恒牙牙根中部根折的治療

[摘要] 目的 評價恒牙牙根中部根折后保存活髓的治療效果。方法 觀察1名女性恒牙牙根中部根折的患者，患者受傷后及時就診，X線攝片顯示根中1/3折斷，根折斷端稍有移位。經復位結扎，使用復合樹脂夾板固定3個月，保持口腔衛生。結果 患牙無不適，檢查無叩痛，牙髓活力正常，X 線片顯示無根尖病變發生。結論 正確復位和保存活髓有利于牙根中部根折的愈合。

[關鍵詞] 恒牙;根折;根中部

[中圖分類號] R783.3[文獻標識碼] A[文章編號] 1004-8650(2009)07-043-02

Treatment of permanent tooth with horizontal fracture in the middle third of root

ZHANGHuai-qin

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

[Abstract] Objective To evaluate the treatment effect of fractured permanent tooth in the middle third of root without endodontic treatment. Methods 1 female patient with fractured tooth in the middle third of root was observed for 3 months. The radiographs showed horizontal root fracture in the middle third of the root with a small displacement. The fractured tooth was gently repositioned by finger pressure and splinted with composite resin. The patients’ oral hygiene was followed up continuously. Results The tooth showed normal color and mobility and gave positive response to the pulp testing and there was a metallic sound to the percussion test after 3-month observation. The radiographs showed there was no sign of periapical pathology. Conclusion To facilitate healing， optimal repositioning and maintaining pulp vitality are considered essential.

[Key words] permanent tooth; root fracture; middle third of root

外傷或因咀嚼硬物可發生牙折，牙冠輕微折裂常無刺激癥狀。如果冠折已暴露牙髓，則有明顯的刺激癥狀。根中1/3折斷可見牙松動，牙齦溝出血，如果處理不當可導致患牙拔除[1]。

1臨床資料

患者，女，45歲，因摔倒而致左上中切牙受傷，受傷后及時就診。輕度叩痛，Ⅰ度松動。X線攝片顯示根中1/3折斷，根折斷端無明顯移位。經復位結扎，并使用酸蝕法復合樹脂夾板固定，囑咐患者注意保持口腔衛生。3 個月復查，患者口腔衛生良好，患牙無不適，檢查無叩痛，牙周組織正常，牙髓活力正常，無松動。X 線片顯示無根尖病變發生，遠期效果有待進一步觀察。

2討論

根折伴有累及釉質、牙本質的冠折，其治療原則為復位、固定和長期監測牙髓活力，促進折斷牙根自然愈合。一般認為水平或斜形根折越近根尖，預后較好。根折限于牙槽骨內，對預后有利。根中部折斷，多數醫生采取了拔牙后再行修復的方法，近來國內外對根中部折斷病例有大量報道，表明如果對牙根中部折斷恒牙能及時復位固定，多數患牙都能夠保存活髓，如果發生死髓，該牙應采用氫氧化鈣治療，促進折斷處鈣沉集形成硬組織屏障。……