根尖诱导成形术对年轻恒牙根尖闭合的影响

Effect of apexification on apical closure of infected young permananent teeth

目的研究根尖诱导成形术对感染型年轻恒牙根尖闭合的影响。方法选择已发生牙髓感染的59颗畸形中央尖患牙和17颗外伤切牙,采取Vitapex成品糊剂进行根尖诱导以促牙根发育、根尖闭合。结果经2年追踪观察,术后患牙100%临床不适症状消失,93.42%完成根尖封闭。17颗根尖内聚型患牙术后根尖均发育完成,平均闭合时间6.70个月;26颗根尖平行型,11颗根尖发育完成,另15颗根管腔无缩窄,但根尖达到闭合,平均闭合时间10.38个月;33颗根尖喇叭口型5颗根尖闭合,23颗在根尖孔处形成钙化桥,4颗形成根管内不规则钙化桥,1颗出现牙根内吸收,平均闭合时间16.71个月。随着治疗进展,患牙根尖孔及根尖1/3处直径逐步缩窄,根尖孔术前平均直径1.99mm,术后均值0.88mm,但仍高于健康对照牙(P<0.05)。患牙根尖1/3处术前平均直径2.19mm,术后均值缩小至1.28mm。结论感染型年轻恒牙牙根经根尖诱导治疗可获得良好发育。不同根尖孔形态患牙其临床疗效无明显差别。术前根尖内聚或平行型患牙,术后根尖发育接近生理性闭合状态,术前根尖孔呈喇叭口型者会影响牙根发育成正常根尖形态,延长根尖闭合时间。

Objective To study the effect of apexification on apical closure of infected young permanent teeth.Methods Fifty nine infected abnormal central cusp teeth and 17 traumatic incisors were treated with apexification to promote apical closure.Results After two years follow-up observation,the success rate in terms of clinical symptoms was 100%,while in terms of apical closure the success rate was 93.42%. Seventeen teeth with convergent apex obtained physiological apical shapes and average time taken to obtain apical closure was 6.70 months. Among 26 teeth with parallel apical walls,11 teeth obtained physiological apical shapes,15 teeth obtained apical closure but didn＇t obtain narrow root canal and average time was 10.38 months. Among 33 teeth with divergent apex,5 teeth obtained apical closure,23 teeth ended with calcification bridge in apex,4 teeth with irregular calcification bridge post-treatment and 1 tooth appeared internal resorption and average time was 16.71 months. During treatment the apical foramen average diameter of teeth with apicoformation progressively decreased in size from 1.99mm to 0.88mm,yet it was larger than healthy contralateral teeth （P〈0.05）. Average diameter of apical 1/3 district decreased from 2.19mm to 1.28mm.Conclusion Infected young permanent teeth could obtain favourable prognosis with apexification. Clinical efficacy of different apical foramen shape teeth had no statistical significance. Teeth with convergent or parallel apical shapes were apt to result in physiological apical shapes post-treatment; divergent apex of the teeth before treatment hindered apical closure.