【 summary 】 odontoclasis is refers to the external mechanical forces effect caused by a sharp teeth teeth broken.See more at top teeth, often accompanied by dental pulp and periodontal tissue injury, severe cases often accompanied by alveolar process fractures.Clinically often break according to its location and can be divided into: fold fold, root, root fracture.
"Diagnosis"
1. The champions league has a history of trauma, tooth crown tooth enamel on dentin fracture, such as not dew pulp only teeth sensitive symptoms. Has the dew pulp pulp point with pink worn by the bleeder, out of pain.
2. The root has a history of trauma, teeth have different degrees of pain and loose, the closer the tooth neck pain and loose. But with the help of X-ray diagnosis.
3. There are many dental pulp exposure, and there are obvious pain. X-ray and transillumination method can help diagnose, respectively.
"Treatment"
1. Less crown fold defect, dentin unexposed crown fold, sharp edges can be polished.Dentin has exposed and had mild sensitive, desensitization treatment is feasible.Sensitive JiaoChongZhe, with temporary crowns, plastic lined with zinc oxide clove oil paste cement, to have enough reparative dentine formation after (6 ~ 8 weeks), with composite resin to repair dental crowns form;At this point, must be used calcium hydroxide preparation, lest produce stimulation to the pulp.Dental pulp has exposed front teeth, the tooth root development pulpectomy municipality and applications;In young permanent teeth should be done according to how much pulp exposure and pollution degree live pith amputation, facilitate the continued development of root.Of dental crowns defects composite resin to repair or with artificial crown restoration.
Should be noted, that there is still a dental pulp vitality, should be in 1, 3, 6 months after treatment, and after a few years, every half year review 1 time, in order to determine the vitality of the pulp.Permanent teeth repair should be 6 ~ 8 weeks after injury.
2. Fold the root root fracture treatment should be the first to promote its natural healing, even if the teeth seems to be stable, also should use splint fixed as soon as possible, in case the activity.Unless the teeth trauma after several weeks to see a doctor, and loose degree of smaller can need not fixed.
It is generally believed its root to fold the closer the apex, the better the prognosis.When root fold limited to alveolar, the outcome is very beneficial, but fracture involving the gingival sulcus or gum fold, often complicated treatment and the prognosis is poor.
Of a third root fracture, in many cases only the splint fixed, without the pulp treatment, is possible to repair and maintain the dental pulp vitality, the idea that the root fold teeth should preventive dental pulp treatment point of view is not correct.Because the root immediately after folding during root canal therapy is often likely to root canal paste pressure between the cut ends, instead affects its repair.But when the pulp necrosis, should quickly for root canal treatment.
The root of a third broken available splint fixation;Such as tooth crown the dislocation, in front of the fixed should be reset.Reset after fixation should review once a month, check whether the plate is loose, replace the plywood when necessary.Review if found root crown section of dental pulp necrosis, should be timely pulp.Fold as the root root pulp is still vibrant, simply fold root crown section of root canal therapy;If the root root tip period of dental pulp necrosis, it should be a root canal therapy.Whether root fold the root section of the pulp dynamic method is: pulling crown pulp and flushing, with smooth marrow needle inspection, if there is pain or bleeding, showed that root tip period of dental pulp still has the vigor;On the other hand, if all the root pulp necrosis, should make complete root canal therapy.Root canal poly carboxylic acid instead of the teeth pointed filling zinc cement will titanium alloy needle or cobalt chromium alloy pile cementation in root canal, will end together, and the root surface of bone deposition.When need to apex fault block by treatment with surgical method to remove, because of the champions league side section is too short and support is insufficient, often need to ｉｎｓｅｒｔ the titanium alloy within the root canal bone teeth to restore the original planting pile length and tooth crown with splint fixed at the same time.This bone tissue can grow in the metal around the "root" and pathological mobility will be eliminated.
Left-edge 1/3 fracture and traffic with gingival sulcus, will not be repair.Enough to post crown repair, such as root length available cutting gum, or use the orthodontic traction method or tooth groove root transposition, the root end pull out on exposure to gum to repair.
Longitudinal fold poor prognosis, often need to tooth.Sometimes for root canal treatment, postoperative as half tooth body resection or root.
Adhesive splinting techniques is fixed the easiest way, the steps are as follows:
(1) with teeth is reset, wiping clean labial surface, using 95% ethanol to wipe, dry, dry, wet.With each method and treatment of healthy teeth on both sides (at least 1 teeth on each side).
(2) take a 0.4 mm diameter stainless steel wire, its length is equal to the risk of tooth crown width and normal tooth width, on both sides of the at least one type to bend it into a bow, to make it consistent lips with the teeth profile.
(3) the labial teeth surface acid corrosion in a third of 1 ~ 2 minutes.Wash with distilled water and dry, the splint fixed with adhesive and composite resin on the wire.At this time should guarantee of teeth in the inherent position (figure 1).Finally take X-ray slice check whether a broken piece of counterpoint is good.In front of the mandibular teeth, should put teeth lingual arch splint, hampering bite.
