国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (2): 125-130.doi: 10.7518/gjkq.2020053

• 专家笔谈 •    下一篇

重度牙周炎患牙的保存治疗

陈斌1,徐蓉蓉2,张家鼎1,闫福华1()   

  1. 1. 南京大学医学院附属口腔医院?南京市口腔医院牙周病科 南京 210008
    2. 南京大学医学院附属口腔医院?南京市口腔医院牙体牙髓病科 南京 210008
  • 收稿日期:2019-10-10 修回日期:2019-12-12 出版日期:2020-03-01 发布日期:2020-03-12
  • 通讯作者: 闫福华
  • 作者简介:陈斌,副主任医师,博士,Email:361734128@qq.com
    专家简介:
    陈斌,博士,副主任医师,供职于南京大学医学院附属口腔医院·南京市口腔医院牙周病科,长期从事牙周病的基础和临床研究,对重度牙周炎规范化诊疗、牙周再生治疗等有丰富的临床经验。主持或参与口腔医学课题7项,发表论文30余篇,作为共同主译之一引进出版牙周病学专著《超声牙周刮治原理与技术》和《微创牙周治疗临床技巧与可视化技术》,约60万字
  • 基金资助:
    南京市医学科技发展资金(QRX17176)

The retention of severe periodontitis-involved tooth

Chen Bin1,Xu Rongrong2,Zhang Jiading1,Yan Fuhua1()   

  1. 1. Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    2. Dept. of Operative Dentistry and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
  • Received:2019-10-10 Revised:2019-12-12 Online:2020-03-01 Published:2020-03-12
  • Contact: Fuhua Yan
  • Supported by:
    This study was supported by Nanjing Medical Science and Technology Development Fund(QRX17176)

摘要:

重度牙周炎患牙,尤其是被判断为“预后无望”的患牙,其保存与否是困扰口腔医师的常见且重要的问题。针对这类患牙,临床医生不应轻易做出拔牙的决策,而应仔细检查病情,充分与患者沟通,找到正确的病因,根据患者的具体情况分析保存患牙的有利因素和不利因素,结合患者的意愿、依从性、经济能力等,综合考虑有无保存的可能。本文以单纯重度牙周炎、牙周来源的牙周牙髓联合病变和“真正的牙周牙髓联合病变”3种不同类型的重度牙周炎患牙为例,列举了重度牙周炎患牙的试保存治疗的过程,以期为重度牙周炎患牙的保存和拔牙决策提供参考。

关键词: 重度牙周炎, 牙周牙髓联合病变, 牙齿保存, 拔牙决策, 治疗计划

Abstract:

Severe periodontitis-involved teeth, especially those considered as “prognosis hopeless”, are a common and important problem that plagues dentists. Clinicians should not make abrupt extraction decisions but rather carefully perform clinical examination, fully communicate with the patient, explore the correct etiological factors, and analyze the favorable and unfavorable factors according to the specific conditions of the patient. Patient’s willingness, compliance, and financial ability should also be considered. This review begins with three typical cases, including simple severe periodontitis-affected teeth, primary periodontal lesion with secondary endodontic involvement teeth, and teeth with “true combined periodontal-endodontic lesion.” The decision-making process of tooth extraction or retention in patients with severe periodontitis was also discussed to serve as future reference.

Key words: severe periodontitis, combined periodontal-endodontic lesion, tooth retention, extraction decision, treatment plan

中图分类号: 

  • R781.4

图 1

患者1在不同时期的全景片 A:初诊全景片;B:治疗后5年;C:治疗后10年。"

图 2

患者2治疗前后影像学检查结果 A:初诊全景片(就诊前4个月拍摄);B:根管治疗前根尖片;C:治疗后5个月根尖片。"

图 3

患者3初诊牙周探诊表(Florida电子探针)"

图 4

患者3治疗前后影像学检查结果 A:初诊CBCT截图;B:初诊根尖片;C:治疗后8个月根尖片。"

