前牙完整性脱位再植根管充填临床应用

目的：评价前牙离体再植根管充填的手术疗效。方法：回顾分析1999年以来收治的96例因外伤致前牙离体脱位患者的临床资料。其中30min至2h前牙离体脱位患者20例,前牙离体脱位超过2h患者76例。结果：76例前牙离体脱位超过2h患者离体牙经处理后,均采用复位再植,固定一次性根管充填,术后显效65例,有效5例,失败6例。30min至2h以内离体牙经处理后再植复位再定,术后显效14例,其中牙髓复活4例,有效4例,失败2例。结论：因外力致完整脱位的自体牙经过处理后复位再植一次性根充治疗有明显的临床疗效。脱位牙离体时间长短关系密切、脱位牙在体外的保存方式是影响成败的主要因素。采用复位再植、固定,根管充填,防止牙骨坏死,根尖感染是目前牙离体再植较理想的术式之一。     

40颗再植牙的临床疗效分析

近年来 ,牙外伤脱位再植成功报道较多 ,本科临床治疗外伤致牙脱位多年 ,通过再植取得了满意效果 ,现就 1993～1996年本科门诊收治的 32例 (4 0颗牙 )脱位上切牙行再植术后疗效报道如下。材料和方法1 临床资料　本组 32例 ,再植牙 40颗 ;男性 14例 (2 0颗 ) ,女性 18例 (2 0颗 ) ;年龄 :8～ 39岁 (平均年龄 12 .7岁 ) ;牙脱位时间 :从 1小时以内至 33小时 ;脱位牙均为上切牙 ,且均为离体脱位 ,其中 1例伴牙槽骨骨折 (2颗 ) ,1例 39岁(其脱位时间 2小时 ) ;脱位原因主要是跌倒、碰撞所致。随访时间 1～ 3年。2 再植方法及结果判断(1)再植方法…     

外伤性脱位前牙再植成功相关因素分析

目的　对影响牙再植成功的各种因素进行分析、讨论 ,以找出规律指导临床。方法　常规处理脱位牙后复位固定 ,随访观察。结果　再植成功率 6 5 .2 2 % (4 5 / 6 9)。年龄因素、口外期长短、牙髓治疗与否、保存方法、对应牙槽骨情况均影响再植成功率。结论　随着年龄增大 ,离体时间延长 ,再植成功率呈下降趋势 ,根尖发育完成 ,牙髓治疗后再植成功率高 ,湿保存方法成功率高 ,脱位牙对应牙槽骨骨折者成功率低     

48例完全脱位牙再植疗效观察

目的:观察外伤后完全脱位牙再植的临床疗效。方法:对2006年以来到我科就诊的48例52个完全脱位牙,经常规处理后再植复位固定,随访观察2~3年。结果:52个脱位牙再植后经2年以上复查,成功48个,失败4个,成功率92%,离体时间2 h内再植成功率高于2 h后(P<0.05),湿保存较干保存再植成功率高(P<0.05),离体时间越短牙周膜愈合情况越好(P<0.05)。结论:离体时间短、合适的保存介质、牙根面良好的牙周膜活性是完全脱位牙再植成功的重要因素。     

外伤全脱位年轻恒牙再植的临床研究

目的：观察不同离体时间的年轻恒牙再植后的成功率。方法：详细记录60颗全脱位牙离体时间、手术及牙愈合情况，对患者进行1～2年的随访。结果：60颗脱位牙（离体时间为15min～16h）再植后牙周膜愈合26颗（43．3％），其中牙髓成活19颗（31．67％）；骨性愈合31颗（51．67％）；纤维愈合3颗。术后对38颗牙进行了根管治疗。结论：缩短脱位牙的离体时间、尽可能保存牙周膜的活性等是再植成功的重要因素。     

