分根术保存治疗下颌磨牙的临床进展  

The Clinical Progress of the Preservation of Mandibular Molars by Root Separation

作　　者：李璇 刘昭影 于改改 王晗 朱松[1] Li Xuan;Liu Zhaoying;Yu Gaigai;Wang Han;Zhu Song(Department of Prosthodontics,Stomatological Hospital of Jilin University,Changchun 130021)

机构地区：[1]吉林大学口腔医院修复科,长春130021

出　　处：《国际老年医学杂志》2022年第1期115-119,共5页International Journal of Geriatrics

基　　金：国家自然科学基金(82071163)。

摘　　要：与单根牙相比,存在根分叉结构的磨牙罹患牙周病变时,牙周组织的破坏不仅表现在垂直方向上骨高度降低,还造成水平方向上累及根分叉部位,使其比单根牙更容易发生附着丧失,并存在更高的牙齿脱落风险。磨牙根分叉部位解剖形态复杂多样,患有根分叉病变或髓室底穿孔时,该处病变组织及菌斑牙石的清除十分困难,单纯保守治疗往往效果不佳。虽然牙周再生治疗,包括引导组织再生和各种类型的骨移植,已被应用于根分叉缺损,但再生治疗对于骨丧失较严重的Ⅲ度及Ⅳ度根分叉病变疗效有限,人类临床试验也并无足够证据表明再生治疗可以关闭贯穿暴露的根分叉。分根术自20世纪70年代应用于临床,用于治疗并保存根分叉病变、髓室底穿通等原因导致的磨牙残冠残根,能够有效消除根分叉区的病变,延长牙根的生存时间,提高咀嚼效率,尤其对于全身系统疾病高发而导致拔牙及种植手术风险较高的老年群体,掌握好适应证的前提下具有较高的临床实用价值。本文将针对分根术的适用范围、牙体牙周治疗、分根术后的桩核冠修复的特殊要点、疗效评价标准等方面近几年新的研究进展进行综述。Compared with single rooted teeth,when multirooted teeth with a bifurcation structure suffer from periodontal disease,the destruction of periodontal tissue is not only manifested in the reduction of bone height in the vertical direction,but also involves the bifurcation in the horizontal direction,making them more prone to loss of attachment and higher risk of tooth loss.Due to the complexity of anatomical morphology of the mandibular molar root bifurcation,the removal of infected lesions,plaque and calculus is difficult when furcation involvement and pulp chamber perforation occur.Conservative treatment is often ineffective.Although periodontal regeneration therapy,including guided tissue regeneration and various types of bone transplantation,has been applied to furcation defects?the regeneration therapy shows limited effect on the class Ⅲ and class Ⅳ furcation lesions with severe bone loss.There is also insufficient evidence in trials to show that regenerative treatment can close the root bifurcation that penetrates the exposure.Root separation has been used clinically since the 1970s to treat and preserve the residual crown and residual roots of molars caused by root bifurcation lesions and pulp chamber perforation.It can effectively eliminate the lesions in the root bifurcation area,prolong the survival time of preserved tooth roots,and improve chewing efficiency.It has high clinical practical value under the premise of mastering the indications,especially for older population with high incidence of systemic diseases leading to tooth extraction and higher risk of implant surgery.This article reviews new research progress in recent years in the scope of application of root separation,endodontic and periodontal treatments,and special technique points of post-core crown restoration after root separation,and evaluation criteria for curative effect.

关 键 词：分根术 下颌磨牙 根分叉病变 桩核冠修复 

分 类 号：R781.05[医药卫生—口腔医学]