[1] Watts T . Critical decisions in periodontology[J]. Br Dent J, 2003,194(9):522.
[2] Avila G, Galindo-Moreno P, Soehren S , et al. A novel decision-making process for tooth retention or ex-traction[J]. J Periodontol, 2009,80(3):476-491.
[3] Popelut A, Rousval B, Fromentin O , et al. Tooth ex- traction decision model in periodontitis patients[J]. Clin Oral Implants Res, 2010,21(1):80-89.
[4] Warren JJ, Hand JS, Levy SM , et al. Factors related to decisions to extract or retain at-risk teeth[J]. J Pu- blic Health Dent, 2000,60(1):39-42.
[5] American Academy of Periodontology. 1999 interna-tional workshop for a classification of periodontal disease and conditions[J]. Ann Periodontol, 1999,4(1): i-112.
[6] Tonetti MS, Greenwell H, Kornman KS . Staging and grading of periodontitis: framework and proposal of a new classification and case definition[J]. J Perio-dontol, 2018,89(Suppl 1):S159-S172.
[7] 赵宇骁, 周延, 浦丽飞 , 等. 上颌中切牙牙龈生物型的相关因素分析[J]. 口腔医学, 2017,37(7):615-620.
Zhao YX, Zhou Y, Pu LF , et al. The correlation ana-lysis of the gingival biotype in maxillary[J]. Stoma-tology, 2017,37(7):615-620.
[8] Zweers J, Thomas RZ, Slot DE , et al. Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review[J]. J Clin Perio-dontol, 2014,41(10):958-971.
[9] Frost NA, Mealey BL, Jones AA , et al. Periodontal biotype: gingival thickness as it relates to probe visi-bility and buccal plate thickness[J]. J Periodontol, 2015,86(10):1141-1149.
[10] 陈斌, 闫福华 . 重度牙周炎非手术治疗[J]. 中国实用口腔科杂志, 2016,9(4):197-201.
Chen B, Yan FH . Non-surgical therapy in advanced periodontitis[J]. Chin J Pract Stomatol, 2016,9(4):197-201.
[11] Graetz C, Dörfer CE, Kahl M , et al. Retention of questionable and hopeless teeth in compliant patients treated for aggressive periodontitis[J]. J Clin Perio-dontol, 2011,38(8):707-714.
[12] 闫福华 . 牙周-牙髓联合病变的规范化诊疗[J]. 中华口腔医学杂志, 2014,49(3):133-137.
Yan FH . Standardized diagnosis and treatment of periodontal-endodontic lesions[J]. Chin J Stomatol, 2014,49(3):133-137.
[13] 金玥, 陈斌, 泥艳红 , 等. 牙周来源的牙周牙髓联合病变和牙周牙髓共存病变患牙牙周治疗时机的系统评价[J]. 华西口腔医学杂志, 2018,36(2):167-173.
Jin Y, Chen B, Ni YH , et al. Time lapse between endodontic and periodontal treatments of combined periodontal-endodontic lesion: a systematic review[J]. West China J Stomatol, 2018,36(2):167-173.
[14] Schmidt JC, Walter C, Amato M , et al. Treatment of periodontal-endodontic lesions—a systematic review[J]. J Clin Periodontol, 2014,41(8):779-790.
[15] Bergström J, Eliasson S, Dock J . A 10-year prospective study of tobacco smoking and periodontal health[J]. J Periodontol, 2000,71(8):1338-1347.
[16] Tonetti MS . Cigarette smoking and periodontal di-seases: etiology and management of disease[J]. Ann Periodontol, 1998,3(1):88-101.
[17] Machtei EE, Hirsch I . Retention of hopeless teeth: the effect on the adjacent proximal bone following periodontal surgery[J]. J Periodontol, 2007,78(12):2246-2252.
[1] 胡文杰. 牙槽嵴保存术的临床实施问题探讨[J]. 国际口腔医学杂志, 2021, 48(3): 249-259.
[2] 张佳喻,罗宁,苗棣,应绚,陈悦. 意向性牙再植治疗重度牙周炎患牙的临床研究[J]. 国际口腔医学杂志, 2019, 46(4): 400-406.
[3] 桂和明,杜丽娟,黄洁英,. 拜阿蒙骨诱导人工骨治疗重度牙周炎的临床疗效[J]. 国际口腔医学杂志, 2007, 34(02): 149-151.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 王昆润. 修补颌骨缺损的新型生物学相容材料[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 陆加梅. 不可复性关节盘移位患者术前张口度与关节镜术后疗效的相关性[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 王昆润. 咀嚼口香糖对牙周组织微循环的影响[J]. 国际口腔医学杂志, 1999, 26(06): .
[4] 宋红. 青少年牙周炎外周血分叶核粒细胞的趋化功能[J]. 国际口腔医学杂志, 1999, 26(06): .
[5] 高卫民,李幸红. 发达国家牙医学院口腔种植学教学现状[J]. 国际口腔医学杂志, 1999, 26(06): .
[6] 侯锐. 正畸患者釉白斑损害的纵向激光荧光研究[J]. 国际口腔医学杂志, 1999, 26(05): .
[7] 轩东英. 不同赋形剂对氢氧化钙抗菌效果的影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[8] 房兵. 唇腭裂新生儿前颌骨矫正方法及对上颌骨生长发育的影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[9] 杨美祥. 前牙厚度在预测上下颌牙量协调性中的作用[J]. 国际口腔医学杂志, 1999, 26(04): .
[10] 赵艳丽. 手术刀、电凝、CO_2和KTP激光对大鼠舌部创口的作用[J]. 国际口腔医学杂志, 1999, 26(04): .