年轻恒牙完全脱位再植后疗效分析

目的：评价年轻恒牙完全脱位再植后的愈合方式,对不同发育阶段年轻恒牙再植术后的疗效进行总结,为更好保留患牙的美观与功能提供参考。方法回顾分析30颗完全脱位年轻恒前牙,根据国际牙外伤协会治疗指南进行治疗。评价再植后年轻恒牙牙周组织愈合方式,分为牙周膜愈合、表面吸收愈合、替代性吸收（骨粘连）、炎性吸收。结果30颗完全脱位的年轻恒牙再植后,其中7颗为牙周膜愈合,占23.3%;1颗为表面吸收愈合,占3.3％;13颗为替代性吸收,占43.3%;9颗为炎性吸收,占30.0％。结论年轻恒牙发生完全脱位,再植后愈合方式受多种因素影响。当出现不良的愈合方式限制颌面部发育时,一定要及时干预,减少患者生理和心理的创伤。     

年轻恒牙脱位再植后髓腔完全钙化1例报告

患儿，男，8岁，因不慎撞伤左上前牙2h来佛山市口腔医院口腔综合就诊。检查：完全脱位，┴1完全脱位，牙冠完整，牙根仅形成1/2，呈喇叭状，根尖处充满牙髓组织，牙槽窝内有血块，牙龈无撕裂，牙槽骨无骨折；     

全脱出恒牙再植预后临床研究进展

牙齿全脱出（tooth avulsion）是指牙齿受外力从牙槽窝中脱出,牙髓和牙周膜同时损伤,牙槽窝空虚或伴有牙槽骨骨折。全脱出是牙齿常见创伤类型之一,发生率约为0.5% ~ 16%,多发于7 ~ 14岁儿童,以上颌中切牙最常见。牙齿全脱出后,再植是目前临床最常用且首选的治疗方式。再植的牙齿预后受多种因素影响,如脱位牙的牙根发育情况、离体干燥时间等。全脱出牙的牙髓及牙周预后情况复杂多样,现将全脱出牙预后及相关影响因素做一综述。     

年轻恒牙外伤性脱位的治疗体会

目的　评价外伤脱位年轻恒牙再植的疗效 ,探讨牙再植的方法。方法　按照常规的牙再植术标准步骤 ,对 2 1例脱位的年轻恒牙进行再植。结果　随访 1年 ,再植牙无松动 ,牙龈健康 ,牙槽骨轻度吸收 ,19颗牙牙根继续形成。结论　年轻恒牙再植存活率很高 ,及时就诊 ,妥善处理脱位牙是再植成功的关键。     

影响再植牙预后的相关因素分析

目的 分析再植牙根吸收的发生率、发生时间、牙齿在口腔内的保留时间及其影响因素。方法 对1988～2002年在北京大学口腔医院儿童口腔科就诊的59名患儿的68颗延期再植恒牙进行1～15年的临床回顾性分析。结果 再植牙根吸收的发生率为71％；根吸收最常发生在外伤后3～6个月；年龄越大，越早发生根吸收；钙离子导入能延长再植牙在口腔内的保留时间；延期再植牙的脱出时间对其在口腔内的保留时间长短影响较小。结论 延期再植牙经适当的临床治疗，仍可在口腔内保留数年。     

2015年南京市353例年轻恒牙外伤的临床分析

［摘要］目的 探讨学龄儿童年轻恒牙外伤的临床特点,更好地维护口腔健康。方法 对2015年1月至12月期间在南京医科大学附属口腔医院儿童口腔科就诊的353例5~12岁学龄儿童年轻恒牙外伤病例的年龄、性别、外伤后就诊时间、外伤牙位、外伤类型及Nolla分期进行回顾性分析,总结其临床特点。 结果 男女比例为2.33∶1;12月份最高发;7～9岁为高发年龄;多在外伤后2~24 h就诊;上颌中切牙最多见;釉质-牙本质折断及亚脱位最多;硬组织损伤中以Nolla 9期最常见。 结论 年轻恒牙外伤有其独有的特点,应加强牙外伤的预防保健宣传,提高公众的就诊意识。     

40颗外伤脱落前牙再植的临床观察

前牙外伤脱落在口腔科门、急诊中多见,抓住时机进行再植多能使脱位牙获得再生。本科自１９９３～１９９６年共完成４０颗外伤完全脱位前牙的再植,追踪３～６年,效果满意,现报道如下。资料和方法一、临床资料：１．性别和年龄：本组４０颗外伤脱落牙,男２４人共３０颗...     

