龈下残根修复前的正畸治疗

目的：本文对损坏至龈缘下1．5～3．5mm的前牙牙根作修复前的正畸牵引术,当根面牵引至平齐龈缘时再行桩冠修复：方法：3例外伤、3例根面龋的患者采用片段弓技术行（he）向牵引,然后桩冠修复：结果：6例患者取得了较满意的效果。结论：若前牙牙根损坏位于龈下,在修复前进行正畸治疗,既保留了常规应拔除的牙根,又可获得较好的功能和美观效果。     

预置临时桩冠的正畸牵引术治疗前牙龈下根折

目的：评价预置临时桩冠的正畸牵引术治疗前牙龈下根折,使其与龈缘平齐的效果。方法：6例9颗龈下根折前牙应用预置临时桩冠的正畸牵引术使根折断面暴露,观察患牙牵引前后及固定保持3个月后的牙龈形态及牙根的稳固性,通过X线片分析牙周膜健康情况。结果：患牙应用预置临时桩冠的正畸牵引术不仅根折断面能安全的到达与龈缘平齐的位置,且固定保持后3个月无复发。结论：预置临时桩冠的正畸牵引术能安全稳定使龈下根折的前牙达到修复前标准。     

前牙外伤性龈下残根牵引后桩冠修复

目的 探讨正畸法冠向牵引龈缘下残根后作铸造核桩冠修复的临床效果。方法 对 36例患者 48颗前牙断根,先行部分弓矫治伸长牙根后再行铸造核桩冠修复,随访1～3年。结果 2例3颗桩冠失败。其中松动脱落1例,残根纵裂1例,折断1例,失败率为6.3％。结论 此修复方法可保存自然牙根,简化修复过程,保留美观、自洁的龈缘。     

正畸法伸长前牙根后行桩冠修复的体会

目的 本文应用正畸法对因各种原因引起前牙根损伤至龈缘下的病员牙根的处理，进行了临床初步探讨。方法 对30例患者31颗前牙，先行部分弓矫治伸长牙根后再行传统桩冠修复。结果 除1例1颗桩冠咬过硬食物造成牙根纵裂拔除外，其余效果良好，目前完好率96.8％。结论 保存了自然牙根，又简化了修复方法，还得到美观、自洁的龈缘，在临床上具有一定的参考意义。     

前牙冠根联合折断的修复前正畸

目的观察正畸牙合向牵引术和牙龈成形术对龈下残根的保存修复治疗效果。方法选择9例患者经过完善根管治疗后,采用正畸牵引方法牵出残根,对于部分龈缘明显高于邻牙的患者,作牙龈成形术恢复牙龈正常状态,固定12周后行核桩烤瓷冠修复。结果9例中有1例上颌中切牙Ⅰ度松动失败,其余8例效果较满意。结论前牙牙根损坏位于龈下釉牙骨质交界处,可行正畸治疗,保留残根进行修复。     

正畸牵引和桩冠修复在龈下根折的外伤前牙保存中的应用

目的 观察外伤致龈下根折前牙正畸牵引加桩冠修复的治疗效果。 方法 选择30例断端位于龈下3 mm以上的外伤前牙进行正畸牵引至龈上1 mm后行桩冠修复,分别于修复后3个月、6个月及1年进行复查,观察临床效果。 结果 除1例在正畸治疗过程中因Ⅲ°松动拔除,其余29例牙冠均完好,牙龈颜色正常,牙周健康,不松动,X线下根尖及牙周无异常情况。 结论 此种方法对外伤前牙断端位于龈下3 mm以上的患牙试保留能取得较好的临床效果。     

前牙龈下冠折根牵引后的桩冠修复

目的 :研究临床龈下冠折低于牙龈 2mm以上断面牙根的桩冠修复方法。方法 :在根管内磷酸锌粘固一个小于根长 1/ 2的 1 0mm不锈钢丝 ,通过橡皮圈 ,固定在唇弓上牵引 ,2～ 4周后 ,当断牙根面与相邻牙龈缘平齐或龈下 0 5mm位置时 ,用金属丝固定 3月后 ,修整断牙根周牙龈组织后 ,桩冠修复。结果 :1988年至 1998年临床前牙冠根折唇断面在龈下 2mm以上且经完善根管治疗后共治疗 12 6例患者 ,14 7颗牙齿 ,通过信函调查发现 4 9例烤瓷桩冠有 3例牙根再次折断后拔除 ,其余患者均满意。结论 :前牙龈下冠折牙根牵引后桩冠修复克服了以往在断根处直接修复易引起牙龈牙周疾病的缺点 ,比切除唇侧牙龈使牙根暴露更能获得较为满意的功能及美学效果。     

