷于接近断面的牙釉质上一分钟。然后用水清洗牙面,用温热的空气吹干牙齿。在酸处理过的牙釉质面上和氢氧化钙上,用小驼毛笔刷一层封闭剂(Nuva-Seal)。     

自酸蚀和酸蚀-冲洗粘结剂对Ⅰ类洞复合树脂充填的2年临床评价

目的:评价酸蚀-冲洗粘结剂和自酸蚀粘结剂在后牙I类洞修复中的临床效果。方法:共25名后牙患龋的患者入选了本次临床试验。每位患者随机接受了至少2颗后牙I类洞的修复,68例患牙随机分为2组,实验组采用自酸蚀粘结剂+复合纳米树脂修复(Adper Easy One+Filtek Z350,3M ESPE)38例,对照组使用全酸蚀牙本质粘结剂+复合纳米树脂修复(Adper Single Bond 2+Filtek Z350,3MESPE)30例。在充填后即刻、术后6个月、1年和2年时,根据改良的USPHS量表,从保存率、术后敏感、颜色匹配、边缘染色、边缘完整性、解剖形态、继发龋和表面质地7个方面对每个修复体都进行评分。结果:在复查的2年内,全酸蚀和自酸蚀组的保存率分别为100%和90.6%,其他各项指标亦均无显著性差异。结论:自酸蚀粘结剂和全酸蚀粘结剂用于修复后牙Ⅰ类洞均可获得较理想的临床效果。     

前牙牙折的一次性牙髓治疗和断冠牙本质的粘结

近来,牙本质粘结材料的发展使牙釉质酸蚀技术的运用范围扩大到更严重的前牙冠折病例。其中包括牙冠颈部三分之一处的牙折。本文所谈的是一例严重的牙冠折断的病人,在一次性就诊时进行牙髓治疗和牙本质粘结的方法。一男孩,13岁,游戏时左上中切牙受击折断,大约18个小时后来就诊,孩子的父亲带来了折断的牙冠。医生检查时发现,牙冠从颈部三分之一处水平折断,直径为2mm的髓腔外露。医生同时对断牙、邻牙及对验牙拍摄了根尖区的X 线片。检查结果,没有查出更多的牙折或移位情况。于是,医生决定进行一次性的牙髓治疗,将断冠再粘结起来。首先,常规进行根管牙胶充填,充填物的顶端离根尖孔约1mm。再进行断面处理,磨去断面锐尖,将断冠用豫皮杯和浮石粉进行清洁打磨,并用手机加深髓角,然后将根面和断冠吹干,所有的牙釉质面用37%的磷     

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目的评价应用G-BOND自酸蚀黏结系统和全酸蚀黏结系统对楔状缺损修复后牙本质敏感的影响。方法选择2008年6月至2010年12月在大连大学附属中山医院口腔科就诊的牙颈部楔状缺损患者64例,共200颗患牙,自身随机配对分为两组,各100颗患牙。自酸蚀组使用G-BOND自酸蚀黏结系统,全酸蚀组使用全酸蚀黏结系统,进行光固化复合树脂修复,比较两组修复后即刻、1个月、3个月的牙本质敏感改善效果。结果自酸蚀组修复后的牙本质敏感减轻效果明显优于全酸蚀组,组间差异有统计学意义(P<0.05)。结论应用G-BOND自酸蚀黏结系统可降低楔状缺损术后敏感发生。     

改良式牙冠延长术保存斜折上中切牙9例临床分析

目的观察改良式牙冠延长术保存斜折上中切牙的临床效果。方法选取2009年1月至2010年6月沈阳市口腔医院牙周科收治的因外伤致上中切牙斜折断端位于龈下的患者9例(12颗患牙),行改良式牙冠延长术并于术后2个月进行修复治疗,以恢复美观和功能。检查并记录术前及修复后6个月探诊深度(PD)、出血指数(BI)和牙齿松动度(M)。结果修复后6个月12颗患牙均未出现松动;11颗患牙PD为2～3mm,仅1颗患牙修复后PD仍为4mm;所有患牙均BI≤3。患者对修复后6个月的美观效果及功能均全部满意,美观和功能VAS平均值分别为9.75和9.50。结论改良式牙冠延长术可恢复丧失的生物学宽度,扩大常规牙冠延长术适应证,保留更多斜折的上中切牙。     

恒前牙冠折露髓部分切髓术的疗效分析

目的：观察恒前牙冠折露髓部分切髓术的疗效。方法：选择26例31牙外伤冠折不超过72h的恒前牙,进行部分冠髓切除术。分别于术后15d、1个月、3个月、6个月、1年、2年进行临床和X线检查。结果：成功29牙,失败2牙,成功率93．5％。失败原因为根管内吸收和暂补料脱落再感染。结论：冠髓部分切除术较根管口部分活髓切断术有许多优点,是一种良好的治疗方法。临床上需严格掌握适应证和操作规程,以提高成功率。     

