口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (5): 305-313.DOI: 10.12016/j.issn.2096-1456.2022.05.001

• 专家论坛 • 上一篇    下一篇

恒前牙外伤水平根折的序列治疗及预后评估影响因素

陈蕾(), 王莹莹   

  1. 南方医科大学口腔医院,广东 广州(510280)
  • 收稿日期:2021-11-02 修回日期:2021-12-07 出版日期:2022-05-20 发布日期:2022-02-17
  • 通讯作者: 陈蕾
  • 作者简介:陈蕾,博士、主任医师,南方医科大学口腔医院综合急诊科主任,南方医科大学研究生导师,美国天普大学牙学院访问学者,广东省牙体牙髓专业委员会和广东省口腔急诊专业委员会常委;擅长牙外伤多学科序列治疗、显微根管治疗和显微根尖外科手术等牙体牙髓疑难病例的诊治。以第一作者或通信作者在国内外杂志上公开发表学术论文近40篇;主持国家自然基金等多项科研项目。
  • 基金资助:
    国家自然科学基金项目(81300890)

Sequential treatment and prognostic factors of traumatic root fracture in permanent anterior teeth

CHEN Lei(), WANG Yingying   

  1. Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
  • Received:2021-11-02 Revised:2021-12-07 Online:2022-05-20 Published:2022-02-17
  • Contact: CHEN Lei
  • Supported by:
    National Nature Science Foundation of China(81300890)

摘要:

恒牙外伤根折是一种涉及到牙本质、牙骨质、牙髓组织、牙周膜韧带甚至周围牙槽骨的病损,高发于10~20岁,大多涉及美学要求较高的上颌前牙区域。对于根折的恒牙,治疗的目标是尽可能维持患牙的生理和功能的完整性,降低并发症的发生。由于根折线的位置较大程度决定了后续治疗方案及患牙的预后,临床医师多根据根折线的位置水平对根折前牙进行分类:根尖段、根中段、根颈中段和根颈部根折。采用三维成像的锥形束CT(cone beam CT,CBCT)影像学检查可最大程度避免误诊和漏诊。恒前牙外伤根折的序列治疗包括了应急治疗、牙髓活力监测和后续并发症处理。应急治疗主要包括局部麻醉、指法复位移位的牙冠、影像学检查确定复位位置、调牙合、弹性夹板固定4周(颈部根折固定时间可长达4个月)。根折病损的修复过程由多组织参与,及时规范地处理牙根折创伤并密切随访观察,患牙预后较好,根折线越靠根尖,远期存活率越高。根折患牙的愈合方式及预后转归,除了根折线的位置外,还受诸多临床因素的影响,包括冠端牙体组织移位及移位程度、牙髓的病理状态、患者的年龄及牙根的发育情况、及时良好的复位、根折固定夹板的种类、合并其它损伤。医师需密切随访,综合判断根折线冠段牙髓是否发生感染。只有临床出现明确根折线感染征象时,才需要补充根折线冠段根管治疗。本文就根折牙外伤的分类、诊断、应急治疗、随访序列治疗,预后评估及预后影响因素作述评,以期为临床医师处理恒前牙根折外伤牙提供参考。

关键词: 牙外伤, 根折, 恒牙, 应急治疗, 序列治疗, 弹性夹板, 预后评估, 根管治疗, 前牙

Abstract:

Root fracture is a kind of dental trauma involving dentin, cementum, pulp tissue, periodontal membrane ligament and even the surrounding alveolar bone. It occurs frequently between the ages of 10-20, mostly in the area of the maxillary anterior teeth with high aesthetic requirements. The treatment goal for root fracture in permanent teeth is to maintain the physiological and functional integrity of the tooth as much as possible and to reduce the incidence of complications. Clinicians usually classify the affected teeth according to the position of the root fracture, including the apical, mid-root, cervical-mid-root and cervical segments, since it determines the treatment plan and the prognosis of the affected teeth. CBCT examination can avoid misdiagnosis and missed diagnosis of root fracture to the greatest extent. The sequential treatment plan of root fracture after permanent anterior tooth trauma includes initial emergency treatment, pulp vitality monitoring and complication management during follow-up. Emergency treatment mainly includes local anesthesia and repositioning, if displaced, the coronal segment of the tooth as soon as possible. Then, after checking its position radiographically, adjustment occlusion and flexible splinting for 4 weeks (4 months for cervical root fracture). The process of root fracture repair includes many tissues and is affected by many clinical factors. Timely and standardized treatment and close follow-up according to the Dental Trauma Guideline guarantee a good prognosis of root fracture. The closer the root fracture line is to the apex, the higher the survival rate is. In addition to the location of the root fracture line, the prognosis is affected by many other clinical factors, such as the displacement of the coronal fragment of the root fracture, the pathological state of the dental pulp, patient age, developmental stage of the root, timely and good replacement of the root fracture, splinting method, and the presence of other dental trauma complications. Pulp vitality should be monitored regularly, and root canal therapy of the coronal segment should be carried out only when infection of the pulp is established. This article reviews the classification, diagnosis, emergency treatment, sequential follow-up treatment, and prognostic assessment of root fracture trauma to provide suggestions for clinicians to manage root fracture trauma in permanent teeth.

Key words: dental trauma, root fracture, permanent tooth, emergency treatment, sequential therapy, flexible splinting, prognostic assessment, root canal therapy, anterior teeth

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