正畸牵引向移动龈下残根的临床应用

目的探讨一种采用正畸方法向牵引龈下牙根后再修复的方法。方法选择龈下牙折患者8名,共10颗患牙,断端最低处距牙槽嵴顶的距离为1.5～2.0mm。经完善的根管治疗4周后,采用正畸固定矫治技术向牵引龈下牙根,平均疗程4～6个月,然后桩冠修复治疗。采用临床检查评价正畸前后牙齿松动度、牙龈形态和牙周状况,并通过X线片测量比较正畸前后断根根尖区相对骨密度的变化、断根倾斜度的变化和修复后冠根比。结果 10颗患牙经正畸治疗后向移动距离平均为3.99 mm,牵引后的牙根唇倾度减小,但与治疗前比较无统计学意义(P0.05)。修复后患牙冠根比与对侧同名牙相比无统计学差异(P0.05)。结论对于伤及牙槽嵴顶下的前牙牙根,在一定条件下可通过正畸方法向牵引龈下牙根,经修复治疗后,可达到美观和功能的效果。     

前牙外伤致龈下断根的牵引修复治疗

目的观察正畸牵引后桩冠修复龈下断根的临床效果。方法收集外伤导致的前牙龈下断根18例患者共23颗患牙,用牙齿少量移动（minor tooth movement,MTM）正畸技术牵引断根后行瓷桩、瓷全冠修复。结果经1—3年随访,17例患者的龈下断根正畸牵引后成功修复,维持了牙根的生理功能,达到美观和功能相结合的良好效果。1例患者的1颗患牙因牙根吸收松动而拔除,推测牙根松动是由牵引力过大所致。结论MTM正畸牵引后桩冠修复可保留龈下断根,维持牙根牙周组织的生理功能,恢复患牙的美观和功能。     

正畸牵引（牙合）向移动龈下残根的临床应用正畸牵引（牙合）向移动龈下残根的临床应用正畸牵引（牙合）向移动龈下残根的临床应用

目的 探讨一种采用正畸方法（牙合）向牵引龈下牙根后再修复的方法.方法 选择龈下牙折患者8名,共10颗患牙,断端最低处距牙槽嵴顶的距离为1.5~2.0mm.经完善的根管治疗4周后,采用正畸固定矫治技术（牙合）向牵引龈下牙根,平均疗程4~6个月,然后桩冠修复治疗.采用临床检查评价正畸前后牙齿松动度、牙龈形态和牙周状况,并通过X线片测量比较正畸前后断根根尖区相对骨密度的变化、断根倾斜度的变化和修复后冠根比.结果 10颗患牙经正畸治疗后（牙合）向移动距离平均为3.99 mm,牵引后的牙根唇倾度减小,但与治疗前比较无统计学意义（P〉0.05）.修复后患牙冠根比与对侧同名牙相比无统计学差异（P〉0.05）.结论 对于伤及牙槽嵴顶下的前牙牙根,在一定条件下可通过正畸方法（牙合）向牵引龈下牙根,经修复治疗后,可达到美观和功能的效果.     

利用改良Nance弓牵引龈下折裂牙

目的:观察使用改良Nance弓牵引龈下折裂牙的方法及疗效.方法:采用改良Nance弓牵引10颗已做完善根管治疗的龈下折裂牙.结果:10颗断根牙经过平均8～10周牵引和12周的保持后,经修复科医师会诊判断均达到桩冠修复的要求.结论:使用改良Nance弓牵引龈下折裂牙不仅可以保存自然牙根达到良好的修复效果,而且很好的解决了长达数个月的正畸牵引和保持过程中患者对美观的要求.     

Rapid orthodontic extrusion of crown root and cervical root fractured teeth.

