恒牙完全性脱位再植术的临床进展

近几年的文献报道显示,世界各国牙外伤的患病率有逐年上升的趋势。所有恒牙列外伤中,完全脱位性损伤占1%～16%[1]。牙脱位性外伤累及牙髓、牙骨质、牙周膜、牙槽骨和牙龈,关于恒牙完全性脱位治疗、预后等相关问题,临床存在颇多争议。     

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。     

外伤性脱位前牙治疗的临床分析

目的 探讨外伤性脱位前牙临床治疗的效果。方法 对71颗不同类型的脱位牙治疗方法和治疗结果进行综合分析。结果 脱位牙的根管治疗率为70.4%，其中部分脱位牙68.9%，完全脱位牙76.2%。脱位牙的牙根吸收率为45.1%，根管治疗前39.4%，根管治疗后5.7%。结论 根管治疗是脱位牙治疗的重要手段。早期根管治疗可预防或减少脱位牙牙根的吸收。     

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；     

脱位牙的临床处理

近来国外文献在脱位牙再植前处理，固定时间，牙髓治疗时机等方面对传统方法提出了较大改进，本文对此进行了综述。     

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。     

脱位再植牙牙髓不同处理方法对比研究

目的 探讨脱位再植牙牙髓治疗的最佳方法。方法 61例67颗再植牙随机分为四组，A组：术前不做牙髓治疗直接再植，出现牙髓病变时常规根充，B组：术前去髓，根充碘仿氢氧化钙，（Metapaste)半年后常规根充，C组；术前去髓，根充氢氧化钙，半年后常规根充，D组；术前去髓常规根充，结果 当牙脱位时间超过30分钟后，术前牙髓治疗组的疗效显著优于术后牙髓治疗组。术前去髓充入根管过渡性药物氢氧化钙或碘仿氢氧化钙组的疗效显著优于即刻常规根管治疗组，单纯使用氢氧化钙与使用Metapaste做根管过渡性药物，二者间疗效无显著性差异。结论 牙脱位时间大于30分钟后，术前去髓，先充入氢氧化钙类根管过渡性药物，半年后行根充糊剂加牙胶尖永久充填为较理想的牙髓治疗方法。     

外伤完全脱位牙再植术围手术期椅旁护理

目的探讨外伤完全脱位牙再植术围手术期椅旁护理方法,协助医生保存脱位牙,保持牙齿正常功能及牙列完整。方法严格执行无菌原则,协助医生对10例患者20颗外伤脱位牙完成牙槽窝清创术、脱位牙根管治疗术、原位再植术、牙弓夹板固定术及术后随访。术后随访0.5～4.0年。结果10例脱位牙再植术均顺利完成,9例18颗患牙均为骨性愈合,1例2颗再植固定术后未复诊。结论护士应熟练掌握护理配合程序,注重对患者的心理护理,操作中应严格执行无菌操作,传递器械迅速、平稳、准确,避免离体牙再次污染及护理意外。     

氢氧化钙在脱位再植牙牙髓坏死治疗中的应用

目的：观察氢氧化钙（calcium hydroxide,CH)及其制剂作为根管内封药和根管充填糊剂在外伤脱位牙牙髓坏死根管治疗术（root canal therapy,RCT)中的应用效果。方法：对使用不同药物根管内封药和不同根管糊剂充填根管治疗外伤脱位再植牙牙髓坏死的疗效进行对比。结果：CMCP、FC、IPI、CH组根管治疗期间的急症发生率差异非常明显，疼痛指数亦以CH组最低；1年后牙根吸收情况和2年失牙率、牙再植成功率CH组与其它组有非常显著差异。结论：CH可以预防其急症的发生和减少牙根吸收，提高牙再植的成功率。     

恒牙根尖区解剖结构对根管治疗的影响

根管治疗的目的是彻底清除根管内感染物质,并严密充填根管,从而预防或治愈根尖周病变.恒牙根尖区解剖结构复杂,形态多样的根尖孔、弯曲根管、侧副根管等会对根管治疗各步骤产生影响,增加治疗难度,影响治疗效果.本文就恒牙根尖区解剖结构对根管治疗影响的研究进展进行综述.     

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     

Tooth avulsion and replantation — A review

Abstract The major causes of post-replantation tooth loss are inflammatory root resorption and root resorption associated with ankylosis. Recent studies have concentrated on delineating the cellular interactions in the pulp and periodontium in order to more fully understand the various factors affecting the prognoses of such teeth. The aim of this report is to discuss the nature of the pathology responsible for tooth loss following avulsion and to review recent replantation and attachment studies.     

影响老年人前牙外伤性脱位再植成功的相关因素分析

目的:对影响老年人前牙再植成功的各种因素进行分析,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58.4%.离体时间长短、牙周膜创伤程度、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.离体时间延长,牙周膜创伤严重,再植成功率呈下降趋势.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.结论:细心保护脱位牙根面牙周膜、良好固定、预防感染、防止咬合创伤是再植成功的重要因素.     

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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。     

Investigation of the children referred to a dental hospital with avulsed permanent incisor teeth

Abstract The management of children referred to a dental hospital because of avulsed permanent incisor teeth was considered in a retrospective study. The group consisted of 49 children between the ages of 6 and 14 years. Most of the children (60%) had their avulsed teeth stored dry while only 7% had them stored in milk, and 19% in saliva. Following avulsion the majority of the children attended a dental surgeon or general hospital. Twenty-three children contacted health care personnel within 30 minutes but only 13 had their teeth replanted in this time period. Thirty-six children had 46 incisors replanted. No relationship was demonstrated between the place or personnel who replanted the teeth, and a successful outcome.     

Emdogain® does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study

Abstract –  Emdogain^® has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis.
The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain^® could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain^® before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain^®. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain^® was not able to prevent or cure ankylosis.     

Knowledge of first-aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren

Abstract –  The prognosis of replantation of an avulsed tooth is determined by which first-aid measures are taken during the first 15 min after avulsion. Knowledge of the correct first-aid measures is therefore crucial to successful replantation. The aims of this study were (i) to assess the present knowledge level of emergency measures for tooth avulsion in Kuwaiti schoolchildren, and (ii) to design and test an interview form with structured standardized questions. A total of 221 Kuwaiti schoolchildren (aged 7–15 years old) were interviewed by professionals using a standardized method to score several areas of knowledge about tooth avulsion and replantation. Earlier experience of first-aid information and subjection to dental trauma was registered. The following fields of knowledge were assessed: general body injury treatment principles, tooth avulsion and replantation principles, avulsed permanent/primary teeth, cleaning of avulsed tooth before replantation, extra alveolar time and storage media. The form for interviewing children proved to be sufficiently structured in performing the interviews and data management. The results of the interviews showed that 30.3% of the children had been exposed to dental trauma in the past. Among children 7–9 years of age, 25% had received information on general first aid as compared with 75% in children 10 years and older. Children 10 years and older, in general, had a high knowledge level of general principles of how to manage injuries to the body. Regardless of age group, there were generally a low knowledge level regarding tooth avulsion, replantation, extra-alveolar time and storage media. We conclude that first-aid knowledge in Kuwaiti schoolchildren is low on avulsion and replantation of teeth despite a high knowledge level of body injuries. The knowledge level of first-aid measures on avulsion and replantation of teeth could be increased through intervention programs.