年轻恒牙挫入性损伤的处理策略

doi:10.7518/gjkq.2021043

摘要/Abstract

摘要：

年轻恒牙挫入性损伤是预后最差的牙外伤类型之一,常导致牙齿缺失,影响患儿的美观及健康。治疗方案通常包括观察再萌出、正畸牵引复位和外科复位3种;临床上应根据患牙的牙根发育情况及挫入程度,参考患儿及家长意愿,选择单独或结合使用上述3种治疗方案进行治疗。治疗后的主要并发症包括牙髓坏死、牙根吸收、牙槽骨边缘性吸收、根管闭塞等。尽量减少并发症并将不良影响降到最低是年轻恒牙外伤治疗的主要目的,因此了解并发症的发生概率及预后、定期复诊、密切观察,在并发症出现的早期进行恰当处理非常重要。本文就年轻恒牙挫入性损伤的处理方法及术后并发症进行综述。

关键词: 挫入性牙外伤, 治疗, 年轻恒牙, 牙髓坏死, 牙根吸收

Abstract:

The intrusive luxation, one of the worst types of dental trauma, often leads to missing teeth, thereby affecting aesthetics and health. Clinical treatments should be based on the developmental stage of tooth roots and the degree of intrusion. Three treatment options, including re-eruption, orthodontic repositioning, and surgical repositioning, are commonly chosen by children and parents. The main complications including pulp necrosis, root resorption, marginal bone resorption and pulp canal obliteration. Additionally, minimizing the occurrence of complications and adverse effects is the main purpose of the treatment in young permanent tooth trauma. The incidence and the prognosis of complications, including pulp necrosis and root resorption, should be learned and reviewed regularly to perform the appropriate management early in the occurrence of complications. This article reviews the handling strategies and the postoperative complications of intrusive luxation of young permanent teeth.

Key words: intrusive luxation, treatment, young permanent teeth, pulp necrosis, root resorption

中图分类号:

R788

周懿婕,宋光泰. 年轻恒牙挫入性损伤的处理策略[J]. 国际口腔医学杂志, 2021, 48(2): 135-140.

Zhou Yijie,Song Guangtai. Management of the intrusive luxation in young permanent teeth[J]. Int J Stomatol, 2021, 48(2): 135-140.

