国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (5): 541-548.doi: 10.7518/gjkq.2021089

• 论著 • 上一篇    下一篇

前牙复杂冠根折外科手术冠向复位治疗的早期效果

廖汶晓1(),马心笛2,洪志薇3,吴昕彧4,邢云娣1,刘经纬5,陈蕾1()   

  1. 1.南方医科大学口腔医院综合急诊科 广州 510220
    2.苏州大学附属口腔医院牙体牙髓科 苏州 215026
    3.汕头市中心医院·中山大学附属汕头医院口腔科 汕头 515031
    4.南方医科大学口腔医院番禺院区牙周科 广州 511400
    5.佛山市禅城区人民医院口腔医院口腔科 佛山 528000
  • 收稿日期:2020-12-11 修回日期:2021-05-20 出版日期:2021-09-01 发布日期:2021-09-10
  • 通讯作者: 陈蕾
  • 作者简介:廖汶晓,主治医师,硕士,Email: liaowenxiao2011@163.com
  • 基金资助:
    全国医学专业学位研究生教育指导委员会2018年学位与研究生教育研究课题(B2-YX20180603-04)

Clinical effect of surgical extrusion in the treatment of complicated crown-root fracture of anterior teeth

Liao Wenxiao1(),Ma Xindi2,Hong Zhiwei3,Wu Xinyu4,Xing Yundi1,Liu Jingwei5,Chen Lei1()   

  1. 1. Dept. of General Consulting and Oral Emergency, Stomatological Hospital, Southern Medical University, Guangzhou 510220, China
    2. Dept. of Cariology and Endodontics, Affiliated Stomatological Hospital, Suzhou University, Suzhou 215026, China
    3. Dept. of Stomatology, Affiliated Shantou Hospital, Sun Yat-sen University, Shantou Central Hospital, Shantou 515031, China
    4. Dept. of Periodontitis, Panyu Branch, Stomatological Hospital, Southern Medical University, Guangzhou 511400, China
    5. Dept. of Dentistry, Stomatological Hospital, People,s Hospital of Chancheng, Foshan 528000, China
  • Received:2020-12-11 Revised:2021-05-20 Online:2021-09-01 Published:2021-09-10
  • Contact: Lei Chen
  • Supported by:
    Academic Degree and Graduate Education Research Project of National Medical Specialty Graduate Education Steering Committee in 2018(B2-YX20180603-04)

摘要:

目的 观察外科手术冠向复位法对复杂冠根折患牙的临床疗效,为临床诊治提供参考。方法 在2017年1月至2019年1月南方医科大学口腔医院综合急诊科就诊的牙外伤患者中,选取复杂冠根折恒牙共计10颗,进行外科手术冠向复位法,随访1年,观察其临床疗效。影像学评估牙周膜愈合方式、牙槽嵴顶骨吸收和根尖周骨密度变化。结果 10例复杂冠根折患者的患牙经治疗后全部存留。9例出现牙周膜愈合,1例出现牙根表面吸收愈合,没有出现牙根炎症吸收或进行性吸收。2例患牙伴发牙槽嵴顶骨吸收。所有患牙根尖骨质密度增高,没有出现根尖病变。结论 外科手术冠向复位法是治疗前牙复杂性冠根折的可行方法。

关键词: 复杂冠根折, 外科手术冠向复位法, 牙外伤, 牙周愈合

Abstract:

Objective This study aimed to evaluate the clinical effect of surgical extrusion in the treatment of complicated anterior teeth crown-root fractures. Methods From January 2017 to January 2019, a total of 10 anterior teeth with complicated crown-root fracture were included and surgically extruded in the General Consulting and Oral Emergency Department of Stomatological Hospital, Southern Medical University. Clinical and radiographic parameters including survival rate, periodontal healing, marginal bone loss, and periapical lesion were evaluated. Follow-up period was 1 year. Results All 10 teeth with complicated crown-root fractures survived during follow-up. Radiographic results showed nine cases of healing with normal periodontal ligament and one case of healing with root-surface resorption. The complication of marginal bone loss occurred in two cases. No periapical lesions, inflammatory root resorption, or ankylosis-related replacement resorption was found. Conclusion Surgical extrusion is a safe and feasible method of treating complicated crown-root fractures in anterior permanent teeth.

