三種樁核冠修復(fù)在牙體缺損治療的應(yīng)用比較

1、三種樁核冠修復(fù)在牙體缺損治療的應(yīng)用比較                                作者：林培，鄭定國,王濤林培【摘要】  目的：比較鑄造合金樁核、鈦及鈦合金成品根管樁和彈性模量與牙本質(zhì)相近的纖維樁制作樁核，3種方法修復(fù)殘冠殘根的臨床效果。方法：牙體缺損患者共1

2、 368例，前牙牙體缺損776例。后牙牙體缺損592例。1 368例患者分為3組,A組838例(鑄造樁核),B組428例(鈦及鈦合金成品根管樁)，C組102例(玻璃纖維樁)，對3組的效果進(jìn)行比較。結(jié)果：隨訪0.53 年，A組成功789例,失敗49例;B組成功423例,失敗5例;C組成功102例,無失敗病例。結(jié)論：彈性模量與牙本質(zhì)相近的纖維樁可減少根折的發(fā)生，修復(fù)療效最好。鈦及鈦合金根管樁具有優(yōu)良的生物相容性、耐腐蝕性，彈性模量相對較小,抗折能力強(qiáng);有相對的優(yōu)越性。鑄造樁核的缺點是腐蝕、過敏使牙齦出現(xiàn)金屬線牙齦變色，易出現(xiàn)根折。 【關(guān)鍵詞】  牙修復(fù)，永久;牙缺失;牙折斷;鈦及鈦合金根

3、管樁;纖維樁;鑄造樁核ABSTRACT Objective: To compare the effect of three post core manufacture methods on repairing residual crown and residual root, including casting alloy post core, titanium and titanium alloy root canal post, and fiber post with similar elastic modulus to dentin. Methods: Selected 1 368 ca

4、ses with tooth defect, including 776 cases with anterior teeth defect and 592 cases with posterior teeth defect. Divided all cases into three groups:838 cases in A group treated by casting post core, 428 cases in B group by titanium and titanium alloy root canal post, and 102 cases in C group by gla

5、ss fiber post. Compared the clinical effect among three groups. Results: Followup for 0.5-3 years showed that the success rates of three groups were 789/838, 423/428, and 102/102 respectively. Conclusion: With similar elastic modulus to dentin, fiber post can decrease the incidence of root fracture,

6、 and is the most effective. Titanium and titanium alloy root canal post had strong anti fracture force, excellent biocompatibility and corrosion resistance, and less elastic modulus than fiber post. Casting post core can cause root fracture and discolored wire gingival by corrosion and allergy.KEY W

7、ORDS Dental restoration, permanent; Tooth lost; Tooth fracture;Titanium and titanium alloy root canal post; Fiber post; Casting post樁核技術(shù)是目前臨床修復(fù)殘冠殘根的主要手段, 經(jīng)過完善根管治療的牙齒,當(dāng)牙體組織缺損較多時,常采用樁核及全冠修復(fù)1。金屬因其良好的機(jī)械性能及易加工性一直作為樁核的材料。隨著對其研究的逐步深入,金屬樁核的不透光、使牙齦染色、致敏性、影響磁共振成像等缺陷限制了金屬樁核在臨床的應(yīng)用。另外,由于金屬的機(jī)械特性與牙體差異較大, 因此,近年來國內(nèi)外

8、一些學(xué)者開始研制新的根管樁,其中包括鈦及鈦合金成品根管樁和彈性模量與牙本質(zhì)相近的纖維樁。本研究選取1 368例牙體缺損患者,分別采用鑄造金屬樁核、鈦及鈦合金成品根管樁、玻璃纖維樁進(jìn)行修復(fù),對三者的臨床效果進(jìn)行比較。1         1 資料與方法1.1 臨床資料本組1 368例牙體缺損患者，前牙牙體缺損776例,男性342例,女性434例,年齡1855歲,平均36歲，前牙咬合關(guān)系基本正常,根管形態(tài)無異常;后牙牙體缺損592例，男性366例，女性226例。外傷344例,齲病1 024例。1 368例分為3組,A組8

9、38例(鑄造樁),B組428例(鈦及鈦合金成品根管樁)，C組102例(玻璃纖維樁)。1.2 材料與器械預(yù)成玻璃纖維樁、鈦及鈦合金成品根管樁(Coltene/Whaledent, USA);雙固化樹脂粘結(jié)劑及配套雙固化型核樹脂(Coltene/Whaledent， USA);玻璃離子水門汀粘結(jié)劑(Shofu, Japan);鑄造鎳鉻合金樁核(Heraeus, Germany); All Bond 2牙本質(zhì)粘結(jié)劑(Bisco, USA);根管預(yù)備鉆針(Bisco, USA);根面預(yù)備鉆針(Mani Japan);寒天印模材(國產(chǎn));排齦線(Ultraden, tUSA);排齦器(Ultraden, tUSA)。1.3 方法患牙經(jīng)過完善的根管后觀察1014 d。根據(jù)X線片測量牙根長度,對患牙進(jìn)行常規(guī)根管預(yù)備,預(yù)備深度為牙根的2/3,直徑不超過牙根直徑的1/3，距根尖4 mm根充材料應(yīng)原封不動以保持良好的根尖封閉2。A組采用傳統(tǒng)兩步法制作金屬樁核,磨除薄壁、弱尖及無基釉。用鑄造蠟制作樁核模型后包埋、鑄造,第1次復(fù)診后試戴,用玻璃離子水門汀粘結(jié)于預(yù)備好的根管中。B組根據(jù)根管的粗細(xì)及長度,選擇合適的根管預(yù)備鉆和與其相對應(yīng)的鈦及鈦合金成品根管樁,雙固化樹脂粘