Beagle犬纵折后牙粘接再植的组织学观察

目的:研究口外粘接再植法治疗纵折后牙的术后疗效和组织愈合.方法:Beagle犬前磨牙完全纵折后,Super Bond C&B粘接剂粘接两断面,植入牙槽窝,组织病理学观察预后.结果:Beagle犬纵折后牙粘接再植术8周后,牙周骨粘连(占55.65%)多于牙周膜愈合(占36.01%),炎性吸收仅占8.33%.结论:口外粘接再植法即时治疗犬纵折后牙,术后有良好的组织愈合.     

2种牙周愈合方式下纵折牙黏结修复的抗疲劳强度体外研究

目的比较纵折牙拔牙黏结再植后2种牙周愈合方式下,纵折牙黏结修复后的抗疲劳强度.方法用硅橡胶和环氧树脂模拟牙周膜和牙槽骨,建立纵折牙黏结再植后的生物力学模型.按牙周愈合方式分为牙周膜愈合组(PLH)和骨黏连愈合组(OIH).振动和动态测试系统进行循环疲劳加载,比较2组样本黏结面断裂时加载次数,对疲劳试验结果进行单因素方差分析,并与黏结面积进行相关性分析.结果加载到一定时间后,2组样本均发生黏结面断裂,PLH组加载次数为155 980±22 995,显著高于OIH组28 080±13 578(P＜0.05).2组样本的加载次数与黏结面积间均有正相关性.结论纵折牙拔牙黏结后再植,牙周膜愈合者抗疲劳强度要高于骨黏连者;黏结面积越大,强度也越大.     

两种方法保留纵折后牙的临床初步研究

目的：比较口内直接粘结法和口外粘结再植法治疗纵折后牙的临床疗效.方法：将符合适应症的纵折后牙随机纳入口内直接粘结组（口内组）和口外粘结再植组（口外组）,口内组患牙超强粘结后直接冠修复,口外组拔除折裂牙后在体外粘结,再植入牙槽窝,术后2周进行全冠修复.术后6月、12月复查,根据临床表现、牙周状况分级,并进行统计分析.结果：6个月随访结果表明,两种方法的半年成功率没有显著差异（P＞0.05）.1年随访结果显示,口外法成功率较口内法高（p＜0.05）.结论：口内直接粘结法和口外粘结再植法是目前临床常见的保存纵折后牙的两种方法,口外粘结再植法的远期疗效可能好于口内粘结法.     

Beagle犬后牙完全性纵折粘结再植的实验研究

目的：探讨建立Beagle犬后牙完全性纵折口外粘结再植模型方法。方法：选取32颗Beagle犬前磨牙,劈裂牙冠后完整拔出,体外完成根管治疗,Super Bond C＆B粘结剂粘结两纵折片,植入牙槽窝,Ribbond弹力纤维固定实验牙。通过大体检查和X线放射检查观察实验牙8周。结果：劈冠后拔牙口外粘结再植成功率为71.9%。结论：Beagle犬前磨牙可作为建立后牙完全性纵折口外粘结再植的动物模型。     

纵折后牙粘结再植术的初步观察

目的评价纵折后牙粘结再植术的愈合情况。方法将49例患者51颗纵折后牙完整拔出,体外行根管治疗,采用Super-BondC&B粘结系统粘结折裂牙体,调牙合,再植入牙槽窝,术后2～6个月行全冠修复。结果术后6个月复查,磨牙组、前磨牙组牙活动度较术前显著下降(P<0.05),但各组X线片骨吸收水平无统计学差异。49例患者治疗后18个月随访结果,再植牙保存率90.2%。结论纵折后牙粘结近期疗效满意,远期疗效还有待进一步观察。     

不同粘结剂对纵折牙根粘结后再植的疗效观察

目的：通过2种粘结剂处理纵折牙根进行粘结后再植术，了解不同黏结剂对后牙纵折愈合类型的影响。方法：3只Beagle犬的前磨牙48个牙根，分成3组，分别用Clearfil SE Bond（CE组，n=18）和SuperBond C＆B（SE组，n=18）进行粘结后再植，与正常牙根再植组（CC组，n=12）进行对照。术后16周处死动物，采集牙根一牙槽骨标本，按照”8等分法”和Andreasen愈合标准，记录各位点组织愈合情况，按有利愈合和不利愈合分类量化各组组织学愈合类型，并对各组牙根余留半径长按照0-4级评分，比较有效愈合率和余留牙根半径。结果：CE、SE、CC三组有效愈合率分别为：51％、31％、59％。余留半径评分分别为：3．38、2．47、3．59。CE组比SE组更能有效促进纵折牙根的愈合。结论：Clearfil SE Bond AP-x粘结系统能有效降低炎症性吸收和置换性吸收的发生率，提高后牙纵折粘结后再植术的手术成功率。     