Figure 1 adhesive splint fixation method
Fixed should be 3 ~ 4 months to clinical examination and X ray film and the dynamic test;Should review once every six month, after 2 ~ 3 times.
Root to fold after healing, using diamond sand mill in addition to composite resin, and loosen the steel wire, get off, smooth surface.
Root to fold the outcome has four forms:
(1) two broken comprised calcification coalition, and the healing of bone lesions is similar.Hard tissue was organized by mesoderm differentiate into into tooth bone cells.In live pith of dental pulp cavity side have irregular dentine formation.
(2) the connective tissue separate paragraphs, on the cross section of bone growth, but not a joint.
(3) are not separated by connective tissue and bone bridge joint of paragraphs.
(4) comprised a chronic inflammatory tissue separated, radicular is live pith, more champions league side section of the dental pulp necrosis.This form is not actually the performance of the repair and healing (figure 2).
Figure 2 fold healing
Sexual healing b. a. calcified connective tissue c. sexual healing bone joint, connective tissue healing d. end being separated chronic inflammation tissue e. teeth in vitro showed that root calcification of folding healing Fountian (copy)
1 form of healing mainly in no dislocation and early fixed teeth.Tooth root discount not as a fixed or not make occlusal adjustment can appear 2 and 3 kinds of forms of healing.With these three histological repair form, corresponding/silk piece can also be observed three repair form, namely almost invisible line or see;End between narrow through ray;End edge obtuse;End to bone is between bridge and so on.
Root discount dental pulp cavity calcification often occur.Medullary cavity decreases due to trauma of dental pulp is characterized by composition of collagen increased, at the same time accompanied by reduced Numbers of cells.
3. Whoever can make the pulp treatment of root fracture after the tooth root fracture, shall be retained as much as possible.After treatment to reinforce a nail, and then make the pile nuclear with full crown restoration;Can also be used in root canal treatment, postoperative covered denture.Crown and root of anterior tooth fold, refer to the tooth neck with oral root to fold the treatment principles of processing.
【 etiology 】
Direct impact force, is a common cause of fractured tooth.Can also be due to chew bite into the sand, broken bones and other hard objects.
"Clinical"
According to the anatomical parts of the teeth can be divided into the fold, root fracture and the three joint root fracture type.In terms of its damage its relationship with the pulp, can be divided into the dew odontoclasis pulp and pulp two kinds big.
1. The crown can be divided into the cross breaks and folding obliquely;After the tooth vertical folding can be divided into obliquely and fracture (FIG. 3 a).
2. See more at discount traumatic root root fracture root fully formed adult teeth, because of young permanent teeth support organization as root and firm, after the formation of outer speech is often degloving or dislocation, generally does not cause the root fold.Force on the root of folding is much for direct attack and facial landing impact.Root left-edge fold according to the parts can be divided into a third, a third in the root and root 1/3 (FIG. 3 b).The most common for a third root.On the fracture line and the long axis vertical teeth or have a certain slope, vertical traumatic fracture is rare.X-ray examination is important basis of diagnosis of root discount, but can’t reveal all folding cases.Rays were taken center must be consistent with the fracture line or parallel, can be displayed on the X ray film fracture line;If the central ray and the Angle of the fracture line is greater than the positive and negative 15 ° ~ 20 °, it is difficult to observe fracture line;At the same time, only when the central ray accordingly in a 6.6% reduction in mineral composition of the following, sparse area can be observed on the X ray film.Fold in the diagnosis of X ray film will not only help root, and also facilitate comparative review.
Figure 3 fractured tooth
A. crown folding b. root fold
Some of the dental clinic, dental pulp vitality test no reaction, but can appear reaction after 6 ~ 8 weeks.Presumably, no dynamic response is the pulp out quickly blood vessel and nerve damage caused by the "shock";Along with the returning of the "shock" to appear dynamic response.
Root to fold the permanent teeth pulp necrosis rate was 20% ~ 24%, and rootless fold trauma permanent teeth pulp necrosis rate was 38% ~ 59%, the difference may be because of the broken side clearance, pulpitis disease because of the drainage.Root whether dental pulp necrosis after folding, mainly depends on the severity of trauma, broken the dislocation and the mobility of champions league side section and other factors.Root can have loose teeth, knocking pain when folding, such as crown side end shift gingival sulcus bleeding, mucous membrane of the roots of bitterness, and so on.Some root no obvious symptoms early, a few days or weeks before symptoms gradually, this is due to the swelling and bite the broken end of separation.
3. Root fracture accounted for a small part of the total number of dental trauma, with oblique line, root fracture pulp often exposed.
After more than 4. Longitudinal fold in the teeth, with the first molar had the highest incidence of the second molars and to illustrate (us) to force is the main pathogenic factors.In addition, no marrow tooth and tooth defect with strong body, its incidence of more than 80%.
The direct cause of the longitudinal fold, accounted for a significant proportion to chew hard objects.
Vertical tooth fracture after the most obvious symptom is chewing pain, followed by elongation.Vertical root fracture, and depth of periodontal pocket, X ray film can assist diagnosis.