吉林大学学报(医学版) ›› 2022, Vol. 48 ›› Issue (4): 1058-1064.doi: 10.13481/j.1671-587X.20220429

• 临床医学 • 上一篇    

前牙修复失败患者再行多学科联合美学修复1例报告及文献复习

夏德庚1,张庆宇2,矫君君1,徐庭瑞2,张天翼1,仲杨1,赵竹兰2,马宁1(),张莉2()   

  1. 1.吉林大学口腔医院牙周科,吉林 长春 130021
    2.吉林大学口腔医院急诊科,吉林 长春 130021
  • 收稿日期:2022-01-10 出版日期:2022-07-28 发布日期:2022-07-26
  • 通讯作者: 马宁,张莉 E-mail:man@jlu.edu.cn;zhang_li99@jlu.edu.cn
  • 作者简介:夏德庚(1996-),男,山东省日照市人,在读硕士研究生,主要从事牙周病诊治方面的研究。
  • 基金资助:
    吉林省教育厅科学技术研究规划项目(JJKH20211213KJ)

Multidisciplinary aesthetic restoration of anterior dental area of patient with failed treatment experience: A case report and literature review

Degeng XIA1,Qingyu ZHANG2,Junjun JIAO1,Tingrui XU2,Tianyi ZHANG1,Yang ZHONG1,Zhulan ZHAO2,Ning MA1(),Li ZHANG2()   

  1. 1.Department of Periodontics, Stomatology Hospital, Jilin University, Changchun 130021, China
    2.Department of Emergency, Stomatology Hospital, Jilin University, Changchun 130021, China
  • Received:2022-01-10 Online:2022-07-28 Published:2022-07-26
  • Contact: Ning MA,Li ZHANG E-mail:man@jlu.edu.cn;zhang_li99@jlu.edu.cn

摘要: 目的

探讨前牙区美学修复的难点及相应解决办法,阐明多学科联合治疗对前牙区美学修复的重要意义,为临床同类疑难病例的诊治提供经验和参考。

方法

选择1例因前牙区连冠修复失败后再行多学科联合美学修复并随访观察3年的病例,结合相关文献复习,从“粉白美学”角度分析多学科联合治疗对前牙区连续多颗患牙进行美学修复的效果。

结果

患者,女性,30岁,因12-22连冠修复体反复脱落就诊。12-22牙冠呈预备体形态,X线片示12、21和22硬骨板清晰,牙槽嵴顶-釉牙骨质界<2 mm,11远中牙槽骨呈角形吸收至颈1/3,11、21和22已行根管治疗,伴有继发龋;11牙周探诊深度唇侧为8 mm,远中5 mm,近中及腭侧为3 mm,呈窄而深的远中邻唇二壁骨缺损,松动Ⅲ°;12、21和22龈缘轻微红肿,探诊深度<3 mm,动度(-)。拟行12、21和22牙冠延长术,拔除11并同期行位点保存术,3个月后行上颌2-2固定桥修复。因患者个人原因未能完成固定桥修复。11个月后患者提出改行11种植修复。锥形束计算机断层摄影(CBCT)示11唇舌向牙槽骨宽度<5 mm,12、21和22牙龈向冠方增生与肩台平齐。拟行12、21和22牙龈成形术后单冠修复,11种植修复并在其唇侧同期行引导骨组织再生术(GBR)。术后龈缘位置稳定,种植区骨量充足,12-22全瓷单冠色泽形态近似天然牙,牙槽嵴丰满度良好,牙龈色粉质韧无炎症表现,龈缘呈左右对称的连续贝壳状。

结论

多学科联合治疗为前牙区连续多颗牙的美学修复难题提供了一个有效的解决办法,不仅可较好地恢复患者的发音和咀嚼功能,而且能达到令人满意的美学效果。

关键词: 前牙区, 美学修复, 牙冠延长, 引导性骨组织再生, 种植

Abstract: Objective

To explore the difficulties and solutions of aesthetic restoration of anterior teeth and clarify the significance of multidisciplinary therapy, and to provide the experience and reference for the diagnosis and treatment of similar difficult cases.

Methods

A case of aesthetic restoration in anterior tooth area successfully completed by multidisciplinary therapy after failing bridge crown restoration was selected and followed up for 3 years. Combined with the relevant literature review, the effect of multidisciplinary therapy on the aesthetic restoration of consecutive affected teeth in the anterior area was analyzed from the perspective of “pink and white aesthetics”.

Results

One 30-year-old female patient was admitted due to repeated loss of 12—22 bridge crown. The specialist examination showed that 12—22 tooth crowns were in the state of preparation; the X-ray image showed lamina dura of 12, 21, 22 was the alveolar bone crest - enamel cemental junction was <2 mm, the alveolar bone on the distal side of 11 was absorbed into 1/3 of the neck in angular shape, 11, 21, 22 had secondary caries, and the root canal treatment had been completed; the periodontal probing depth of 11 was 8 mm on the labial side, 5 mm on the distal side, 3 mm on the proximal and palatal side, which presented a narrow and deep bone defects in the two walls of the labial and distal sides, tooth mobility (Degree 3);the gingival margin of 12, 21, 22 were slight swelling, the periodontal probing depth was <3 mm, tooth mobility (-). Crown lengthening (12, 21, 22), extraction (11) and site preservation simultaneously were planned, and 12—22 fixed bridge repair was performed 3 months later. Due to the personal reasons, the patient failed to perform the fixed bridge repair on time, and 11 months later, the patient proposed switching to implant repair 11. The CBCT results showed that the width of alveolar bone in the lip-lingual direction of 11 was<5 mm, and the gingival margin of 12, 21, and 22 were enlarged in the coronal direction and at the same level as the shoulder. Therefore, 12, 21, 22 single-crown restoration after gingivoplasty was planned, implantation were performed in 11 and guided bone regeneration (GBR) was performed simultaneously on its labial side. Finally, the position of the gingival margin was stable and the bone mass was sufficient. The color and shape of 12—22 all-ceramic single crown are similar to natural teeth, and the alveolar ridge fullness was good, the gingival was pink and tough without inflammation, and the gingival margin was continuous conch shape with left and right symmetry.

Conclusion

Multidisciplinary therapy provides an effective solution to the aesthetic repair problem of continuous multiple teeth in the anterior area, which not only better restores the patients’pronunciation and mastication function, but also achieves the satisfactory aesthetic effects.

Key words: Anterior dental area, Aesthetic restoration, Crown extension, Guided bone regeneration, Planting

中图分类号: 

  • R781.45