根管消毒药物对年轻恒牙牙髓血运重建术疗效影响的临床研究

发布时间：2018-02-15 04:55

本文关键词： 牙髓血运重建术年轻恒牙牙根发育根管消毒药物　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的对于牙根尚未完全发育完成的年轻恒牙发生的牙髓或根尖周的感染,传统的治疗方法是根尖诱导成形术,这种治疗方法尽管临床治疗的成功率较高,但是无法取得患牙牙根的正常发育,常常造成患牙的冠根比例不良,使患牙后期发生根折的风险大大增加。近年来,对于此类患牙,学者们提出了牙髓血运重建的治疗方法,在牙髓血运重建术的治疗过程中,不进行根管的传统机械预备而是通过根管冲洗和根管消毒去除根管内感染,所以根管消毒药物的作用显得更加重要。本研究通过收集应用牙髓血运重建术治疗牙髓病变或根尖周感染的年轻恒牙的病例,评价牙髓血运重建术的治疗效果,并分析根管消毒药物对其疗效的影响,为以后应用牙髓血运重建术治疗牙髓病变或根尖周感染的年轻恒牙提供参考。方法通过复查青岛大学附属医院儿童口腔科2015年2月至2016年8月接诊患儿的牙片,收集因外伤或畸形中央尖折断造成年轻恒牙牙髓病变甚至根尖周感染,采用牙髓血运重建术进行治疗的病例,共21颗患牙。21颗患牙经常规开髓、清理牙髓后,通过大量次氯酸钠溶液和生理盐水冲洗根管,并结合灭菌水超声荡洗来去除根管内感染坏死物,干燥根管后,根管内导入三联抗生素糊剂或氢氧化钙糊剂进行根管消毒,炎症得到有效控制后,根管锉刺激根尖周组织出血进入根管内形成血凝块,冠方用3M玻璃离子水门汀进行封闭,而后上方再用树脂充填。21颗患牙中,14颗患牙采用了三联抗生素糊剂(甲硝唑、米诺环素和环丙沙星)进行根管消毒,三联抗生素糊剂由甲硝唑、米诺环素和环丙沙星按1:1:1等比例与灭菌水混合而成;7颗牙齿采用了氢氧化钙进行根管消毒。通过分析病例资料,比较两组治疗的成功率,对数据进行统计分析,并分析临床疗效的影响因素。结果经过最短8个月,最长24个月的随访观察,经牙髓血运重建术治疗的21颗患牙中14颗患牙无不适症状,临床检查无叩痛、无松动,牙龈黏膜无红肿和瘘管等体征;X线片检查无根尖周组织病变,牙根增长,根管壁增厚,评价为治疗成功,治疗成功率为66.67%。5颗牙齿出现根尖周病变的症状,2颗牙齿治疗后在随访观察期间,未出现不适临床症状和体征,但始终未出现牙根继续发育,评价为治疗失败。14颗采用三联抗生素糊剂进行根管消毒的病例中,治疗成功患牙11颗,成功率78.57%;7颗采用氢氧化钙进行根管消毒的病例中,治疗成功患牙3颗,成功率42.86%;总体成功率为66.67%。经统计分析p0.05,两组间成功率之间的差异无统计学意义。结论牙髓病变或根尖周感染的年轻恒牙进行牙髓血运重建治疗后,可以使得此类年轻恒牙牙根继续发育,牙根长度增加,根管壁增厚,根尖封闭。三联抗生素糊剂与氢氧化钙相比,对牙髓血运重建术临床疗效影响的差异无统计学意义。
[Abstract]:Objective in the case of pulp or periapical infection in young permanent teeth with incomplete root development, the traditional treatment is apical induction, despite the high success rate of clinical treatment. However, the failure to achieve normal root development often results in poor crown and root ratio, which greatly increases the risk of root fracture in the later stage of the affected tooth. In recent years, for this kind of tooth, scholars have proposed a method for the treatment of pulp blood circulation reconstruction. In the treatment of dental pulp revascularization, root canal infection is removed by root canal washing and root canal disinfection instead of traditional mechanical preparation of root canal. So the effect of root canal disinfectant is more important. In this study, we evaluated the effect of endodontic revascularization in the treatment of young permanent teeth with pulp lesion or periapical infection by using dental pulp blood revascularization. The effect of root canal disinfectant on its curative effect was analyzed. To provide a reference for the treatment of young permanent teeth with pulp lesion or periapical infection. Methods the dental films of children received from February 2015 to August 2016 in the Department of Children's Stomatology, affiliated Hospital of Qingdao University, were reviewed. A total of 21 teeth were treated with pulp lesion or periapical infection caused by trauma or malformed central cusp fracture. A total of 21 teeth were treated with pulpion revascularization. The root canal was washed by a large amount of sodium hypochlorite solution and normal saline, and the infection necrosis in root canal was removed by ultrasonic washing with sterilizing water. After drying root canal, the root canal was disinfected by introducing triple antibiotic paste or calcium hydroxide paste into root canal. After the inflammation was effectively controlled, the root canal file stimulated periapical bleeding into the root canal to form blood clots, and the crown was sealed with 3M glass ionomer cement. Then the upper teeth were filled with resin and 14 of the teeth were disinfected with three antibiotic paste (metronidazole, minocycline and ciprofloxacin), and the triple antibiotic paste was metronidazole. Minocycline and ciprofloxacin were mixed with sterilizing water at the ratio of 1: 1: 1 and 7 teeth were disinfected with calcium hydroxide. By analyzing the case data, the success rate of treatment was compared between the two groups, and the data were statistically analyzed. Results after the shortest 8 months and the longest 24 months of follow-up observation, 14 of 21 teeth treated by pulp blood reconstruction had no symptoms, no percussive pain and no loosening in clinical examination. No signs of gingival mucosa, such as redness, fistula and so on, were detected by X-ray examination. There was no periapical tissue lesion, root growth, and root canal wall thickening, which were evaluated as successful treatment. The success rate of treatment was 66.67.5 the symptoms of periapical lesion in two teeth. During the follow-up observation, no clinical symptoms and signs were found, but the root continued to develop. In 14 cases of failed treatment, 11 teeth were successfully treated, 7 cases were treated with calcium hydroxide, 3 teeth were successfully treated. The overall success rate was 66.67. There was no significant difference in the success rate between the two groups by statistical analysis (p0.05). Conclusion the pulp disease or periapical infection of young permanent teeth were treated by blood revascularization. It can make the root of this kind of young permanent tooth continue to develop, the root length increases, the root canal wall thickens, and the root tip is closed. There is no significant difference in the effect of triple antibiotic paste and calcium hydroxide on the clinical curative effect of pulp blood transport reconstruction.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.05

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