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ENGLISH ABSTRACT
前牙美学区龈下骨上冠根折断牙再接修复的临床病例回顾
蒙萌
赵洁
张燕婷
余昊翰
陈莉
张芳
方明
周炜
作者及单位信息
·
DOI： 10.3760/cma.j.cn112144-20250114-00014
Clinical case retrospective study on fragment reattachment of anterior teeth with sub-gingival & supra-alveolar ridge crown-root fractures in esthetic zone
Meng Meng
Zhao Jie
Zhang Yanting
Yu Haohan
Chen Li
Zhang Fang
Fang Ming
Zhou Wei
Authors Info & Affiliations
Meng Meng
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Zhao Jie
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Zhang Yanting
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Yu Haohan
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Chen Li
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Zhang Fang
Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Fang Ming
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
Zhou Wei
Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi′an 710032, China
·
DOI： 10.3760/cma.j.cn112144-20250114-00014
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摘要

目的评估前牙美学区龈下骨上冠根折断牙再接修复的临床效果，分析断牙再接修复技术在龈下骨上冠根折微创修复中应用的可行性。

方法收集2016年1月至2024年8月因前牙龈下骨上冠根折于空军军医大学口腔医院口腔修复科就诊完成断牙再接修复治疗的患者12例（14颗患牙），回顾分析断牙再接修复后3年治疗成功率和随访期内并发症，评估断牙再接修复技术在前牙美学区龈下骨上冠根折微创修复中的临床应用效果。

结果14颗患牙经断牙再接修复治疗，随访（36.0±33.7）个月（4~99个月），其中2颗患牙出现并发症，1颗患牙脱粘接后拔除，改行可摘局部义齿修复；1颗断牙再接修复治疗后腭侧出现窦道，对窦道进行生理盐水局部冲洗、上药，2周后窦道愈合，随访12个月，患牙仍留存；其余患牙随访期内未出现任何并发症，治疗成功率为13/14。

结论断牙再接修复治疗是前牙美学区龈下骨上冠根折的一种微创、快捷、经济的治疗方式，在严格控制适应证的前提下能获得较好的治疗效果，延长患牙的临床寿命。

牙折断;美学，牙科;美学区;前牙;冠根折;断牙再接
ABSTRACT

ObjectiveTo evaluate the clinical process of fragment reattachment in crown-root fractures (CRF) of teeth that the fracture occurred between sub-gingival and supra-alveolar ridge (sub-gingival & supra-alveolar ridge) in the esthetic zone, and to analyze the feasibility of this minimally invasive technique for sub-gingival & supra-alveolar ridge CRF involving anterior teeth.

MethodsFourteen sub-gingival & supra-alveolar ridge CRF involving anterior teeth in 12 patients received fragment reattachment in the Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University from January 2016 to August 2024. The success rate of the fractured teeth 3 years after reattachment and the complications during the follow-up period were retrospectively analyzed. The 3-year success rate and complications during follow-up were evaluated to assess the clinical efficacy of this technique.

ResultsThe 14 treated teeth were followed for an average of (36.0±33.7) months (range: 4-99 months). Complications occurred in 2 teeth: one was extracted due to debonding and replaced with a removable partial denture, while the other developed a palatal sinus post-reattachment, which healed after local saline irrigation and medication (followed for 12 months without recurrence). The remaining 12 teeth exhibited no complications, resulting in a success rate of 13/14.

ConclusionsFragment reattachment is a minimally invasive, rapid, and cost-effective treatment option for sub-gingival & supra-alveolar ridge CRF in the anterior esthetic zone. With strict case selection, it delivers favorable outcomes and extends the clinical lifespan of affected teeth.

Tooth fractures;Esthetics, dental;Esthetic zone;Anterior teeth;Crown-root fracture;Fragment reattachment
Zhou Wei, Email: mocdef.aabnis4740iewuohz, Tel: 0086-29-84776128
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引用本文

蒙萌,赵洁,张燕婷,等. 前牙美学区龈下骨上冠根折断牙再接修复的临床病例回顾[J]. 中华口腔医学杂志,2025,60(04)：347-354.

DOI:10.3760/cma.j.cn112144-20250114-00014

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冠根折是指牙齿外伤后，牙冠合并牙根组织发生折裂离断，是牙外伤的常见病，约占恒牙外伤性损伤的5% ［ 1 , 2 ］ ，根据牙髓是否暴露，分为复杂冠根折和非复杂冠根折 ［ 3 ］ 。冠根折好发于前牙美学区，特别是上颌前牙，冠根折可对患者美观、功能、心理等方面产生一系列影响 ［ 4 , 5 , 6 ］ 。冠根折的折裂线一般始于牙冠唇侧颈部，斜行向下、向腭侧倾斜延伸，严重者可伤及牙髓 ［ 7 ］ ，断裂牙片存在软组织附着或完全脱落，触诊时患者常伴剧烈疼痛。通常牙齿在外力作用下，折断面可能位于龈上、龈下骨上（牙槽嵴顶上）或骨下。
1964年学者首次报道利用铸造桩核进行断牙再接修复，治疗中切牙复杂冠根折 ［ 8 ］ 。随着粘接技术的发展，20世纪70年代后期许多学者开始利用牙釉质粘接剂和复合树脂材料进行断牙再接修复治疗 ［ 9 ］ ，并取得良好的修复效果。近年，龈上断牙再接修复的成功率大幅度提高 ［ 3 ］ ，越来越多的医师已接受这种微创的修复方式。对于折断面位于骨下的复杂冠根折，由于断牙再接修复过程中可能涉及去骨，影响后期的常规种植手术治疗，因此一般采用即刻种植或早期种植的方式进行修复。目前最有争议的是牙齿折断位置位于龈下骨上的冠根折，由于担心断牙再接修复后的治疗效果，较多医师仍选择种植修复治疗，但无论是即刻种植还是早期种植，均存在美学区种植风险，例如技术要求高、治疗周期长以及薄龈生物型患者易并发美学并发症等。本课题组对龈下骨上冠根折进行断牙再接修复，并对病例修复效果进行随访，就断牙再接修复技术在龈下骨上冠根折牙齿修复中的应用进行深入研究，以探索相关临床流程，评估该技术在龈下骨上冠根折微创修复中应用的可行性。
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备注信息
A
周炜，Email： mocdef.aabnis4740iewuohz，电话：029-84776128
B

蒙萌：查阅文献、实验设计、文章撰写；赵洁：数据整理及统计分析；张燕婷：采集数据；余昊翰：作图、文章修改；陈莉：采集数据；张芳：数字化导板设计与制作；方明：论文审阅；周炜：研究指导，论文审阅、经费支持

C
蒙萌, 赵洁, 张燕婷, 等. 前牙美学区龈下骨上冠根折断牙再接修复的临床病例回顾[J]. 中华口腔医学杂志, 2025, 60(4): 347-354. DOI: 10.3760/cma.j.cn112144-20250114-00014.
D
所有作者声明不存在利益冲突
E
国家自然科学基金 (82471010)
西安市科技计划 (24YXYJ0140)
空军军医大学第三附属医院临床新技术项目 (LX2022-303，LX2022-508)
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