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目的：评价微创与传统拔牙法拔除下颌阻生第三磨牙的术后愈合情况,进一步验证微创拔牙法的优越性。方法选取2010年9月至2012年10月在佛山市禅城区向阳医院·禅城区口腔医院就诊,且需要拔除中位、前倾阻生下颌第三磨牙的男性患者100例,随机分为试验组和对照组（各50例）。试验组采用微创拔牙法,对照组采用传统拔牙法。比较2组患者术后发生水肿、疼痛、张口受限等情况的差异,并记录2组患者牙槽窝骨愈合过程中的骨密度曲线图。结果试验组患者术后水肿、疼痛的发生率低于对照组（P〈0.05）,试验组患者术后第4、8、12周的牙槽窝骨密度变化值明显高于对照组患者（P〈0.01）,两组差异有统计学意义。两组患者张口受限发生率比较,差异无统计学意义（P〉0.05）。结论微创拔牙术有利于牙槽窝的愈合,值得临床推广应用。     

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。     

微创与传统拔牙法拔除下颌阻生第三磨牙术后愈合情况比较研究

目的 评价微创与传统拔牙法拔除下颌阻生第三磨牙的术后愈合情况,进一步验证微创拔牙法的优越性。方法 选取2010年9月至2012年10月在佛山市禅城区向阳医院·禅城区口腔医院就诊,且需要拔除中位、前倾阻生下颌第三磨牙的男性患者100例,随机分为试验组和对照组（各50例）。试验组采用微创拔牙法,对照组采用传统拔牙法。比较2组患者术后发生水肿、疼痛、张口受限等情况的差异,并记录2组患者牙槽窝骨愈合过程中的骨密度曲线图。结果 试验组患者术后水肿、疼痛的发生率低于对照组（P < 0.05）,试验组患者术后第4、8、12周的牙槽窝骨密度变化值明显高于对照组患者（P < 0.01）,两组差异有统计学意义。两组患者张口受限发生率比较,差异无统计学意义（P > 0.05）。结论 微创拔牙术有利于牙槽窝的愈合,值得临床推广应用。     

高速涡轮牙钻辅助拔除下颌智齿后伤口愈合情况的研究

目的：了解高速牙钻法拔3除下颌智齿后拔牙创的愈合状况。方法：210例下颌需拔除的智齿,随机分成2组,分别用高速牙钻和牙凿辅助去除阻力,观察比较拔牙创愈合情况。结果：牙钻组拔牙后并发症明显少于骨凿组（P＜0．05）,同一个体使用不同方法拔除智齿后牙槽窝伤人微生物状态无明显差异,牙槽窝骨密度恢复早期有差异,但长期无明显差异,结论：高速牙钻法辅助拔除智齿后伤口愈合状况优于骨凿法。     

Prognosis of intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin

There is no particular treatment established to preserve vertically fractured teeth. We evaluated the long-term prognosis of the intentional replantation of 26 vertically fractured roots after reconstruction with 4-META/MMA-TBB dentin-bonded resin. Replanted teeth were evaluated according to clinical criteria and radiographic examinations for periods ranging from 4 to 76 months. Eighteen cases were functional and retained, with six fully successful; the others needed further observation. Eight cases failed to respond to treatment because of refracture, recurrence of gingival inflammation, or both. Longevity was calculated as 88.5% at 12 months after replantation, 69.2% at 36 months, and 59.3% at 60 months. All failures occurred in premolar and molar teeth. Longitudinal fractures extending more than 2/3 from the cervical portion toward the apex showed significantly shorter longevity compared with fractures within the 2/3 area (log-rank test, p = 0.02). Intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin may be considered for incisors as an alternative to extraction, although the long-term success is not optimal.     

