Braun A, Appel T, Frentzen M
Department of Operative Dentistry and Periodontology, University of Bonn, Welschnonnenstr. 17, D-53111 Bonn, Germany.
Int Endod J. 2003 May;36(5):380-6. doi: 10.1046/j.1365-2591.2003.00668.x.
A geminated maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report describes the coordination of coronal division, root extraction, bone grafting, endodontic treatment and orthodontics in achieving treatment goals. It is the intention of this report to show how a difficult case could be managed by properly coordinated multidisciplinary care.
Pulp testing of the geminated central right maxillary incisor gave a normal response. Radiographic investigation indicated a connection of the pulp chambers. Both the mesial and distal root were filled with gutta-percha. The connection between the two root canals was sealed with a flowable dentine-bonded resin. After dividing the crown with a diamond bur, the mesial part of the tooth was removed and the extraction socket was filled with beta-tricalcium phosphate ceramic (Cerasorb). Radiographs taken immediately after surgery and after 6 months showed no periodontal or periapical lesions. No signs of external resorption were identified. The diastema between the central incisors was closed by orthodontic treatment.
Geminated teeth may present aesthetic and functional problems which require multidisciplinary care. Careful clinical and radiographic examination is essential to decide on the fate of the coronal and root halves involved. A proper coordination between endodontic and surgical treatment may result in maintaining one tooth half, even if a midroot connection between the pulp chambers becomes evident. Orthograde endodontic treatment, hemisection and orthodontics may solve the aesthetic problem of a geminated tooth.
一颗双生上颌切牙需要复杂的多学科治疗以保持健康并恢复美观。本报告描述了在实现治疗目标过程中冠部分离、牙根拔除、骨移植、牙髓治疗和正畸治疗的协调配合。本报告旨在展示如何通过恰当协调的多学科护理来处理一个复杂病例。
右上颌双生中切牙的牙髓测试反应正常。影像学检查显示牙髓腔相通。近中根和远中根均已用牙胶充填。两根管之间的连接用可流动的牙本质粘结树脂封闭。用金刚砂车针将牙冠分开后，去除牙齿的近中部分，拔牙窝用β-磷酸三钙陶瓷（Cerasorb）充填。术后即刻及6个月后拍摄的X线片显示无牙周或根尖病变。未发现外部吸收迹象。通过正畸治疗关闭了中切牙之间的间隙。
双生牙可能会出现美观和功能问题，需要多学科护理。仔细的临床和影像学检查对于决定所涉及的冠部和根部两半的命运至关重要。即使牙髓腔之间的根中部连接明显，牙髓治疗和手术治疗之间的恰当协调也可能导致保留其中一半牙齿。顺行性牙髓治疗、半切术和正畸治疗可以解决双生牙的美观问题。
