国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (5): 778-786.doi: 10.7518/gjkq.2026016

• 临床实践 • 上一篇    

第二磨牙远中根面龋伴牙周牙髓联合病变意向性牙再植的临床考量

陶倩媛1(),李向芬2,苏勤1()   

  1. 1.口腔疾病防治全国重点实验室 国家口腔医学中心 口腔疾病国家临床医学研究中心 四川大学华西口腔医院牙体牙髓病科 成都 610041
    2.口腔疾病防治全国重点实验室 国家口腔医学中心 口腔疾病国家临床医学研究中心 四川大学华西口腔医院儿童口腔科 成都 610041
  • 收稿日期:2025-03-16 修回日期:2025-05-20 出版日期:2026-09-01 发布日期:2026-08-28
  • 通讯作者: 苏勤
  • 作者简介:陶倩媛，医师，硕士，Email：fkristie@foxmail.com
  • 基金资助:
    四川省自然科学基金(2024NSFSC1583);国家自然科学基金(82201044)

Clinical considerations for intentional replantation in cases of distal root surface caries with periodontal-endodontic lesions in second molars

Qianyuan Tao1(),Xiangfen Li2,Qin Su1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2025-03-16 Revised:2025-05-20 Online:2026-09-01 Published:2026-08-28
  • Contact: Qin Su
  • Supported by:
    Natural Science Foundation of Sichuan Province(2024NSFSC1583);National Natural Science Foundation of China(82201044)

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摘要：

第二磨牙常因第三磨牙阻生导致远中根面龋，进而引发牙周牙髓联合病变。临床根管治疗面临诸多难点，如操作空间狭小、根管解剖复杂、龈下龋损修复困难以及牙周病变治愈率低，常致常规口内治疗操作复杂且预后较差。意向性牙再植术作为一种末位保牙技术，因其操作简便、能彻底清除龋坏并同步处理牙周病变等优势，逐渐被用于复杂难治性牙髓根尖周病的治疗。本文针对其临床应用中需考虑的第二磨牙解剖特点、龋坏及牙周病变特征以及手术操作要点等逐一分析，细致考量，为意向性牙再植术用于第二磨牙伴牙根损害的牙周牙髓联合病变的临床治疗提供参考。

关键词: 第二磨牙, 第三磨牙, 根面龋, 意向性牙再植术, 牙周牙髓联合病变

Abstract:

The second molars often develop distal root surface caries due to the impaction of the third molars, which subsequently induces periodontal-endodontic lesions. Clinical root canal treatment for such cases faces numerous challenges, including limited operating space, complex root canal anatomy, difficulty in repairing subgingival caries, and low cure rates for periodontal lesions. These factors often lead to complex procedures and poor prognosis in conventional en-dodontic treatments. Intentional replantation, as a last-resort tooth-saving technique, has gradually been applied to treat complex and refractory endodontic periapical diseases given its simplicity, thorough removal of caries, and simultaneous management of periodontal lesions. However, its clinical application requires careful consideration of the anatomical features of the second molars, the characteristics of caries and periodontal lesions, and the key points of surgical procedures. This study analyzes these aspects one by one and provides a comprehensive review to offer a reference for the clinical treatment of periodontal-endodontic lesions in the second molars with root damage via intentional replantation.

Key words: second molars, third molars, root surface caries, intentional replantation, periodontal-endodontic lesions

中图分类号: 

  • R781.05

图1

第二磨牙远中根面龋伴牙周牙髓联合病变患牙病损特点患牙临床牙冠相对完整，邻面龋坏常位于颈部以下，波及远中根面，伴随第二磨牙边缘牙槽骨吸收。"

图2

第二磨牙远中根面龋伴牙周牙髓联合病变IR流程A：患牙在体状态；B：拔出患牙去除龋坏，邻面入路，用球钻和超声ET去除髓腔内牙髓及感染物质；C：截根及根管逆向预备；D：根管充填及根尖倒充填；E：髓腔及邻面洞树脂充填；F：再植入牙槽窝。"

图3

第二磨牙远中根面龋伴牙周牙髓联合病变IR治疗A：第二磨牙拔牙术后；B：第二磨牙远中龋损洞型制备；C：远中龋损树脂充填术后；D：根尖进行截根倒预备；E：根尖行倒充填；F、G、H：IR治疗术前CBCT；I：IR治疗术前X线片；J、K、L：术后3个月、6个月及18个月复查X线片，根周牙周膜间隙正常；M：IR治疗术前口内照，患牙冠方完整，Ⅰ度松动；N、O分别为术后3个月及18个月复查口内照片，显示患牙冠方完整，黏膜未见异常，生理动度。"

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