影響臼齒牙根切除或分離術治療結果之因素 -回溯性研究

A Retrospective Study on the Survival of Root-resected Molars

王秀櫻(Hsiu-Ying Wang)

指導教授 ： 蔡吉政

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2009年)

https://doi.org/10.6832/KMU.2009.00034

摘要

研究背景：大臼齒區因複雜的解剖形態構造，對於嚴重破壞的牙根區，牙根切除術或切半術（root resection and /or separation）是治療方法中較簡化並且易改善維護的方式。本研究目的將利用病歷回溯之分析，探討影響臼齒牙根切除或分離術之存活率與失敗原因。材料與方法：本研究共有341位患者（男性222人，女性119人），平均年齡為52.1±10.2歲（從16歲至80歲），收集其基本資料。挑選X光片並利用繪圖軟體測量X光片，經測量後取得骨頭剩餘高度。結果：本研究手術案件共為354顆牙齒。術後追蹤期間被拔除之牙齒列為手術失敗，其失敗率佔全部手術的24%；其中因牙周疾病的再發生所造成的失敗佔全部失敗的71.8％（61/85），有18顆牙齒（21.2％）因牙根斷裂而被拔除。追蹤七年期間，牙根切除或分離術之術後存活率為75.99%。結論：牙根切除後被拔除的牙齒主要因素為牙周疾病的再復發，手術前的評估和手術後口腔衛生教育與維護、定期回診，對於牙根切除後牙齒的存活率是很重要的。有21%失敗原因是因牙根斷裂而被拔除，因此，手術前之根管治療應保守，以避免過度擴大其牙髓腔而造成齒質結構之脆弱。

關鍵字

牙根切除術或切半術 ； 牙周疾病 ； 牙根斷裂

並列摘要

Objective: Root resection is one of the treatment modalities to remove the most severely destructed root (s) at the level of furcation and to leave the remaining root (s) in function. Through root resection treatment, the tooth topography of the furcation-involved molars is simplified. Therefore, the oral hygiene care for patients is easier and the maintenance is improved. The prognosis of root resection therapy showed in several reports was disparate. The important factors associated with the prognosis of this treatment have to be identified. The aim of the investigation was to analyze factors associated with the clinical outcome of root resection therapy by a retrospective study.
Material and Methods: This investigation consisted of 341 patients (222 males; 119 females, mean age:52.1±10.2, range 16 to 80) received root resection treatment at Kaohsiung Medical University Hospital. There were 354 resected molars including 169 maxillary first molars, 50 maxillary secondary molars, 107 mandibular first molars and 28 mandibular secondary molars. The following data were collected: the reasons for root resection, the amount of bone support and the type of the restoration of the remaining root(s), the status of the opposing dentition, and the reasons for extraction of the remaining root (failed) after surgery. The radiographs were taken before or after the root resection on the day of surgery. The amount of bone support was the proportion of the ﹝distance from the most coronal bone level on the proximal sites to the root apex﹞to ﹝the distance from the cemento-enamel junction to the root apex﹞. The other data were recorded by clinical examinations and the dental charting.
Result: In a total of 354 resected teeth. The majority (78%) of root resection were done on first molars. The reasons for root resection were presented. In our study subjects, 81.4% molars received root resection due to periodontal disease. Eighty-two percent of the remaining roots had more than 50% bone support. The types of restoration of the remaining root after resection and the status of the opposing dentition, 28.5% of the remaining roots did not have any restoration. Most of the opposing dentition was natural teeth (57.6%). The reasons for failure (extraction of the remaining root) of the resected molars. Eighty-five roots (24.0%) were removed after root resection, among them, 61 roots (71.8%) were due to continuing periodontal destruction, 18 root (21.2%) were due to root fracture. According the restoration types of the remaining roots, 33 roots (38.8%) removed were without any restoration, 22roots (25.9%) removed were using as abutments of fixed prosthesis, and 21 roots (24.7%) removed were restorated with single crowns.
Conclusion: The major reason for the extraction of resected-roots was due to the continuing periodontal destruction, therefore, the pre-surgical evaluation and post-surgical oral hygiene education and maintenance and regular re-call visits were important for the long-term survival of resected-roots. Approximately 21% of the resected molars were extracted due to root fracture. The endodontic treatment prior to root resection should be conservative to avoid the over-instrumentation and tooth structure weakened.

並列關鍵字

Periodontal disease ； Evaluation ； Root resection

參考文獻

參考文獻

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