本文選題：VRF + 早期診斷��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的通過分析總結(jié)25例診斷為牙根縱裂患者的臨床資料，結(jié)合相關(guān)文獻(xiàn)復(fù)習(xí)，探討牙根縱裂的早期癥狀、可疑誘發(fā)因素及有效診斷手段，為臨床VRF的預(yù)防及早期診斷提供理論依據(jù)。 方法1、進(jìn)行VRF相關(guān)文獻(xiàn)復(fù)習(xí)，了解國內(nèi)外有關(guān)VRF的最新研究進(jìn)展； 2、（1）收集2012年9月-2014年3月就診于山西醫(yī)科大學(xué)口腔醫(yī)院綜合科的25例診斷為VRF患者的臨床資料，分別記錄患牙的牙位、牙髓治療狀態(tài)、牙周情況、牙合面特征及患者的臨床表現(xiàn)、咬牙合情況、咀嚼習(xí)慣、咀嚼創(chuàng)傷史、夜磨牙史等。（2）、所有患牙均拍攝X線根尖片，必要時(shí)經(jīng)患者同意拍攝CBCT,以明確縱裂牙根、部位和方向，并了解根周骨吸收破壞情況。（3）、對以上所有信息進(jìn)行分析總結(jié)。 結(jié)果1、25例VRF患者中，男18例，女7例，年齡39-57歲,平均年齡51歲。 2、牙位分布：下頜第一磨牙13顆，下頜第二磨牙5顆，上頜第一磨牙4顆，上頜第二磨牙2顆，下頜第二前磨牙1顆。磨牙發(fā)生最多（24/25），占96%；下頜第一磨牙的發(fā)生率最高(13/25)，占52%。 3、牙髓治療狀態(tài)：25例患牙中，活髓牙10顆，經(jīng)過根管治療的15顆。 4、縱裂牙根：下頜磨牙近中根15顆，遠(yuǎn)中根3顆；上頜磨牙近中頰根4顆，遠(yuǎn)中頰根1顆，遠(yuǎn)中頰根+腭根1顆；下頜第二前磨牙1顆。近中根發(fā)生最多（19/25），占72%。方向均為頰舌向縱裂。 5、牙周情況：25顆患牙中，16顆表現(xiàn)為牙齦紅腫、可探及4~10mm牙周袋且有松動(dòng)。 6、臨床表現(xiàn)：活髓牙多表現(xiàn)為冷熱刺激痛、牙髓活力溫度測驗(yàn)異常等牙髓炎癥狀；無髓牙多出現(xiàn)牙齦紅腫、竇道、局部深牙周袋、牙周溢膿等表現(xiàn)。所有患牙均有咬牙合不適或不同程度的咬牙合痛。 7、25例VRF患者中，，有偏側(cè)咀嚼或喜嚼硬物史、夜磨牙史的15例、咀嚼創(chuàng)傷史的3例。咬牙合面存在不同程度磨耗的20例，咬牙合關(guān)系異常的15例。 8、X線根尖片表現(xiàn)：患根根管腔增寬，增寬線色深，邊界清楚，根尖分開，寬度越向根尖越明顯。牙周膜間隙增寬，硬骨板消失，牙根周圍“V”形骨喪失�；佳劳砥谘栏芮蝗L增寬，邊界不一定整齊，嚴(yán)重者根折裂片可發(fā)生移位。經(jīng)過根管治療的患牙可觀察到根充物或樁與縱裂處的髓腔之間有間隙。 9、診斷方法：X線根尖片診斷18例，CBCT診斷4例，X線根尖片+CBCT診斷2例，拔牙后診斷1例。 結(jié)論VRF的發(fā)生存在一定的易感因素，且臨床表現(xiàn)復(fù)雜多樣，缺乏特異性。臨床醫(yī)師應(yīng)具備全面系統(tǒng)的VRF相關(guān)理論知識(shí)，以期能及時(shí)發(fā)現(xiàn)VRF的早期癥狀，并采用合理的診斷方法，對VRF做出早期診斷。同時(shí)應(yīng)規(guī)范臨床操作，以預(yù)防醫(yī)源性VRF的發(fā)生。
[Abstract]:Objective to analyze and summarize the clinical data of 25 cases of root longitudinal fissure, and to discuss the early symptoms, suspicious inducing factors and effective diagnostic methods of root longitudinal fissure. To provide theoretical basis for the prevention and early diagnosis of clinical VRF. Methods 1. To review the relevant literatures of VRF, to understand the latest research progress of VRF at home and abroad. 2, (1) to collect the clinical data of 25 patients diagnosed as VRF from September 2012 to March 2014 in the Department of Stomatology, Shanxi Medical University. The tooth position, pulp treatment status, periodontal condition, occlusal features and clinical manifestations, occlusion, masticatory habits, history of chewing trauma, history of night molars were recorded respectively. (2) all the affected teeth were taken X-ray apical film. When necessary, CBCTs were taken with the consent of the patient to determine the root, position and direction of the longitudinal fracture, and to understand the bone resorption damage around the root. (3) all the above information were analyzed and summarized. Results 1 among 25 VRF patients, 18 were males and 7 females, aged 39-57 years, with an average age of 51.2. The distribution of teeth was as follows: 13 mandibular first molars, 5 mandibular second molars, 4 maxillary first molars and 2 maxillary second molars. 1 mandibular second premolar. The molar rate was the highest (24 / 25), accounting for 96%, and the first mandibular molar rate was the highest (13 / 25), accounting for 52. 3. Of the 25 cases of dental pulp treatment, 10 were alive pulp teeth. 15 of them were treated with root canal, and 15 of them were treated with longitudinal canals: 15 were proximal middle root of mandibular molar, 3 were distal root, 4 were mesiobuccal root, 1 was distal buccal root, 1 was palatal root of distal buccal root, and 1 was mandibular second premolar. The most occurrences occurred near the middle root (19 / 25), accounting for 72%. The direction was buccal and lingual longitudinal fissure. 5. Among 25 teeth with periodontal condition, 16 of 25 teeth showed gingival redness, 4~10mm periodontal bag could be detected and loosened. 6. Clinical manifestation: living pulp teeth showed cold and hot irritation pain. Pulpitis symptoms such as abnormal temperature test of pulp vitality, gingival redness, sinus tract, local deep periodontal bag, periodontal overflow, etc. 725 patients with VRF had history of unilateral mastication or liking to chew hard objects, 15 cases of night molars history, and 3 cases of masticatory trauma history. There were 20 cases with different degree of attrition on the occlusal surface and 15 cases with abnormal occlusal relationship. The X ray film showed that the root canal cavity was enlarged, the line color depth was enlarged, the boundary was clear, the apex was separated, and the width became more and more obvious to the root tip. The periodontal ligament space was widened, the hard bone plate disappeared and the V shaped bone around the root was lost. The full length of the root canal was enlarged and the boundary was not regular in the late stage of the affected teeth, and the root fracture could be displaced in severe cases. There was a gap between the root filling or post and the medullary cavity in the longitudinal fissure after root canal treatment. [WT5HZ] [WT5 "HZ] [WT5" HZ] [WT5BZ] X-ray apical radiography was performed in 18 cases and CBCT in 4 cases, and after tooth extraction in 1 case. Conclusion there are some susceptible factors in the occurrence of VRF, and the clinical manifestations are complicated and lack of specificity. Clinicians should have comprehensive and systematic knowledge of VRF theory in order to find the early symptoms of VRF in time and make early diagnosis of VRF with reasonable diagnostic methods. At the same time, clinical practice should be standardized to prevent iatrogenic VRF.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R781.2

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