易娟 谌铭

[摘要] 目的 探讨应用即刻暂时冠治疗隐裂牙的效果。 方法 选取2011年7月～2014年7月期间到我科就诊的因牙隐裂导致的急性牙髓炎、急慢性根尖周炎患者218例作为研究对象，其中有急性牙龈炎病牙数102颗，急性根尖周炎病牙数109颗，慢性瘘型根尖周炎病牙数122颗。按照就诊顺序将其随机分为实验组和对照组。将其进行再分组，其中急性牙髓炎实验组为A组，急性牙髓炎对照组为B组，急性根尖周炎实验组为C组，急性根尖周炎对照组为D组，慢性瘘型根尖周炎实验组为E组，慢性瘘型根尖周炎对照组为F组。比较不同疾病类型患者的治疗效果。 结果 在全冠修复前，实验组与对照组的治疗有效率差异无统计学意义（P>0.05），在随访6、12个月时，实验组患者的治疗有效率均明显高于对照组，差异有统计学意义（P<0.01）；在全冠修复前及随访6、12个月时，A组与C组比较，差异无统计学意义（χ2=0.105、0.333、0.017，P>0.05）；在全冠修复前及随访6、12个月时，A组与E组比较，差异有统计学意义（χ2=7.667、6.769、5.939，P<0.05），C组与E组比较，差异有统计学意义（χ2=6.333、4.415、4.465，P<0.05）；在全冠修复前及随访6、12个月时，B组与D组比较，差异无统计学意义（χ2=5.125、5.375、2.980，P>0.05）；在全冠修复前及随访6、12个月时，F组与D组比较，差异有统计学意义（χ2=5.030、3.575、14.546，P<0.05），F组与B组比较，差异有统计学意义（χ2=11.315、23.793、18.285，P<0.05）。 结论 使用即刻临时冠治疗隐裂牙，具有较高的治疗效果；隐裂导致的根尖周炎特别是瘘型根尖周炎患牙的远期疗效不佳。

[关键词] 隐裂牙；牙髓炎；根尖周炎；即刻暂时冠

[中图分类号] R783 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0100-04

[Abstract] Objective To explore the effect of applying immediate temporary crown to treat cracked teeth. Methods From July 2011 to July 2014，218 patients with acute pulpitis and acute or chronic periapical periodontitis due to teeth cracked who visited our department for treatment were selected.There were 102 teeth in acute pulpitis，109 in acute periapical periodontitis，and 122 in periapical periodontitis （fistula type）.According to the sequence of seeing doctors，they were randomly divided into experimental group and control group.They were altogether divided into A to F groups including experimental group of acute pulpitis （group A），control group of acute pulpitis （group B），experimental group of acute periapical periodontitis （group C），control group of acute periapical periodontitis （group D），experimental group of chronic-fistula periapical periodontitis （group E），and control group of chronic-fistula periapical periodontitis （group F）.The therapeutic effects in different types of dental diseases in the experimental group and control group were compared. Results Before complete coronal restoration，the therapeutic effect in the experimental group and control group was not statistical （P>0.05）.During 6-month and 12-month follow up visits，the therapeutic effective rates in the experimental group were much higher than those in the control group with statistical difference （P<0.01）.There was no statistical difference in prior restoration of complete crown，6-month follow up visit，and 12 month follow up visit between group A and group C （χ2=0.105，0.333，0.017，P>0.05）.In comparison with group A and E，there were statistical differences in three above mentioned periods （χ2=7.667，6.769，5.939，P<0.05）.There were statistical differences in three above mentioned periods between group C and group E （χ2=6.333，4.415，4.465，P<0.05）.During three periods of prior restoration of complete crown，6-month follow up visit，and 12 month follow up visit，there was no statistical difference between group B and group D （χ2=5.125，5.375，2.980，P>0.05）.However，there were statistical differences between group F and group D （χ2=5.030，3.575，14.546，P<0.05） and between group F and group B （χ2=11.315，23.793，18.285，P<0.05）. Conclusion In the treatment of cracked teeth，application of immediate temporary crown can obtain a good therapeutic effect，but is not satisfactory for periapical periodontitis especially chronic-fistula periapical periodontitis in long term.

[Key words] Cracked tooth；Pulpitis；Periapical periodontitis；Immediate temporary crown

牙隐裂综合征（CTS）是不完全断裂的牙齿，它通常通过咬合痛和冷热刺激痛作出初步诊断，在针对隐裂牙的治疗上，对仅有遇冷热刺激痛、咬合不适或临床症状不明显的隐裂牙，既往多给予调整咬合、填充术等方法治疗，因不知深度和方向的裂缝面贯穿整个牙体结构，不知是否已进展到牙髓腔或牙周膜，部分隐裂牙会裂隙加宽加深，加重临床症状的症状，诱发牙髓坏死、尖周炎、不可复性牙髓炎等临床症状，甚至有部分患者存在直接纵折，最后只得将患牙拔出[1-2]。然而……