Key words: complicated crown-root fracture, surgical extrusion, dental trauma, periodontal healing

中图分类号: 

  • R781.05

表 1

10例复杂冠根折病例初诊时口内检查及治疗方案"

病例 性别 年龄/岁 外伤时间 就诊时间 面部软组织 患牙 折断线
位置
牙龈
情况
旋转
角度/°
固定方式 根管治疗
时机
1 29 2018年12月 外伤后1 h 左侧面颊部、上唇部擦伤,少量渗血、渗液 22 龈下3 mm 龈缘渗血 180 缝合+弹性固定 外伤后14 d
2 22 2018年12月 外伤后2周 右侧上唇见结痂 21 龈下4.5 mm 红肿 0 缝合+弹性固定 就诊当天
3 26 2017年2月 外伤后1 h 双侧上唇皮下血肿,未见开放性伤口 11 龈下5 mm 龈缘渗血 0 缝合+弹性固定 外伤后14 d
4 37 2017年5月 外伤后3 h 双侧上唇皮下血肿,未见开放性伤口 21 龈下3.5 mm 龈缘渗血 180 缝合+弹性固定 外伤后12 d
5 30 2017年7月 外伤后2 h 右侧上唇及右侧鼻翼擦伤,少量渗血 12 龈下3 mm 龈缘渗血 180 缝合+弹性固定 外伤后13 d
6 45 2017年10月 外伤后2 h 双侧上唇皮下血肿、右侧面颊部擦伤 12 龈下3 mm 龈缘渗血 90 缝合+弹性固定 外伤后14 d
7 22 2018年2月 外伤后1 h 上唇及颏部擦伤,少量渗血 21 龈下6 mm 龈缘渗血 45 缝合+弹性固定 外伤后14 d
8 33 2018年3月 外伤后0.5 h 上唇擦伤,少量渗血 11 龈下3 mm 龈缘渗血 180 缝合+弹性固定 外伤后13 d
9 24 2018年7月 外伤后2 h 上唇皮下血肿,颏部擦伤 11 龈下4 mm 龈缘渗血 0 缝合+弹性固定 外伤后14 d
10 36 2018年10月 外伤后2.5 h 右侧上唇擦伤,少量渗血 21 龈下5 mm 龈缘渗血 90 缝合+弹性固定 外伤后14 d

图1

牙周膜愈合方式示意图 A:牙周膜愈合;B:表面吸收愈合;C:炎症性吸收;D:牙根粘连(强直)和替代性吸收。"

表 2

复杂冠根折患牙采用外科手术冠向复位后的临床及影像学检查"

复诊时间 患牙数/颗 主观症状 正常叩诊音 牙周探诊深度<3 mm 临床松动度检查 牙周膜愈合 表面吸收 炎症吸收 替代性吸收 边缘牙槽骨吸收 根尖骨质密度增高
生理动度 Ⅰ度 Ⅱ度
6~8周 10 0 10 10 0 1 9 10 0 0 0 0 0
3个月 9* 0 9 9 2 6 1 8 1 0 0 1 9
6个月 8** 0 8 8 7 1 0 7 1 0 0 2 8
1年 10 0 10 10 9 1 0 7 1 0 0 2 8

图2

病例1治疗经过 A:术前唇侧照;B:术前腭侧照;C:折断面达龈下3~4 mm;D:微小牙折片;E:外科手术冠向复位牙根;F:弹性固定;G:术后3个月;H:牙龈切除术后;I:全冠预备后;J:全冠修复后;K:术前X线片;L:术前CBCT矢状位截图;M:根管充填后;N:术后8周复诊;O:术后3个月复诊;P:术后1年复诊。"

图3

病例2治疗经过 A:术前唇侧照;B:术前腭侧照;C:松动的唇侧牙折片;D:折断面位于龈下3~4 mm;E:外科手术冠向复位牙根;F:松牙固定后;G:牙龈切除后;H:术后半年复诊;I:术后1年复诊;J:术前X线片;K:术前CBCT矢状位截图;L:外科手术冠向复位牙根后;M:术后6个月随访。"

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