国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (4): 400-406.doi: 10.7518/gjkq.2019064

• 论著 • 上一篇    下一篇

意向性牙再植治疗重度牙周炎患牙的临床研究

张佳喻,罗宁,苗棣,应绚,陈悦()   

  1. 西安交通大学口腔医院牙周黏膜科 西安 710004
  • 收稿日期:2018-08-12 修回日期:2019-02-04 出版日期:2019-07-10 发布日期:2019-07-12
  • 作者简介:张佳喻,硕士,Email: 411368006@qq.com
  • 基金资助:
    西安市科技计划项目(2016051SF/YX07);西安交通大学口腔医院新技术项目(xjkqxjs2015-06);西安交通大学口腔医院青年基金项目(2015-2)

Clinical study on intentional replantation for periodontally involved hopeless teeth

Zhang Jiayu,Luo Ning,Miao Di,Ying Xuan,Chen Yue()   

  1. Dept. of Periodontal and Oral Mucosa, The Stomatological Hospital of Xi’an Jiaotong University, Xi’an 710004, China
  • Received:2018-08-12 Revised:2019-02-04 Online:2019-07-10 Published:2019-07-12
  • Supported by:
    This study was supported by Xi’an Science and Technology Planning Projects(2016051SF/YX07);New Technology Projects of the Stomatological Hospital of Xi’an Jiaotong University(xjkqxjs2015-06);Youth Fund Project of the Stomatological Hospital of Xi’an Jiaotong University(2015-2)

摘要:

目的 评价意向性牙再植治疗重度牙周炎患牙的临床效果,探索其愈合机制及可能影响预后的因素。方法 选取42位重度牙周炎患者的42颗患牙进行意向性牙再植,术后随访18个月,收集其临床和影像资料,采用Wilcoxon秩和检验或配对t检验对数据进行分析。结果 患牙存留率从术后9个月的95.2%降至术后18个月的90.5%;术后9个月的松动度改善率为87.5%;术后18个月固连发生率为76.3%。患牙术后的探诊深度和骨丧失程度有所改善,但是牙龈退缩有一定程度增加,术前术后变化的差异均存在统计学意义(P<0.05)。吸烟者术后疗效较不吸烟者差(P<0.05)。结论 意向性牙再植治疗重度牙周炎临床效果良好,牙齿固连可能是一种合理并且重要的术后愈合机制,吸烟应当被列为该治疗的禁忌证。

关键词: 意向性牙再植, 重度牙周炎患牙, 松动度, 牙齿固连, 吸烟

Abstract:

Objective To evaluate the clinical effect of intentional replantation for periodontally hopeless teeth and explore its healing mode and factors affecting prognosis.Methods Forty-two periodontally hopeless teeth from forty-two patients were intentionally replanted and followed up for 18 months. Clinical and radiographic data were collected and analyzed using the Wilcoxon signed-rank test or paired t-test.Results The survival rate declined from 95.2% at the ninth month to 90.5% at the eighteenth month. Approximately 87.5% of the patients showed improved mobility rate at the ninth month, and ankylosis occurred in 76.3% of the patients at the eighteenth month. Probing depth and bone loss improved, whereas gingival recession increased (P<0.05). Smoking decreased both mobility improvement and bone gain (P<0.05).Conclusion Intentional replantation for periodontally hopeless teeth could achieve favorable outcomes, and tooth ankylosis may be an important and reasonable post-operative healing procedure. Smoking should be regarded as a contraindication for this procedure.

Key words: intentional replantation, periodontally hopeless teeth, mobility, tooth ankylosis, smoking

中图分类号: 

  • R781.4

图 1

手术步骤 A:翻起黏骨膜瓣,拔除患牙;B:患牙清洁前;C:患牙清洁后;D:CGF层与红细胞层;E:CGF膜;F:Bio-oss骨粉;G:植骨、复位患牙、覆盖CGF膜;H:严密缝合黏骨膜瓣。"

图 2

患牙根尖片测量项目ht:邻面牙根总长;hi:邻面骨内根长。"

表 1

松动度分布频率"

时间 松动度
0
术前 0 0 1 39
术后9个月 23 12 0 5

图 3

典型病例 A:术前口内照;B:术后9个月口内照;C:术后18个月口内照;D:术前X线片;E:术后9个月X线片;F:术后18个月X线片。"

图 4

患牙牙周指标变化情况"

