冠折年轻恒前牙活髓切断术后临床及X线研究

Clinical and radiographic study of the fractured immature anterior permanent teeth after pulpotomy

目的观察冠折年轻恒前牙活髓切断术后的 X 线表现并进行测量,为行活髓切断术治疗的牙齿在牙根形成后是否需要及时改做根管治疗提供依据。方法回顾分析25例(31颗牙)曾行活髓切断术、牙根已形成的冠折年轻恒前牙的病例资料,并对其中的12例仅单侧上中切牙冠折病例(对侧上中切牙正常,无外伤史)和50名志愿者的100颗正常上中切牙分别进行了 X 线片的测量。结果活髓切断术后牙根继续发育,根长及根尖形态均与正常牙相似,但部分患牙根管可明显缩窄,甚至几乎根尖闭锁。测量结果显示正常双侧上中切牙距根尖为根长1/4、1/2、3/4处根管径的宽度[右上切牙分别为(0.67±0.14)mm,(1.05±0.19)mm,(1.78±0.34)mm,左上切牙分别为(0.66±0.12)mm,(1.04±0.17)mm,(1.76±0.30)mm]差异无统计学意义(P>0.05),而活髓切断术后的冠折牙齿与其对侧正常中切牙相比距根尖为根长1/4、1/2、3/4处根管径的宽度明显缩窄[活髓切断中切牙分别为(0.70±0.23)mm,(1.16±0.24)mm,(1.96±0.34)mm,对侧正常中切牙分别为(0.99±0.17)mm,(1.51±0.25)mm,(2.24±0.36)mm],差异有统计学意义(P<0.05)。结论活髓切断术后的冠折牙齿其根管有缩窄、钙化趋势,当牙根形成时,尤其是需利用髓腔和根管固位进行修复者,不宜观察时间过长,最终应打通钙化桥进行根管治疗。

Objective To observe the outcome of the fractured immature anterior permanent teeth after pulpotomy by X-ray measurement. Methods A total of 31 （25 cases ） fractured immature anterior permanent teeth after pulpetomy was reviewed. Radiographic measurements were performed on 12 cases with unilateral fractured central incisors and completely formed roots after pulpetomy and 100 （50 subjects） healthy maxillary central incisors. Results The roots development continued after pulpetomy, and the root length and periapical configuration were both similar to the healthy teeth, hut some root canals became narrow or even nearly obturated at the root apex. There was no significant difference in root canal width between healthy right and left maxillary central incisors at the site of 1/4 [ right： （ 0. 67 ± 0. 14 ） mm, left： （0. 66 ±0. 12）mm,P 〉0.05], 1/2[ right： （ 1.05 ± 0. 19） mm,left： （ 1.04 ± 0. 17）mm,P 〉0.05], 3/4 [ right： （ 1. 78 ± 0. 34 ） mm, left： （ 1. 76 ± 0. 30 ） mm, P 〉 0.05 ] of root, but the root canal width of the fractured incisors at the same site was significantly different from that of the contralateral healthy incisor,the 1/4 site pulpetomy ： （0. 70 ± 0. 23 ） mm, control： （0.99 ± 0. 17 ） mm, the 1/2 site pulpetomy： （ 1. 16 ± 0. 24 ） mm, control ： （ 1.51 ± 0. 25 ） mm ; the 3/4 site pulpotomy ： （ 1.96 ± 0. 34 ） mm, control： （ 2. 24 ± 0. 36 ） mm. Conclusions There was a tendency that the root canals of fractured teeth after pulpotomy became narrowed and obturated. It should not be followed up for too long to perform root canal treatment when roots completely formed.