全牙列垫固定脱位再植牙的临床观察与分析

研究显示,有近35%的牙脱位发生在9岁以前,需及时复位并固定治疗。我们通过对15名患儿的17个外伤脱位牙再植进行临床观察,分析脱位牙应用全牙列牙合垫固定时间及其影响因素。1临床资料和方法1.1临床资料2000—2005年在济南市口腔医院儿童口腔科就诊的15名患儿17个脱位牙,8～13岁16个,19岁1个。其中根尖未发育完成7个。离体时间超过2h6个,2h以内11个。1.2方法1.2.1术前脱位牙处理用无菌生理盐水将脱位牙冲洗干净,脱位离体2h以内者再植前不做根管治疗,清洗后放入生理盐水中保存备用;超过2h者刮除根面残留的牙周膜,去髓并行氢氧化钙暂时充填。1.…     

12例牙根未发育成熟全脱位恒牙再植后疗效评价

目的研究保存牙髓对牙根未发育成熟的全脱位恒牙再植预后的影响。方法选择因外伤来院就诊的全脱位恒牙26颗,干燥保存,离体时间在1h～2h之间。试验组为13颗根尖孔未闭合的年轻恒牙,使用生理盐水冲洗完全脱位牙及牙槽窝,局麻下复位,树脂夹板固定,调(?),2周后拆除固定装置。对照组为13颗根尖已经闭合的恒牙,复位固定一周后进行常规牙髓治疗,Vitapex糊剂充填。6个月后更换一次糊剂。所有病例每三个月拍摄牙片,观察评价牙根吸收程度。随访18个月后。根据牙根是否发生炎症性吸收评价治疗是否成功。采用SPSS13.0软件包对数据进行统计学分析。结果再植后18个月,实验组成功率为46.2%,对照组成功率为84.6%,两组差异具有统计学意义(P<0.05)。结论对于保存条件差,离体时间长的根尖未闭合全脱位恒牙,建议复位固定一周后应采用常规牙髓治疗,充填Vitapex糊剂,以减轻髓腔内及根尖区炎症反应,促进牙本质桥形成,诱导根尖发育。     

外伤脱位离体牙再植23例成功

作者二十多年来对所遇到的 9例患者 ,2 3颗上前牙外伤性脱位离体 ,及时予以再植术 ,并取得满意远期效果。1　临床材料9例患者 ,男 7例 ,女 2例 ,年龄 9～ 33岁 ,均为牙体完整 ,无断根的上前牙 ,脱落原因主要是跌摔伤 ,拳击伤 ,离体时间 1 :30～ 1 5小时 (指牙脱位离体距就诊时间 )。2　手术方法2 .1　牙体处理情况 :对根尖发育尚未完成 ,牙根表面有轻度污染 ,牙周膜完好的脱落牙 ,就诊在 8小时之内者 ,将脱位离体牙置入 0 .9%生理盐水中浸泡6min后取出 ,清除牙根表面污物 ,尽力保存残余牙周膜纤维 ,然后将处理完毕的离体牙继续浸泡 0 .9%盐…     

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目的探讨外伤脱位牙即刻再植的临床疗效及其影响因素。方法选择1993年10月至2005年10月于江西省萍乡市人民医院和广东工业大学医院口腔科就诊的外伤脱位牙患者46例60颗牙进行即刻再植,术后随访观察5年。结果再植牙术后5年成功率为75%,累计有11例15颗再植牙失败,失败原因主要为术后牙根吸收大于根长1/3(占60%)、继发感染(占26.7%)、固定不牢靠(占13.3%)。离体时间<30 min再植牙的牙髓成活率和牙周膜愈合率均高于离体时间>30 min的再植牙,差异有统计学意义(P<0.01)。结论即刻再植外伤脱位牙经适当的临床治疗仍可保留多年,再植成功的关键是严格选择适应证、正确选择离体牙储存介质、尽快植入缩短牙离体时间、尽可能保存牙周膜活性、牢靠的固定结合功能运动和及时有效防治感染。     

