意向性牙再植术治疗畸形根面沟的预后及相关因素分析

Treament of radicular grooves by intentional replantation

目的:评价意向性牙再植术对上颌前牙畸形根面沟的治疗效果及影响再植术预后的相关因素。方法:选择上颌前牙伴有畸形根面沟致牙周牙髓联合病变的患者9例,经完善的根管治疗后,行意向性牙再植术,分别观察术后1周、1个月及3年的疗效。结果:治疗前患者均有牙源性窦道,牙周袋深度6~10 mm。意向性牙再植术后1周,有7例患牙窦道未愈合,探诊出血,探诊深度4~6 mm,叩(+-),松动Ⅰ°;2例患牙窦道愈合,探诊深度2~3 mm,叩(-),无松动;X线片示,9例患牙根尖周及牙周稀疏区无明显改善。1个月后,9例患牙窦道基本完全愈合,探诊深度2~3 mm,叩(-),无松动;X线片示,根尖周及牙周稀疏区较术后1周明显缩小,伴有部分牙周膜组织的愈合。3年后,9例患牙探诊深度<2 mm,叩(-),无松动;X线片示,原稀疏区基本被新生骨组织充满,牙周膜结构清晰。结论:对于由畸形根面沟引起的上颌前牙牙周牙髓联合病变,意向性牙再植术是比较有效的治疗方案。

AIM： To observe the curative effects of intentional replantation in the treament of maxillary anterior teeth with radicular grooves. METHODS： 9 patients with radicular grooves on maxillary anterior teeth were treated by conventional root canal treatment and then intentional replantation. Follow-up examination was conducted 1 week,1 month and 3 years after treatment respectively. RESULTS： At 1-week recall after intentional replantation,7 of 9 teeth still had sinus tract,gingival tumefaction,purulent discharge and bled on probing from the teeth,the pocket depth were 4 ~ 6 mm,with teeth percussion（＋-） and mobility of degree Ⅰ°; sinus tract closed in 2 cases. Radiographic examination revealed an extensive periradicular radiolucency involving the periapical and periodontal membrane. At 1-month recall,the sinus tract almost closed in 9 cases; the gingival were normal,the pocket depth were2 ~ 3 mm,teech percussion（-）,with no mebility. Radiographic examination revealed a dramatic decline of periradicular radiolucency of the periapical and periodontal membrane. At the evaluation appointment 3 years after treatment the gingival were normal without swelling,purulent discharge,bleeding and gingival atrophy; the adjacent labial alveolar mucosa was health,the pocket depth was 〈 2 mm,teech percussion（-）,with no loose degree of the 9 teeth. The patients were asymptomatic with occlusion. Radiographic examination showed complete periapical and periodontal membrane healing. CONCLUSION： Intentional replantation is effective for the treatment of radicular grooves.