149颗前牙残冠残根桩核冠修复的临床应用

Clinical study of 149 dowel-core-crown prostheses in restoration of residual roots and crown of anterior teeth

目的探讨前牙残冠残根的根管治疗和桩核冠修复中存在的问题和处理方法.方法选择门诊100例患者149颗残冠残根进行临床检查,包括问、叩、探诊和X线牙片检查,在进行桩核冠修复的同时,并记录根管治疗和桩核冠修复后所存在的问题.结果检查结果:110颗(73.81%)根管充填完好,25颗(16.78%)根管充填不理想,其中7颗根管充填不致密,18颗欠充3mm以上,14颗(9.39%)未作根管治疗.149颗牙中有12颗已进行桩冠修复,24颗为不良修复体,2颗根尖囊肿形成.治疗结果:以上所有存在问题的病例经对症处理后作根管治疗,149颗均采用铸造桩核烤瓷冠修复,经1～4年的门诊复查,成功138颗(92.59%),失败11颗(7.38%),包括崩瓷4颗(2.68%),桩核松动脱位3颗(2.01%),颈部露金属色4颗(2.68%).结论完善的根管治疗是修复科桩核冠修复的首要条件,桩核冠是残冠残根理想的修复体.

Objective: To analyze the problems existing in the root canal treatment and restoration of anterior teeth and to probe the proper solutions. Methods: 149 residual roots and crowns of 100 patients were examined physically and X-ray photos were taken. After completion of root canal treatment, the residual roots and crowns were restored with dowel-core-crowns. Results: Examination results: Among 149 residual roots and crowns, 110 (73.81%) existing endodontically treated teeth had good apical seal; 25 inadequate root fillings (16.87%) should be retreated; and 7 of them were not filled compactly, 18 of them lacked at least 3 mm; 14 existing no fillings (9.39%) were treated with root canal treatment firstly. While coming to our clinic, 2 patients had chronic periapical cysts and then surgery treatments were done; 12 teeth had been restored with simply dowel crowns; 24 teeth had harmful prostheses. Treatment results: After finishing the endodontic treatment or surgery treatment, 149 teeth were restored with dowel-core-prostheses. The observation involving 100 patients evaluated 149 dowel-core-crowns followed 3~4 years: the success rate was very high (92.59%), 138 prostheses had good esthetic, phonetic and mastication effects; the failure rate was 7.38%. Among the 11 failed cases, 4 prostheses (2.68%) failed because of porcelain fracture, 3 cases (2.01%) failed in retention, and 4 cases (2.68%) were unsatisfied with gingival metal line. Conclusions: The completion of good root canal treatment is necessary before restoration with dowel-core-crowns. Dowel-core-crown is an ideal technique for restoration of residual roots and crowns.