失活剂烧伤致乳磨牙早失及恒牙胚丧失2例  

Early loss of primary molar and permanent tooth germ caused by the use of devitalizer during primary molar root canal therapy:Two cases report

作　　者：田靖 秦满[1] 陈洁[1] 夏斌[1] TIAN Jing;QIN Man;CHEN Jie;XIA Bin(Department of Pediatric Dentistry,Peking University School and Hospital of Stomatology&National Center of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology&NHC Research Center of Engineering and Technology for Computerized Dentistry&NMPA Key Laboratory for Dental Materials,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院儿童口腔科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京100081

出　　处：《北京大学学报（医学版）》2022年第2期381-384,F0003,共5页Journal of Peking University:Health Sciences

摘　　要：失活法曾经在乳恒牙根管治疗过程中普遍使用,随着局部麻醉药物和注射技术的发展,这种有巨大潜在风险的治疗方法已逐步废弃,但是,2018年全国儿童口腔科学术会议中对参会代表的调查问卷结果显示,采用失活法的医生比例高达38.1%(383/1005),使用失活剂导致的化学烧伤问题仍需要引起高度关注。失活剂多为三氧化二砷、金属砷或多聚甲醛等具有生物毒性的药物,使用过程中存在烧伤周围软硬组织的风险。Devitalization has been widely used in the root canal therapy of primary and permanent teeth in China more than ten years ago.With the development of local anesthetic drugs and injection technologies,this treatment method with high potential risks has been gradually abandoned.However,a questionnaire survey targeted all the participants at the 2018 China Pediatric Dentistry Conference showed that the devitalizer utilization proportion was still as high as 38.1%(383/1005),even though the ratio was much lower than 75.5%(105/139)in 2003.These doctors had pay more attention to tissue burn caused by devitalizer marginal leakage or direct leakage,and know how to identify and handle with devitalizer burn.Devitalizers were usually made of arsenic trioxide,metal arsenic or paraformaldehyde,which have cytotoxicity,allergenicity,mutagenicity,carcinogenicity,and teratogenic effects on animals.Marginal leakage of devitalizers have high risks of causing soft and hard tissue necrosis.Most of the dentists have an understanding of the potential damages of arsenic-containing devitalizers,so they will choose parafor-maldehyde with relatively less toxicity.Paraformaldehyde has a certain self-limitation,and there are few cases reported,so some dentists lack of vigilance.Paraformaldehyde can also causes tissue necrosis if leakage happens,and the treatment methods are similar to that of arsenic-containing devitalizers.When handling with devitalizers burn,the necrosed soft and hard tissue,for example gingiva,alveolar bone or teeth that cannot keep,must be completely removed until fresh blood appears,then rinse with large amount of saline and seal with iodoform gauze.This paper described two cases of devitalizer burn during the root canal treatment of primary molars,both of the doctors failed to identify the devitalizer burn symptoms in the early stage,thus didn’t do proper treatments immediately after burning.Resulting in the necrosis of large area of gingiva and alveolar bone,loss of primary molars and permanent tooth germs 1-2 months

关 键 词：牙髓失活术 乳牙 磨牙 牙胚 放射摄影术 

分 类 号：R788[医药卫生—口腔医学]