This study concerns the relapse tendency and extent of root resorption in 33 extruded non-vital crown root fractured or cervical root fractured teeth in 32 patients 10-20 years old. They constitute all orthodontically extruded teeth at the Orthodontic or Pedodontic Departments, Eastman Institutet, Stockholm (1982-1987). A simple extrusion mechanism exerted a force of 60-70 p along the root axis of the tooth. An extrusion of 2-3 mm was obtained in most patients; the most extreme effect was 6 mm. In 16 patients the extrusion was achieved within 3 weeks, in 12 it lasted for 4-6 weeks and in 5, 7-9 weeks. The treatment was more complicated in the lower jaw. After the extrusion, a fibrotomy was done and in most patients also a gingival recontouring to create an optimal relation between the gingiva and the margin of the restoration. Periodically identical radiographs were taken immediately before and after the extrusion, after 3 months and after 1 year. A minor relapse, about 0.5 mm, was observed in 3 patients. Limited root resorption was found in 6 teeth and severe in only 1. The resorptions did not progress in the following 2 years of observation.     

Rapid orthodontic extrusion of crown root and cervical root fractured teeth

Abstract This study concerns the relapse tendency and extent of root resorption in 33 extruded non-vital crown root fractured or cervical root fractured teeth in 32 patients 10–20 years old. They constitute all orthodontically extruded teeth at the Orthodontic or Pedodontic Departments, Eastman Institutet, Stockholm (1982–1987). A simple extrusion mechanism exerted a force of 60–70 p along the root axis of the tooth. An extrusion of 2–3 mm was obtained in most patients; the most extreme effect was 6 mm. In 16 patients the extrusion was achieved within 3 weeks, in 12 it lasted for 4–6 weeks and in 5, 7–9 weeks. The treatment was more complicated in the lower jaw. After the extrusion, a fibrotomy was done and in most patients also a gingival recon–touring to create an optimal relation between the gingiva and the margin of the restoration. Periodically identical radiographs were taken immediately before and after the extrusion, after 3 months and after 1 year. A minor relapse, about 0.5 mm, was observed in 3 patients. Limited root resorption was found in 6 teeth and severe in only 1. The resorptions did not progress in the following 2 years of observation.     

A conservative multidisciplinary approach for improved aesthetic results with traumatised anterior teeth

A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the health of the periodontal tissues. If the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded by orthodontic forced eruption after root canal treatment. Extrusion enables the remaining root portion to be elevated above the epithelial attachment. Endodontic posts may be useful in exerting vertical forces to the root for extrusion without buccal tipping. The following case shows multidisciplinary management of a case of dental trauma. Orthodontic forced eruption is incorporated using endodontic posts and restoration with porcelain fused to metal crowns--leading to successful restoration of the traumatised teeth.     

牙隐裂病因分析与临床治疗

目的：探讨牙隐裂的临床治疗及其影响因素。方法：对44颗隐裂患牙根据其临床表现不同,分别采用活髓全冠修复（5颗）、根管治疗前即刻暂时冠修复＋根管治疗后全冠修复（6颗）、大量调＋根管治疗后全冠修复（25颗）、桩核冠修复（6颗）及冠延长术＋桩核冠修复（2颗）等不同的治疗方法,治疗后追踪0.5-5年。结果：修复后的成功率84.1%,临床疗效受多种因素的影响,其中隐裂纹的深度、隐裂纹涉及的边缘嵴数、牙周袋的深度均影响治疗的成功率。结论：针对不同程度的牙隐裂,采取不同的临床治疗方法是治疗成功的关键。     

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目的    探讨玻璃纤维桩联合纳米复合树脂对儿童年轻外伤恒前牙临时过渡性修复的临床效果。方法    2004年９月至2008年３月于杭州市口腔医院儿童牙科对65例78颗儿童外伤冠折恒前牙行完善的根尖诱导和根管治疗后,使用玻璃纤维桩修复后直接用纳米复合树脂修复外形作为至18岁的过渡性修复,随访3年,观察其临床修复效果。结果    术后3个月复查,未见纤维桩折断、根折、根吸收。术后6个月有1例因二次外伤发生根折。术后24个月复查,仅3例出现表面着色,未见树脂脱落,边缘渗漏偶有发生,经处理均使患者满意。术后36个月,未见纤维桩脱落、根折。结论    玻璃纤维桩和纳米复合树脂联合修复儿童外伤恒前牙是成功有效的过渡性修复方法。它能够避免直接树脂修复或断冠修复造成的反复脱落,又能降低根折风险,最大限度的保留牙体组织。     