The effect of systemic tetracycline on resorption of dried replanted dogs' teeth

Abstract— The use of systemic penicillin after an avulsion injury has been recommended to decrease the occurrence of resorption complications. Tetracycline antibiotics have been reported to possess anti-resorptive propemes in addition to their anti-microbial actions. The purpose of this study was to evaluate histologically the effect of systemically administered tetracycline and amoxicillin on the inhibition of resorption due to attachment damage after replantation of dogs' teeth. Thuty-one roots from the teeth of four beagle dogs were endodontically treated to inhibit subsequent inflammatory root resorption of pulpal origin. They were then extracted and left to bench dry for 1 h to ensure severe periodontal ligament damage before replantation. For the teeth in the experimental groups, two dogs were given tetracycline hydrochloride and the other two dogs were given amoxicillin, administered orally, on the day of extraction/replantation and for the following 6 days.
The control group were teeth in these animals treated in the same manner but where no antibiotics had been given. After 12–16 weeks, the dogs were sacrificed and histological sections were prepared and evaluated for complete healing, inflammatory and replacement root resorption, and the groups were compared. It was shown that healing in the amoxicillin and the control groups was poor (10.90% and 11.28%, respectively), while for the tetracycline group, 35.45% showed complete healing. Individual teeth with over 50% complete healing sites were considered as having good healing, and sigdicantly more of these teeth were found in the tetracycline group (5 of 11 teeth) compared to the amoxicillin (1 of 11 teeth) or control group (1 of 8 teeth).     

高压氧用于年轻恒牙再植术的临床研究

目的 探讨年轻恒牙脱位再植后，高压氧（ｈｙｐｅｒｂａｒｉｃ ｏｘｙｇｅｎ，ＨＢＯ）治疗对牙髓牙周损伤修复的作用。方法 对６９例年轻恒前牙脱位患者的１３８颗患牙行再植术，术后分为ＨＢＯ组和对照组，ＨＢＯ组给予ＨＢＯ治疗１０ｄ，对照组不给予ＨＢＯ治疗，进行对照。结果 ＨＢＯ组和对照组的牙再植总成功率分别为９７．２６％和７０．７７％，二者差异有显著性（Ｐ〈０．０５）；１年后失牙情况；ＨＢＯ组１颗（１．３     

完全脱位牙即刻与延迟再植根吸收的动态观察

目的：动态观察实验大鼠再植牙牙根吸收及愈合过程,辅助临床治疗及预防再植牙牙根吸收。方法：30只6周龄SPF级Wistar雄性大鼠,分为6组,每组5只,其中一组为空白对照组。实验组大鼠双侧上颌第一磨牙脱位后再植,每只大鼠随机选取一侧脱位牙齿即刻再植,对侧同名牙则于体外干燥保存30min后再植回牙槽窝。分别于术后1、3、7、14、21d处死,分离上颌骨,拍摄x线片,应用IPP软件测量上颌第一磨牙近中根根周透影面积。标本脱钙后制作切片、HE染色,进行组织学观察。结果：再植牙根尖周透影面积随时间延长而增大,干燥组表现尤其明显;组织学上表现为初期炎症反应较明显,随着炎症发展,牙根表面吸收陷窝逐渐增多、增大,后期即刻组牙髓及牙周膜修复反应明显,干燥组牙槽骨修复反应强烈,牙根、牙周膜逐渐被类骨质样组织替代。结论：再植牙初期以炎症反应为主,后期主要表现为修复反应,即刻与延迟再植导致牙周膜细胞活性不同决定了再植牙根吸收的进展。     

DELAYED TOOTH REPLANTATION AFTER ROOT SURFACE TREATMENT WITH SODIUM HYPOCHLORITE AND SODIUM FLUORIDE: HISTOMORPHOMETRIC ANALYSIS IN RATS

In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8), had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin-embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn''s tests. The results showed that root structure and cementum extension were more affected by resorption in group III (p<0.05). All groups were affected by root resorption but the treatment performed in group III was the least effective for its control. The treatment accomplished in groups I and II yielded similar results to each other.     

折裂磨牙的分类及拔除方法探讨

目的:探讨折裂磨牙的分类及手术拔除方法。方法:统计分析486例折裂磨牙的折裂类型,在拔除方法上随机分为实验组和对照组,实验组386例先用牛角钳拔,对照组100例先用磨牙钳拔。对牙钳夹碎牙冠后的残留部分,先分根再分别挺出;对残留的牙根分别采用普通牙挺或根尖挺、三角挺挺出;对于残留牙槽窝内位置较深的断根,采用根尖挺或翻瓣去骨的办法拔除,统计各种方法拔除牙的数量。应用SPSS13.0软件包对数据进行多元方差分析。结果:上颌磨牙以纵折为主,下颌磨牙以斜折为主。上颌第一磨牙用牛角钳和磨牙钳完全拔除率分别是35%(50/143)和12.5%(8/40),差异有显著性(P=0.041);上颌第二磨牙用牛角钳和磨牙钳完全拔除率分别是40%(30/75)和23.5%(4/17),差异有显著性(P=0.016);下颌第一磨牙用牛角钳和磨牙钳完全拔除率分别是37.5%(45/120)和21.4%(6/28),差异具有显著性(P=0.004);下颌第二磨牙用牛角钳和磨牙钳完全拔除率分别是48%(23/48)和20%(3/15),差异无显著性(P=0.662)。结论:对于折裂磨牙的拔除,应首选牛角钳,约40%的牙可以完整拔除,70%以上的牙可以不同程度地拔除,然后再选用牙挺或三角挺拔除残留牙根;对个别残留较深的断根,采用根尖挺或翻瓣去骨法拔除。按此流程操作,可以快速拔除折裂牙,减少创伤,减少手术时间,减轻患者痛苦。     

