Jia Xue-ting, Zhen Min, Hu Wen-jie, Liu Yun-song
Department of Periodontics, Peking University School & Hospital of Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Oct 18;47(5):878-82.
In this article, different methods to deal with teeth fractures were discussed by presenting a case of traumatic crown-root fracture in the anterior esthetic zone. The traumatic crown-root fracture is a common problem in clinic. When a fracture line locates in close proximity to or below the alveolar bone crest, the fracture most likely involve the junctional epithelium and the connective tissue attachment. This type of fracture becomes a challenge for restorative dentists because it involves biologic, functional, and esthetic considerations, especially when the fracture occurs in an esthetic area. In this case, a young patient presented with two fractured upper anterior teeth to the Department of Periodontics, Peking University School and Hospital of Stomatology. After the comprehensive clinical evaluation, the right central incisor was decided to extract for implant therapy and the right lateral incisor was decided to retain by one modified crown lengthening surgery. The most common technique applied to save a retained root is a clinical crown lengthening procedure. However, the aggressive alveolar bone resection of both target and adjacent teeth to reestablish the bone width and periodontal health may compromise functional and esthetic outcomes. To reduce loss of excessive osseous tissue during osteotomy procedure, the modified crown lengthening of the right lateral incisor was performed, including minor bone resection and root reshaping. Regarding the right central incisor, the retained root was all located below the alveolar bone crest. The extraction and implant procedure, combined with guided bone graft were performed to avoid the damage to neighbor teeth during traditional restorative therapy and to reshape a preferable buccal contour. At the last visit, the patient was recalled with healthy periodontium, normal tooth function and favorable esthetic results.
在本文中，通过呈现一例前牙美学区创伤性冠根折病例，讨论了处理牙齿折断的不同方法。创伤性冠根折是临床上常见的问题。当骨折线位于牙槽嵴附近或下方时，骨折很可能累及结合上皮和结缔组织附着。这种类型的骨折对修复牙医来说是一个挑战，因为它涉及生物学、功能和美学方面的考虑，尤其是当骨折发生在美学区域时。在这个病例中，一名年轻患者到北京大学口腔医学院牙周科就诊，其上前牙有两颗折断。经过全面的临床评估，决定拔除右上中切牙进行种植治疗，而右上侧切牙则通过一次改良的冠延长术予以保留。挽救保留牙根最常用的技术是临床冠延长术。然而，对目标牙和相邻牙齿进行激进的牙槽骨切除以重建骨宽度和牙周健康，可能会影响功能和美学效果。为了减少截骨过程中过多骨组织的损失，对右上侧切牙进行了改良冠延长术，包括少量骨切除和牙根重塑。对于右上中切牙，保留的牙根全部位于牙槽嵴下方。进行了拔牙和种植手术，并结合引导性骨增量，以避免在传统修复治疗过程中对邻牙造成损伤，并重塑更理想的颊侧轮廓。在最后一次复诊时，患者的牙周组织健康，牙齿功能正常，美学效果良好。