Traumatic crown fractures in permanent incisors with immature roots: a follow-up study

Abstract – A follow-up study of crown fractured permanent incisors with incomplete root formation was carried out in a group of patients, aged 6–12 years, over a 5-year-period in the Dental Clinic of the University of Verona, Italy. The number of injured patients was 55, representing 84 injured incisors. All patients were followed clinically and radiographically using a standardized follow-up protocol. The most common type of trauma was fracture of enamel and dentine without pulpal exposure (80%) and the most common type of treatment was restoration with the acid-etch composite resin technique (46%). Bonding of the crown fragment was performed in 10 instances (12%). At the 5-year-control all teeth with fracture of the enamel had no pulp complications. Four of 67 teeth (6%) with fracture of the enamel and dentine without pulpal involvement showed pulp necrosis and 1 tooth showed pulp obliteration (1.5%). Eight of 14 teeth (57%) with fractures of the enamel and dentine with pulp involvement showed pulp necrosis. Aesthetically 36 of the restored teeth were deemed satisfactory (43%). In 9 teeth the bonded fragment had to be rebonded. 14 teeth were considered unsatisfactorily restored due to wear of the composite (17%). 34 restored teeth had to be retreated because of a new trauma (40%). In one tooth a previous bonded fragment had to be rebonded. These results confirmed that crown fractures without pulp involvement in permanent incisors with incomplete root formation have a low percentage of pulp complications, while 60% of the teeth with crown fractures with pulp involvement had pulp complications.     

Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures

Abstract – Background: The reported risk of pulp necrosis (PN) is generally low in teeth with subluxation injuries. A concomitant crown fracture may increase the risk of PN in such teeth. Aim: To analyse the influence of a concomitant trauma‐related infraction, enamel‐, enamel–dentin‐ or enamel–dentin–pulp fracture on the risk of PN in permanent teeth with subluxation injury. Material and Methods: The study included 404 permanent incisors with subluxation injury from 289 patients (188 male, 101 female). Of these teeth, 137 had also suffered a concomitant crown fracture. All the teeth were examined and treated according to a standardized protocol. Statistical Analysis: The risk of PN was analysed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log‐rank test and Cox regression analysis. The level of significance was set at 5%. Risk factors included in the analysis were gender, patient age, crown fracture type, mobility and response to an electric pulp test (EPT) at the initial examination. Results: Teeth with immature root development: The risk of PN was increased in teeth with a concomitant enamel fracture (log‐rank test: P = 0.002), enamel–dentin fracture (log‐rank test: P < 0.0001), enamel–dentin–pulp fracture (log‐rank test: P < 0.0001) and in teeth with no response to EPT at the initial examination [hazard ratio: 21 (95% confidence interval, CI: 2.5–172.5), P = 0.005]. Teeth with mature root development: the risk of PN was increased in teeth with an enamel–dentin fracture [hazard ratio: 12.2 (95% CI: 5.0–29.8), P < 0.0001], infraction [hazard ratio: 5.1 (95% CI: 1.2–21.4) P = 0.04] and in teeth with no response to EPT at the initial examination [hazard ratio: 8 (95% CI: 3.3–19.5), P < 0.0001]. Conclusion: A concomitant crown fracture and no response to EPT at the initial examination may be used to identify teeth at increased risk of PN following subluxation injury.     

Introduction of a new technique of partial pulp amputation in permanent teeth in children after mechanical injuries. Preliminary communication

The study material comprised 56 permanent teeth with traumatic pulp exposure complicated in 15 cases by partial tooth luxation in 52 children aged from 7 to 15 years. In each case routine clinical and radiological examinations were done. The time between trauma and procedure ranged from several hours to 70 days. In all teeth partial pulp amputation was done cutting off by the gentle technique a part of the coronal pulp and covering of the remaining pulp with calcium hydroxide, zinc oxide with eugenol or with Dycal, carboxyl cement and permanent filling. The analysis of the studied material showed that the greatest group comprised children aged 8-11 years (40 cases), and fractures of one-half of the crown prevailed (32 cases), point pulp exposure (32 cases), developmental stage Rc and A 1/2 of root (40 cases). The short-lasting follow-up made possible clinical and radiological control of only 39 teeth after 6 months, and 7 teeth after 12 months. After 6 months good results were obtained in 84.6% of cases.     

A crown reconstructing method for resin-embedded transparent teeth.

OBJECTIVE: Resin-embedded transparent teeth are devoid of the original crown morphology, because enamel is lost by demineralization. This study was designed to reproduce artificial enamel and to reconstruct the original crown morphology for resin-embedded transparent teeth. METHOD AND MATERIALS: The impression of the coronal portion of human permanent teeth was taken with a silicone impression material. After demineralization, drawing ink was injected into the pulp cavities. The ink-infiltrated teeth were made transparent with methyl salicylate and embedded with polyester resin. Urethane prepolymer was injected into the impression, and the resin-embedded teeth were reinserted into the impression. After polymerization of the urethane resin, the specimens and the urethane resin were removed from the impression. RESULTS: The original crown morphology of the resin-embedded transparent teeth could be precisely reconstructed with artificial and removable enamel. The resin-embedded teeth showed morphologic details of the black-stained pulp cavities through the transparent dentin and cementum. CONCLUSION: This study established a crown reconstructing method for resin-embedded transparent teeth. The specimens will be useful for demonstration of morphology of teeth and pulp cavities.     