年轻恒牙的外伤治疗

在许多国家,牙外伤已经严重影响着青少年的口腔健康,外伤所累及的年轻恒牙在形态和结构上尚未完全发育成熟,根尖孔开放,髓腔宽大,根管壁薄。当年轻恒牙发生冠折和脱位性损伤时,治疗方法的选择对其预后显得尤为重要。年轻恒牙的牙本质小管比成熟恒牙的粗大,外伤冠折累及牙本质时,细菌容易进入牙本质小管感染牙髓;牙本质长期暴露,可造成牙髓坏死和牙冠变色。年轻恒牙外伤后应尽量保存暴露的活髓,选择氢氧化钙行盖髓术或活髓切断术;年轻恒牙即便发生牙髓坏死,也应选择根尖诱导形成术,促进牙根继续发育完成。     

儿童50 颗恒牙再植后的回顾性研究

目的:分析再植牙的预后及影响预后的相关因素,观察再植后牙根吸收出现时间及影响因素.方法:对2000～2006 年于北京大学口腔医学院儿童口腔科注册的系统病历中,观察期≥6 个月的全脱位牙再植病历进行回顾性研究,记录患者及再植牙信息.应用卡方检验和生存分析(cox regression)进行统计学分析.结果:符合纳入标准的外伤病历39 份,涉及再植牙50 颗.牙周膜愈合的发生率为18%,牙根吸收发生率为82%,替代性吸收是最常见的牙周组织预后形式(64%).牙根发育情况和保存方式与牙周组织预后具有显著相关性;牙根发育情况、牙髓治疗时机可以影响牙根吸收出现的时间(P<0.05).结论:替代性吸收是再植牙最常见的牙周组织预后形式.再植牙牙根发育情况和保存方式与牙周组织预后具有显著相关性.牙根发育情况、牙髓治疗时机可以影响牙根吸收出现的时间.     

恒前牙外伤性完全脱出再植术的护理及健康教育

本文对2001—04—2004—09我科38例病人（男26例，女12例，年龄10～16岁）41个恒切牙，因外伤完全脱出，进行再植入的护理与健康教育措施小结如下。     

Results after replantation of avulsed permanent teeth. I. Endodontic considerations

Abstract – Following avulsion and replantation, teeth are at risk for infection and infection related resorption (IRR). Severe discolorations of tooth crowns and cervical root fractures are common. This study presents data on endodontic related complications of avulsed teeth replanted following an extraoral endodontic treatment. Periodontal aspects will be discussed in the second part of the present publication. Twenty‐eight permanent teeth in 24 patients aged seven to 17 years were replanted after avulsion. All teeth could be evaluated. In all teeth extraoral endodontic treatment by retrograde insertion of ceramic or titanium posts was performed. Mean observation period was 31.2 months (median: 24.1 months). Nine teeth healed with a functional peridontal ligament (PDL) (functional healing, FH), 19 teeth exhibited replacement resorption (RR), which was succeeded by IRR in three teeth after observation periods of more than 14 months. Diagnosis was set to tunneling resorption (one case) and to cervical resorption preceded by complete RR (two cases). No early IRR was observed. All six teeth rescued in physiologic conditions (cell culture medium of tooth rescue box) exhibited FH. Discolorations of tooth crowns or other complications (cervical root fractures, fractures of posts) were not observed. No differences in the healing results of immature and mature teeth were observed which is in contrast to previous studies. This finding is explained with the different endodontic treatment protocols. Extraoral endodontic treatment by retrograde insertion of posts prevents early IRR and minimizes the overall incidence of IRR. The method does not negatively influence periodontal healing. As there are further advantages (no discoloration, no root fractures, patient not involved, less radiographs, less time consumption, less costs) the method is recommended in isolated teeth before replantation. Especially immature teeth profit from the prevention of complications.     

An investigation of replantation of traumatically avulsed permanent incisor teeth.

The success of treatment of 46 replanted, avulsed permanent incisors in 36 children was investigated in relation to some of the factors which have been reported to affect prognosis. Treatment was considered to have been successful if the tooth was still present in the mouth and required no further treatment. If more treatment was necessary, the outcome was considered to be uncertain, while if the tooth had been lost a failure was recorded. Treatment was considered to be successful for 21 teeth, uncertain for 20 teeth and a failure for 5 teeth. A significant relationship was found between success and the method of storing the avulsed tooth, with milk, saliva or saline being the best media. No relationship was demonstrated between the time the avulsed tooth was out of the mouth and success. Root resorption was the most frequent complication of replantation and occurred in 24 teeth. However, no significant relationship between resorption and the time that the avulsed tooth was out of the mouth was demonstrated.     

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影响牙再植的因素众多,牙再植的成功率并不高。如何改善牙再植的预后一直是儿童牙科临床面临的一大挑战。牙再植的过程一般包括患牙及牙槽窝的处理、惠牙再植和固定。辅助治疗则包括全身性抗生素的应用、局部抗菌措施、破伤风疫苗的强化等。由于牙根发育程度的不同以及惠牙根面牙周膜细胞活性状态的差异等原因,患牙的根面处理及再植后的固定措施有所差异。此外,还需根据患牙牙根发育是否完全、患牙根面是否有活性牙周膜细胞覆盖等对患牙牙髓进行相应的观察或处理。本文拟就这些方面进行简要的介绍。     

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。     

Preserving avulsed teeth for replantation.

We performed a retrospective study of 34 replanted avulsed teeth placed in an EPTS before replantation. Even when extraoral time was 120 minutes or more, 91 percent of the teeth showed excellent or moderate success for follow-up periods ranging from three to 30 months. We think that the success of a replanted avulsed tooth is increased by use of a prefabricated tooth preserving and protecting system as described.