Chung Hsien-Yang, Lin Hung-Chieh, Lu Chun-Tai, Tsai Shi-Ru, Tsai Chi-Cheng
Department of Dentistry, China Medical College Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2002 Apr;18(4):191-7.
To treat furcation involvement is a crucial challenge to periodontists, not only because of the limitation in pocket reduction by osteoplasty and apically positioned flap, but also because of the unpredictability in regenerative approaches. Therefore, if the first molar is absent and the second molar has to be retained strategically for prosthetic reasons, very few alternatives besides nonsurgical/surgical debridement can be taken in treating the furcation of the second molar, where the interradicular root proximity and fusion frequently occur. On the other hand, root amputation/hemisection has long been considered a contraindication in treating furcations with two close roots; however, this impression is only empirical. A series of clinical cases involved in the treatment of intrabony defects associated with interradicular root proximity and fusion by root amputation/hemisection has been reported. Without any help of regenerative material, thorough root debridement and pocket reduction were attained. Based on these cases, we suggested that the cut surface created by odontoplasty during root amputation was compatible for periodontal healing and the extraction socket provided striking potential for defect repair. We re-examined the clinical feasibility and benefit of treating intrabony defects associated with interradicular root proximity and fusion in molar furcations by root amputation/hemisection, and suggested that its role should be favorably reconsidered on case basis. The short-term success in periodontal and prosthetic aspects needed to be further evaluated at long-term follow-up.
治疗根分叉病变对牙周病医生来说是一项至关重要的挑战，这不仅是因为通过骨成形术和根向复位瓣进行牙周袋深度降低存在局限性，还因为再生治疗方法具有不可预测性。因此，如果第一磨牙缺失，而出于修复原因必须保留第二磨牙，那么在治疗第二磨牙根分叉病变时，除了非手术/手术清创外，几乎没有其他选择，因为该部位常常出现根间距离过近和融合的情况。另一方面，长期以来，根切除术/半切术一直被认为是治疗两根根分叉病变的禁忌证；然而，这种观点仅仅是经验性的。已有一系列临床病例报道了通过根切除术/半切术治疗与根间距离过近和融合相关的骨内缺损。在没有任何再生材料辅助的情况下，实现了彻底的牙根清创和牙周袋深度降低。基于这些病例，我们认为根切除术过程中通过牙体成形术形成的切割面有利于牙周愈合，拔牙窝为缺损修复提供了显著的潜力。我们重新审视了通过根切除术/半切术治疗磨牙根分叉病变中与根间距离过近和融合相关的骨内缺损的临床可行性和益处，并建议应根据具体病例重新审视其作用。牙周和修复方面的短期成功需要通过长期随访进一步评估。
