Wigen Tove Irene, Agnalt Reidun, Jacobsen Ingeborg
Department of Pediatric Dentistry and Behavioural Science, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
Dent Traumatol. 2008 Dec;24(6):612-8. doi: 10.1111/j.1600-9657.2008.00686.x.
BACKGROUND/AIM: External replacement resorption (ankylosis-related) is a severe complication leading eventually to tooth loss. Little information exists regarding the influence of variables such as degree of intrusion or treatment method on the development of replacement resolution in intruded permanent incisors. The aim of this study was to report the most frequently involved age group, the preferred type of treatment, and the type and frequency of healing complications. Special attention was paid to the effect of treatment on the occurrence of replacement resorption.
Fifty-one intruded permanent incisors were studied in 20 boys and 19 girls aged 6 to 17 years. Only three patients were over 12 years of age. Complete intrusion had occurred in 21 teeth, and 31 teeth were classified as immature. Re-eruption was awaited for 37 teeth. The remaining teeth were repositioned orthodontically (7 teeth) or surgically (7 teeth).
Re-eruption occurred in 35 out of 37 teeth over a period of 3-12 months. After a mean observation period of 4 years ranging from 1-12 years, retained pulp vitality was recorded in 22 teeth (43%). Pulp necrosis had developed in 57%, inflammatory resorption in 26% and replacement resorption in 12%. Whereas all inflammatory resorptions were arrested after long-term calcium hydroxide treatment, replacement resorption always led to complete root resorption. In the analysis all orthodontic and surgical repositioned teeth were combined into an active treatment group. The non-active treatment group consisted of teeth allowed to re-erupt. The distribution of replacement resorption was significantly lower in teeth allowed to re-erupt than in teeth repositioned actively.
The best treatment of intruded incisors in 6-12 year-old children is to await re-eruption. Should endodontic treatment be required before re-eruption has occurred, a gingivectomy can be performed to gain access to the root canal.
背景/目的：外部替代性吸收（与粘连相关）是一种严重的并发症，最终会导致牙齿脱落。关于诸如侵入程度或治疗方法等变量对侵入性恒切牙替代性吸收发展的影响，目前所知甚少。本研究的目的是报告最常涉及的年龄组、首选的治疗类型以及愈合并发症的类型和频率。特别关注治疗对替代性吸收发生的影响。
对20名男孩和19名年龄在6至17岁的女孩的51颗侵入性恒切牙进行了研究。只有3名患者年龄超过12岁。21颗牙齿发生了完全侵入，31颗牙齿被归类为未成熟。37颗牙齿等待再萌出。其余牙齿通过正畸（7颗）或手术（7颗）进行复位。
37颗牙齿中有35颗在3至12个月内再萌出。平均观察期为4年，范围从1至12年，22颗牙齿（43%）记录到牙髓活力得以保留。牙髓坏死发生率为57%，炎症性吸收为26%，替代性吸收为12%。虽然所有炎症性吸收经长期氢氧化钙治疗后均得到控制，但替代性吸收总是导致牙根完全吸收。在分析中，所有正畸和手术复位的牙齿合并为一个积极治疗组。非积极治疗组由允许自行再萌出的牙齿组成。允许自行再萌出的牙齿中替代性吸收的分布明显低于积极复位的牙齿。
6至12岁儿童侵入性切牙的最佳治疗方法是等待再萌出。如果在再萌出之前需要进行牙髓治疗，可以进行牙龈切除术以进入根管。
