国际口腔医学杂志

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:2019-07-01 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:2019-07-01 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)

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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 Ⅰ Ⅱ Ⅲ
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"

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