年轻恒牙冠折一次性修复的临床观察

临床上对于冠折牙本质暴露但未露髓的外伤恒前牙多采用Ca(OH)_2盖髓后光敏树脂修复外形的处理方法,但盖髓剂的厚度影响光敏树脂的固位。本研究选择冠折牙本质暴露病例45例,分成实验组和对照组。实验组用日本Sunmedical公司生产的Superbond D Liner(SDL)涂布牙本质断面后光敏树脂一次性修复外形,对照组用Ca(OH)_2盖髓后光敏树脂修复。并于术后3个月、6至10个月观察,发现两组在固位方面和牙髓炎症反应方面无显著差异。但SDL仅在牙本质表面形成一层薄膜不增加修复体厚度又可加强牙本质与光敏树脂的粘着,在冠折牙齿一次性修复上很有发展前途。虽然出现了几例炎症反应,但它们与外伤程度及就诊时间都有关系,是否是SDL引起还需长期观察。     

脱矿牙本质基质用于根尖诱导成形术的临床研究

目的　观察同种脱矿牙本质基质(DDM)用于根尖诱导成形术的临床效果。方法　将人牙本质去脂、脱矿粉碎、冻干等处理制备成DDM,作为根尖诱导剂应用于临床,并以氢氧化钙糊剂作为对照,共治疗患牙57颗。分别于术后1年、2年拍X线片及临床检查。结果　根尖诱导成形术后1年,患牙X线片有不同程度的根尖屏障形成,或虽无明显的X线改变但根管内探测有明显阻力,此时更换永久性根管充填材料。术后2年的临床观察发现, DDM组的治愈率为92·86%,略高于氢氧化钙组的91·30%,但无显著性差异。结论　脱矿牙本质基质可作为一种新的根尖诱导剂应用于临床。     

Comparison of iRoot BP Plus and Calcium Hydroxide as Pulpotomy Materials in Permanent Incisors with Complicated Crown Fractures: A Retrospective Study

IntroductionCalcium hydroxide has been used as a traditional pulpotomy agent for a long time but has some disadvantages. iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, Canada) is a newly developed, ready-to-use calcium silicate–based bioactive ceramic with excellent bioactivity and sealing ability. However, whether iRoot BP Plus shows superiority over calcium hydroxide as a pulpotomy material on permanent incisors with complicated crown fractures remains unknown.MethodsThis research included 205 permanent incisors with complicated crown fractures. These teeth were treated with pulpotomy and divided into 2 groups according to the pulpotomy material (105 treated with iRoot BP Plus and 100 with calcium hydroxide). Clinical and radiographic information was collected during the 12- to 24-month follow-up period. The formation of reparative dentin bridges and pulp canal obliteration were analyzed using radiographs in both groups.ResultsThe success rates for recall in the average follow-up period of 17.5 ± 4.4 months (12–24 months) after pulpotomy treatment were significantly different between the 2 groups, with 99% for the iRoot BP Plus group and 93% for the calcium hydroxide group. Reparative dentin bridges were observed in 92.4% of the iRoot BP Plus group and 90% of the calcium hydroxide group, but the difference was not significant. Pulp canal obliteration was observed in 2 teeth (2%) in each group.ConclusionsThe success rates obtained in our study indicate that iRoot BP Plus as a pulpotomy agent can be a suitable alternative to calcium hydroxide to manage complicated crown fractures.     

Recovering the function and esthetics of fractured teeth using several restorative cosmetic approaches. Three clinical cases

Abstract – The teeth most commonly affected by trauma are the maxillary central incisors. The most frequent types of traumatic dental injuries to permanent teeth are enamel fractures, enamel and dentine fractures, and enamel and dentine fractures with pulp involvement. This article describes three clinical cases with different levels of traumatized maxillary incisors and several cosmetic approaches for recovery of the esthetics and the masticatory function, as well as the social/psychological aspects of treatment. All cases involved young adult men. The three clinical cases involve dentin and enamel fractures, dentin and enamel fractures with pulp exposure, and dentin and enamel fractures with pulp exposure associated with root fracture. The cosmetic treatments used to resolve fractures were direct composite resin by layering technique, indirect all‐ceramic restorations (laminate veneer and ceramic crowns over the teeth), and immediate implant after extraction followed by immediate loading (ceramic abutments with ceramic crown over implant). In all three cases, excellent functional and esthetic results were achieved by use of these treatment modalities. The patients were very satisfied with the results.