利用玻璃纖維樁加固牙齒的臨床應用

田鴻旭　王毅

[摘要] 目的 探討利用玻璃纖維樁加固重度楔狀缺損前磨牙、預防折斷的臨床應用價值。 方法 將2007～2010年煙臺山醫(yī)院門診接診的100例患者共138顆重度楔狀缺損的上頜第一前磨牙完成根管治療后預防性地將玻璃纖維樁置于已預備好的根管腔中，并采用流動樹脂與納米樹脂結(jié)合的三明治技術充填牙頸部的楔狀缺損部位。隨訪1～3年，檢查牙齒頸部填充物邊緣是否密合、完整性及咀嚼功能。 結(jié)果 100例患者共138顆牙隨訪1～3年，136顆牙治療成功，均無自覺不適癥狀，咀嚼功能正常。X線片示：牙周膜腔無增寬，無繼發(fā)齲。僅2例于術后1年出現(xiàn)因咀嚼不當導致冠部分缺損，未發(fā)現(xiàn)根折或冠折。 結(jié)論 充分利用玻璃纖維樁的特性加固根管治療術后的重度楔狀缺損前磨牙有良好的預防折斷的臨床效果，流動樹脂與納米樹脂結(jié)合應用的三明治技術充填楔狀缺損部位能夠達到良好的近期與遠期效果，這種方法尤其適合重度楔狀缺損已行根管治療術、牙冠完整且不愿接受全冠修復的患者。

[關鍵詞] 玻璃纖維樁；加固；重度楔狀缺損；前磨牙；預防牙折

[中圖分類號] R783 [文獻標識碼] A [文章編號] 1673-7210（2015）09（c）-0120-05

[Abstract] Objective To evaluate the clinical application value of glass fiber post for reinforcing teeth to prevent tooth fracture. Methods After having been perfectly finished by root canal treatment， 138 maxillary premolar teeth of 100 patients with severe wedge-shaped defect were restored with glass fiber post and composite resin core， sandwich technique of fluid resin and nano-composite resin for wedge-shaped defect， in Yantai Shan Hospital from 2007 to 2010. Patients were followed up for 1-3 years after treatment， and the integrity， masticatory function and retention were examined. Results A total of 138 teeth of 100 patients were followed up for 1-3 years， treatment of 136 teeth were successful， without conscious symptoms， chewing function was normal. X-ray film showed that， periodontal membrane cavity without broadening， no secondary caries formation. Only 2 teeth were broken in the crown because of wrong use， found no tooth broken off or crown root fracture. Conclusion The glass fiber posts are effective for the restoration of tooth with severe wedge-shaped defect for reinforcing teeth and preventing crown and root fractures； together with the sandwich technique of fluid resin and nano-composite resin restored the cervical defect. The effective rate of instant and long-time outcome of this technique is high， especially for the tooth without any other defect or caries and person who is reluctant to receive full crown reservation.

[Key words] Glass fiber post； Reinforce； Severe wedge-shaped defect； Premolar； Prevention of tooth fracture

重度楔狀缺損的患牙牙頸部缺損深度近髓或者已露髓，牙體組織的完整性遭到嚴重破壞，根管治療后牙體及根管壁牙本質(zhì)會進一步喪失，這使得牙體的抗折強度降低，盡早進行樁冠修復才能避免牙體折斷。但是由于大多數(shù)的病例牙冠完整，患者比較抗拒進行冠修復，從而忽視了這類牙齒治療后的潛在危險。筆者對這類牙齒在完善的根管治療術后，預防性使用玻璃纖維樁，不僅大大降低了牙折的風險，有效地保留患牙，同時也減少了傳統(tǒng)的樁核+冠修復的治療方案所帶來的對牙體的破壞，患者更容易接受，也為日后患者的冠修復需求做好了充足的準備。

1 資料與方法

1.1 一般資料

選取2007～2010年在山東省煙臺山醫(yī)院口腔科就診的100例患者，共138顆重度楔狀缺損或伴有牙體缺損的患牙。納入標準：重度楔狀缺損深度達到髓腔或近髓腔，不伴有牙體缺損或前牙因楔狀缺損或頸部齲致根尖周炎或牙髓炎的患牙，經(jīng)完善根管治療后，患者無意愿接受冠修復的。