国际口腔医学杂志

国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (6): 623-631.doi: 10.7518/gjkq.2023099

• 专家笔谈 •    下一篇

部分断冠粘接术在儿童恒前牙复杂冠根折中的初步应用

吴礼安   

  1. 口颌系统重建与再生全国重点实验室 国家口腔疾病临床医学研究中心陕西省口腔疾病临床医学研究中心 第四军医大学口腔医院儿童口腔科 西安 710032
  • 收稿日期:2023-04-13 修回日期:2023-08-27 出版日期:2023-11-01 发布日期:2023-10-24
  • 通讯作者: 吴礼安
  • 作者简介:<named-content content-type="corresp-name">吴礼安</named-content>，博士，教授，主任医师，博士生导师，第四军医大学口腔医院儿童口腔科主任，东京医科齿科大学访问学者，德州大学圣安东尼奥健康科学中心博士后，空军高层次人才，获军队优秀专业技术人才岗位津贴。任中华口腔医学会儿童口腔医学专业委员会常务委员，陕西省口腔医学会儿童口腔专业委员会副主任委员，国家规划教材《儿童口腔医学》数字资源副主编。主持国家自然科学基金4项，陕西省国际合作重点项目等省、部级科研课题11项，发表学术论文100余篇，被SCI数据库收录论文32篇。获陕西省科技进步奖一等奖3项，中华口腔医学会科技奖二、三等奖各1项。主编/译专著4部，参编/译专著6部，是陕西省卫生健康科研创新团队、陕西省一流本科课程、陕西省课程思政示范课程和空军精品课程负责人。<email>lianwu@fmmu.edu.cn</email>
  • 基金资助:
    陕西省国际合作重点项目(2021KWZ-26);陕西省卫生健康科研创新团队(2023TD-01);国家口腔疾病临床医学研究中心专项课题(LCC202204)

Application of partial crown reattachment in complicated crown-root fractures of permanent anterior teeth in children

Wu Li’an   

  1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Dept. of Pediatric Dentistry, School of Stomatology, the Fourth Military Medical University, Xi’an 710032, China
  • Received:2023-04-13 Revised:2023-08-27 Online:2023-11-01 Published:2023-10-24
  • Contact: Li’an Wu
  • Supported by:
    Shaanxi Provincial Key Research and Development Program for International Collaboration(2021KWZ-26);Shaanxi Provincial Health Research Innovation Ability Improvement Plan Team Support Project(2023TD-01);Special Project from National Clinical Research Center for Oral Disease(LCC202204)

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摘要：

复杂冠根折是牙外伤中较为严重的一种类型，涉及牙体、牙髓和牙周组织损伤，临床上常用治疗方法包括正畸牵引、外科牵引、意向再植和断冠粘接术等。这些方法能够比较有效地保存患牙，但需要先拔出冠部断端，暴露龈下断面，然后再行粘接修复，可能会导致外伤牙冠根比不协调或牙周问题，给远期疗效带来挑战。近期，笔者尝试冠部断端非拔出技术联合部分断冠粘接术，即保留冠部断端不予拔出，仅沿龈上折裂线和龈下折裂线（髓腔侧）进行粘接，而龈下折裂线（牙周侧）不做处理，旨在简化操作，最大限度地减少对牙周组织的二次损伤，降低牙周并发症的可能，短期内取得了较满意的效果，但粘接强度和远期疗效尚有待观察与评估。

关键词: 儿童, 恒前牙, 复杂冠根折, 冠部断端, 部分断冠粘接术

Abstract:

Complicated crown-root fracture is a serious type of dental trauma, involving dental hard tissues, tooth pulp and periodontal tissues. The most commonly recommended treatment methods by International Association of Dental Traumatology (IADT) include orthodontic extrusion, surgical extrusion, intentional replantation and adhesive coronal fragment reattachment, etc. The common feature of these treatment methods is to extract the broken coronal fragment, expose the fracture line and make the restoration. However, the extraction itself and the subsequent treatments will cause various problems, which severely compromise and challenge the long-term prognosis. Recently, we tried a technique including non-extraction of the coronal fragment and partial coronal fragment reattachment. I.E., the coronal fragment was retained instead of extraction, and the reattachment was only performed along the supragingival fracture line and subgingival fracture line across pulp cavity side only, while the subgingival fracture line across periodontal side was left untreated. Our technique, basing on the concept of periodontal preservation, and aiming at simplifying the operation procedure, reducing the re-injury to periodontal tissues to the greatest extent, and decreasing subsequent pe-riodontal complications as possible, has got satisfying clinical manifestation so far. However, the adhesive strength of the partial coronal fragments reattachment and their long-term prognosis need to be observed and evaluated further.

Key words: children, permanent anterior teeth, complicated crown-root fracture, coronal fragment, partial coronal fragment reattachment

中图分类号: 

  • R 788+.4

图 1

年轻恒牙复杂冠根折体内断冠粘接术A：术前口内照；B：进行翻瓣、牙髓处理和制作固位沟槽；C：拔出断冠，进行增加固位处理；D：体内断冠粘接（唇面观）；E：松牙固定+??垫治疗；F：术后半年复诊（唇面观）；G：术后半年复诊可见舌侧牙龈有炎症（箭头）；H：术后半年复诊根尖片。"

图 2

成熟恒牙复杂冠根折体外断冠粘接术A：脱落牙冠；B：残留牙根；C：体内行根管治疗；D：拔出断根；E：体外粘接；F：粘接完成；G：复位+固定；H：术后半年复诊（唇面观）；I：术后半年复诊（??面观）；J：术后半年复诊根尖片。"

图 3

复杂冠根折牙齿部分断冠粘接术操作示意图A：复杂冠根折示意图，龈上折裂线（蓝色）、龈下折裂线髓腔侧（绿色）和龈下折裂线牙周侧（黄色）；B：部分断冠粘接示意图，龈上折裂线、龈下折裂线（髓腔侧）行粘接修复（黑色），龈下折裂线（牙周侧、黄色）未粘接。"

图 4

年轻恒牙复杂冠根折部分断冠粘接术诊疗情况A：11牙纵向复杂冠根折（初诊）（箭头）；B：折裂线达牙槽嵴顶（箭头）；C：唇侧初步粘接；D：舌侧牙髓切断术+髓腔折裂线粘接；E：玻璃离子垫底后树脂修复；F：唇侧再次树脂修复；G：术后1年口内照；H：术后1年根尖片。"

图 5

成熟恒牙复杂冠根折断端非拔出技术联合部分断冠粘接术诊疗情况A：初诊口内照；B：初诊根尖片；C：唇侧树脂初步固定+松牙固定+根管治疗+纤维桩；D：术后1个月拆除松牙固定；E：术后9个月口内照；F：术后9个月根尖片。"

图 6

儿童恒牙复杂冠根折治疗策略"

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