外伤脱位牙即刻再植临床效果分析

Analysis of the clinical effects of immediate replanting of traumatic dislocated teeth

目的探讨外伤脱位牙即刻再植的临床疗效及其影响因素。方法选择1993年10月至2005年10月于江西省萍乡市人民医院和广东工业大学医院口腔科就诊的外伤脱位牙患者46例60颗牙进行即刻再植,术后随访观察5年。结果再植牙术后5年成功率为75%,累计有11例15颗再植牙失败,失败原因主要为术后牙根吸收大于根长1/3(占60%)、继发感染(占26.7%)、固定不牢靠(占13.3%)。离体时间<30 min再植牙的牙髓成活率和牙周膜愈合率均高于离体时间>30 min的再植牙,差异有统计学意义(P<0.01)。结论即刻再植外伤脱位牙经适当的临床治疗仍可保留多年,再植成功的关键是严格选择适应证、正确选择离体牙储存介质、尽快植入缩短牙离体时间、尽可能保存牙周膜活性、牢靠的固定结合功能运动和及时有效防治感染。

Objective To probe the clinical effects and influencing factors of immediate replanting of traumatic dislocated teeth.Methods Sixty traumatic dislocated teeth from 46 patients in dental clinics were chosen for immediate replanting,which were followed by five-year post-operation observation.Results The success rate of replanted teeth reached 75%;15 replanted teeth from 11 patients failed due to root resorption over 1/3 root length after operation（60%）,secondary infection（26.7%）,and unstableness（13.3%）.Compared with the teeth dislocated more than 30 minutes,those dislocated less than 30 minutes had higher pulp survival and periodontal ligament healing rates,and the differences had statistical significance（P 0.01）.Conclusion Treated properly,traumatic dislocated teeth which are immediately replanted can be retained for many years.The keys to successful replanting lie in strictly selected indications,the right storage media for dislocated teeth,immediate replanting to shorten the time of teeth dislocation,trying to keep the activity of periodontal ligament,solid fixation combined with functional movement,and timely effective infection control.