图/表 1

图1

参考文献 40

[1]	Soares TRC, Silva LP, de Almeida Salazar SL, et al. Profile of intrusive luxation and healing complications in deciduous and permanent teeth-a retrospective study[J]. Acta Odontol Scand, 2018,76(8):567-571. doi: 10.1080/00016357.2018.1481226 pmid: 29909718
[2]	Andreasen JO, Bakland LK, Matras RC, et al. Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth[J]. Dent Traumatol, 2006,22(2):83-89.
[3]	Wang N, Chen J, Zhao Y. Clinical outcomes of 79 traumatically intruded permanent teeth in Chinese children and adolescents: a retrospective study[J]. Dent Traumatol, 2020,36(2):174-184. pmid: 31638331
[4]	Humphrey JM, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. Ⅰ. Intrusions[J]. Dent Traumatol, 2003,19(5):266-273. pmid: 14708651
[5]	郑树国. 儿童牙外伤Ⅳ.年轻恒前牙挫入和半脱位的临床处理[J]. 中华口腔医学杂志, 2011,46(9):571-574.
	Zheng SG. Children dental trauma Ⅳ. The manage-ment of intrusion and sublxsation in young perma-nent teeth[J]. Chin J Stomatol, 2011,46(9):571-574.
[6]	DiAngelis AJ, Andreasen JO, Ebeleseder KA, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth[J]. Dent Traumatol, 2012,28(1):2-12.
[7]	Costa LA, Ribeiro CCC, Cantanhede LM, et al. Treatments for intrusive luxation in permanent teeth: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Surg, 2017,46(2):214-229. pmid: 27649968
[8]	Kim HJ, Kim YI, Min KS. A combined approach with passive and active repositioning of a traumatically intruded immature permanent incisor[J]. Eur J Paediatr Dent, 2017,18(1):27-31. doi: 10.23804/ejpd.2017.18.01.06 pmid: 28494599
[9]	Bassetti MA, Mischler DC, Kuttenberger JJ, et al. Spontaneous reeruption after intrusive luxation of the permanent incisors by incomplete root formation. Two case reports (in German)[J]. Swiss Dent J, 2019,129(9):709-717. pmid: 31484473
[10]	Nolla CM. The development of the permanent teeth[J]. J Dent Child, 1960,27.
[11]	Nicoloso GF Pötter IG de Oliveira Rocha R, et al. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on cli-nical and radiographic outcomes: a systematic review and meta-analysis[J]. Int J Paediatr Dent, 2017,27(3):217-227.
[12]	Hurley E, Stewart C, Gallagher C, et al. Decisions on repositioning of intruded permanent incisors; a review and case presentation[J]. Eur J Paediatr Dent, 2018,19(2):101-104. pmid: 29790773
[13]	Neto JJ, Gondim JO, de Carvalho FM, et al. Longitudinal clinical and radiographic evaluation of severely intruded permanent incisors in a pediatric population[J]. Dent Traumatol, 2009,25(5):510-514. doi: 10.1111/j.1600-9657.2009.00789.x pmid: 19614934
[14]	Albadri S, Zaitoun H, Kinirons MJ. UK National Clinical Guidelines in Paediatric Dentistry: treatment of traumatically intruded permanent incisor teeth in children[J]. Int J Paediatr Dent, 2010,20:1-2.
[15]	徐丹, 何旭顺, 高志雄, 等. 微创牵引复位外伤挫入年轻恒牙的临床疗效观察[J]. 中华口腔医学研究杂志(电子版), 2018,12(1):37-47.
	Xu D, He XS, Gao ZX, et al. Clinical observation on minimally invasive orthodontic extrusion of in-truded immature central incisors[J]. Chin J Stomatol Res (Electron Ed), 2018,12(1):37-47.
[16]	Medeiros RB, Mucha JN. Immediate vs late orthodontic extrusion of traumatically intruded teeth[J]. Dent Traumatol, 2009,25(4):380-385.
[17]	Andreasen JO, Bakland LK, Andreasen FM. Trauma-tic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of sp-lint, length of splinting and antibiotics on 140 teeth[J]. Dent Traumatol, 2006,22(2):99-111. pmid: 16499633
[18]	Dias RS, Cajazeira Neto JA, de Carvalho FM, et al. Surgical repositioning of a traumatically intruded permanent incisor in a patient with rheumatic fever: case report[J]. Dent Traumatol, 2009,25(1):e12-e15. pmid: 19208001
[19]	Chacko V, Pradhan M. Management of traumatically intruded young permanent tooth with 40-month follow-up[J]. Aust Dent J, 2014,59(2):240-244.
[20]	何怡, 邹静, 杨燃. 年轻恒牙外伤固定方法的研究进展[J]. 国际口腔医学杂志, 2013,40(1):129-131.
	He Y, Zou J, Yang R. Developments on fixation tech-niques for immature permanent tooth[J]. Int J Stoma-tol, 2013,40(1):129-131.
