Lee Ji-Hyun, Yoon Sung-Min
Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA.
Dent Traumatol. 2015 Apr;31(2):150-5. doi: 10.1111/edt.12121. Epub 2014 Aug 11.
The objective of this case report is to describe the treatment procedure involved in surgical extrusion of multiple crown-root fractures and review the critical factors to be considered for successful and predictable outcome. The treatment of complicated crown-root fracture in anterior teeth is likely to compromise function and aesthetics when approached with conventional surgical crown lengthening. Orthodontic extrusion has also been suggested; however, it is time-consuming, aesthetically compromising and hardly applicable on multiple anterior crown-root fractures due to the limited source of anchorage. To overcome the shortcomings of suggested treatment modalities, we performed atraumatic surgical extrusion of four anterior fractured teeth along with their rotation within the sockets. The teeth were gently luxated and extruded to the desired position, minimizing damage to the marginal alveolar bone and root surfaces without rigid splint. The treated teeth were functioning normally 18 months after the procedure, and the mobility and probing depths were within normal limits. Radiographs revealed functional periodontal ligament space along with lamina dura formation around the extruded roots. There was neither root resorption nor significant marginal bone loss. This technique might be a promising alternative to conventional crown lengthening, especially in the anterior zone to avoid functional or aesthetic complications.
本病例报告的目的是描述多颗冠根折裂牙手术牵引复位的治疗过程，并回顾为获得成功且可预测的结果需考虑的关键因素。在前牙复杂冠根折裂的治疗中，采用传统的手术冠延长术可能会影响功能和美观。也有人建议采用正畸牵引复位；然而，这种方法耗时较长，美观性较差，而且由于支抗来源有限，很难应用于多颗前牙冠根折裂的情况。为克服上述治疗方法的缺点，我们对四颗前牙折裂牙进行了无创手术牵引复位，并使其在牙槽窝内旋转。牙齿被轻柔地松动并牵引至理想位置，在不使用坚固夹板的情况下，将对牙槽嵴顶骨和牙根表面的损伤降至最低。术后18个月，治疗后的牙齿功能正常，松动度和探诊深度均在正常范围内。X线片显示牵引牙根周围有功能正常的牙周膜间隙和硬骨板形成。既没有牙根吸收，也没有明显的边缘骨丧失。这种技术可能是传统冠延长术的一种有前景的替代方法，尤其是在前牙区，可避免功能或美观方面的并发症。
