临床桩核修复失败原因初步探讨

The initial investigation of the causes of 32 failure cases on post-core repair in clinic

目的:分析桩核修复失败的原因,探讨临床上影响桩核修复的可能因素,选择最适合患者的桩核冠系统。方法:收集因桩核修复失败前来天津医科大学口腔医院修复科就诊的病例132例134颗牙,年龄20-80岁,常规门诊检查、拍摄X线片及询问病史,并进行问卷调查,观察桩核修复失败常见的临床表现并分析桩核修复失败的原因。结果:①桩核松脱91颗(67.9%);牙体劈裂43颗(32.1%)。②在91颗桩核松脱病例中,桩核修复时间最短4个月,最长16年,平均5年,较常见的原因为牙体缺损至龈下(43.9%),桩长度不足(17.6%),桩与根管不密合(13.2%)、患者饮食习惯及咬合(8.8%)、桩锥度过大(8.8%)、修复时间≥5年(4.4%)和义齿基牙(3.3%);③43颗牙体劈裂病例中,20颗为非贵金属铸造桩且根管壁薄(46.5%),12颗为螺纹桩(27.9%),11颗牙颈部继发龋(25.6%);④所收集134颗病例中以前牙和前磨牙的修复失败较多,120颗为金属铸造桩核,13颗螺纹桩和1颗纤维桩,除纤维桩采用树脂粘结剂粘结外,其余均采用水门汀粘结剂。结论:所收集病例中桩核修复失败的主要临床表现有桩核松脱、牙体劈裂等。其主要影响因素有桩核的设计、患牙本身条件、粘接剂、修复体在牙弓中的位置以及患者习惯等。医师应严格掌握适应证,注意正确的临床操作和精确的技工制作,患者应定期复诊,以减少修复失败。

Objective： To analyse the causes of 32 failure cases on post-core repair in clinic.Discuss the possible factors which influence the post-core repair and choose the most suitable post and core crowns system for patients.Methods： Thirty-two failure cases with post-core cure were entered into the study.These cases were collected from prosthodontic department of stomatology hospital of Tianjin medical university from 2008 to 2011,134 teeth of 132 patients,aged between 20 to 80.Common examination,X-ray and medical history were made.And answer letter investigation were carried.The clinical manifestations of post-core failure repair were observed.The causes of failure were analyzed.Then provide the treatment and prevention measures.Results： ①91 teeth（67.9 percent） were due to the post crown＇s loosing or broken away.43 teeth（32.1 percent） were with the broken dental crown.②Among 91 loosing teeth,the shortest time of restoration was 4 months and the longest was 16 years,and 5 years averaged.The most common reason was the root below the gingival（43.9%）.Short of the post-and-core is the secondary common reason（17.6%）.Others are unsuitable post-root canal（13.2%）,eating habit and occlusion（8.8%）,angle of post（8.8%）,repair time≥5years（4.4%） and abutment of denture（3.3%）.③Among 43 teeth split,the most common reason was the base metal cast post and thin-walled root canal（46.5%）.The second was screw post（27.9%） and secondary caries in dental cervix（25.6%）.④Anterior teeth and premolars were the most common teeth which failed in restoration.There were 120 teeth restored with cast post-and-cores,13 teeth with screw post and 1 tooth with fiber pile.The fiber pile was adhered with resin-bonded.Others were bonded with cement.Conclusions： Loose or drop of the post-core,dental crown and root fracture were the chief clinical manifestations in post-core failure repair among all the cases.The main factors include post-core designs,teeth conditions,the adhesive,the tooth position and the habits of the patients.Dentists should pay attention to the correct clinical operation.And precise mechanic manufacture should be taken to reduce the failure.