牙冠延長術治療齦下根折的評價

[摘要] 目的 評價恒牙冠根折的牙冠延長術治療效果。方法 切開牙齦并去除需切掉的牙齦，根據術后骨嵴生物學寬度要求，牙槽嵴頂降至牙斷緣的根方3.5 mm。待2個月后核樁及烤瓷冠修復。結果 修復后1個月復查，患牙無不適，不松動，X 線片顯示牙周組織健康。結論 治療累及齦溝的冠根折，牙冠延長術是一種有效的方法。

[關鍵詞] 恒牙;根折;根尖1/3

[中圖分類號] R781.3[文獻標識碼] A[文章編號] 1004-8650(2009)09-017-02

Evaluation of crown lengthening in treatment of tooth with subgingival destruction

ZHANG Huai-qin

(Research Institute of Stomatology， Nanjing Medical University， Nanjing 210029， China)

[Abstract] ObjectiveTo evaluate the effect of the surgical crown lengthening on cosmetic prosthesis for the patients with subgingival destruction. Methods The tooth with vertical fractures in subgingival lesions was performed with surgical crown lengthening. The distance between the margin of tooth and bone crest was about 3.5mm. 2 months after the surgical procedure， a dowel post was placed in the root canal， and a porcelain veneer crown restoration was completed. Results 1 month after prosthetic treatments， the good periodontal health was shown in the radiograph after surgery. The tooth showed normal mobility. Conclusion Crown lengthening is an effective surgical procedure in increasing the clinical crown height.

[Key Words] crown lengthening;biologic width

冠根聯合折可見牙冠折裂、缺損或隱裂、叩痛，以及牙髓常暴露和齦溝出血。X線攝片顯示根折。冠根聯合折累及齦溝時，修復前，應采用正畸牽引術，外科牽引術或牙冠延長術使齦下牙根暴露。本文對1例前牙冠根聯合折患者，行牙冠延長術，并觀察了修復效果。

1臨床資料

男性患者1人，26歲。上中切牙因外傷導致冠根折，腭側斷面位于齦下。患者全身狀況良好。在確定牙根斷面的位置后，設計切口，作內斜切口。切開牙齦并去除需切掉的牙齦，將切開的齦粘骨膜瓣翻開，暴露牙槽骨。徹底清除根面上的殘留物，刮除肉芽組織、齦下結石、斷根碎片及牙周膜纖維。根據術后骨嵴生物學寬度要求，進行骨修整，形成牙槽嵴斜坡，牙槽嵴頂降至牙斷緣的根方3.5 mm。生理鹽水沖洗術區，將碎片沖干凈。將齦瓣的外形和厚度修整合適，將齦瓣復位縫合于牙槽嵴頂處，間斷縫合。壓迫止血，上牙周塞治療劑。術后適當應用抗生素控制感染，一周后折線。創口愈合后2周先作臨時冠修復，待2個月后再作永久修復。……