断冠再接术联合活髓切断术治疗外伤冠折露髓年轻恒前牙疗效观察.docx
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1、9关合活O刀断术治疗外伤超斤露ii鲜轻I雷讶疗婀嚓滴要)目的:探衬折冠再接术和活髓切断术治疗外伤冠折蔻髓年轻恒前牙的临床疗效。方法:选取2018年9月-2019 年9月笔者医院牙体牙髓科就诊的90例外伤冠折露髓年轻恒前牙患儿为观察对象,按冠折断片保存完整与否分为断冠 再接组45例(共45颗患牙)和树脂修复坦45例(共49颗患牙),两组均行口腔检查和活瓶切断术治疗,在此基础 上断冠再接组给子断冠再接术修复牙冠,树脂修复组给予树脂修复牙冠,比拟两组患儿随诊临床疗效和术后24个月冠 方修复体临床美学效果、牙周相临床指标及主观满意度。结果:经过12年的临床随诊观察,两组16个月成功率均 为100%,
2、12个月、24个月后断冠再接组成功率分别为78.94%和67.65%,树脂修复组成功率分别为68.42%和55.56%, 差异均无统计学意义(X2=1.086, 1.079, P0.05);断冠再接组边缘染色和边缘密合性评分均高于树脂修复组(P0.05);断冠再接组牙周临床各指标均低于树 脂修复组(P0.05) .结论:断冠再接术联合活皖切断术治疗可提高外伤冠折露髓年轻恒前牙的中、短期 临床疗效,具有较佳临床美学效果,对患儿牙周组织健康影响较小,有利于提高治疗满意度,值得临床推广应用。关键词)断冠再接术;活他切断术;年轻恒前牙;临床疗效;美学效果;主观满意度Abstract: Objectiv
3、e To observe and explore the clinical efficacy of broken crown reattachment and vital pulpotomy in the treatment of young permanent anterior teeth with traumatic crown fracture and pulp exposure. Methods 90 children with young permanent anterior teeth with traumatic crown fracture and pulp exposure
4、in the hospital department of dentistry and endodontics between September 2018 and September 2019 were selected as the observation subjects. According to whether the crown fragments were kept intact or not. the children were divided into broken crown reattachment group (45 cases. 45 teeth) and resin
5、 restoration group (45 cases, 49 teeth). Both groups underwent oral examination and vital pulpotomy, and on this basis, the broken crown reattachment group was given broken crown reattachment, and the resin restoration group was treated with resin crown restoration. The follow-up clinical efficacy,
6、and clinical aesthetic effect of crown restoration, clinical periodontal indicators and subjective satisfaction at 24 months after surgery were compared between the two groups of children. Results After 1 to 2 years of clinical follow-up observation, the success rates of both groups were 100% and 10
7、0% after 1 to 6 months, and the success rates after 12 months and 24 months were 78.94% and 67.65% in broken crown reattachment group and were 68.42% and 55.56% in resin restoration group respectively (x2=1.086. 1.079. all P0.05). The scores of marginal staining and marginal adaptation of broken cro
8、wn reattachment group were higher than those of resin restoration group (P0.05). The clinical periodontal indicators of broken crown reattachment group were lower than those of resin restoration group( P0.05). The scores of aesthetics and comfort were higher in broken crown reattachment group than t
9、hose in resin restoration group P0.05) . Conclusion The combination of broken crown reattachment and vital pulpotomy can improve the short-term and medium-term clinical efficacy of young permanent anterior teeth with traumatic crown fracture and pulp exposure. It has a better clinical aesthetic effe
10、ct and smaller impact on the health of periodontal tissues, and it is conducive to improving the treatment satisfaction. thus it is worthy of clinical promotion and application.Key words: broken crown reattachment; vital pulpotomy; young permanent anterior teeth; clinical efficacy;aesthetic effect;
11、subjective satisfaction年轻恒牙是指刚萌出到口腔内的恒牙,其在形态和结构上尚未完全发育成熟,从萌出到口腔中的时间也是牙齿处 于生长发育阶段,此阶段牙周韧带与牙槽骨之间连接相对较弱,尤其是儿童前牙区,因其位置关系成为牙外伤高发部位 1牙外伤的类型之一是牙齿折断,其中牙冠折断最为常见,当损伤较多遗成牙髓暴露时,假设不及时治疗或者治疗不当, 可导致牙锄发生感染坏死,进而影响年轻恒牙牙根的生长发育2。对于治疗巳冠折霄融的年轻恒牙来说,不仅要考虑牙 懿状况、牙髓暴露时间、露便大小、牙根发育程度等,还需最大可能地保存没有感染的活盹组织,减少对牙根生理性发 育的影响3。断冠再接术是在断
12、裂局部保存相对完整的情况下,重新粘接剩余的牙齿结构,是一种暂时恢复牙冠的方式, 具有可预测性、操作简单、平安性高及本钱低等特点4。活髓切断术是仅切除可能感染的牙前组织暴露端,留下方未感 染部位,以更多地保存颈部牙侵组织,需操作迅速,减少再次感染的机会5)。本研究旨在探讨断冠再接术联合活笛切断 术治疗外伤冠折露髓年轻恒前牙的临床疗效,现报道如下。1资料和方法1.1 一般资料:选取2018年9月-2019年9月笔者医院牙体牙搬科就诊的90例外伤冠折露髓年轻恒前牙患儿为 研究时象,按冠折断片保存完整与否分为断冠再接组45例(共45颗患牙)和树脂修曳组45例(共49颗患牙。两 组患者一般资料比拟差异无
13、统计学意义(P0.05),具有可比性,见表1。本研究经医院伦理委员审核批准。1.2 纳入标准:均诊断为冠折雾僦;患牙均为年轻恒前牙;年龄813岁;X线片显示牙槽骨骨折、无根 折、脱位等;冠折断片保存完整或断冠丧失者;家长知情同意。1.3 排除标准:存在根尖周病变(根尖区根周膜增宽、根尖周低密度影、硬骨板不连续或消失等)者;合并严 重系统性疾病;有过敏史;依从性较差不能定期复诊者。1.4 治疗方法:两组均行口腔检查,以了解牙齿的折裂情况和牙周膜的健康情况,并告知家属患儿具体病情、治 疗流程、预后情况及可能出现的问题和处理措施等,在此基础上再行活切断术时患牙牙髓进行处理。具体操作如下: 使用曳方盐
14、酸阿替卡因局部浸润麻爵后,常规消毒术区和铺巾,像皮障隔湿后用已灭菌的涡抡机切除露髓孔下方牙髓组 织(深度12mm),之后用生理盐水冲洗牙髓断面剩余牙本质碎屑,待牙髓断面土色呈鲜红色无明显炎性渗出时,用 无南棉球吸干断面,轻轻放置调制的话然保存剂,厚度12mm,再横盖一薄层光固化玻璃离子垫底。断冠再接组绐子断冠再接术修复牙冠,需提前用生理盐水浸泡干燥断冠2h以备用,首先是将剩余牙冠和游离断 冠端的唇、腭侧制备一斜面(宽约1mm),以获御更大的粘接面积增加固位。之后用37%的磷酸凝胶酸蚀粘接面(游 离断冠断端粘质和牙体断弗釉质酸性30s,牙本质酸性155)后冲洗吹干,于两断墙先用小毛刷分别涂Sin
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- 再接 联合 切断 治疗 外伤 露髓 年轻 恒前牙 疗效 观察
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