牙根纵裂临床相关研究（附25例临床病例分析）

发布时间：2018-07-11 16:06

本文选题：VRF + 早期诊断　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的通过分析总结25例诊断为牙根纵裂患者的临床资料，结合相关文献复习，探讨牙根纵裂的早期症状、可疑诱发因素及有效诊断手段，为临床VRF的预防及早期诊断提供理论依据。方法1、进行VRF相关文献复习，了解国内外有关VRF的最新研究进展； 2、（1）收集2012年9月-2014年3月就诊于山西医科大学口腔医院综合科的25例诊断为VRF患者的临床资料，分别记录患牙的牙位、牙髓治疗状态、牙周情况、牙合面特征及患者的临床表现、咬牙合情况、咀嚼习惯、咀嚼创伤史、夜磨牙史等。（2）、所有患牙均拍摄X线根尖片，必要时经患者同意拍摄CBCT,以明确纵裂牙根、部位和方向，并了解根周骨吸收破坏情况。（3）、对以上所有信息进行分析总结。结果1、25例VRF患者中，男18例，女7例，年龄39-57岁,平均年龄51岁。 2、牙位分布：下颌第一磨牙13颗，下颌第二磨牙5颗，上颌第一磨牙4颗，上颌第二磨牙2颗，下颌第二前磨牙1颗。磨牙发生最多（24/25），占96%；下颌第一磨牙的发生率最高(13/25)，占52%。 3、牙髓治疗状态：25例患牙中，活髓牙10颗，经过根管治疗的15颗。 4、纵裂牙根：下颌磨牙近中根15颗，远中根3颗；上颌磨牙近中颊根4颗，远中颊根1颗，远中颊根+腭根1颗；下颌第二前磨牙1颗。近中根发生最多（19/25），占72%。方向均为颊舌向纵裂。 5、牙周情况：25颗患牙中，16颗表现为牙龈红肿、可探及4~10mm牙周袋且有松动。 6、临床表现：活髓牙多表现为冷热刺激痛、牙髓活力温度测验异常等牙髓炎症状；无髓牙多出现牙龈红肿、窦道、局部深牙周袋、牙周溢脓等表现。所有患牙均有咬牙合不适或不同程度的咬牙合痛。 7、25例VRF患者中，，有偏侧咀嚼或喜嚼硬物史、夜磨牙史的15例、咀嚼创伤史的3例。咬牙合面存在不同程度磨耗的20例，咬牙合关系异常的15例。 8、X线根尖片表现：患根根管腔增宽，增宽线色深，边界清楚，根尖分开，宽度越向根尖越明显。牙周膜间隙增宽，硬骨板消失，牙根周围“V”形骨丧失。患牙晚期牙根管腔全长增宽，边界不一定整齐，严重者根折裂片可发生移位。经过根管治疗的患牙可观察到根充物或桩与纵裂处的髓腔之间有间隙。 9、诊断方法：X线根尖片诊断18例，CBCT诊断4例，X线根尖片+CBCT诊断2例，拔牙后诊断1例。结论VRF的发生存在一定的易感因素，且临床表现复杂多样，缺乏特异性。临床医师应具备全面系统的VRF相关理论知识，以期能及时发现VRF的早期症状，并采用合理的诊断方法，对VRF做出早期诊断。同时应规范临床操作，以预防医源性VRF的发生。
[Abstract]:Objective to analyze and summarize the clinical data of 25 cases of root longitudinal fissure, and to discuss the early symptoms, suspicious inducing factors and effective diagnostic methods of root longitudinal fissure. To provide theoretical basis for the prevention and early diagnosis of clinical VRF. Methods 1. To review the relevant literatures of VRF, to understand the latest research progress of VRF at home and abroad. 2, (1) to collect the clinical data of 25 patients diagnosed as VRF from September 2012 to March 2014 in the Department of Stomatology, Shanxi Medical University. The tooth position, pulp treatment status, periodontal condition, occlusal features and clinical manifestations, occlusion, masticatory habits, history of chewing trauma, history of night molars were recorded respectively. (2) all the affected teeth were taken X-ray apical film. When necessary, CBCTs were taken with the consent of the patient to determine the root, position and direction of the longitudinal fracture, and to understand the bone resorption damage around the root. (3) all the above information were analyzed and summarized. Results 1 among 25 VRF patients, 18 were males and 7 females, aged 39-57 years, with an average age of 51.2. The distribution of teeth was as follows: 13 mandibular first molars, 5 mandibular second molars, 4 maxillary first molars and 2 maxillary second molars. 1 mandibular second premolar. The molar rate was the highest (24 / 25), accounting for 96%, and the first mandibular molar rate was the highest (13 / 25), accounting for 52. 3. Of the 25 cases of dental pulp treatment, 10 were alive pulp teeth. 15 of them were treated with root canal, and 15 of them were treated with longitudinal canals: 15 were proximal middle root of mandibular molar, 3 were distal root, 4 were mesiobuccal root, 1 was distal buccal root, 1 was palatal root of distal buccal root, and 1 was mandibular second premolar. The most occurrences occurred near the middle root (19 / 25), accounting for 72%. The direction was buccal and lingual longitudinal fissure. 5. Among 25 teeth with periodontal condition, 16 of 25 teeth showed gingival redness, 4~10mm periodontal bag could be detected and loosened. 6. Clinical manifestation: living pulp teeth showed cold and hot irritation pain. Pulpitis symptoms such as abnormal temperature test of pulp vitality, gingival redness, sinus tract, local deep periodontal bag, periodontal overflow, etc. 725 patients with VRF had history of unilateral mastication or liking to chew hard objects, 15 cases of night molars history, and 3 cases of masticatory trauma history. There were 20 cases with different degree of attrition on the occlusal surface and 15 cases with abnormal occlusal relationship. The X ray film showed that the root canal cavity was enlarged, the line color depth was enlarged, the boundary was clear, the apex was separated, and the width became more and more obvious to the root tip. The periodontal ligament space was widened, the hard bone plate disappeared and the V shaped bone around the root was lost. The full length of the root canal was enlarged and the boundary was not regular in the late stage of the affected teeth, and the root fracture could be displaced in severe cases. There was a gap between the root filling or post and the medullary cavity in the longitudinal fissure after root canal treatment. [WT5HZ] [WT5 "HZ] [WT5" HZ] [WT5BZ] X-ray apical radiography was performed in 18 cases and CBCT in 4 cases, and after tooth extraction in 1 case. Conclusion there are some susceptible factors in the occurrence of VRF, and the clinical manifestations are complicated and lack of specificity. Clinicians should have comprehensive and systematic knowledge of VRF theory in order to find the early symptoms of VRF in time and make early diagnosis of VRF with reasonable diagnostic methods. At the same time, clinical practice should be standardized to prevent iatrogenic VRF.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R781.2

【相似文献】