三种桩核冠修复在牙体缺损治疗的应用比较

1、三种桩核冠修复在牙体缺损治疗的应用比较                                作者：林培，郑定国,王涛林培【摘要】  目的：比较铸造合金桩核、钛及钛合金成品根管桩和弹性模量与牙本质相近的纤维桩制作桩核，3种方法修复残冠残根的临床效果。方法：牙体缺损患者共1

2、 368例，前牙牙体缺损776例。后牙牙体缺损592例。1 368例患者分为3组,A组838例(铸造桩核),B组428例(钛及钛合金成品根管桩)，C组102例(玻璃纤维桩)，对3组的效果进行比较。结果：随访0.53 年，A组成功789例,失败49例;B组成功423例,失败5例;C组成功102例,无失败病例。结论：弹性模量与牙本质相近的纤维桩可减少根折的发生，修复疗效最好。钛及钛合金根管桩具有优良的生物相容性、耐腐蚀性，弹性模量相对较小,抗折能力强;有相对的优越性。铸造桩核的缺点是腐蚀、过敏使牙龈出现金属线牙龈变色，易出现根折。 【关键词】  牙修复，永久;牙缺失;牙折断;钛及钛合金根

3、管桩;纤维桩;铸造桩核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桩核技术是目前临床修复残冠残根的主要手段, 经过完善根管治疗的牙齿,当牙体组织缺损较多时,常采用桩核及全冠修复1。金属因其良好的机械性能及易加工性一直作为桩核的材料。随着对其研究的逐步深入,金属桩核的不透光、使牙龈染色、致敏性、影响磁共振成像等缺陷限制了金属桩核在临床的应用。另外,由于金属的机械特性与牙体差异较大, 因此,近年来国内外

8、一些学者开始研制新的根管桩,其中包括钛及钛合金成品根管桩和弹性模量与牙本质相近的纤维桩。本研究选取1 368例牙体缺损患者,分别采用铸造金属桩核、钛及钛合金成品根管桩、玻璃纤维桩进行修复,对三者的临床效果进行比较。1         1 资料与方法1.1 临床资料本组1 368例牙体缺损患者，前牙牙体缺损776例,男性342例,女性434例,年龄1855岁,平均36岁，前牙咬合关系基本正常,根管形态无异常;后牙牙体缺损592例，男性366例，女性226例。外伤344例,龋病1 024例。1 368例分为3组,A组8

9、38例(铸造桩),B组428例(钛及钛合金成品根管桩)，C组102例(玻璃纤维桩)。1.2 材料与器械预成玻璃纤维桩、钛及钛合金成品根管桩(Coltene/Whaledent, USA);双固化树脂粘结剂及配套双固化型核树脂(Coltene/Whaledent， USA);玻璃离子水门汀粘结剂(Shofu, Japan);铸造镍铬合金桩核(Heraeus, Germany); All Bond 2牙本质粘结剂(Bisco, USA);根管预备钻针(Bisco, USA);根面预备钻针(Mani Japan);寒天印模材(国产);排龈线(Ultraden, tUSA);排龈器(Ultraden, tUSA)。1.3 方法患牙经过完善的根管后观察1014 d。根据X线片测量牙根长度,对患牙进行常规根管预备,预备深度为牙根的2/3,直径不超过牙根直径的1/3，距根尖4 mm根充材料应原封不动以保持良好的根尖封闭2。A组采用传统两步法制作金属桩核,磨除薄壁、弱尖及无基釉。用铸造蜡制作桩核模型后包埋、铸造,第1次复诊后试戴,用玻璃离子水门汀粘结于预备好的根管中。B组根据根管的粗细及长度,选择合适的根管预备钻和与其相对应的钛及钛合金成品根管桩,双固化树脂粘