The effect of Emdogain gel on periodontal healing in replanted monkeys' teeth

OBJECTIVE: We sought to histologically evaluate the effect of Emdogain gel on periodontal healing in monkeys' teeth undergoing delayed replantation.Study design Mature monkey teeth simulating avulsion were endodontically treated before extraction. Negative control teeth (group N = 10 roots) underwent immediate replantation, whereas the rest were bench-dried for 1 hour and treated in one of the following ways before replantation: the positive control teeth (group P = 12 roots) had no further treatment; group C teeth (4 roots) had the periodontal ligament removed; group D teeth (10 roots) were treated with Emdogain gel; group E teeth (6 roots) had the periodontal ligament removed before the application of Emdogain gel; and group F teeth (7 roots) had the periodontal ligament removed, the root surface conditioned, and Emdogain gel applied. Periodontal healing was evaluated after 16 weeks by undertaking histomorphometric analysis. RESULTS: The Kruskal-Wallis and Mann-Whitney U tests revealed that group N teeth had a statistically higher occurrence of complete healing than did all other groups, whereas group P was not significantly different in any of the healing categories from D, E, and F, the groups in which Emdogain gel was used. Group C teeth had a significantly higher occurrence of replacement root resorption than did the teeth in groups P and F-but were not significantly different from teeth in groups D and E. CONCLUSION: Emdogain gel did not appear to significantly reduce replacement resorption in monkeys' teeth that had undergone delayed replantation.     

Intentional Replantation with an Atraumatic Extraction System in Teeth with Extensive Cervical Resorption

External cervical resorption (ECR) often renders a tooth nonrestorable, especially if it extends deeply within the dental hard tissue. Intentional replantation is sometimes performed as the last resort to save the tooth but may limit conventional forceps extraction because of the high risk of periodontal ligament cell damage or crown fracture.This case report describes the intentional replantation of an upper central incisor with extensive ECR using an axial, atraumatic extraction system to save the otherwise hopeless tooth. The patient was an asymptomatic 37-year-old man with no contributing medical history. The treatment protocol included atraumatic extraction followed by granulation tissue removal, extraoral root canal treatment, and adhesive restoration of the extensive resorption defect. During extraoral manipulation, the utmost care was taken to prevent root surface drying, contamination with dental adhesive, or heat-induced periodontal ligament damage during curing. Two and a half years after replantation, clinical and radiographic examinations revealed normal healing and no symptoms but a slight reduction of bone level compared with the preoperative level and no signs of root resorption or ankylosis. The successful outcome in this case supports the idea of performing intentional replantation with an atraumatic extraction system to save teeth with extensive cervical root resorption and a high risk of fracture during extraction.     

Effect of different endodontic treatment protocols on periodontal repair and root resorption of replanted dog teeth.

This study examined, histologically, the healing of intentionally damaged root surfaces of replanted teeth with either uninfected or infected root canals treated with short- and long-term calcium hydroxide. Thirty beagle dog incisors were randomly divided into four groups. In group 1, uninfected obturated incisors were extracted, the roots were longitudinally grooved and the teeth were replanted within 2 min. In group 2 the root canals were artificially infected followed by extraction, longitudinal grooving, and replantation as described in group 1. Fourteen days after replantation, the root canals were fully instrumented and medicated with intracanal calcium hydroxide. One week later the root canals were permanently obturated with gutta-percha and sealer. The teeth in group 3 were treated as described in group 2 but after 1 wk the calcium hydroxide dressing was repacked for the duration of the study. In group 4 (positive control) the teeth were treated as described in groups 2 and 3 but no endodontic treatment was performed. After 8 wk, sacrifice and histological preparation were carried out. In group 1 complete cemental repair was seen in all teeth. In groups 2 and 3, complete and incomplete cemental repair was seen in seven and two teeth, respectively. An ankylotic area was present in one tooth in group 3. None of the teeth in group 4 showed cemental repair. It was concluded that short- and long-term calcium hydroxide treatment resulted in similar healing patterns when endodontic treatment is initiated 14 days after replantation of teeth.