意向性牙再植术治疗双根型上颌侧切牙牙周牙髓联合病变1例报道及文献回顾  

Intentional replantation for the treatment of a double-rooted maxillary lateral incisor with periodontal-endodontic lesions:a case report and literature review

作　　者：任小腊 王亚静 谭旭 REN Xiaola;WANG Yajing;TAN Xu(School of Stomatology,Guizhou Medical University,Guiyang 550004,China;Departments of Endodontics,Affiliated Stomatological Hospital of Guizhou Medical University,Guiyang 550004,China;Department of Periodontics,Affiliated Stomatological Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学口腔医学院,贵州贵阳550004 [2]贵州医科大学附属口腔医院牙体牙髓病科,贵州贵阳550004 [3]贵州医科大学附属口腔医院牙周科,贵州贵阳550004

出　　处：《口腔疾病防治》2024年第5期376-382,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：贵州省科技计划项目(ZK[2021]436);贵州省卫生健康委科学技术基金项目(gzwjkj2021⁃1⁃355)。

摘　　要：目的探讨畸形舌侧沟致双根型上颌侧切牙严重牙周牙髓联合病变的临床特点、诊断及治疗方法,为临床诊治提供参考。方法对1例伴畸形舌侧沟及严重牙周牙髓联合病变的双根型左上颌侧切牙,进行完善的根管治疗和意向性再植手术治疗,并结合文献对该类型病例的诊疗进行回顾性分析。结果术后3年患者无不适,左上侧切牙愈合良好,无病理性松动,腭侧龈沟探诊深度约1 mm。文献复习结果表明,患牙预后和治疗方案的选择与舌侧沟向根方的延伸长度及深度、牙周状况和患牙的牙髓状态相关;对轻度畸形舌侧沟、牙髓活力未丧失的患牙,采用翻瓣术、牙成形术,可避免牙髓治疗或再治疗;对深或长的舌侧沟导致了牙周组织的严重丧失,则需要牙髓治疗、牙成形术或者封闭沟裂、引导组织再生;对形成双根的畸形舌侧沟,可通过根管治疗、切除小根并用根尖修复材料进行充填、意向性再植的方法,使患牙得以保留。结论发生于双根型上颌侧切牙的畸形舌侧沟导致严重牙周牙髓联合病变的病例,根据临床表现及影像学检查可减少漏诊,治疗应结合舌侧沟向根方的延伸长度及深度、牙周状况和患牙的牙髓状态选择合适的治疗方案。Objective To investigate the clinical characteristics,diagnosis and treatment of severe combined peri-odontal-endodontic lesions in a double-rooted maxillary lateral incisor with a palatal radicular groove and to provide a reference for clinical diagnosis and treatment.Methods A patient with a double-rooted left maxillary lateral incisor with a palatal radicular groove and severe combined periodontal-endodontic lesions underwent complete root canal thera-py and intentional replantation,and a retrospective analysis of the management of this type of patient was performed based on the literature.Results The 3-year follow-up examination revealed no discomfort,good healing of the upper left lateral incisor,no pathological loosening,and a palatal gingival sulcus was found at a depth of approximately 1 mm.Review of the literature showed that the prognosis of the affected tooth and the choice of treatment plan were correlated with the length and depth of extension of the lingual groove toward the root,the periodontal condition and the pulpal sta-tus of the affected tooth.For minor PRGs or for affected teeth with no loss of pulpal viability,flap surgery and odonto-plasty can be used to avoid endodontic treatment or retreatment.For deep or long lingual grooves that result in signifi-cant loss of periodontal tissue,endodontic treatment,odontoplasty,or closure of the grooves and guided tissue regenera-tion are needed.In the case of PRGs with double root formation,the affected tooth can be preserved via root canal thera-py,removal of the small root and filling with apical restorative material,and intentional replantation.Conclusion In cases of severe combined periodontal-endodontic lesions due to palatal radicular grooves occurring in double-rooted maxillary lateral incisors,clinical presentation and imaging can prevent missed diagnoses,and appropriate treatment should be based on the length and depth of lingual grooves extending toward the roots,periodontal conditions,and pulp-al status of the affected teeth.

关 键 词：上颌侧切牙 畸形舌侧沟 牙周牙髓联合病变 意向性牙再植术 根管治疗 窦道 牙周组织 牙髓治疗 

分 类 号：R78[医药卫生—口腔医学]