[21]	Morales JL, Skowronski PP, Thaller SR. Management of pediatric maxillary fractures[J]. J Craniofacial Surg, 2010,21(4):1226-1233.
[22]	Lima TFR, Nagata JY, de Souza-Filho FJ, et al. Post-traumatic complications of severe luxations and replanted teeth[J]. J Contemp Dent Pract, 2015,16(1):13-19.
[23]	Ashkenazi M, Kaufman A, Einy S. The diagnostic and treatment challenges associated with traumatized intruded permanent incisors: a case report[J]. Quintessence Int, 2015,46(4):309-315. pmid: 25642459
[24]	Andreasen FM, Pedersen BV. Prognosis of luxated permanent teeth: the development of pulp necrosis[J]. Dent Traumatol, 1985,1(6):207-220.
[25]	秦满. 儿童恒牙外伤后牙髓预后评估及其影响因素[J]. 中国实用口腔科杂志, 2012,5(9):517-520.
	Qin M. Assessment of pulp sequela of young perma-nent teeth after traumatic dental injuries[J]. Chin J Pract Stomatol, 2012,5(9):517-520.
[26]	Tzanetakis GN. Management of intruded immature maxillary central incisor with pulp necrosis and severe external resorption by regenerative approach[J]. J Endod, 2018,44(2):245-249.
[27]	Cantekin K, Herdem G, Peduk K. Revascularization in an immature necrotic permanent incisor after severe intrusive luxation injury: a case report[J]. Eur J Paediatr Dent, 2014,15(1):203-206.
[28]	Nazzal H, Tong H, Nixon P, et al. Regenerative en-dodontic therapy for managing immature non-vital teeth: a national survey of UK paediatric dental specialists and trainees[J]. Br Dent J, 2018,224(4):247-254. pmid: 29472688
[29]	de Souza BDM, Dutra KL, Reyes-Carmona J, et al. Incidence of root resorption after concussion, subluxation, lateral luxation, intrusion, and extrusion: a systematic review[J]. Clin Oral Investig, 2020,24(3):1101-1111.
[30]	Soares AJ, Souza GA, Pereira AC, et al. Frequency of root resorption following trauma to permanent teeth[J]. J Oral Sci, 2015,57(2):73-78. pmid: 26062854
[31]	吴佳益, 李鑫, 汪成林, 等. 炎症性牙根外吸收致病机制的研究进展[J]. 华西口腔医学杂志, 2019,37(6):656-659.
	Wu JY, Li X, Wang CL, et al. Research progress on the pathogenesis of inflammatory external root resor-ption[J]. West China J Stomatol, 2019,37(6):656-659.
[32]	Şermet Elbay Ü, Elbay M, Kaya E, et al. Management of an intruded tooth and adjacent tooth sho-wing external resorption as a late complication of dental injury: three-year follow-up[J]. Case Rep Dent, 2015,2015:1-6.
[33]	Lima TFR, Silva EJNLD, Gomes BPFA, et al. Relationship between initial attendance after dental trauma and development of external inflammatory root resorption[J]. Braz Dent J, 2017,28(2):201-205. doi: 10.1590/0103-6440201701299 pmid: 28492750
[34]	Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study[J]. Dent Traumatol, 1992,8(2):45-55.
[35]	Lima TFR, Vargas Neto J, Casarin RCV, et al. Multidisciplinary approach for replacement root resorption following severe intrusive luxation: a case report of decoronation[J]. Quintessence Int, 2017,48(7):555-561. doi: 10.3290/j.qi.a38334 pmid: 28555199
[36]	房瑞贞, 李思逸, 高磊, 等. 延期再植术后替代性吸收的截冠处理及术后4年临床观察[J]. 华西口腔医学杂志, 2017,35(6):665-669.
	Fang RZ, Li SY, Gao L, et al. Decoronation manage-ment of the replacement resorption after delayed replantation of avulsed teeth: case report with 4-year follow-up[J]. West China J Stomatol, 2017,35(6):665-669.
[37]	Andreasen JO, Bakland LK, Andreasen FM. Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth[J]. Dent Traumatol, 2006,22(2):90-98. pmid: 16499632
[38]	Gondim JO, Diniz MB, de Abreu-e-Lima FC, et al. Alternative treatment modalities for immature intruded permanent incisors: report of 2 cases[J]. Pediatr Dent, 2009,31(4):340-345. pmid: 19722445
[39]	Andreasen FM, Zhijie Y, Thomsen BL, et al. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition[J]. Endod Dent Traumatol, 1987,3(3):103-115.
[40]	李畅, 包志凡, 陈旭. 牙外伤后根管闭锁研究进展[J]. 中国实用口腔科杂志, 2014,7(12):753-756.
	Li C, Bao ZF, Chen X. Pulp canal obliteration fol-lowing dental trauma[J]. Chin J Pract Stomatol, 2014,7(12):753-756.

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