成熟恒牙自体移植术中联合应用体外根尖手术的预后影响因素分析:84例病例总结  

Analysis of prognosticative factors in autotransplantation of mature permanent teeth combined with extracorporeal apical surgery:A summary of 84 cases

作　　者：杨霞 李永清 姜永 徐宁 王捍国 许广杰 惠小勇 马媛媛 侯锐 Yang Xia;Li Yongqing;Jiang Yong;Xu Ning;Wang Hanguo;Xu Guangjie;Hui Xiaoyong;Ma Yuanyuan;Hou Rui(State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Department of Oral&Maxillofacial Surger,School of Stomatology,The Fourth Military Medical University,Xi'an 710032,China;State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture,Department of Dentistry for Special Service,School of Stomatology,The Fourth Military Medical University,Xi'an 710032,China;Department of Stomatology,General Hospital of the Central Theater Command,Wuhan 430070,China;State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Key Laboratory of Stomatology,Department of Operative Dentistry&Endodontics,School of Stomatology,The Fourth Military Medical University,Xi'an 710032,China;Department of Stomatology,Naval Medical Center of PLA,Shanghai 200052,China;Department of Outpatient,Rocket Army Guangzhou Special Service Sanitarium,Guangzhou 510515,China;Department of Stomatology,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学口腔医院口腔颌面外科,西安710032 [2]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔生物工程工程技术中心,空军军医大学口腔医院口腔特诊科,西安710032 [3]中国人民解放军中部战区总医院口腔科,武汉430070 [4]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔医学重点实验室,空军军医大学口腔医院牙体牙髓病科,西安710032 [5]海军特色医学中心口腔科,上海200052 [6]火箭军广州特勤疗养中心门诊部,广州510515 [7]陆军军医大学第一附属医院口腔科,重庆400038

出　　处：《中华口腔医学研究杂志(电子版)》2025年第1期33-40,共8页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：口颌系统重建与再生全国重点实验室自主研究课题(2021ZA06);第四军医大学临床研究项目(2022LC2258)。

摘　　要：目的探讨成熟恒牙自体牙移植术中联合应用体外根尖手术的病例进行成功率的影响因素,为临床判断成功率提供参考。方法纳入2014年6月至2023年5月就诊于第四军医大学口腔医院口腔外科行成熟恒牙自体牙移植且术中联合应用体外根尖手术的病例。联合应用体外根尖手术的原因一是供牙拔出时根尖折断被动需要联合手术,二是供牙根尖过度弯曲难以植入受牙区故需要主动联合手术。对影响成功率的可能因素进行归纳并分组,对临床检查和影像学检查数据进行记录并判定结果。调取患者以往病历中的手术记录和照片资料(包括性别、年龄、牙根形态和供牙位置等12个因素)进行回顾性分析,采用生存分析方法进行统计学分析,筛选出影响经过联合应用体外根尖手术的移植牙累计成功率的因素。结果84颗移植牙的5年累计成功率为77.2%,其中单因素Log-Rank分析显示,受牙区位置(P=0.004)、受牙区牙槽骨高度(P=0.002)、供牙离体时间(P=0.005)和初期稳定性(P=0.001)与联合应用体外根尖手术移植牙累计成功率显著相关,多因素Cox比例风险回归分析显示,受牙区位置(P=0.039)和受牙区牙槽骨高度(P=0.036)与行联合应用体外根尖手术的移植牙成功率显著相关。结论通过术中减少离体时间、恢复牙槽骨高度,以及确保良好的初期稳定性,成熟恒牙供牙术中联合应用体外根尖手术后能够获得良好的成功率。Objective The factors influencing the success rate of mature permanent tooth autotransplantation combined with external apical surgery were analyzed to provide reference for clinical judgment of success rate.Methods Patients who received autologous tooth transplantation of mature permanent teeth and combined external apical surgery in the Department of Oral Surgery of Stomatology,Hospital of the Fourth Military Medical University from June 2014 to May 2023 were included.The reasons for the external apical surgery were as follows.Firstly,the root apex of the donor tooth was broken passively during extraction.Secondly,the root apex of the donor tooth was too crooked to implant into the recipient area.The possible factors affecting the success rate were summarized and evaluated.Surgical records and photography data from patients'previous medical records,including 12 factors such as gender,age,root shape and donor location,were analyzed.Survival analysis was used for statistical analysis to screen out the factors affecting the cumulative success rate of transplanted teeth after external apical surgery.Results The cumulative five-year success rate of 84 transplanted teeth was 77.2%.Single factor Log-Rank analysis showed that the location of the receiving area(P=0.004),the alveolar bone height of the receiving area(P=0.002),the donor time(P=0.005)and the initial stability(P=0.001)were significantly correlated with the cumulative success rate of tooth transplantation after external apical surgery.Multivariate Cox proportional hazard regression analysis showed that the location of the receiving area(P=0.039)and the height of the alveolar bone in the receiving area(P=0.036)were significantly correlated with the success rate of transplantation after external apical surgery.Conclusions By reducing the intraoperative time,restoring the alveolar bone height,and ensuring good initial stability,high success rate can be achieved for mature permanent tooth autotransplantation after external apical surgery.

关 键 词：自体牙移植 体外根尖手术 成功率 生存分析 

分 类 号：R78[医药卫生—口腔医学]