老年人牙隐裂治疗临床疗效分析

目的:探讨老年人牙隐裂治疗的临床疗效及其影响因素。方法:对44颗隐裂患牙根据其临床表现不同,分别采用活髓全冠修复(5颗)、根管治疗前即刻暂时冠修复 根管治疗后全冠修复(6颗)、大量调 根管治疗后全冠修复(25颗)、桩核冠修复(6颗)及冠延长术 桩核冠修复(2颗)等不同的治疗方法,治疗后追踪半年-5年。结果:修复后的成功率84.1%,临床疗效受多种因素的影响,其中隐裂纹的深度、隐裂纹涉及的边缘嵴数、牙周袋的深度均影响治疗的成功率。结论:针对不同程度的牙隐裂,采取不同的临床治疗方法是治疗成功的关键。     

Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation

The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary.     

牙根牵引联合龈切治疗上前牙冠根联合折的临床研究

目的观察牙根牵引联合龈切、树脂冠修复治疗儿童及青少年上前牙冠根联合折的临床疗效。方法患牙根管治疗后,应用牙根牵引方法使牙根延伸2～4 mm不等,平均3.125 mm,再联合患牙舌侧牙龈切除2 mm和树脂冠修复,治疗上前牙冠根联合折病例16例,16颗患牙。结果 2年后临床检查树脂冠修复情况、患牙牙周和根尖周健康情况,X线片上牙根和根周牙槽骨情况。16颗患牙治疗后,疗效达成功标准的有5颗,有效10颗（患牙唇侧牙龈轻微增生）,失败的1颗（患牙再次外伤拔除）。结论牙根牵引联合龈切、树脂冠修复是保守治疗儿童及青少年上前牙冠根联合折的一种理想方法。     

Forced orthodontic extrusion to restore extensively damaged anterior and premolar teeth as abutments for single-crown restorations: Up to 5-year results from a pilot clinical study

Statement of problemClinical data on orthodontic extrusion to restore teeth deemed unrestorable because of their defect size are scarce. It remains unclear for which defects forced orthodontic extrusion and tooth retention is preferred to extraction.PurposeThe purpose of this pilot clinical study was to investigate the survival, frequency, and type of complications of extensively damaged teeth requiring single-crown restorations after forced orthodontic extrusion.Material and methodsParticipants were recruited from consecutive patients in need of restorative treatment of extensively damaged teeth at a university clinic. The teeth were orthodontically extruded to reestablish the biologic width and to ensure a 2-mm ferrule preparation before restoration. The primary endpoint was restoration success and survival. At recall, survival was defined as the tooth being in situ and success as a symptom-free tooth with an intact, caries-free restoration and with physiological pocket probing depths, no signs of intrusion, ankylosis, root resorption, or periapical radiolucency. Recalls were performed every 6 months; the outcome was assessed by radiographic and clinical evaluation after up to 5 years of clinical service. Quantitative parameters were described with mean values and standard deviations.ResultsThirty-four participants were assessed for eligibility and enrolled (mean ±standard deviation age: 53.4 ±18.9 years). Four participants were premature dropouts. Data were analyzed for 35 teeth in 30 participants. The amount of extrusion varied between 2 and 6 mm (mean ±standard deviation 3.4 ±0.9 mm). The mean duration of extrusion was 18.9 ±12.6 days and the mean duration of retention was 126.94 ±88.1 days. The mean ±standard deviation crown-to-root ratio after treatment was 0.8 ±0.1 (range: 0.5 to 1.0). Three participants exhibited orthodontic relapse before restoration. Teeth were successfully restored after repeated extrusion. After a mean observation period of 3.3 years (range: 1 to 5.2 years), 29 of 31 teeth were still in situ. Two teeth were fractured, and 4 participants were not available for recall. Thus, the survival rate was 94%. No resorption or periapical translucencies were observed radiographically. Clinical examinations revealed physiological probing depths and absence of ankyloses. One tooth presented with marginal bone loss. The most frequent type of complication was orthodontic relapse at recall (n=3). A total of 84% of teeth were considered a success.ConclusionsForced orthodontic extrusion allowed for the restoration of anterior and premolar teeth deemed as nonrestorable because of their defect size. Tooth retention of extensively damaged teeth and their use as abutments for single-crown restorations can be recommended.