本文關(guān)鍵詞： 牙髓血運(yùn)重建術(shù) 年輕恒牙 牙根發(fā)育 根管消毒藥物　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的對(duì)于牙根尚未完全發(fā)育完成的年輕恒牙發(fā)生的牙髓或根尖周的感染,傳統(tǒng)的治療方法是根尖誘導(dǎo)成形術(shù),這種治療方法盡管臨床治療的成功率較高,但是無(wú)法取得患牙牙根的正常發(fā)育,常常造成患牙的冠根比例不良,使患牙后期發(fā)生根折的風(fēng)險(xiǎn)大大增加。近年來(lái),對(duì)于此類患牙,學(xué)者們提出了牙髓血運(yùn)重建的治療方法,在牙髓血運(yùn)重建術(shù)的治療過(guò)程中,不進(jìn)行根管的傳統(tǒng)機(jī)械預(yù)備而是通過(guò)根管沖洗和根管消毒去除根管內(nèi)感染,所以根管消毒藥物的作用顯得更加重要。本研究通過(guò)收集應(yīng)用牙髓血運(yùn)重建術(shù)治療牙髓病變或根尖周感染的年輕恒牙的病例,評(píng)價(jià)牙髓血運(yùn)重建術(shù)的治療效果,并分析根管消毒藥物對(duì)其療效的影響,為以后應(yīng)用牙髓血運(yùn)重建術(shù)治療牙髓病變或根尖周感染的年輕恒牙提供參考。方法通過(guò)復(fù)查青島大學(xué)附屬醫(yī)院兒童口腔科2015年2月至2016年8月接診患兒的牙片,收集因外傷或畸形中央尖折斷造成年輕恒牙牙髓病變甚至根尖周感染,采用牙髓血運(yùn)重建術(shù)進(jìn)行治療的病例,共21顆患牙。21顆患牙經(jīng)常規(guī)開髓、清理牙髓后,通過(guò)大量次氯酸鈉溶液和生理鹽水沖洗根管,并結(jié)合滅菌水超聲蕩洗來(lái)去除根管內(nèi)感染壞死物,干燥根管后,根管內(nèi)導(dǎo)入三聯(lián)抗生素糊劑或氫氧化鈣糊劑進(jìn)行根管消毒,炎癥得到有效控制后,根管銼刺激根尖周組織出血進(jìn)入根管內(nèi)形成血凝塊,冠方用3M玻璃離子水門汀進(jìn)行封閉,而后上方再用樹脂充填。21顆患牙中,14顆患牙采用了三聯(lián)抗生素糊劑(甲硝唑、米諾環(huán)素和環(huán)丙沙星)進(jìn)行根管消毒,三聯(lián)抗生素糊劑由甲硝唑、米諾環(huán)素和環(huán)丙沙星按1:1:1等比例與滅菌水混合而成;7顆牙齒采用了氫氧化鈣進(jìn)行根管消毒。通過(guò)分析病例資料,比較兩組治療的成功率,對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,并分析臨床療效的影響因素。結(jié)果經(jīng)過(guò)最短8個(gè)月,最長(zhǎng)24個(gè)月的隨訪觀察,經(jīng)牙髓血運(yùn)重建術(shù)治療的21顆患牙中14顆患牙無(wú)不適癥狀,臨床檢查無(wú)叩痛、無(wú)松動(dòng),牙齦黏膜無(wú)紅腫和瘺管等體征;X線片檢查無(wú)根尖周組織病變,牙根增長(zhǎng),根管壁增厚,評(píng)價(jià)為治療成功,治療成功率為66.67%。5顆牙齒出現(xiàn)根尖周病變的癥狀,2顆牙齒治療后在隨訪觀察期間,未出現(xiàn)不適臨床癥狀和體征,但始終未出現(xiàn)牙根繼續(xù)發(fā)育,評(píng)價(jià)為治療失敗。14顆采用三聯(lián)抗生素糊劑進(jìn)行根管消毒的病例中,治療成功患牙11顆,成功率78.57%;7顆采用氫氧化鈣進(jìn)行根管消毒的病例中,治療成功患牙3顆,成功率42.86%;總體成功率為66.67%。經(jīng)統(tǒng)計(jì)分析p0.05,兩組間成功率之間的差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論牙髓病變或根尖周感染的年輕恒牙進(jìn)行牙髓血運(yùn)重建治療后,可以使得此類年輕恒牙牙根繼續(xù)發(fā)育,牙根長(zhǎng)度增加,根管壁增厚,根尖封閉。三聯(lián)抗生素糊劑與氫氧化鈣相比,對(duì)牙髓血運(yùn)重建術(shù)臨床療效影響的差異無(wú)統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective in the case of pulp or periapical infection in young permanent teeth with incomplete root development, the traditional treatment is apical induction, despite the high success rate of clinical treatment. However, the failure to achieve normal root development often results in poor crown and root ratio, which greatly increases the risk of root fracture in the later stage of the affected tooth. In recent years, for this kind of tooth, scholars have proposed a method for the treatment of pulp blood circulation reconstruction. In the treatment of dental pulp revascularization, root canal infection is removed by root canal washing and root canal disinfection instead of traditional mechanical preparation of root canal. So the effect of root canal disinfectant is more important. In this study, we evaluated the effect of endodontic revascularization in the treatment of young permanent teeth with pulp lesion or periapical infection by using dental pulp blood revascularization. The effect of root canal disinfectant on its curative effect was analyzed. To provide a reference