田鴻旭　王毅

[摘要] 目的 探討利用玻璃纖維樁加固重度楔狀缺損前磨牙、預(yù)防折斷的臨床應(yīng)用價(jià)值。 方法 將2007～2010年煙臺(tái)山醫(yī)院門診接診的100例患者共138顆重度楔狀缺損的上頜第一前磨牙完成根管治療后預(yù)防性地將玻璃纖維樁置于已預(yù)備好的根管腔中，并采用流動(dòng)樹(shù)脂與納米樹(shù)脂結(jié)合的三明治技術(shù)充填牙頸部的楔狀缺損部位。隨訪1～3年，檢查牙齒頸部填充物邊緣是否密合、完整性及咀嚼功能。 結(jié)果 100例患者共138顆牙隨訪1～3年，136顆牙治療成功，均無(wú)自覺(jué)不適癥狀，咀嚼功能正常。X線片示：牙周膜腔無(wú)增寬，無(wú)繼發(fā)齲。僅2例于術(shù)后1年出現(xiàn)因咀嚼不當(dāng)導(dǎo)致冠部分缺損，未發(fā)現(xiàn)根折或冠折。 結(jié)論 充分利用玻璃纖維樁的特性加固根管治療術(shù)后的重度楔狀缺損前磨牙有良好的預(yù)防折斷的臨床效果，流動(dòng)樹(shù)脂與納米樹(shù)脂結(jié)合應(yīng)用的三明治技術(shù)充填楔狀缺損部位能夠達(dá)到良好的近期與遠(yuǎn)期效果，這種方法尤其適合重度楔狀缺損已行根管治療術(shù)、牙冠完整且不愿接受全冠修復(fù)的患者。

[關(guān)鍵詞] 玻璃纖維樁；加固；重度楔狀缺損；前磨牙；預(yù)防牙折

[中圖分類號(hào)] R783 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2015）09（c）-0120-05

[Abstract] Objective To evaluate the clinical application value of glass fiber post for reinforcing teeth to prevent tooth fracture. Methods After having been perfectly finished by root canal treatment， 138 maxillary premolar teeth of 100 patients with severe wedge-shaped defect were restored with glass fiber post and composite resin core， sandwich technique of fluid resin and nano-composite resin for wedge-shaped defect， in Yantai Shan Hospital from 2007 to 2010. Patients were followed up for 1-3 years after treatment， and the integrity， masticatory function and retention were examined. Results A total of 138 teeth of 100 patients were followed up for 1-3 years， treatment of 136 teeth were successful， without conscious symptoms， chewing function was normal. X-ray film showed that， periodontal membrane cavity without broadening， no secondary caries formation. Only 2 teeth were broken in the crown because of wrong use， found no tooth broken off or crown root fracture. Conclusion The glass fiber posts are effective for the restoration of tooth with severe wedge-shaped defect for reinforcing teeth and preventing crown and root fractures； together with the sandwich technique of fluid resin and nano-composite resin restored the cervical defect. The effective rate of instant and long-time outcome of this technique is high， especially for the tooth without any other defect or caries and person who is reluctant to receive full crown reservation.

[Key words] Glass fiber post； Reinforce； Severe wedge-shaped defect； Premolar； Prevention of tooth fracture

重度楔狀缺損的患牙牙頸部缺損深度近髓或者已露髓，牙體組織的完整性遭到嚴(yán)重破壞，根管治療后牙體及根管壁牙本質(zhì)會(huì)進(jìn)一步喪失，這使得牙體的抗折強(qiáng)度降低，盡早進(jìn)行樁冠修復(fù)才能避免牙體折斷。但是由于大多數(shù)的病例牙冠完整，患者比較抗拒進(jìn)行冠修復(fù)，從而忽視了這類牙齒治療后的潛在危險(xiǎn)。筆者對(duì)這類牙齒在完善的根管治療術(shù)后，預(yù)防性使用玻璃纖維樁，不僅大大降低了牙折的風(fēng)險(xiǎn)，有效地保留患牙，同時(shí)也減少了傳統(tǒng)的樁核+冠修復(fù)的治療方案所帶來(lái)的對(duì)牙體的破壞，患者更容易接受，也為日后患者的冠修復(fù)需求做好了充足的準(zhǔn)備。

1 資料與方法

1.1 一般資料

選取2007～2010年在山東省煙臺(tái)山醫(yī)院口腔科就診的100例患者，共138顆重度楔狀缺損或伴有牙體缺損的患牙。納入標(biāo)準(zhǔn)：重度楔狀缺損深度達(dá)到髓腔或近髓腔，不伴有牙體缺損或前牙因楔狀缺損或頸部齲致根尖周炎或牙髓炎的患牙，經(jīng)完善根管治療后，患者無(wú)意愿接受冠修復(fù)的。