牙脱位再植的临床分析

目的对牙脱位后再植的时间、储存介质及牙髓处理进行临床分析并探讨手术成功的影响因素。方法将脱位牙立即用生理盐水冲洗,置于0.25%氯霉素溶液中浸泡5min备用。常规局麻下清创,尽可能保存牙槽窝内的牙周膜,用生理盐水反复冲洗,最后用0.25%氯霉素溶液冲洗,轻刮牙槽窝使之充满血液,将离体牙按牙脱位方向植入并固定。结果随访3年,87例共98颗牙齿成功93颗,成功率94.9%。结论牙脱位特别是离体牙再植手术越早成功率越高。离体牙切忌干放,最好含在嘴里或放在牛奶中就诊。未出现严重牙周组织炎症时,尽可能保存活髓。     

Contemporary endodontic retreatments: an analysis based on clinical treatment findings

A prospective in vivo investigation was conducted to determine radiographic and clinical factors associated with contemporary nonsurgical endodontic retreatments. Approximately 1,100 failing endodontically treated teeth were screened to determine an appropriate treatment plan. Using magnification, 337 consecutive retreatment cases were evaluated and treated. The vast majority of the retreated cases involved multiple factors. Eighty-five percent of the cases presented with periradicular radiolucencies. Sixty-five percent of the cases demonstrated poor radiographic obturation quality. Associated pain was noted 51% of the time. Forty-two percent of the teeth had untreated canal space. It was statistically significant (Chi-square, p < or = 0.05) that additional canal space was located and treated in 89% of the cases that had previous radiographic asymmetrical obturations. Evidence of coronal leakage was noted in 13% of the retreated teeth. Tooth number, obturation materials, overfills, and previous surgical retrofillings were also recorded. Recommendations were made that might improve the rate of clinical success.     

Prognosis of permanent teeth with internal resorption: a clinical review

Abstract This study was performed in order to report the clinical features of internal resorption cases and evaluate their prognosis after endodontic treatment. Twenty-seven patients with 28 teeth with internal resorption were referred to our clinic and 20 teeth were treated endodontically. Sixteen teeth had non-perforating internal resorption and were treated by conventional root canal therapy. The remaining 4 teeth had perforating internal resorption and were initially treated by remineralization therapy with calcium hydroxide. The teeth treated by conventional root canal therapy showed clinical and radiographic evidence of healing. However, the remineralization therapy was successful in only one case. The three failed cases were subsequently treated by endodontic surgery. The surgical therapy was unsuccessful in one case due to extensive loss of marginal alveolar bone and increased tooth mobility.     

外科与正畸联合治疗埋伏阻生上颌前牙

目的探讨埋伏阻生上颌前牙获得良好的牙龈形态的有效治疗方法。方法对18例上颌前牙骨内埋伏阻生的正畸患者，采用根尖向粘骨膜瓣暴露法与固定矫治器以轻力牵引进行治疗。结果18例患者的埋伏阻生牙均被引入正常牙列，其牙龈形态与邻牙一致且术后无并发症。结论采用外科与正畸联合治疗骨内埋伏阻生上颌前牙可以获得满意的治疗效果。     

拔牙导致上颌窦瘘22例报告

目的 :探讨拔牙导致上颌窦瘘的原因、治疗方法及预防措施。方法 :收集 1994-2 0 0 2年间我科门诊拔牙导致上颌窦瘘病例 2 2例 ,进行回顾性分析。结果 :2 2例中 ,拔除上颌埋伏尖牙 4例 ,拔除上颌第一磨牙 8例 ,拔除上颌第二磨牙 4例 ,拔除上颌第三磨牙 5例 ,拔除上颌第二前磨牙 1例。术后即时发现者 2 0例 ,立即进行了保守治疗 ,其中 17例处理后瘘口 1周左右愈合 ,3例换药后行瓦合瓣修复。另外 2例于术后发现 ,1例换药后瘘口愈合 ,1例行瓦合瓣修复。保守治疗有效率 90 %。结论 :拔除上颌后牙及埋伏尖牙 ,均可能出现上颌窦瘘 ,正确及时的保守治疗多数可以一期愈合。     

