牙半切除术治疗下颌磨牙重度病损的临床疗效观察

发布时间：2018-06-02 14:55

本文选题：牙半切除术 + 植骨术　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：对常规根管治疗及牙周基础治疗不能治愈的下颌磨牙不均衡重度病损，予以牙半切除术治疗联合术后固定修复，观察其对天然牙保存治疗的临床疗效。方法：收集10例牙半切除术临床病例，其中5例根折病例、4例牙周炎累及一根病损较重、1例髓室底穿。术前行临床检查并拍摄放射片观察其牙周情况，确保患牙符合适应症：（1）可施行完善的根管治疗者；（2）牙槽骨量足够者；（3）仅涉及到一根的根折；（4）余留的健康部分牙根不短于7mm者；（5）余留牙根根尖状况良好或虽有炎症，但预估经根管治疗可治愈者。若存在以下症状则不能施行手术：（1）无法行完善的根管治疗者；（2）牙根没有足够的牙槽骨支持，预计行植骨术预后仍不佳者；（3）根分叉过低者；（4）无法配合治疗及难以在治疗过程中按规定时间复诊的患者等。对患牙符合上述要求者，行全面细致的根管治疗后，翻瓣施行牙半切除术，在术中对需要恢复牙槽嵴高度及宽度者酌情施行植骨术，使牙槽嵴丰满并利于所保留牙根的稳固。对牙体缺损过多者行桩核修复，术后行临时冠修复以恢复牙冠形态、维持间隙并有利于自洁以保护其牙周组织。术后3到6个月复诊检查，确保患牙愈合良好、牙周状况明显改善并稳定后，则可行后期固定修复。本次病例研究中多采用利用余留牙及一侧邻牙作为基牙的固定修复设计，此种设计可以分散牙合力，减小余留牙所受咬合压力，保护基牙，以达到良好的远期疗效。结果：对10例下颌磨牙重度病损患者，，行牙半切除术后，余留牙根牙周状况良好，伴发炎症消失。其中3例欲增加牙槽骨高度及牙槽嵴丰满度者术中叠加施行植骨术，选用有骨引导功能的材料，术后有新生牙槽骨形成，恢复状况良好。术后桥体稳固，咀嚼功能恢复，基牙牙周状况维持较好，放射片未见牙槽骨继续吸收。其中一例在术后复诊中发现有余留牙根牙周膜增宽，经减径降低咬合处理后症状缓解。全部10例患者均表示治疗后原不适症状消失，适应较好。结论：牙半切除术在结合全面的牙周治疗及根管治疗后，可以最大程度保留常规根管治疗及牙周基础治疗不能保存的重度病损下颌磨牙，伴牙槽骨吸收者可考虑施行植骨术，预后效果更佳。术后以余留牙根结合单侧邻牙行固定修复为佳。磨牙经牙半切除术后,不仅可以最大程度保留天然牙还可以预防牙槽骨废用性萎缩，维持其应有高度及宽度，在临床实践中取得了很好的疗效。
[Abstract]:Objective: to observe the clinical effect of orthodontic root canal therapy and periodontal basic therapy on the treatment of mandibular molar unbalance and severe lesion. Methods: ten cases of hemiexy were collected, of which 5 cases were root fracture, 4 cases were periodontitis, one case was serious lesion and 1 case was pulp chamber floor puncture. Clinical examination was performed before operation and radiograph was taken to observe the periodontal condition. To ensure that the affected teeth conform to the indication: 1) A person with perfect root canal therapy can do 2) the alveolar bone mass is adequate and only involves one root fracture 4) the remaining healthy part of the root is not less than that of the person with 7mm (5) the residual root tip is in good condition or although there is inflammation. However, it is estimated that root canal therapy can be cured. If you have the following symptoms, you can't perform surgery: 1) if you can't do a perfect root canal therapy, you don't have enough alveolar bone to support your teeth. It is estimated that the prognosis of bone grafting is still poor. (3) the patients with lower root bifurcation can not cooperate with the treatment and the patients who are difficult to return to the treatment according to the prescribed time in the course of treatment and so on. For the affected teeth that meet the above requirements, after comprehensive and meticulous root canal treatment, the flap was treated with half-excision, and bone grafting was performed on those who needed to restore the height and width of alveolar ridge during the operation, so as to make the alveolar ridge fullness and the stability of the reserved root. Post and core prostheses were performed for the patients with excessive tooth defects, and temporary crown repair was performed after the operation to restore the shape of the crowns, maintain the gap and facilitate self-cleaning to protect the periodontal tissues. Follow-up examination 3 to 6 months after operation to ensure good healing of the affected teeth, periodontal condition improved and stable, then can be fixed later repair. In this case study, the residual teeth and the side adjacent teeth were used as the fixed restoration design. This design can disperse the force of teeth, reduce the occlusal pressure and protect the abutments, so as to achieve a good long-term effect. Results: in 10 patients with severe mandibular molar disease, the periodontal condition of residual root was good and the inflammation disappeared. Among them, 3 cases who wanted to increase the height of alveolar bone and the fullness of alveolar ridge were treated with bone graft during operation. The materials with bone guiding function were selected, the new alveolar bone was formed after operation, and the recovery condition was good. After operation, the bridge was stable, the masticatory function was restored, the periodontal condition of abutment was maintained well, and the alveolar bone was not absorbed by radiography. In one case, the residual periodontal ligament was widened, and the symptoms were alleviated by reducing the diameter and reducing the occlusal diameter. All the 10 patients indicated that the original symptoms disappeared and adapted well after treatment. Conclusion: after combined with comprehensive periodontal therapy and root canal therapy, the severely damaged mandibular molars which can not be preserved by conventional root canal therapy and periodontal basic treatment can be preserved. Bone grafting can be considered for those with alveolar bone resorption. The prognosis is better. It is better to fix the residual root and unilateral adjacent teeth after operation. The molar can not only preserve the natural teeth to the maximum extent but also prevent the atrophy of alveolar bone and maintain the height and width of the molars after semi-excision. It has achieved a good effect in clinical practice.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.4

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