Horwitz J, Gabay E
Dept. of Periodontology, School of Graduate Dentistry Rambam Health Care Campus, Haifa, Israel.
Refuat Hapeh Vehashinayim (1993). 2012 Jan;29(1):7-14, 62.
The treatment of furcation defects is one of the most challenging aspects of periodontal therapy. The periodontal therapist can utilize various treatment modalities, including: non surgical root debridement, local drug delivery, open flap surgery, tunneling, root resection, guided tissue regeneration and extraction. Each treatment method has its advantages and disadvantages. The dilemmas concerning tooth prognosis and prosthetic considerations in such cases are especially demanding, especially in comparison to implant therapy. The clinician's decision in these situations must comply with the objective condition in the particular case based on his abilities and knowledge and the patient expectations. In order to evaluate the relevancy of root resection procedures we reviewed the literature focusing on root resection therapy prognosis as well as the different therapeutic alternatives for furcated molar teeth. Root resection treatment guidelines, indications and contraindication are presented along with clinical examples. Root resection is currently a relevant treatment modality for furcation defects. By using proper case selection, good surgical technique, proper prosthetic treatment and good periodontal supportive care, a good 5 year prognosis can be achieved and complications can be minimized. In light of the growing literature concerning dental implants complications, extraction and dental implant placement should be recommended as the last option when all other conservative options cannot be used, or following their failure.
根分叉病变的治疗是牙周治疗中最具挑战性的方面之一。牙周治疗师可以采用多种治疗方式,包括:非手术性根面清创、局部药物递送、翻开瓣手术、隧道技术、牙根切除术、引导组织再生和拔牙。每种治疗方法都有其优缺点。在此类病例中,关于牙齿预后和修复考量的困境尤其棘手,特别是与种植治疗相比。临床医生在这些情况下的决策必须根据其能力、知识以及患者期望,符合具体病例的客观情况。为了评估牙根切除术的相关性,我们回顾了聚焦于牙根切除术治疗预后以及分叉磨牙不同治疗选择的文献。文中呈现了牙根切除术的治疗指南、适应证和禁忌证,并配有临床实例。牙根切除术目前是治疗根分叉病变的一种相关治疗方式。通过恰当的病例选择、良好的手术技术、合适的修复治疗以及良好的牙周支持治疗,可以获得良好的5年预后,并将并发症降至最低。鉴于有关牙种植体并发症的文献不断增多,当所有其他保守治疗方法均不可行或失败后,拔牙和牙种植体植入应作为最后的选择。