[1] Asgary S, Alim Marvasti L, Kolahdouzan A . Indications and case series of intentional replantation of teeth[J]. Iran Endod J, 2014,9(1):71-78.
[2] Rouhani A, Javidi B, Habibi M , et al. Intentional replantation: a procedure as a last resort[J]. J Contemp Dent Pract, 2011,12(6):486-492.
[3] Madison S . Intentional replantation[J]. Oral Surg Oral Med Oral Pathol, 1986,62(6):707-709.
[4] Lee EU, Lim HC, Lee JS , et al. Delayed intentional replantation of periodontally hopeless teeth: a retrospective study[J]. J Periodontal Implant Sci, 2014,44(1):13-19.
[5] Cho SY, Lee SJ, Kim E . Clinical outcomes after intentional replantation of periodontally involved teeth[J]. J Endod, 2017,43(4):550-555.
[6] Ryana HK, Srinath R ,Prakash S.Surgical re-entry of an intentionally replanted periodontally compromised tooth treated with platelet rich fibrin(PRF): hopeless to hopeful[J]. J Clin Diagn Res, 2016, 10(6): ZD01-ZD04.
[7] Keceli HG, Hendek MK . Fifteen months follow-up of a hopeless tooth treated with two-step procedure involving intentional replantation and free gingival graft[J]. Eur J Dent, 2014,8(4):559-562.
[8] Nagappa G, Aspalli S, Devanoorkar A , et al. Intentional replantation of periodontally compromised hopeless tooth[J]. J Indian Soc Periodontol, 2013,17(5):665-669.
[9] Torabinejad M, Dinsbach NA, Turman M , et al. Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review[J]. J Endod, 2015,41(7):992-998.
[10] Andreasen JO. 牙齿外伤手册[M]. 葛立宏,译. 2版. 北京: 人民卫生出版社, 2006: 50-70.
Andreasen JO. Traumstic dental injuries: a manual [M]. Ge LH, tran. 2nd ed. Beijing: People’s Medical Publishing House, 2006: 50-70.
[11] Andreasen JO . Periodontal healing after replantation and autotransplantation of incisors in monkeys[J]. Int J Oral Surg, 1981,10(1):54-61.
[12] Andreasen JO . Analysis of pathogenesis and topography of replacement root resorption (ankylosis) after replantation of mature permanent incisors in monkeys[J]. Swed Dent J, 1980,4(6):231-240.
[13] Isaacson RJ, Strauss RA, Bridges-Poquis A , et al. Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis[J]. Angle Orthod, 2001,71(5):411-418.
[14] Andersson L, Blomlöf L, Lindskog S , et al. Tooth ankylosis. Clinical, radiographic and histological assessments[J]. Int J Oral Surg, 1984,13(5):423-431.
[15] Gargiulo AW, Wentz FM, Orban B . Dimensions and relations of the dentogingival junction in humans[J]. J Periodontol, 1961,32(3):261-267.
[16] Andreasen J . The effect of excessive occlusal trauma upon periodontal healing after replantation of mature permanent incisors in monkeys[J]. Swed Dent J, 1981,5(3):115-122.
[17] Andreasen JO . A time-related study of periodontal healing and root resorption activity after replantation of mature permanent incisors in monkeys[J]. Swed Dent J, 1980,4(3):101-110.
[18] Andreasen JO . The effect of splinting upon periodontal healing after replantation of permanent incisors in monkeys[J]. Acta Odontol Scand, 1975,33(6):313-323.
[19] Andreasen JO . The effect of pulp extirpation or root canal treatment on periodontal healing after replantation of permanent incisors in monkeys[J]. J Endod, 1981,7(6):245-252.
[20] 周宏志 . 自体牙移植的研究进展及临床应用[J/CD]. 中华临床医师杂志(电子版), 2013,7(10):4177-4180.
Zhou HZ . Research progress and clinical application of autogenous tooth transplantation[J/CD]. Chin J Clinicians (Electr Ed), 2013,7(10):4177-4180.
[21] Sapir S, Shapira J . Decoronation for the management of an ankylosed young permanent tooth[J]. Dent Traumatol, 2008,24(1):131-135.
[22] Wang F, Li Q, Wang Z . A comparative study of the effect of Bio-Oss ® in combination with concentrated growth factors or bone marrow-derived mesenchymal stem cells in canine sinus grafting [J]. J Oral Pathol Med, 2017,46(7):528-536.
[1] 房栗, 王翔, 王文梅. 吸烟相关疾病模型的研究进展[J]. 国际口腔医学杂志, 2017, 44(5): 587-590.
[2] 李雪,贾春蓉,赵晓曦. 四手操作应用于意向性牙再植术的护理探讨[J]. 国际口腔医学杂志, 2016, 43(4): 409-411.
[3] 侯琳 马肃 陈力 陈蕊 刘培红 秦春林. 被动吸烟对鼠牙槽骨钙、磷含量及碱性磷酸酶活性的影响[J]. 国际口腔医学杂志, 2014, 41(5): 526-529.
[4] 刘琼综述 黄建生审校. 白介素-1 基因多态性、牙周炎和吸烟因素与种植体周围炎相关性的研究进展[J]. 国际口腔医学杂志, 2012, 39(3): 353-356.
[5] 李磊丹综述 李超伦审校. 牙齿松动度的测量方法[J]. 国际口腔医学杂志, 2011, 38(1): 112-114.
[6] 赵川江. 吸烟对牙周病宿主反应的影响[J]. 国际口腔医学杂志, 2002, 29(02): -.
[7] 徐燕,李颂,李剑农,王明丽. 吸烟与牙周病关系的研究进展[J]. 国际口腔医学杂志, 2001, 28(02): -.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!