本文選題：牙半切除術 + 植骨術��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：對常規(guī)根管治療及牙周基礎治療不能治愈的下頜磨牙不均衡重度病損，予以牙半切除術治療聯合術后固定修復，觀察其對天然牙保存治療的臨床療效。 方法：收集10例牙半切除術臨床病例，其中5例根折病例、4例牙周炎累及一根病損較重、1例髓室底穿。術前行臨床檢查并拍攝放射片觀察其牙周情況，確�；佳婪线m應癥：（1）可施行完善的根管治療者；（2）牙槽骨量足夠者；（3）僅涉及到一根的根折；（4）余留的健康部分牙根不短于7mm者；（5）余留牙根根尖狀況良好或雖有炎癥，但預估經根管治療可治愈者。若存在以下癥狀則不能施行手術：（1）無法行完善的根管治療者；（2）牙根沒有足夠的牙槽骨支持，預計行植骨術預后仍不佳者；（3）根分叉過低者；（4）無法配合治療及難以在治療過程中按規(guī)定時間復診的患者等。 對患牙符合上述要求者，行全面細致的根管治療后，翻瓣施行牙半切除術，在術中對需要恢復牙槽嵴高度及寬度者酌情施行植骨術，使牙槽嵴豐滿并利于所保留牙根的穩(wěn)固。對牙體缺損過多者行樁核修復，術后行臨時冠修復以恢復牙冠形態(tài)、維持間隙并有利于自潔以保護其牙周組織。術后3到6個月復診檢查，確�；佳烙狭己�、牙周狀況明顯改善并穩(wěn)定后，則可行后期固定修復。本次病例研究中多采用利用余留牙及一側鄰牙作為基牙的固定修復設計，此種設計可以分散牙合力，減小余留牙所受咬合壓力，保護基牙，以達到良好的遠期療效。 結果：對10例下頜磨牙重度病損患者，，行牙半切除術后，余留牙根牙周狀況良好，伴發(fā)炎癥消失。其中3例欲增加牙槽骨高度及牙槽嵴豐滿度者術中疊加施行植骨術，選用有骨引導功能的材料，術后有新生牙槽骨形成，恢復狀況良好。術后橋體穩(wěn)固，咀嚼功能恢復，基牙牙周狀況維持較好，放射片未見牙槽骨繼續(xù)吸收。其中一例在術后復診中發(fā)現有余留牙根牙周膜增寬，經減徑降低咬合處理后癥狀緩解。全部10例患者均表示治療后原不適癥狀消失，適應較好。 結論：牙半切除術在結合全面的牙周治療及根管治療后，可以最大程度保留常規(guī)根管治療及牙周基礎治療不能保存的重度病損下頜磨牙，伴牙槽骨吸收者可考慮施行植骨術，預后效果更佳。術后以余留牙根結合單側鄰牙行固定修復為佳。磨牙經牙半切除術后,不僅可以最大程度保留天然牙還可以預防牙槽骨廢用性萎縮，維持其應有高度及寬度，在臨床實踐中取得了很好的療效。
[Abstract]:Objective: to observe the clinical effect of orthodontic root canal therapy and periodontal basic therapy on the treatment of mandibular molar unbalance and severe lesion. Methods: ten cases of hemiexy were collected, of which 5 cases were root fracture, 4 cases were periodontitis, one case was serious lesion and 1 case was pulp chamber floor puncture. Clinical examination was performed before operation and radiograph was taken to observe the periodontal condition. To ensure that the affected teeth conform to the indication: 1) A person with perfect root canal therapy can do 2) the alveolar bone mass is adequate and only involves one root fracture 4) the remaining healthy part of the root is not less than that of the person with 7mm (5) the residual root tip is in good condition or although there is inflammation. However, it is estimated that root canal therapy can be cured. If you have the following symptoms, you can't perform surgery: 1) if you can't do a perfect root canal therapy, you don't have enough alveolar bone to support your teeth. It is estimated that the prognosis of bone grafting is still poor. (3) the patients with lower root bifurcation can not cooperate with the treatment and the patients who are difficult to return to the treatment according to the prescribed time in the course of treatment and so on. For the affected teeth that meet the above requirements, after comprehensive and meticulous root canal treatment, the flap was treated with half-excision, and bone grafting was performed on those who needed to restore the height and width of alveolar ridge during the operation, so as to make the alveolar ridge fullness and the stability of the reserved root. Post and core prostheses were performed for the patients with excessive tooth defects, and temporary crown repair was performed after the operation to restore the shape of the crowns, maintain the gap and facilitate self-cleaning to protect the periodontal tissues. Follow-up examination 3 to 6 months after operation to ensure good healing of the affected teeth, periodontal condition improved and stable, then can be fixed later repair. In this case study, the residual teeth and the side adjacent teeth were used as the fixed restoration design. This design can disperse the force of teeth, reduce the occlusal pressure and protect the abutments, so as to achieve a good long-term effect. Results: in 10 patients with severe mandibular molar disease, the periodontal condition of residual root was good and the inflammation disappeared. Among them, 3 cases who wanted to increase the height of alveolar bone and the fullness of alveolar ridge were treated with bone graft during operation. The materials with bone guiding function were selected, the new alveolar bone was formed after operation, and the recovery condition was good. After operation, the bridge was stable, the masticatory function was restored, the periodontal condition of abutment was maintained well, and the alveolar bone was not absorbed by radiography. In one case, the residual periodontal ligament was widened, and the symptoms were alleviated by reducing the diameter and reducing the occlusal diameter. All the 10 patients indicated that the original symptoms disappeared and adapted well after treatment. Conclusion: after combined with comprehensive periodontal therapy and root canal therapy, the severely damaged mandibular molars which can not be preserved by conventional root canal therapy and periodontal basic treatment can be preserved. Bone grafting can be considered for those with alveolar bone resorption. The prognosis is better. It is better to fix the residual root and unilateral adjacent teeth after operation. The molar can not only preserve the natural teeth to the maximum extent but also prevent the atrophy of alveolar bone and maintain the height and width of the molars after semi-excision. It has achieved a good effect in clinical practice.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R783.4

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