for the treatment of young permanent teeth with pulp lesion or periapical infection. Methods the dental films of children received from February 2015 to August 2016 in the Department of Children's Stomatology, affiliated Hospital of Qingdao University, were reviewed. A total of 21 teeth were treated with pulp lesion or periapical infection caused by trauma or malformed central cusp fracture. A total of 21 teeth were treated with pulpion revascularization. The root canal was washed by a large amount of sodium hypochlorite solution and normal saline, and the infection necrosis in root canal was removed by ultrasonic washing with sterilizing water. After drying root canal, the root canal was disinfected by introducing triple antibiotic paste or calcium hydroxide paste into root canal. After the inflammation was effectively controlled, the root canal file stimulated periapical bleeding into the root canal to form blood clots, and the crown was sealed with 3M glass ionomer cement. Then the upper teeth were filled with resin and 14 of the teeth were disinfected with three antibiotic paste (metronidazole, minocycline and ciprofloxacin), and the triple antibiotic paste was metronidazole. Minocycline and ciprofloxacin were mixed with sterilizing water at the ratio of 1: 1: 1 and 7 teeth were disinfected with calcium hydroxide. By analyzing the case data, the success rate of treatment was compared between the two groups, and the data were statistically analyzed. Results after the shortest 8 months and the longest 24 months of follow-up observation, 14 of 21 teeth treated by pulp blood reconstruction had no symptoms, no percussive pain and no loosening in clinical examination. No signs of gingival mucosa, such as redness, fistula and so on, were detected by X-ray examination. There was no periapical tissue lesion, root growth, and root canal wall thickening, which were evaluated as successful treatment. The success rate of treatment was 66.67.5 the symptoms of periapical lesion in two teeth. During the follow-up observation, no clinical symptoms and signs were found, but the root continued to develop. In 14 cases of failed treatment, 11 teeth were successfully treated, 7 cases were treated with calcium hydroxide, 3 teeth were successfully treated. The overall success rate was 66.67. There was no significant difference in the success rate between the two groups by statistical analysis (p0.05). Conclusion the pulp disease or periapical infection of young permanent teeth were treated by blood revascularization. It can make the root of this kind of young permanent tooth continue to develop, the root length increases, the root canal wall thickens, and the root tip is closed. There is no significant difference in the effect of triple antibiotic paste and calcium hydroxide on the clinical curative effect of pulp blood transport reconstruction.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.05

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