骨性埋伏阻生智齿引起邻牙牙根外吸收的预后研究

A Prognostic Research of Adjacent Teeth with External Root Resorption Caused by Full Bony Impacted Wisdom Teeth

目的:针对骨性埋伏阻生智齿引起相邻第二磨牙牙根外吸收的现象,探讨不同治疗方法对牙根外吸收第二磨牙预后的影响。方法:以52颗因骨性埋伏阻生智齿引起牙根外吸收的无临床症状的第二磨牙作为研究对象,根据患者意愿分为实验组(拔除阻生智齿)和对照组(保留阻生智齿)并进行随访,分别记录不同治疗方法对相邻第二磨牙的牙根外吸收程度、牙髓活力、远中牙周探诊深度(PD)的影响。结果:实验组和对照组第二磨牙在观察期内牙根外吸收均未出现进展。实验组中5颗第二磨牙术后出现了牙髓症状,其中2颗可复性牙髓炎随诊观察至今、2颗因牙髓坏死后行根管治疗、1颗最终拔除。实验组其余27颗及对照组所有第二磨牙均未出现牙髓症状。实验组第二磨牙术后远中探诊PD较术前有所增加,差异有统计学意义(P<0.05),对照组随访前后远中探诊PD无显著变化;实验组与对照组随访前后PD差值(末次复查PD-初次就诊PD)具有统计学差异。结论:对于骨性埋伏阻生智齿引起的相邻第二磨牙牙根外吸收的病例,立即拔除阻生智齿可能不是唯一的选择。若必须拔除此类阻生智齿,术中亦应注意保护相邻外吸收第二磨牙的牙髓。

Objective:To investigate the effects of different treatments for full bony impacted wisdom teeth on the prognosis of adjacent second molar with external root resorption.Methods:52 asymptomatic second molars were included with external root resorption caused by full bony impacted teeth,and then divided into two groups--test group(extraction of the impacted wisdom teeth)and control group(reservation of the impacted wisdom teeth)-according to the willing of fully informed patients.As long-term follow-up was taken,symptoms and signs were recorded and comparatively analyzed,including the progress of external root resorption,pulp vitality,distal probing depth(PD)of the second molar.Results:No continuous progress of external root resorption was observed in both the test group and the control group.Pulp symptoms were observed in 5 teeth in test group in which 2 teeth were proved transient sensitivity,2 teeth with pulp necrosis were applied root canal therapy and 1 teeth were extracted finally.Pulp symptoms were not observed in other 27second molars.The postoperative distal PD of the second molars in the test group became deeper with significant difference;while in the control group,there was no significant difference in the distal PD before and after the follow-up.The difference of the changes of the distal PD between the two groups was statistically significant.Conclusion:Removal of the full bony impacted teeth might not be the only option for the compromised adjacent teeth with external root resorption.To the cases that the impacted wisdom must be extracted,the pulp of adjacent second molars should also be protected during operation.