恒牙列中的牙槽突骨折。第2部分。牙槽突骨折累及牙齿的愈合并发症风险。
Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture.
作者信息
Lauridsen Eva, Gerds Thomas, Andreasen Jens Ove
机构信息
Department of Odontology, Pediatric Dentistry and Clinical Genetics, University of Copenhagen, Copenhagen, Denmark.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
出版信息
Dent Traumatol. 2016 Apr;32(2):128-39. doi: 10.1111/edt.12229. Epub 2015 Oct 14.
AIM
To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors.
MATERIAL AND METHOD
A total of 91 patients with 223 traumatized teeth.
STATISTICS
The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%.
RESULTS
Immature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1-63.9), IRR: 2.5% (95% CI: 0-5.1), ARR: 2.1% (95% CI: 0.1-4.1), MBL: 2.4% (95% CI: 0.3-4.4), and TL: 7.8% (95% CI: 0-15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 - 5.7), P = 0.01), displacement in the horizontal part of the fracture >2 mm (HR: 1.8; 95% CI: 1.1-3.2, P = 0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN.
CONCLUSION
Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended.
目的
分析牙槽突骨折累及牙齿发生根管闭锁（PCO）、牙髓坏死（PN）、修复性吸收（RRR）、感染性吸收（IRR）、粘连性吸收（ARR）、边缘性骨吸收（MBL）和牙齿缺失（TL）的风险，并确定可能的危险因素。
材料与方法
共91例患者，累及223颗外伤牙。
统计学分析
采用Kaplan-Meier法和Aalen-Johansen法分别分析牙根发育未成熟和成熟牙齿发生PCO、PN、RRR、IRR、ARR、MBL和TL的风险。采用Cox回归分析成熟牙齿发生PN的可能危险因素（年龄、根尖相关骨折、移位、牙龈损伤、复位程度、夹板类型、夹板固定时间、治疗延迟和抗生素使用情况）。显著性水平为5%。
结果
牙根发育未成熟：随访期间未诊断出严重并发症（PN、IRR、ARR、MBL或TL）。牙根发育成熟：10年随访后的估计风险：PN：56%（95%置信区间（CI）：48.1-63.9），IRR：2.5%（95%CI：0-5.1），ARR：2.1%（95%CI：0.1-4.1），MBL：2.4%（95%CI：0.3-4.4），TL：7.8%（95%CI：0-15.7）。以下因素显著增加了牙根发育成熟牙齿发生PN的风险：根尖相关骨折（风险比（HR）：2.6（95%CI：0.2-5.7），P=0.01），骨折水平部分移位>2mm（HR：1.8；95%CI：1.1-3.2，P=0.03），复位不完全（HR：2.1（95%CI：1.3-3.5），P=0.003），年龄>30岁（HR：2.3（95%CI：1.1-4.6），P=0.02）。夹板类型（刚性或柔性）、夹板固定时间（超过或少于4周）和抗生素使用情况均不影响PN的风险。
结论
除PN外，牙槽突骨折累及的牙齿预后良好。建议采用保守治疗方法。
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