滑动直丝弓矫治技术在术前术后正畸中的应用

目的　对利用滑动直丝弓矫治器进行术前术后正畸治疗的牙颌面畸形病例进行疗效分析 ,供临床工作参考。方法　牙颌面畸形患者 5 1例 ,男 16例 ,女 35例 ,年龄最大者 34岁 4个月 ,最小15岁 ,平均 18岁 9个月。所有患者均来自北京大学口腔医学院正畸与正颌外科联合门诊 ,均进行系统的术前术后正畸治疗和正颌外科手术。结果　患者中拔牙病例 18例 ,非拔牙病例 33例。平均术前正畸时间 13 3个月 ,术后正畸时间 10 4个月。全部疗程时间为 2 5 5个月。结论　直丝弓矫治器预制了牙齿冠舌腭向与近远中倾斜度 ,在术前术后正畸时利用平直方弓丝即可达到对牙齿在三维方向的有效控制 ,因而取得良好的矫治效果     

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。     

含牙囊肿囊内埋伏牙的正畸治疗

目的:探讨及评估含牙囊肿囊内埋伏牙的正畸治疗方法及效果。方法:对9颗含牙囊肿内埋伏牙以固定矫治器结合外科开窗、囊肿刮除,正畸牵引导萌进行治疗。结果:所有病例X线片示囊腔消失,腔内骨组织再生,病变的囊性组织为正常骨组织所代替;埋伏牙被引导至正常的位置,牙根发育正常;牙列排齐、后牙尖窝关系良好和覆盖覆牙合正常。完成时间为14～36月,平均为21.25月。结论:外科开窗、囊肿刮除结合正畸牵引治疗含牙囊肿可消除囊腔,促进正常牙槽骨的再生和有助囊内埋伏阻生牙的萌出排齐。     

Tooth loss in 1535 treated periodontal patients

Of 1535 treated recall patients surveyed over an average time of 12.9 years since treatment was completed, 1371 had lost no teeth from periodontal disease. The total number of teeth lost was 444, with the average tooth loss for the 1535 patients being 0.29. In the three full arch splinted cases, the loss rate was 14.67 teeth per patient. Patients treated without any excisional or flap surgical procedures made up 26.5% of those surveyed, whereas 73.5% had required various surgical procedures. No attempt was made to compare different pocket therapy procedures. Although many patients developed recurrent periodontal problems during recall, only 15.9% of the 1535 patients required surgical retreatment. Teeth that were originally given a doubtful prognosis often were responsible for recurrent problems and sometimes required extraction.     

Longitudinal clinical and radiographic evaluation of severely intruded permanent incisors in a pediatric population

Abstract – Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7–14 years and 8 months). Mean time elapsed to follow‐up was 26.6 months (range 10–51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre‐injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post‐injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root resorption after intrusive luxation, but the existence of additional injuries and the stage of root development influenced the clinical case outcome in a negative and positive manner, respectively.     

单侧完全性唇腭裂患者牙槽植骨后前牙牵引助萌矫治效果评价

目的 观察单侧完全性唇腭裂患者牙槽突裂植骨术后,阻生前牙牵引助萌效果,并分析其成败原因。方法 选取2002—2012年大连大学附属口腔医院 大连市口腔医院诊治的8例二期植骨成功的替牙期单侧完全性唇腭裂伴牙槽突裂患者,其中男5例,女3例,年龄（10.5 ± 2.6）岁。均有尖牙或侧切牙阻萌,其中侧切牙阻萌2例、尖牙阻萌6例。采用直丝弓矫治技术,在牙列排齐整平并开大阻生前牙间隙后与外科配合进行闭合式牵引助萌,同时进行矫治结果分析。结果 6例牵引成功,平均疗程（22.5 ± 4.5）个月,牵引时间（从手术开窗到牙齿破龈）平均（6.5 ± 3.5）个月;牵引到位的牙齿与邻牙邻接关系良好,牙合关系稳定,但与对侧正常萌出前牙相比,牙龈形态略不同。其余2例（1例阻生侧切牙、1例阻生尖牙）牵引失败。结论 对于唇腭裂伴牙槽嵴裂植骨术后出现前牙阻萌患者,应在矫治中及时进行牵引助萌。植骨时间、成功率、阻生尖牙萌出角度及与邻牙关系、助萌手术对阻生牙影响等均直接关系到牵引助萌的成败。