Conservative Approaches of Restoring Complicated Crown Root Fracture at the Cervical Level in Young Permanent Maxillary Incisors- Report of Three Cases

上顎年輕恆門齒複雜性牙冠牙根斷裂於齒頸部的保守復形處理方式－三病例報告

蕭伃君(Yu-Chun Hsiao) ； 黃曉楓(Hsiao-Feng Huang) ； 蔡宗平(Tzong-Ping Tsai) ； 謝承祐(Cheng-Yu Hsieh)

《臺灣兒童牙醫學雜誌》 21卷2期 (2021/06) Pp. 66-73

https://doi.org/10.6319/TJPD.202106_21(2).0004

摘要

Introduction: The most challenging situations in restoring complicated crown root fracture (CCRF) in young permanent teeth are fractures at the cervical level or coronal third of the root. There are difficulties in accessing the fracture margin and creating ideal isolation. Solutions to the issue include gingival retraction, gingivectomy, crown lengthening, orthodontic extrusion or surgical extrusion. The aim of this report is to present three conservative approaches with satisfactory clinical outcomes. Case 1: a 13Y1M healthy girl presented with a CCRF of #21. The fracture extended subgingivally 3 mm on the palatal side. The margin was exposed with gingival retraction cord. Pulpotomy with Biodentine and coronal fragment reattachment were performed. Five months after trauma, #21 remained vital with satisfactory clinical results. Case 2: a 9Y4M healthy girl presented a CCRF of #11 extended subgingivally to the coronal third of the root on the palatal side. After removing the mobile coronal fragment, a non-mobile subgingival crack of the crown was noted. A gingivectomy was used to facilitate pulpotomy using SavDent MTA and repair of subgingival crack using flowable composite. The rest of the crown portion was restored with packable composite. At the 11-month follow up, #11 showed continued root development and good clinical gingival condition. Case 3: a 10Y9M healthy boy with Class II deep bite malocclusion suffered a CCRF of #21 at the cervical level. Apexogenesis of #21 with Proroot MTA was performed under microscope. The coronal opening was sealed with resin-modified glass ionomer and composite resin. The fractured coronal fragment was used as a pontic for esthetics. Twenty-two months follow up showed continued root development. Conclusions: Treatment of CCRF in growing patients requires careful evaluation of subgingival extension of the fracture margin and ways of isolation. The treatment plan should include short term, interim and long-term plans. Conservative treatment requires multidisciplinary approaches by pediatric dentist to achieve the best possible outcome.

關鍵字

Complicated crown root fracture ； Young permanent maxillary incisors

並列摘要

前言：當年輕恆門齒遭受外傷之複雜性牙冠牙根斷裂（Complicated Crown Root Fracture, CCRF），尤其斷裂在齒頸部及近牙冠三分之一處者，以復形時如何使斷裂邊緣露出得到良好的評估與隔溼最難處理。處理方式包含使用排齦線、牙齦切除術、牙冠露出術、矯正突出術或手術突出術。本病例報告呈現上顎年輕恆門齒在CCRF之後採取保守處置並獲得良好臨床結果的三種方式。病例一：患者為一13歲女生，左上正中門齒因外傷造成CCRF，腭側斷裂延伸至牙齦下3毫米，先使用排齦線露出左上正中門齒完整的邊緣，再使用Biodentine進行斷髓術，最後將冠部的裂片進行再附連。5個月的追蹤顯示左上正中門齒維持活性及臨床上的美觀。病例二：患者為一9歲女生，右上正中門齒因外傷造成CCRF，腭部斷裂至牙根冠部三分之一，移除腭部裂片後，發現牙齒上仍有一延伸至牙齦下的裂痕。先使用牙齦切除術確認裂痕邊緣，再使用流動樹脂修復牙齦下裂痕並以SavDent MTA進行斷髓術。斷失之牙冠部分則以可壓擠式樹脂復形。11個月的追蹤發現牙根持續生長且牙齦狀況良好。病例三：患者為10歲呈二級咬合合併深咬的男生，因外傷造成左上正中恆門齒齒頸部複雜性牙冠牙根斷裂，在顯微鏡下使用Proroot MTA進行根尖生成術，並使用樹脂改良型玻璃離子及複合樹脂做冠部封填，最後，因應美觀考量，將冠部裂片以橋體的型式固定，等待日後與各科合作進行全口矯正、矯正突出術、及最終贋復物。在22個月的追蹤中，左上正中門齒牙根持續生長且呈現良好的美觀。結論：在治療生長中孩子齒頸部之CCRF時須要小心地評估斷裂邊緣延伸狀況、隔溼方式，考慮涵蓋短、中、長期的治療計劃。保守性的處置需要兒童牙科醫師利用跨領域的手段才能獲取最佳療效。

並列關鍵字

複雜性牙冠牙根斷裂 ； 上顎年輕恆門齒